//fpnotebook.com/
Return to Work in Lumbar Back Pain
Aka: Return to Work in Lumbar Back Pain, Low Back Injury and Return to Work
- See Also
- Low Back Pain
- Start Back Screening Tool
- Epidemiology
- Low Back Pain in the last 3 months is reported by 25% of working adults in U.S.
- Low Back Pain accounts for 1 in 20 outpatient visits
- However, only one third of workers with Low Back Pain seek medical attention
- Of those with ongoing Low Back Pain for 2 years, 70% never took medical or Sick Leave
- Evaluation
- See Acute Low Back Pain
- Risk Factors: Work-related back injury
- Heavy lifting (esp. >55 lb or 25 kg)
- Bending or twisting frequently
- Whole body vibration
- Management
- See Low Back Pain Management
- Physical therapy speeds recovery
- Start with physical therapy 3-5 times weekly and gradually decrease frequency
- Initiate home therapy program at initial visit
- Reevaluate in clinic after 6 physical therapy visits or 2 weeks
- Consider multidisciplinary rehabilitation program if standard therapy fails after 4-12 weeks
- Team approach includes physicians, physiotherapists, and mental health counselors
- Back school or other work hardening programs are not recommended (low efficacy)
- Return to work timing
- Early return to work is key (despite persistent symptoms)
- With appropriate work restrictions, early return does not risk further injury
- Prolonged or recurrent work absence risks longterm Disability and joblessness
- Missing 4-12 weeks of work associated 40% chance of missing the next year of work
- Missing 2 years of work associated with high likelihood of never working again
- Screen and intervene with patients at high risk of chronic Low Back Pain and Disability
- See Start Back Screening Tool
- Address fear avoidance beliefs (activities that are avoided due to fear of injury)
- Encourage early functional return to work
- Provide in-depth physicial therapy
- Consider behavioral health follow-up (as indicated for Major Depression or Anxiety Disorder)
- Teach Mindfulness and stress reduction techniques
- Instructions: Work Restrictions for light work activity
- Criteria that defines light work activity
- Primarily sitting
- Occasional standing and walking
- Lifting and carrying <20 pounds
- Work restrictions
- No lifting over 5 pounds three times per hour
- Change position for 5 minutes every 30 minutes
- Avoid prolonged sitting, standing or walking
- Duration of light duty restrictions
- Mild Low Back Pain: 0 days
- Severe Low Back Pain: 3 days
- Low Back Pain with Sciatica: 5 days
- Instructions: Work Restrictions for medium work activity
- Criteria that defines moderate work activity
- Mix of sitting, standing and walking
- Occasional bending, twisting, or stooping
- Lifting and carrying <50 pounds
- Work restrictions
- No lifting over 5 pounds three times per hour
- Change position for 5 minutes every 30 minutes
- Avoid prolonged sitting, standing or walking
- Avoid bending, twisting, or stooping
- Duration of light duty restrictions
- Mild Low Back Pain: 0 weeks
- Severe Low Back Pain: 2-2.5 weeks
- Low Back Pain with Sciatica: 3 weeks
- Instructions: Work Restrictions for heavy work activity
- Criteria that defines heavy work activity
- Primarily standinga and walking
- Frequent bending, twisting, or stooping
- Lifting and carrying as much as 100 pounds
- Work restrictions
- No lifting over 25 pounds 15 times per hour
- Ten minute break for every hour of standing, walking
- Limits on driving
- Light truck or car: 6 hours per day
- Heavy vehicle or equipment: 4 hours per day
- Avoid bending, twisting, or stooping
- Duration of light duty restrictions
- Mild Low Back Pain: 1-1.5 weeks
- Severe Low Back Pain: 4-5 weeks
- Low Back Pain with Sciatica: 4-5 weeks
- Prognosis
- Predictors of Prolonged recovery (persistent back pain at one year)
- Poor pain coping skills
- Fear avoidance (avoiding activities due to fear that they will cause pain)
- Baseline functional Impairment
- Psychiatric illness
- Low general health status
- Additional predictors of Delayed Return to Work (or longterm Disability)
- Attorney involvement or active litigation
- Work absence beyond 30 days
- Workers compensation case
- Prevention
- Effective Workplace Preventive Interventions
- Core strengthening Exercise
- Structured program (e.g. yoga, pilates)
- Unstructured program (patient performs on their own) is as effective as structured program
- Extension Exercises
- Even performing a single extension Exercise once weekly as a group at work is effective
- Measures that do NOT appear effective
- Back braces
- Shoe Insoles
- Preventive employee education
- Modification of ergonomic and mechanical factors at the workplace
- References
- Denniston (2005) Disability Guide, Work Loss Data Inst.
- Becker (2019) Am Fam Physician 100(11): 697-703 [PubMed]
- Kinkade (2007) Am Fam Physician 75(8):1181-92 [PubMed]
- Nguyen (2007) Am Fam Physician 76:1497-4 [PubMed]
- Williams (2002) Work 19:87-93 [PubMed]