There have been significant advances in our understanding of occupational low back pain over the last decade largely because of a noteworthy improvement in the number and quality of prospective trials. More recent work confirms that genetic factors may drive a large portion of thr risk factors. The importance of physical fitness and spine support muscle fitness is believed to protect against future occurrences. Psychosocial factors can play a role in increasing the risk of future low back pain and acute pain in becoming chronic. Some of the psychological influence may be through a muscular pain component. It is arguable that an emphasis should be placed on resources, education, and support to allow workers to be productive whether suffering from back pain or not.