Once an injured worker has low back pain, chances are pretty good he’ll have a recurrence. In fact, new research shows that after an acute episode of LBP, one-third of people will have another episode within a year; and the odds of a recurrence triples after two episodes.
Those statistics are somewhat surprising, given that recurring LBP can be avoided. Gustavo C. Machado and his colleagues at the University of Sydney’s School of Public Health tracked more than 1,000 LBP patients in Australia from 2011-12. Their results were published by the American Physical Therapy Association.
“We know if you do exercise and receive advice you reduce the risk of having a recurrence,” said Machado, lead author of the study. “Some research shows if you do exercise, you reduce your risk of a back pain episode by 35%; and if you do exercise and get some sort of education or information, that risk is reduced by 45%. So it’s a big reduction in risk. “
With LBP one of the most prevalent causes of workers’ compensation claims, the industry could prevent unnecessary pain among workers and save significant dollars for payers by better educating workers on LBP.
An estimated one-third of workers’ compensation claims involve LBP, with direct costs of more than $14 billion annually. Some 1 in 4 workers with LBP remain out of work for up to six months, increasing the chances of permanent disability.
Workers of any age can experience LBP, though it typically affects those over the age of 40. The reasons for LBP can vary with age.
“With older workers, you see degenerative changes,” said Daniel Sanchez, a physical therapist and VP of Operations for OnSite-Physio, a company that provides PT to injured workers on site. “For younger workers, the LBP tends to be muscular soft tissue in nature. But both degenerative and soft tissue LBP can be recurring.”
See also: The State of Workers’ Compensation
Acute episodes of LBP last for no more than six weeks, while chronic LBP continues for at least three months. While injured workers with acute LBP should avoid vigorous activity, that does not mean they should be bedridden.
“The first thing initially is to rest, but don’t over rest,” Sanchez explained. “Depending on the severity, maybe a day or two of not overdoing it, but not being laid out in bed all day. Just not doing heavy exercise; no movements that aggravate the pain.”
The simple act of reaching down to pick up something can aggravate the pain. For the first couple of days, injured workers should “take it easy, allowing the body to heal,” Sanchez said.
Machado concurred. “For those patients, the best thing is to remain active. So do not stay in bed, just keep on the move. Try to keep up with routine activities, such as work,” he said. “It’s also very important to receive advice and education about pain, about recurrences.”
The majority of LBP cases resolve within a few weeks. For those that linger, a different regimen is needed.
“A quick fix for LBP does not exist,” Machado said. “The latest research shows taking pills doesn’t help much. Exercise and education seem to be the key for treating back pain, reducing back pain and preventing recurrences. The problem is people are not engaged in exercise.”
There are a variety of exercises touted as best for addressing back pain: pilates, yoga and strengthening among others. They are equally effective.
“The more research that comes out, the more it’s clear there is no one exercise that is better,” Machado said. “The best is the one you like to do, they one you’re going to engage in, the one you’re going to stick to.”
A combination of exercises that improve stability, flexibility and strength will increase mobility and range of motion, thereby reducing pain. When muscles are tight and weak, the joints cannot move properly, Sanchez said.
- Strengthening exercises. The most effective of these, according to Sanchez, are those that target the muscles in the front and back of the spine; the deeper, transverse abdominis that support the spine. Planks are among the most effective and can help the intrinsic, tiny muscles that attach to each vertebrae. These provide postural support which is very important.
- Flexibility exercises. These, especially to the lower extremities, are extremely important. The lumbopelvic hip complex includes muscles that attach from the lower extremities, such as the hip rotators, hamstrings and hip flexors. Exercises that target these areas can relieve tight hips, which helps relieve chronic LBP.
- Posture. Practicing sound posture, good body mechanics and lifting habits are also helpful, Sanchez said. Having a neutral spine is the goal.
Future of LBP
The research on LBP should include more robust studies looking at recurrence, Machado said. In the meantime, he and his colleagues are analyzing other aspects of LBP.
“The main one we are looking at is over diagnosis and treatment, because a main issue is that people get lots of X-rays and imaging and that’s usually unnecessary,” Machado said. “Lots of people also get opioids. We know that’s a big problem, especially in the U.S. It is not helpful. There are few benefits and really serious risks for side effects.”
Machado has a trial study starting soon in Sydney. Along with others, he is also looking into technology; specifically, smart phone apps that claim to help back pain.
“We found over 69 apps to download. They’re making big promises but have not been tested for effectiveness,” he said. “We are planning to do another study in a few months on a specific app that could be promising… This one recommends a 10-week exercise program, mainly strengthening. The problem is there is no research testing this app as to whether it’s effective in reducing pain.”
For now, Machado hopes the latest study will provide guidance for providers treating patients with LBP. “We didn’t know how common recurrence was; it shows one-third after recovery will have another episode,” he said. “That’s something a clinician can use to educate a patient when they come, to say ‘look, a third of people have a recurrence, so engage in exercise.’ They can use this to educate them now.”
For more information visit https://www.apta.org or http://www.onsite-physio.com.