Work Related Back Pain; Part 1Reading Time: 3 minutes
Back pain is a very common affliction which affect people of all ages and ranks as one of the top 10 reasons worldwide for a doctor’s visit. It is estimated that between 15-45% of the population experience back in any particular year. Back pain peaks between the ages 35yo to 55yo with a lower incidence in the younger population.
Although the exact incidence of work related back pain is difficult to estimate it is believe to be higher than in the general population. Naturally, certain types of employment have a greater risk for developing back pain. These jobs include construction work, heavy laborer work, truck drivers and janitorial work. Sometimes, back pain develops suddenly due a specific incident but other times back pain develops over time due to repetitive injury.
Since the lower back is a very complex structure, there are many different structures which can be injured. These structures include:
- Lumbar disc: these are the soft gel like structure that sits between the vertebral bodies
- Lumbar vertebral bodies
- Lumbar facets: these are the joints which connect the adjacent vertebral bodies and allow the spine to move
- Lumbar muscles and ligaments: these support the spine and also help to move the spine
- Lumbar nerves: at each spine segment, the spinal nerves exit the spine to supply sensation and motor function to the lower extremity
With age or with repetitive use of the lumbar spine, injury to the lumbar disc can occur. In this circumstance the injured worker might complain of a deep seated back pain that is worse with activities and better with rest. Injury to the facet joints can lead to back pain that is better with rest and worse with activities especially extension or bending backwards. Ligament or muscle injury presents mainly as muscle spasms which can be very painful and make movement very difficult. Lumbar nerve injury can present as back pain, buttock pain and more classically as radiation pain down into the legs. Injury to the lumbar vertebral body is very uncommon in the injured worker unless there is, for example, a very severe accident such as a very bad fall or severe motor vehicle accident.
The mechanism of a low back injury often determine the type of back pain and the subsequent treatment. That is, the more severe the accident the more likely that the accident will cause serious injury to structures such as the discs, nerves or even the vertebral bodies. Despite the cause of the injury, sudden or repetitive, the presentation can be the same. The injured worker can present with the following:
- Central lower back pain
- Lower Back pain with radiation to the buttock and hip region
- Lower back pain with radiating leg pain
- Leg pain and weakness
If any of these symptoms are accompanied by loss of bladder or bowel control, then the injured worker might have more than just a lower back injury. Loss of bladder and bowel control would indicate severe damage to the nerves in the lower spine and indicate for urgent evaluation and possibly surgical treatment.
Treatment for lower back pain without any bladder or bowel complication in the injured work is based on the presenting symptoms and the mechanism. The initial evaluation and work up is based on the worker’s symptoms. For lower back pain without any radiating leg pain, treatment is often a 6 week course of medications usually an anti-inflammatory and physical therapy. During this time, the injured worker can continue working at his/her regular job or on light duty.
If at the end of this initial treatment, the symptoms have resolved then the injured worker can return to regular duty. If there is no improvement in the worker’s condition then additional evaluation is often warranted. These additional evaluation include radiographs of the lower back. If the injured worker has both back and leg pain then a MRI scan of the lower back is ordered to evaluate for a possible disc herniation.
Further treatment is then determined by the injured worker complaints and the results of these studies.