The Anatomy of the Spine
The spinal cord is the core of a person’s central nervous and skeletal system. It is an important part of the body’s infrastructure. It is made up of many important parts that holds a person together.
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With respect to the spinal cord, several key segments claim handlers need to understand. This includes:
- Cervical spine: This is the region of the spine that connects to a person’s brain stem. It is comprised of seven (7) vertebrae. In layman’s terms, this region of the spine is called the neck.
- Thoracic spine: This is the midsection of the spine and is comprised of 12 vertebrae. This portion of the spine does not bend back and forth as often, which allows vertebrae fractures to heal with some certainty.
- Lumbar spine: This is the lower part of the spinal cord and is comprised of five vertebrae. Like the cervical spine, this part is subject to many stresses of everyday activities. Functions such as bending, twisting and sitting place extreme stress and are subject to a part percentage of everyday and work-related injuries.
There are also other important components to a spine. They include:
- Sacrum and Coccyx: The sacrum typically includes five vertebrae structures, which are attached to the lumbar spine. In turn, the sacrum is connected to the coccyx, which is commonly referred to as the “tailbone.” These bones are also involved in countless work injuries.
- Discs: These are the spinal cords “shock absorbers” and are similar to a jelly donut. Injuries to discs result in herniations, which causes them to lose their absorbency.
Dealing with Secondary Gain in Low Back Pain
Degenerative changes in the spinal cord, especially the lower back, are common for any person to experience over their lifetime. This is based on activities of daily living that places stress on the vertebrae. Studies indicate that the average American over the age of 40 has some degenerative changes in their back, which may include herniation without symptomogy. The result of this is for members of the claims management team to be proactive when handling a claim involving a spinal cord injury. Factors that delay recovery often include:
- Common themes for this characteristic include the age of the employee;
- Tenure in a position (both long and short term);
- Language or other cultural barriers;
- Lack of interest in returning to work;
- The presence of return-to-work opportunities; and
- Seriousness of the injury.
Identifying Secondary Gain and the Low Back
One common test used to identify malingering is the Waddell’s Test. Gordon Waddell developed this test in 1980 to indicated symptom magnification in low back injuries. This test can be a part of an independent medical examination, as well as a review by the treating physician. Proper use of this test includes the following:
- Superficial tenderness or overreaction exhibited by the patient;
- Testing that does not cause stress on the spin, but results in pain;
- Examination techniques that include distraction and re-verification when the patient is properly oriented; and
- Disturbances that do not have a known etiology.
Claimants who exhibit a “positive” test should be scrutinized and possibly treated for other underlying conditions, which can include depression, or other psychological/psychiatric conditions.
Conclusions
Dealing with low back pain claims can be challenging for members of the claims management team. Through properly training and understanding of the spinal cord, members can develop tactics to identify symptom magnification and resolve troublesome claims.
Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%. He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: [email protected].
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