A new direction in low-back pain research.

This article suggests reasons for the difficulty in understanding and preventing low-back pain (LBP), provides a framework for understanding the causes of reported LBP, and highlights an important new direction in research that could accelerate progress in reducing LBP. Fundamental to understanding LBP is the recognition that it is a symptom not an underlying condition. Worker reports of LBP depend not only on the extent and nature of underlying injury but also the worker's perceptions and the likelihood of reporting the symptoms. Each of these factors, in turn, depends on a number of other proximal and distal factors. Identifying the root causes of underlying injury is essential to improving prevention programs. Yet, many of the methods used to study LBP and its causes have serious shortcomings, adding to the confusion over appropriate preventive strategies. An important gap in LBP research has been the factors influencing preventive behaviors for both workers and managers. If workers or managers attribute the causes of LBP to the wrong factors, preventive behaviors will be misdirected and ineffective. Attribution theory, a relatively recent application in the occupational health field, offers promise for identifying incorrect attributions and modifying these attributions so that appropriate protective actions are taken.