Volvo winners find genetic link to back injury

Dr Tapio Videman

New research by two members of the Faculty of Rehabilitation Medicine is "causing people to rethink the whole area of back pain and spinal problems," says the faculty's dean, Dr. Albert Cook.

A paper just published by Drs. Tapio Videman and Michele Battié‚ shows "disk degeneration may be, in large part, genetically influenced" rather than caused primarily by strain or exertion. Back problems are regarded as the biggest concern "in terms of work-related injury for the general population," says Cook.

The research has again won Videman and Battié‚ a Volvo Award from the International Society for the Study of the Lumbar Spine. For Videman, this 1998 Volvo is an unprecedented fifth award and for Battié, an unprecedented fourth. They are the only researchers to have won the award more than twice.

The pair's latest project - conducted with the help of four other colleagues including Leena Peltonen, director of the Human Genome project at UCLA - is a comprehensive study of 85 Finnish identical twin pairs raised in different environments.

It had long been assumed manual labor was the principal cause of back injury, says Videman. And yet, while work environments have improved over the past two decades with decreased physical demands and better ergonomic conditions, while people are exercising more and smoking less, and while cars are better designed than ever before, incidents of disk degeneration are steadily on the rise.

"Back pain is probably the most expensive disease affecting the working population," says Videman, "and no other disease group has grown so fast in the past 20 years." He says the number of patients with back disability has increased in line with the number of rehabilitation institutes: "I think it is obvious - without jumping on anyone's toes - that we have all failed.

"Few treatments have been shown to have a clear effect beyond that explained by the natural history and placebo effect. While an industry has developed around back pain prevention, there are no interventions with a solid scientific basis and clear evidence of efficacy."

Evidence now indicates less than five per cent of intervertebral disc problems can be attributed to heavy work. Since the genetic material determining disk quality was identified about a year ago, it will now be possible to focus on other degenerative influences. Videman says the direction of future lower back research will likely shift to the interaction between heredity and environmental/behavioral risks.

"Now at least we can say why the past 25 years of prevention have failed," he says. But "there is light at the end of the tunnel," he adds.

"Identifying genetic determinants does not mean that we should become fatalistic. In fact, it is just the opposite. After we have identified important gene-environment interactions, it will be possible to identify those with 'weak' connective tissues and to direct appropriate interventions to those vulnerable individuals."

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