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In Reply: We believe that Dr Garg and colleagues have misconstrued our Commentary. We fervently support actions that reduce the incidence of injuries. Our Commentary is a discussion of disablement associated with regional backache in occupational settings, not a discussion of workplace safety.

Regional backache is an intermittent and remittent predicament of life inside and outside the workplace. No consistent relationship has been demonstrated between physical activities that are customary (and customarily comfortable) and the incidence of regional backache. Furthermore, there is no compelling evidence that episodes of regional backache can be circumvented, even with programs designed explicitly to do so.¹ Most persons will have to cope with an episode eventually. Most cope effectively by a combination of avoidance and forbearance until the episode finally passes. For some people some of the time, forbearance and avoidance are rendered inadequate by coincident contextual challenges, particularly those producing emotional distress.²

Garg et . . . [Full Text of this Article]

Nortin M. Hadler, MD
nmh@med.unc.edu
University of North Carolina
Chapel Hill

Raymond C. Tait, PhD; John T. Chibnall, PhD
Saint Louis University
St Louis, Missouri

RELATED LETTER

Low Back Pain and the Workplace
Arun Garg, Fred Gerr, Jeffrey N. Katz, William S. Marras, and Barbara Silverstein
JAMA. 2007;298(4):403-404.
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