The Best Tidbits of News from the Workers Comp Community

Here are the some of the hot topics from the Workers Comp world this week:

 

Teach Your Data To Fight Opiod Abuse

Workers’ Compensation research, networking communities, and press are overflowing with information about Opioid overuse and how it is negatively impacting claim costs and outcomes. Information about the problem abounds. Opioid abuse is clearly recognized as a serious problem in the industry, clearly evidenced by recent research.   Read More…


Rulebook Supplement 2012-13 Available Online

The Texas Workers’ Compensation Rulebook Supplement 2012-03 containing rules adopted by the Commissioner of Workers’ Compensation is available online from the Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC). The supplement can be printed from the TDI website at http://www.tdi.texas.gov/wc/rules/supplements.html.  See more… Information provided by Downs . Stratford, PC 



Security and Risk Management as a Social Science by Emily Holbrook


Here at the Gartner Security & Risk Management Summit, I sat in on a session regarding human behavior and it’s connection to information security. Tom Scholtz, an analyst with Gartner, started off with a statement many of us know to be true, but often forget.

“The single weakest link in the information security chain still remains the human being,” he said.  Read More…

 

The High Cost of Treating Low Back Pain by Dr. David C. Radford from West Hartford Group, Inc.

According to the American College of Physicians, low back pain is the fifth most common reason for all physician visits in the United States. Approximately one quarter of U.S. adults reported having low-back pain lasting at least 24 hours in the past 3 months, and 7.6% reported at least 1 episode of severe acute low-back pain within a 1-year period. Low-back pain is also very costly: Total incremental direct health care costs attributable to low-back pain in the United States were estimated at $26.3 billion in 1998. It is estimated that the real cost of back pain including the cost of health care and lost production now exceeds $100 billion a year.  

To better understand the role of the nation’s chiropractic physicians in reducing the health care cost of low-back pain, WHG has produced a public service video announcement



Watch the video: http://youtu.be/Wfkg3hTSbDI


News From Lexis Nexis

Fifth Circuit Muddies the Water in Hearing Loss Cases

HEARING LOSS UNDER LHWCA

Stephen Embry

I Can See Clearly Now, Just Can't Hear So Good, by Stephen Embry, Esq. In the study of the law styled jurisprudence, there are many schools of thought. Some students of the law believe that past cases predict the future and that precedent must prevail. In this philosophy, past words have meaning and are the expression of internal logic that controls and instructs us as to how current and future conflicts must be resolved. Others follow another road, believing that past cases are at best examples of isolated arguments that worked in the past and may be instructive of arguments that may be useful in the future. Read More…


DEFENSE BASE ACT BILL

JohnKawcyznski

New Bill Proposes to Exclude Private Carriers from DBA Insurance Market, by John E. Kawczynski, Esq. Congressman Elijah E. Cummings (D-MD), the Ranking Member of the House Oversight and Government Reform Committee, has introduced the "Defense Base Act Insurance Improvement Act of 2012" (H.R. 5891) which would exclude private insurance carriers from the Defense Base Act insurance market. Instead, a new "Government Defense Base Act self-insurance program" would be created Read More…


THOMAS A. ROBINSON TO SPEAK AT NATIONAL WORKERS' COMP CONFERENCE

LexisNexis has partnered with the National Workers' Compensation Conference to create an enhanced legal track for attorneys and other workers' comp professionals.Tom Robinson thumbnailLexisNexis author Thomas A. Robinson will be speaking on several panels, including theFuture of Exclusive Remedy. View the program agenda. Overall, there are 15 members of the Larson's National Workers' Compensation Advisory Board speaking at this event. You don't want to miss this conference! Take advantage of the special discount for all LexisNexis Workers' Compensation Law Community members. Community membership is free at our site.

 

Note: If your company has any developments you'd like to share, please send them to us at: mstack@reduceyourworkerscomp.com

 

Author Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher.  www.reduceyourworkerscomp.com Contact mstack@reduceyourworkerscomp.com

 

 

 

 


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©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

 

 

 

 

 

 

 

Occupational Low Back Pain Part III: Treatment Options

Authors: Brian Anderson DC, CCN, MPH and David Radford DC, MSc

 

In the first article of this series, we discussed the huge impact Occupational Low Back Pain (OLBP) has on both employers and employees.  The statistics on prevalence and disability due to OLBP cannot be ignored.  In part two, strategies that employers can take which may prove effective in reducing the burden of OLBP were discussed.  Now, in the final article of this series, we will discuss the all-important topic of treatment options for those suffering from OLBP.

 

 

There are a few variables related to the treatment low back pain (LBP) that make it particularly challenging.  First, it is estimated that approximately 80% of LBP is non-specific, which means there is no well-defined cause.   Second, imaging studies (x-ray, MRI) are not particularly helpful in determining those with LBP vs. those who are asymptomatic.  A 1994 study in the New England Journal of Medicine concluded, “Given the high prevalence of these findings and of back pain, the discovery by MRI of disc bulges or protrusions in people with low back pain may frequently be coincidental.”  Another source states that “The false positive rate for identifying clinically significant herniated discs or degenerative conditions with imaging is so high as to make the tests clinically inappropriate as screening procedures”.  Unfortunately, the “biomedical model” employed by the majority of the medical community is dependent on diagnosing an abnormality on an imaging study, and treating this abnormality with medications, rest, injections and surgery. (WCxKit)

 

 

What we are recommending, and what the current literature is supporting, is a “bio psychosocial” approach to treating LBP.  This model recognizes that the experience of pain has many components, and that all these components must be addressed for long term healing.  Patients with LBP experience what is called fear-avoidance behaviors; they anticipate worsening of symptoms with certain activities or movements.  This anticipation sets up a vicious cycle, which goes something like this

fear of painàactivity avoidanceàdeconditioningàacute tissue overloadà chronic sensitization to pain

 

Those LBP sufferers with “yellow flags” must get involved in a bio psychosocial program very early on, or are at high risk for developing chronic pain syndromes.  These yellow flags are included.

  • ·      radiating (travelling) pain
  • ·      poor self-rated general health
  • ·      anxiety/depression
  • ·      self-perceived inability to control symptoms
  • ·      self-perceived inability to perform normal activities

 

People with LBP must be educated that hurt does not equal harm; in other words, they should continue to participate in normal daily activities even if there is some pain during these activities.  Patients with acute LBP may experience some benefits in pain relief and functional improvement from advice to stay active compared to advice to rest in bed.

 

 

In an ideal situation, a treatment team would be developed to deal with OLBP.  This team would consist of: a return to work coordinator; an occupational health provider (MD or nurse); a health psychologist; a Chiropractic Physician; a Physical Therapist; and a Physiatrist/Neurosurgeon/Orthopedic surgeon for possible consultation.  We are suggesting that all cases of OLBP be triaged by the occupational health provider and automatically referred for consultation with a Chiropractic Physician, due to their unique expertise dealing with this particular condition.  This scenario would no doubt save countless healthcare dollars by preventing unnecessary imaging studies, medication use and interventional procedures such as injections and surgery.

 

 

Regarding conservative treatment of LBP, very high quality evidence exists that supports various treatment modalities.  Below is a review of some of this research.

 

  • ·      There is good evidence that cognitive-behavioral therapy, exercise, spinal manipulation, and interdisciplinary rehabilitation are all moderately effective for chronic or sub acute (>4 weeks’ duration) LBP
  • ·      Fair evidence that acupuncture, massage, yoga, and functional restoration are also effective for chronic LBP
  • ·      For acute LBP (<4 weeks’ duration), the only non-pharmacologic therapies with evidence of efficacy are superficial heat and spinal manipulation
  • ·      There is moderate quality evidence that post-treatment exercises can reduce both the rate and the number of recurrences of back pain.
  • There is moderate scientific evidence showing that multidisciplinary rehabilitation, which includes a workplace visit or more comprehensive occupational health care intervention, helps patients to return to work faster, results in fewer sick leaves and alleviates subjective disability.
  • Spinal manipulation was more effective in reducing pain and improving the ability to perform everyday activities than sham (fake) therapy and therapies already known to be unhelpful.  It was no more or less effective (but no doubt less costly) than medication for pain, physical therapy, exercises, back school or the care given by a general practitioner.

 

Significant evidence also exists suggesting that invasive treatments, such as injections and surgery, are questionable treatment options for most patients. (WCxKit)

 

  •       There is no strong evidence for or against the use of any type of injection therapy for individuals with sub acute or chronic low- back pain.
  •       There is serious lack of scientific evidence supporting surgical management for spinal arthritis
  •       There is no acceptable evidence of the efficacy of any form of fusion for spinal arthritis, back pain or instability
  •        38% of surgeries performed in two university based neurosurgical units were prospectively evaluated and were determine to be inappropriate

 

As mentioned in the opening of part I of this series, employers are unlikely to find another issue that leads to more absenteeism and detracts from productivity in the workplace more than OLBP.  We hope that, after this three part series, readers are more educated as to how to prevent and treat this serious issue.  We encourage safety managers and coordinators of care to consider a comprehensive approach to dealing with OLBP.  For further information or questions, please contact the authors.

 

 

Dr. Anderson works as a supervising clinician and instructor at National University of Health Sciences in Lombard IL.  He has been in private practice, as well as part of a team in a University based Integrative Medicine setting.  In addition, Dr. Anderson has experience in the medico-legal field, serving as an expert for various insurance companies and legal firms.  He earned a Masters Degree in Public Health, as well as a Certified Clinical Nutritionist designation. He is currently working toward a specialty diplomate in Functional Rehabilitation.  Contact Dr. Anderson for more information at banderson@nuhs.edu

 

Dr. Radford is in private practice. He is a third generation Doctor of Chiropractic Medicine. He earned a Master’s Degree in Advanced Clinical Practice and he provides conservative primary care. He has treated work related injuries for more than 30 years. Dr. Radford has found that treating the co-morbidities that often accompany injured workers like obesity, medication overuse, and addiction lead to a more complete recovery. He was a founding member of the Cleveland Orthopaedic and Spine Hospital, Cleveland, Ohio.  Contact for more information at DCR8888@aol.com or phone: (440)-248-8888.

 

 

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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

 

©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact

 

 

Occupational Low Back Pain Part II Workplace Solutions

 

 

 

pic1In part one of this three part series on occupational low back pain (OLBP), we discussed how back pain was the most common reason for worker absenteeism. Also discussed were some statistics related to the scope of OLBP, the most common causes, and an introduction to the importance of workplace involvement in both primary and secondary prevention. In part two of this series, we discuss the concept of workplace intervention in greater detail.

 

 

 

Multiple studies have supported the incorporation of workplace intervention programs for both primary and secondary prevention of OLBP. When discussing primary prevention, the hope is to prevent a low back injury from occurring to begin with.

 

 

 

Secondary prevention is related to those individuals who have already suffered a back injury, but the ideal would be to prevent it from becoming chronic and/or recurring. Ideally, workplaces focus on primary prevention, given the major problem of time lost and disability claims. Due to the unpredictable nature of low back injury, most research is focused on secondary prevention. The buzzword being used in recent research regarding workplace intervention programs is “participatory ergonomics.”(WCxKit)

 

 

 

Research in participatory ergonomics (PE) and return to work indicate a two-fold long-term improvement over clinical interventions (treatment) alone. These programs aim to involve the worker in the process of identifying and correcting factors that negatively impact physical health. This process requires a team approach; members of this team include the employee, the healthcare provider, an ergonomic specialist and a return-to-work coordinator.

 

 

 

The employer must be willing to allow changes to occur in the way work is carried out, as well as the environment in which this work happens. Methods and techniques involved in the PE approach include:

  1. Problem analysis/activity analysis.
  2. Creativity stimulation and idea generation.
  3. Concept development, focus groups.
  4. Concept evaluation, intervention ideas.
  5. Preparation and support- team formation and building.

 

 

 

One of the most effective strategies for preventing low back injury on the job is using selection criteria to match the worker to the job. Any employee who will be performing repetitive tasks or heavy lifting should be screened prior to job placement. An onsite nurse or physician should ideally perform this screening. If a new hire has a previous history of low back injury, significant time should be spent deciding what type of tasks this employee can handle.

 

 

 

Unless a very comprehensive training and ongoing evaluation program is in place, workers with a previous history of LBP would do well to avoid repetitive bending, twisting, lifting, and reaching. Predictors of increased risk of OLBP, which should be very closely assessed in a screening, include:

  1. Previous history of low back pain.
  2. Infrequent physical activity.
  3. Age (older = greater risk).
  4. High work stress.
  5. Lack of social support network.
  6. Depression.

 

 

 

The use of lumbar support braces is often suggested in industries with employees at high risk for OLBP. Employers assume they are providing a safer work environment for employees who have to perform heavy lifting, etc. as part of their duties. There have been many studies examining the use of lumbar support braces; below are some of the conclusions of these studies:

  1. The only group that may benefit from these braces are those with a history of recent back injury, and braces are only suggested as a short term solution.
  2. Back braces should not take the place of training on proper mechanical lifting technique.
  3. Three of every five large, randomized trials failed to show any benefit from the use of back braces.
  4. The Canadian Centr for Occupational Health and Safety and the United States National Institute for Occupational Safety and Health do not support the use of back belts as a preventive measure.(WCxKit)

 

 

 

Implementing workplace solutions for OLBP prevention can be a time-consuming process, and therefore may not take precedence in the realm of things managers have to deal with on a daily basis. However, based on the information provided in the first two articles of this series, we hope the problem of OLBP will be given more thought. After all, business will ultimately suffer when workers are not able to perform their jobs because they are on disability! For the last part of this series, we will discuss various treatment options for those with low back pain. Stay tuned!

 

 

Authors: Brian Anderson DC, MPH, CCN and David Radford DC, MSc

 

 

Dr. Anderson works as a supervising clinician and instructor at National University of Health Sciences in Lombard IL. He has been in private practice, as well as part of a team in a University based Integrative Medicine setting. In addition, Dr. Anderson has experience in the medico-legal field, serving as an expert for various insurance companies and legal firms. He earned a Masters Degree in Public Health, as well as a Certified Clinical Nutritionist designation. He is currently working toward a specialty diplomate in Functional Rehabilitation. Contact Dr. Anderson for more information at banderson@nuhs.edu

 

 

Dr. Radford is in private practice. He is a third generation Doctor of Chiropractic Medicine. He earned a Master’s Degree in Advanced Clinical Practice and he provides conservative primary care. He has treated work related injuries for more than 30 years. Dr. Radford has found that treating the co-morbidities that often accompany injured workers like obesity, medication overuse, and addiction lead to a more complete recovery. He was a founding member of the Cleveland Orthopaedic and Spine Hospital, Cleveland, Ohio. Contact for more information at DCR8888@aol.com or (440)-248-8888.

 

Resources:

-Use of back belts to prevent occupational low-back pain. CMAJ, AUG. 5, 2003; 169 (3)

-Finding ergonomic solutions—participatory Approaches. Occupational Medicine 2005;55:200–207

-Designing a workplace return to work program for occupational low back pain: an intervention mapping approach. BMC Musculoskeletal Disorders 2009 10:65

 


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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

 

©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact

 

Occupational Low Back Pain Causes, Workplace Solutions and Treatment Options

Authors: Brian Anderson DC, CCN, MPH and David C. Radford, DC, MSc

 

 

Employers are unlikely to find another issue that leads to more absenteeism and detracts from productivity in the workplace more than occupational low back pain (LBP). This, the first in a series of articles, introduces the ubiquity of this problem in the workplace, what solutions are effective in addressing it, and what treatment options can be most successfully employed when workers do injure their low backs.

 

 

In order to understand the scope of this problem, it is worthwhile to discuss some statistics related to occupational LBP.

 

  • Occupational LBP is the largest single health problem related to work absenteeism, and the  most common cause of incapacity among workers younger than forty-five years old.
  • Worldwide, 37% of LBP was attributed to occupation.
  • 1% of the US population is permanently disabled from this problem.
  • Occupational LBP accounts for 68% of sick days and 76% of sick leave payment costs in some industries.

 

As is obvious from the above statistics, LBP consistently creates huge expenditures and time loss from work. Employees whose job involves lifting, bending, twisting or repetitive spinal movements are most at risk for these injuries. This type of LBP is classified as kinetic or dynamic overload injury. Due to the nature of LBP, these workers are also more likely to need extended time off work when suffering a low back injury. Transitionally, they may also need modified duty for a period of time on their return to work.

 


Ergonomic interventions
, which will be addressed in part two of this series, are crucial for the prevention of occupational LBP. Acute LBP is almost never related to one specific event, but rather is the culmination of a long history of improper mechanics and micro-trauma to the spine. As apposed to kinetic injury, static or postural LBP is also a huge problem for “desk jockeys,” or those who sit for prolonged periods of time. Lack of movement can sometimes be as detrimental as too much movement.

 

To summarize, the risk factors for occupational LBP are:

 

  • cumulative traumas;
  • dynamic activity-trunk flexion and rotation, heavy physical work, bending or squatting, lifting or carrying loads;
  • long work shifts without pauses;
  • static and inadequate postures.

 

 

Workers suffering low back injuries can be divided into three groups: work being the primary cause of LBP; work being one of many contributing factors related to LBP; and those with a preexisting back injury which may be aggravated by work. Those workers who fall into the latter category should be very carefully monitored. There will always be cases of occupational LBP that cannot be predicted or even prevented, but a worker with a previous history of LBP does not fall into this category. Matching the worker to the job is a crucial prevention strategy, which will be discussed in part two of this series.

 

 

What should be most concerning to employers, and is likely the most important reason for intervention, is preventing acute low back pain from becoming a chronic problem. There is plenty of data to suggest that most acute low back pain is self-limiting. With or without treatment, many cases of acute low back pain resolve in a few weeks. There are, however, two issues that should be of concern regarding occupational LBP; recurrence and chronicity. The recurrence rate of low back pain is 30-60% within 1-2 years.

 

 

There are also some documented risk factors for developing chronic LBP after an acute injury which employers and health care providers should be aware of. These are:

 

  • dissatisfaction with work
  • physical inactivity/obesity
  • low vitamin D levels
  • smoking
  • performing heavy lifting
  • depression
  • being involved in litigation
  • educational level

 

 

In part three of this series, we will discuss treatment options designed to prevent chronic low back pain.

 

 

If employers are not actively working with their company nurses and doctors developing strategies and programs to address and prevent occupational LBP, hopefully they will after reading this series of articles. Next time we will address programs and interventions targeting primary and secondary prevention of occupational LBP. Stay tuned!

 

 

Resources:

 

  1. Estimating the global burden of low back pain attributable to combined occupational exposures – http://www.who.int/quantifying_ehimpacts/global/5lowbackpain.pdf
  2. Occupational low back pain: Rev Assoc Med Bras 2010; 56(5): 583-9
  3. Preventing Occupational Low-Back Pain. West J Med 1988 Feb; 148:235
  4. Can We Identify People at Risk of Non-recovery after Acute Occupational Low Back Pain? Results of a Review and Higher-Order Analysis. Physiother Can. 2010;62:9 –16
  5. Designing a workplace return to work program for occupational low back pain: an intervention mapping approach. BMC Musculoskeletal Disorders 2009 10:65
  6. Liebenson, C. Rehabilitation of the Spine- A Practitioners manual, 2ndedition. Lippincott Williams & Wilkins

 

 

Dr. Anderson works as a supervising clinician and instructor at National University of Health Sciences in Lombard IL. He has been in private practice, as well as part of a team in a University based Integrative Medicine setting. In addition, Dr. Anderson has experience in the medico-legal field, serving as an expert for various insurance companies and legal firms. He earned a Masters Degree in Public Health, as well as a Certified Clinical Nutritionist designation. He is currently working toward a specialty diplomate in Functional Rehabilitation. Contact Dr. Anderson for more information at banderson@nuhs.edu

 

 

Dr. Radford is in private practice. He is a third generation Doctor of Chiropractic Medicine. He earned a Master’s Degree in Advanced Clinical Practice and he provides conservative primary care. He has treated work related injuries for more than 30 years. Dr. Radford has found that treating the co-morbidities that often accompany injured workers like obesity, medication overuse, and addiction lead to a more complete recovery. He was a founding member of the Cleveland Orthopaedic and Spine Hospital, Cleveland, Ohio. Contact for more information at DCR8888@aol.com or (440)-248-8888.

 

 

Our WORKERS COMP BOOK:  www.WCManual.com

 

WORK COMP CALCULATOR:  www.LowerWC.com/calculator.php

MODIFIED DUTY CALCULATOR:  www.LowerWC.com/transitional-duty-cost-calculator.php

WC GROUP:   www.linkedin.com/groups?homeNewMember=&gid=1922050/

SUBSCRIBE:  Workers Comp Resource Center Newsletter

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

 

©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact

 

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