09/08/17 Safety National
Millions of dollars are spent annually on treating low back pain (LBP). It accounts for one third of all occupational musculoskeletal injuries and illnesses resulting in work disability. At the 2017 CWC and Risk conference a panel of experts discuss lower back pain and the latest research.
Conservative treatment options
There is no magic bullet. There is moderate evidence for multiple forms of conservative treatment. Acute lower back pain(LBP) treatment options include reassurance, remain active, heat, manipulation and acupuncture.
Meds can include NSAIDs or muscle relaxants (not opioids). Chronic LBP options are exercise, mindfulness based approaches, cognitive behavioral therapy, multidisciplinary rehab. Meds can include NSAIDs, tramadol. Bed rest is not advised. Physical agents and modalities are of unproven benefit to justify their costs in patients with acute LBP. There is evidence against traction for acute LBP but there is some support for chronic LBP. There is building evidence for stratified care based on risk profile that includes psychological and physical characteristics. Some patients may need a little more than reassurance and simple education. Others may need more advanced “psychologically informed” rehabilitation.
Central sensitization is becoming better understood and represents significant changes within the nervous system. This may require multidisciplinary care that includes specialized physical rehab and pharmacotherapy. People with uncomplicated LBP who are first sent for MRIs are more likely to receive a surgical or injection intervention, require specialty care or visit to an emergency system and LBP related medical charges were higher. MRIs can trigger catastrophic thinking and disability beliefs.
The Power of Words
• Reassure or frighten
• Signal interest or not
• Build trust /confidence or distrust or insecurity
• Create expectations – positive or negative
• Grow relationships or not
Words are most powerful when you are seen as a credible authority (benevolent, trustworthy and expert in the matter at hand. When you are familiar with and respect the worker’s specific situation: What are they wondering or worrying about, and what they want to accomplish.
University of California – WorkStrong program
The WorkStrong program is a University of California system-wide program developed with the expertise and collaborative support of UC staff in wellness programs, occupational health and recreational services. It is designed to promote recovery and prevent future workplace injuries. Each UC campus has its own unique program to suit the needs of the employees on its campus. All campuses offer the core services of WorkStrong, which include a 6 month gym membership, exercise guidance and nutrition counseling, while each campus offers their own unique programming to suit the needs of its campus.
Some of the program benefits include:
• Post-rehab wellness program (pre- and post-body composition assessments included)
• Pre- and post-flexibility/mobility and strength assessment
• Flexible hours geared towards what works best for you
• Focused on functional strength for your workplace