The purpose of this study was to determine the association between the prevalence of lower back problems, fear-avoidance beliefs, and pain-coping strategies in using an analytical cross-sectional epidemiological study among a group of 109 workers in a South African manganese industry. Outcome (LBP) was defined using a guided questionnaire and functional rating indexes. Exposure to psychosocial risk was determined using the Fear-Avoidance Beliefs (FABQ) and Coping Strategies (CSQ) questionnaires. Using inclusive and stringent definitions for perceived LBP, point prevalence was 37.6 and 29.4%, respectively. Only 8 cases of LBP were, however; recorded officially over a 7-year period reflecting a tendency of underreporting. Multivariate logistic regression analyses indicated significant adjusted relative risk ratios (RR) for work-related fear-avoidance beliefs (RR 2.35; 95% CI 1.39-3.95) as a singular psychosocial risk while no specific coping strategy could be isolated. In conclusion, work hardening and a contented ethos of the manual laborers under study moderates the association between the prevalence and etiology of LBP.