7 - Back To Work - Information

Goals Information Skills Drills Questions Review

 Information to Master

Not everyone who works has back pain. And not everyone with back pain works. So whether you're trying to get safely back to work, recreation, or hobbies, you'll find helpful tips in this session. As you go through this session, you'll see many references to workers and the workplace. But similar principles may be applied when people are attempting to return safely to a particular sport, activity, or hobby.

The activities and work we do influence our chances of having back pain. Researchers are still trying to determine which activities pose the most risk for back trouble. Is it harder on your back to sit all day, or is it better to be on your feet? Does being sedentary at work pose greater problems than doing physically challenging work? Many questions remain unanswered.

One unanswered question is whether people in jobs that require heavy lifting, bending, and twisting tend to report back symptoms and back injuries more often than people in less demanding jobs. Notably, scientists believe that the risks from these heavy activities probably have a smaller role in back problems than other factors in workers' lives. Do the workers smoke heavily? Are they physically unfit? Do they routinely recreate or do hobbies that put an even bigger strain on the spine?

In this session, we'll look at these and other factors that may have a role in back problems at the workplace. But what about people who've had a back injury or experienced back pain at work? Today's advice is that if they are working, they should probably stay on the job. And those who are off work due to back problems should attempt to get back to work sooner, rather than later. Recall from Session One that people generally recover faster when they stay active and resume normal activities as soon as possible after having back pain or a back injury.

The longer people stay off work, the greater their risk for long-term pain and disability. And the longer they're off, the smaller the chance they'll get back to work. It is important that employees with back pain return to work as soon as they can, even if they're still feeling some pain. There are many good reasons why staying on the job is a good idea. People at work tend to stay more active. They enjoy the social interaction of being at work. Their self-image is raised because they see themselves as productive workers. They sense that they are well, not "ill." And they find that their pain, though often annoying, is not disabling.

Sometimes there are barriers that keep people from getting back to the job. This session will look at these barriers and what people can do to overcome them as they attempt to get back to work.

Before jumping ahead, spend time recalling what you learned in Session Six. Review the answers to the last session's Questions for Review.

 Answers for Review

In the last session, you were asked three questions. Take a few moments to compare your answers to those given here.

1. How would you describe nonspecific low back pain?

Nonspecific pain is the most common type of back pain. It's usually a signal that the back is not working right. The spine hasn't been damaged. The pain is "mechanical," and it usually goes away in a matter of a few days to several weeks. People do best when they use simple measures to take care of the pain and when they get moving sooner, rather than later.

2. Which spine structures can be a source of low back pain?

The spine has numerous structures that can be a source of low back pain. They include muscles, discs, bones, ligaments, joints, and nerves.

3. When should a person with back pain raise a "red flag" for prompt medical attention?

First, immediate attention is needed when symptoms of cauda equina syndrome occur. These symptoms can include back pain, pain going down the backs of one or both thighs, disturbed function of the bowels or bladder, and numbness in the genital area. Second, numbness or weakness in the lower limbs that is steadily getting worse requires prompt attention. And third, people who feel back or leg pain that continues to get worse should report their symptoms to their doctor and therapist.

Connecting the Dots from Work to Back Pain

Back injuries are the most common work-related injury. They are one of the most frequent reasons for work absence. What is the connection between working and the onset of back pain? In industrialized nations where vast amounts of money are spent on work-related back pain, this is a multi-billion-dollar question. The connection isn't always clear. But today's research shows that numerous factors are at play, many of which probably work together as the real causes of back pain.

Obvious factors in back pain include smoking and obesity. If you smoke or are overweight, help is available so you can face these problems. By addressing these issues, you immediately improve your outlook for improved spine health. Talk to your healthcare provider for suggestions.

Influences on Work-Related Back Pain

  • Obesity
  • Smoking
  • Low job satisfaction
  • Low education levels
  • Working lots of overtime
  • Sedentary work conditions
  • No influence on work conditions
  • Work that involves whole body vibration
  • Driving more than one-half of the work day
  • Dealing with extremely heavy loads at work
  • A past episode of back pain or previous back injury

The physical demands of the job can also contribute to back pain among workers. Back injuries are more often reported by workers who have to deal with extremely heavy loads at work. As you'll recall from Session Four, lifting is often blamed as a cause of back pain. But lifting itself is not necessarily a risk factor for back pain until other variables are added. For example, lifting becomes a risk when poor technique is used, such as lifting when the back is bent and especially when it is twisted. People who must lift more than half of the work day or who must repeatedly lift 50 pounds or more are also at risk for work-related back pain. There is also some evidence that workers who are exposed to whole body vibration are at risk for back pain. Driving is the main culprit for this type of vibration. It is estimated that people who drive more than half their work day may be at greater risk of work-related back pain.

There is a connection between back pain and peoples' attitudes at work. Where there is high job satisfaction and good relationships throughout the company, there are generally fewer problems with back pain and back injuries. Stressful jobs and jobs where people don't feel they have any influence on what happens at work tend to report more back problems.

Employers have a growing awareness about how they can help combat back problems at work. Many are beginning to work more closely with employees to identify problem areas, to encourage greater communication through the workforce, and to address potential problems. Developing this type of "safety culture" is showing modest results. Companies with this model in place sometimes see a drop in the reported number of back problems.

Jumping Hurdles to Get Back to Work

People with back pain sometimes run into barriers that keep them from returning to work. Being warned about these barriers can help you know ahead of time what to look out for and where you may need extra help. If you see barriers that may be holding you back, talk with your doctor and therapist. They will attempt to learn all they can about your job to help you work around any obstacles.

Barriers to Getting Back to Work

  • Older age
  • Depression
  • Poor fitness
  • Heavy smoking
  • Fear of re-injury
  • Previous back injury
  • Higher pain intensity
  • Pending legal action
  • Sciatica (leg pain coming from the back)

People who've injured their back while doing their job may be afraid of hurting themselves again. Their fear of re-injury strongly predicts that they'll have a harder time getting back to their jobs. Studies show that this type of fear accounts for about 25 percent of work disability. This means that in at least one-fourth of all workers with back pain who don't get better, psychological and emotional factors are the key. If you have similar concerns, talk them over with your doctor and therapist. Helping you overcome this fear is an important step in getting you safely back to work.

Researchers know that low back pain is often linked with anxiety or depression. The relationship is especially strong in patients whose pain doesn't get better. No one is exactly sure how this relationship works. Does the pain and inactivity cause anxiety and depression? Or does anxiety and depression set people up to have pain? The answer probably depends on the patient. But either way, it has become clear that doctors and therapists must deal with the psychological distress associated with low back pain in some patients.

A stressful job can deter a person from wanting to go back to work, especially for older workers. Older workers are particularly prone to the challenges a workplace can put on health. Stress can be a barrier for getting back to work, regardless of age. But for older workers especially, a stressful work setting makes back pain less tolerable and potentially more disabling. And older workers may be less free to change jobs to relieve the mental or emotional strain of work. Seek advice from your doctor and therapist about possible stresses at work that may be keeping you from wanting to go back to your job. If they don't have answers, they'll attempt to get you the help you need.

Join the Team

Everyone on the healthcare team is pulling for you. They want the best for you and your back. They'll help in every way to improve your safety at work (and play). You're on the team, too! What steps are you taking on your behalf? Are you applying the information and skills you've been learning in Back Care Boot Camp? If you smoke, have you taken steps to stop? If you are overweight, have you taken steps to lose weight? Are you trying to use safe posture, body mechanics, and lifting strategies? Have you discussed fears that may be keeping you from resuming normal daily and work activities?

You can also make a difference by taking note of your work tasks. How is your work or hobby environment arranged? Take a look at the items you must grasp, lift, and carry. Are they in a convenient spot? Or do you have to reach awkwardly to get them? Are the items bulky, heavy, or unpredictable? If you work long hours at a bench or in a chair you may need to be taught how to adjust them. If you have any questions or concerns about the safety of your work station or job tasks, let your therapist and doctor know. They'll work with others on the team to help you.

Goals Information Skills Drills Questions Review

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