Lower back injuries: Prevention and Treatment Strategies

According to the Workers’ Compensation Insurance Rating Bureau, lower back injuries remain the single most common type of work-related injury.

• Business Insurance magazine reports that lower back problems affect half of all working-age Americans and are the number one cause of temporary disability in people age 45 and younger. Two percent of the U.S. workforce receives compensation for back problems each year, with costs running between $20 and $50 billion.
• The National Institute for Occupational Safety and Health (NIOSH) reports that back injuries account for almost 20 percent of workplace injuries, costing the nation up to $50 billion a year.
• Liberty Mutual Insurance data shows that back pain accounts for 16 percent of all workers’ compensation claims, representing 33 percent of workers’ compensation costs.
• The American Journal of Public Health notes that of the 150 million workdays lost each year due to back pain, two-thirds are lost by people with work-related back pain.
• A Gallup Poll sponsored by CIGNA IntegratedCare found that 44 percent of employees missed work due to musculoskeletal injuries and 35 percent of these injuries involved the back. The average time off work was 17 weeks.
• The Spine Institute of New England reports that 80 percent of adults will experience at least one episode of back pain during their lives.

Of the 2 to 5 percent who seek medical help or miss work due to the pain, half recover within a week, 70 percent within three weeks, and 90 percent within three months. The remaining 10 percent account for 90 percent of the total costs expended on back injury treatment.The National Institute for Occupational Safety and Health (NIOSH) reports that back injuries account for almost 20 percent of workplace injuries, costing the nation up to $50 billion a year.

Propane industry concerns

Back pain is the most common work injury for the thousands of workers delivering propane throughout the nation.

Studies show that after the age of 30, the blood supply to the disks tends to dry up. The only way to keep them lubricated is with fluid that is pumped in and out through exercise.

“For propane delivery drivers, as the hose is being pulled, the increasing weight adds strain,” says Larry L. Snodgrass, executive director of the Arkansas Propane Gas Association.

The Virginia Propane Gas Association is trying to get out ahead of the problem.

“If a driver pulls a 100-foot hose the wrong way, it can result in a back injury,” says Joe Budd, executive director of the association.

“Our association is starting to offer seasonal driver training, because a number of our marketers hire drivers just for the winter heating season. Among other things, the training will cover safety elements of the job, such as preventing back injuries.”

Strains from pulling, bending, and twisting are just a few potential causes of injuries for drivers, though.

“In terms of back injuries, getting in and out of the truck may be more dangerous than pulling hose, especially in bad weather when the driver might slip and fall,” says Snodgrass.

“Drivers get in and out of trucks dozens of times a day, often on driveways that aren’t level and that aren’t cleared of ice and snow.”

Causes

While most people are in agreement about the problems back injuries cause, few concur about the causes of back injuries and pain.

Research by the Harvard School of Public Health found that there is a lot of opinions and claims, but no definitive research for up to 85 percent of back pain. Much depends on whom you ask.

For instance, a physician will most often say muscle strain, a surgeon will say a disk, a chiropractor will usually say misalignment and a physical therapist will usually say muscle weakness.

Some research does point to causes that are more common than others, however. As a person ages, they are more likely to lose flexibility and experience tighter muscles. In addition, back injuries tend to run in families, regardless of the type of work or other activity family members perform, according to research in Finland.

While the muscles, tendons and bones in the back are the primary source of problems, new research suggests that attention should also be paid to a body part about two feet higher – the brain.

An article in Spine reported on a study that examined the impact of stress on a person’s ability to lift.

During the first lift, subjects were encouraged and praised by researchers. During the second lift, they were subjected to criticism and led to believe they were not lifting correctly. Interestingly, more than 90 percent of the subjects experienced increased blood pressure during the second lift.

Subjects classified as introverts experienced an increase in spinal compression of 14 percent and an increase of sideways forces on the spine of 27 percent. There was little change in extroverts, however.

“The criticism just rolled right off the extroverts, but introverts changed the way they used their muscles, so that lifting became much more mechanically stressful,” the study notes.

Researchers at University of Surrey in England studied 8,000 workers for three years. They found that work-related stress caused a significant increase in back injuries.

Personal habits can also affect back safety. A report published by NIOSH found that smokers had a 3.96 incidence rate of back injury workers’ compensation claims, while non-smokers had only a 2.40 incidence rate.

Researchers say smoking reduces flow of blood and other fluids to the spine. Nicotine causes the small blood vessels that feed the back to constrict, and reducing blood flow also reduces the amount of oxygen in bloodstream.

There also is substantial research data showing that obesity increases the risk of back injuries.

Prevention

Several strategies are used to help prevent back injuries.

In some industries, it is possible to eliminate the need to lift by introducing mechanical equipment or redesigning job activities and process. These are rarely options that propane dealers can consider, given the nature of the work.

A more traditional strategy is to be sure your employees are trained how to lift and bend properly, especially for new hires.

“For propane truck drivers, the best way to reduce the potential for back injuries may be to pull the hose while walking backwards,” says Snodgrass. “Drivers should be trained to pull the hose with both arms at the same time, rather than pulling from the side, which involves twisting and turning. They should also keep both feet firmly planted on the ground.”

Back Belts: Useful Or Not?

Realize that training and educating employees are two separate functions.

Training focuses on showing employees how to lift properly. Educating focuses on teaching employees the problems associated with back injuries.

Employers may want to invite a medical practitioner to educate workers about herniated disks and sciatica and the consequences of getting hurt. For instance, a herniated disk can result in surgery where part of the bone in the spine has to be chiseled out. When employees hear that, they begin to think seriously about back safety.

Another strategy is to offer exercise programs. Employees who engage in physical labor are really “industrial athletes.” The work they do is similar to athletic events, and they likewise need to warm up and stretch before they work.

This is especially true for older workers. After the age of 30, the blood supply to the disks tends to dry up, so the only way to keep them lubricated is with fluid that is pumped in and out through exercise.

Lower leg strengthening and balancing exercises are also recommended.

Overall, exercise helps to keep abdominal muscles strong and flexible. It is important to remember that employees are most vulnerable to back injuries in the early morning hours, primarily due to lack of lubricating fluids and warmth in their muscles and disks.

Finally, consider introducing a wellness program that emphasizes the importance of a healthy diet, an exercise program, the importance of maintaining a healthy weight, the dangers of smoking, and stress management.

Employers also should encourage workers to drink plenty of water during the day, which helps hydrate the body and keep the muscles lubricated.

Treating the problem

Choosing a treatment for employees who suffer back pain is no simple matter.

An article in Spine entitled “Low Back pain: A 20th Century Enigma,” notes, “In the United States, medical care for lower back pain is overspecialized, over-invasive, and over-expensive, whereas in the United Kingdom, care for back pain is under funded, too little, and too late. However, clinical outcomes of treatment differ little.”

Another study reported in the same issue, titled “Low-Back Pain: A Primary Care Challenge,” found that 80 percent of patients with lower back pain seemed to improve on their own, regardless of what type of treatment was prescribed or given. The remaining 20 percent developed chronic lower back pain, regardless of the type of treatment, or whether no treatment occurred.

Research conducted at the Harvard School of Public Health studied the results of virtually all common treatments, such as bed rest, chiropractic manipulation, exercise, medication, hot/cold packs, traction, acupuncture, injections and surgery.

It found that regardless of the type of treatment – or whether patients received any treatment at all – the outcomes were about the same: About 75 percent of people recovered from acute lower back pain within two weeks, and another 15 percent recovered within six weeks.

The Vermont Back Research Center created the Vermont Disability Prediction Questionnaire to help predict which employees with lower back pain will become disabled and who will recover. A number of questions focus on issues such as sleep disturbances, appetite disturbances, depression, preoccupation with pain, negative feelings about oneself and negative feelings about one’s job.

The Center concluded that psychological stress could play as big a part in lower back pain disability as physical stress. Specifically, it found that employees who have trouble with their supervisors may translate these feelings of conflict into increased back pain.

Beyond the psychological issues, the traditional school of thought for treatment called for constant bed rest for several weeks, supplemented with strong, prescription painkillers. If the regimen failed, back surgery often is scheduled.

Both treatments are expensive. Indemnity costs skyrocket when employees are bedridden for weeks and extended bed rest causes muscles to atrophy. And no surgery is cheap.

New approaches

Recent research is beginning to suggest that there is a better approach to treating lower back pain–one that is physically and psychologically better for employees and less expensive for employers.

In the late 1990s, the U.S. Department of Health and Human Services Agency for Health Care Policy and Research published new guidelines for treating acute lower back injuries. The recommendations were mild conditioning exercises and non-prescription painkillers and anti-inflammatories.

A recent research report published in the Archives of Physical Medicine and Rehabilitation supports this approach. It reports that by engaging in an aggressive back strengthening exercise program, 35 of 38 patients with lower back problems were able to avoid surgery.

Another option is physical therapy, which, according to a recent study published in the Journal of Occupational and Environmental Medicine, should take place sooner than later.

When employees injure themselves at work, the biggest cost driver is time. Besides medical costs, employers have to deal with indemnity costs and associated administrative costs.

For employees who have suffered moderate lower back injuries, research conducted by the Occupational Health Research Institute found that the “sports model” of medical treatment is more effective in returning them to work quickly than the traditional non-work-related injury medical model. Sports medicine is designed to get athletes back quickly, and the research found that it could do the same for employees.