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:
- Estimating the global burden of low back pain attributable to combined occupational exposures – http://www.who.int/quantifying_ehimpacts/global/5lowbackpain.pdf
- Occupational low back pain: Rev Assoc Med Bras 2010; 56(5): 583-9
- Preventing Occupational Low-Back Pain. West J Med 1988 Feb; 148:235
- 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
- Designing a workplace return to work program for occupational low back pain: an intervention mapping approach. BMC Musculoskeletal Disorders 2009 10:65
- 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.
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