In 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:
- Problem analysis/activity analysis.
- Creativity stimulation and idea generation.
- Concept development, focus groups.
- Concept evaluation, intervention ideas.
- 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:
- Previous history of low back pain.
- Infrequent physical activity.
- Age (older = greater risk).
- High work stress.
- Lack of social support network.
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:
- 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.
- Back braces should not take the place of training on proper mechanical lifting technique.
- Three of every five large, randomized trials failed to show any benefit from the use of back braces.
- 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 firstname.lastname@example.org
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.
-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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