The authors investigated the nature, cause, and treatment of 224 back injuries which occurred in 156 different situtations in underground coal mines. A detailed interview was conducted with each injured miner as 137 variables were explored to provide a complete picture of the injury scenario. The miners worked at 23 mines in 6 states. An important finding of the study was that sudden movement, which occurred in 52 pct of the injuries, is a more frequent factor than heavy lifting in causing back injuries. Along with sudden movement, other major injury-causing factors were equipment seat design, lifting, cable handling, and slips and trips. No significant differences were found between the injury scenarios associated with lost-time and non-lost-time injuries; thus, both sets of scenarios should be used in developing back injury control strategies. Medical treatment and rehabilitation varied in content and quality. Dialogue between the medical, rehabilitation, and mining communities is needed to develop an effective treatment strategy. Back-injury-control-related training was found to be inadequate in most mines. Mine-specific training for physical stress recognition and potential sudden force release should be added to the training currently given. Based on the information collected in this study, recommendations were made regarding equipment design, mechanical assists, and procedures for material handling, training, etc., which, if implemented, will assist in reducing the frequency of back injuries in underground coal mining.