Relationship between the development and worsening of degenerative intervertebral disc disease and occupational exposure to physical load and vibration: systematic review.

Summary Introduction: Degenerative intervertebral disc disease (DDD) is one of the primary causes of chronic low back pain and functional disability in the adult population, representing a significant public and occupational health challenge. Epidemiological evidence indicates that occupational factors—especially prolonged exposure to physical loads and whole-body vibration—are associated with the development and progression of degenerative spinal changes. Objective: To analyze whether there is an association between the development or worsening of degenerative intervertebral disc disease and occupational activities involving exposure to physical loads and/or vibration in adult workers. Methods: This is a systematic literature review. The protocol will be registered on the OSF platform, and results will be reported according to the PRISMA-ScR guidelines and conducted following JBI recommendations. The search strategy will be developed for the PubMed (via Medline) and SciELO databases. Original articles and literature reviews will be included. Two independent reviewers will screen, select studies, and extract data. Expected results: It is expected that the findings will demonstrate the magnitude of the association between occupational factors and disc degeneration, identifying highly vulnerable work activities and professional groups, as well as contributing to the understanding of the biomechanical and inflammatory mechanisms involved. These findings may support the development of preventive strategies, ergonomic guidelines, and occupational health policies aimed at protecting the intervertebral disc and reducing the socioeconomic impact on workers. Keywords: Degenerative disease, intervertebral disc, occupational exposure, physical exertion, vibration. Introduction The spine is a complex and vital structure responsible for the mechanical support of the axial skeleton, protection of the spinal cord, and facilitation of multi-axis mobility. However, it is frequently the target of degenerative processes, with degenerative disc disease (DDD) being one of the most prevalent and debilitating conditions in the contemporary adult population (LIRA et al., 2024). The intervertebral disc (IVD) is a fibrocartilaginous structure fundamental to spinal physiology; its primary mechanical function is to transmit and dissipate loads resulting from body weight and muscular activity. In the absence of an evident central pathology, the onset of intervertebral disc degeneration (IVDD) emerges as a complex mechanical process in which abnormal biomechanical stimuli can trigger a cascade of structural failure, inflammation, and cellular dysfunction (QIAO et al., 2025). DDD is not merely a natural consequence of aging but a multifactorial process involving biochemical, structural, and functional changes to the discs, often resulting in chronic low back pain and significant functional disability (BATTISTI et al., 2021). Although IVDD is multifactorial, genetic influence is a key initial and progressive determinant of the pathology, explaining up to 60% of disc alterations (MA et al., 2025; KONG; PARK, 2025; LI et al., 2025). Genomic investigations associate polymorphisms in the COL1A1 gene and variations in other collagen genes with an increased risk of degeneration (XIE et al., 2021; KUSMA et al., 2021). Furthermore, the expression of key genes such as MMP3 and SPARC regulates extracellular matrix (ECM) homeostasis, while bioinformatics analyses have identified differentially expressed genes (DEGs)—including FN1, COL1A2, and LUM—that coordinate proteolytic degradation (HU et al., 2020; ZĄBEK et al., 2025). Additionally, the PI3K-Akt pathway plays a role in cellular protection against apoptosis and ferroptosis, and its modulation is essential for emerging personalized therapeutic strategies (CAI et al., 2026; XUE; MIAO, 2025). The epidemiological magnitude of this condition is alarming and follows a global and national growth trajectory. Globally, it was estimated that 619 million people suffered from lumbar pain in 2020, with projections indicating this number will reach 843 million by 2050 (GBD 2021 LOW BACK PAIN COLLABORATORS, 2023). In the Brazilian context, data from the National Health Survey (PNS) reveal that approximately 21.6% of the adult population suffers from chronic back pain, equivalent to more than 35 million Brazilians (MALTA et al., 2022). The socioeconomic impact is equally severe; in 2025, back pain was the leading cause of work absence in Brazil, accounting for more than 237,000 temporary disability benefits granted by the INSS, followed by herniated discs, which totaled approximately 205,000 cases (AGÊNCIA BRASIL, 2026). In occupational health, the relationship between the work environment and the progression of disc pathologies is direct and disproportionate in certain sectors. It is estimated that approximately 38.8% of years lived with disability due to low back pain worldwide are attributed to modifiable risk factors, among which ergonomic occupational factors play a central role (GBD 2021 LOW BACK PAIN COLLABORATORS, 2023). Recent studies indicate that the prevalence of low back pain among drivers reaches critical levels, hitting 68.4% in heavy vehicle operators (SALO et al., 2022). Mining and construction workers also show high rates, with approximately 46.8% reporting chronic symptoms associated with ergonomic and mechanical factors. Among the most critical risks are the habitual handling of heavy loads and prolonged exposure to whole-body vibration (PATTERSON et al., 2021). Economically, DDD and low back pain impose a multi-billion dollar burden. In Brazil, the annual social cost—including direct treatment and loss of productivity—is estimated to exceed 2.2 billion dollars. International studies reinforce that indirect costs related to absenteeism and presenteeism are often twice as high as direct healthcare costs (AGÊNCIA BRASIL, 2025; MALTA et al., 2022). Physical load handling imposes compressive and shear forces that can exceed the physiological limits of tissue tolerance. Epidemiological studies indicate a positive dose-response relationship between cumulative occupational workload and severe disc degeneration, particularly at the L5-S1 level, where workers exposed to heavy loads are 1.86 times more likely (OR 1.86) to develop serious injuries (SALO et al., 2022; CHENG et al., 2025; QIAO et al., 2025). Simultaneously, whole-body vibration—common among machine operators and drivers—induces cyclical stresses that compromise disc nutrition via diffusion and promote soft tissue fatigue (PATTERSON et al., 2021). Although whole-body vibration is a recognized clinical risk factor for low back pain, the evidence for its isolated association with morphological changes in imaging studies is still debated, suggesting a complex interaction with genetic predisposition and lifestyle (MACEDO et al., 2022). Despite its etiological complexity, the socioeconomic relevance of DDD is indisputable. It remains one of the primary causes of reduced quality of life for workers, who are frequently subjected to chronic pain and persistent functional limitations (SALO et al., 2022). In this scenario, understanding the relationship between the development and worsening of IVDD and exposure to physical loads and vibration is crucial for the advancement of occupational medicine and ergonomics (REN et al., 2025; SALO et al., 2022). This study proposes a systematic literature review to answer the guiding question: Is there an association between the development or worsening of degenerative intervertebral disc disease and occupational activities involving exposure to physical loads and/or vibration in adult workers? Methodology Study Design This systematic review will be conducted according to the recommendations of the JBI Collaboration (JBI, 2022) and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols extension for scoping reviews (PRISMA-ScR) guidelines (TRICCO et al., 2018). The protocol for this review will be registered in the Open Science Framework (OSF) (OPEN SCIENCE FRAMEWORK, 2026). To formulate the research question, the PCC mnemonic (Population, Concept, and Context) was used, establishing the following elements: Population: Adults aged 18 years and older, concept: Degenerative intervertebral disc disease e context: Occupational exposure to physical loads and vibration. Based on this strategy, the following research question was developed: Is there an association between the development or worsening of degenerative intervertebral disc disease and occupational activities involving exposure to physical loads and/or vibration in adult workers? Eligibility Criteria Type of studies This review will include original research and reviews published within the last 10 years. Research Strategy and Data Extraction The search strategy was developed with the assistance of a librarian specializing in health databases. Health descriptors from the Health Sciences Descriptors (DeCS) and Medical Subject Headings (MeSH) were utilized. The search included the PubMed (via Medline) and SciELO databases. Inclusion criteria consist of articles published in the last 10 years targeting adult populations. Exclusion criteria include articles that do not address the primary theme. Language restrictions will apply to English, Portuguese, and Spanish. References will be imported into Rayyan software, where duplicates will be removed. Figure 1 outlines the search strategies for the databases. Figure 1. Search strategy developed for databases. Ribeirão Preto, SP, 2026. PubMed (MEDLINE) Inquiries 1 ("Degenerative disease" AND "intervertebral disc" AND "occupational exposure" AND "physical exertion" AND "vibration"). 2 (("Intervertebral Disc Degeneration"[Mesh]) OR ("Intervertebral Disc Disease"[Title/Abstract] OR "Degenerative Disc Disease"[Title/Abstract])) AND (("Occupational Exposure"[Mesh])