Objective: This review evaluates (in retrospect) the contribution of Liles and associates (1984) to the causality debate of the work relatedness of low back pain. Background: Often it takes years to appreciate the role of a paper with respect to the body of literature as a whole. Method: Although many papers appear remarkable when they are first published, the real value of a contribution often can be appreciated by considering how the paper “fills in the pieces of the puzzle” over time. This paper examines how the Liles paper influenced low back pain causality efforts after its introduction. Results: This analysis indicates that Liles and associates contributed to the science of low back disorder causality by (a) advancing the idea of quantitative measures used for field studies, (b) identifying a dose-response relationship for low back pain, and (c) recognizing the influence of a system of work and nonwork influences related to low back pain development. Conclusion: The Liles contribution to Human Factors has proven to play a pivotal role in our understanding of how low back pain is influenced by work exposure. Application: The concepts introduced here can help future efforts associated with understanding musculoskeletal disorder causality and work.
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