No consensus on causality of spine postures or physical exposure and low back pain: A systematic review of systematic reviews. Two independent reviewers screened 4285 publications with 41 reviews included in the final review. Both positive and null associations between spine posture, prolonged standing, sitting, bending and twisting, awkward postures, whole body vibration, and components of heavy physical work were reported. Results from meta-analyses were more consistently in favour of an association, whereas systematic reviews that included only prospective studies were less able to provide consistent conclusions. Evidence that these factors precede first time LBP or have a dose response relationship with LBP outcomes was mixed. Despite the availability of many reviews, there is no consensus regarding causality of physical exposure to LBP. Association has been documented but does not provide a causal explanation for LBP.
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