Lower Back Pain in the Workplace

Lower back Injury

     Injuries of the lower back can be extremely debilitating and are common in many different workplaces.  Although the symptoms of lower back pain across many scenarios may be similar, the causes of low back pain are hard to identify and can be extremely varied.  This is because there are many anatomical structures at risk in the lower back, including nerve roots, muscles, bones, and vertebral discs.¹  These structures can be injured through a variety of movements, including heavy lifting, sudden impacts, repetitive bending or twisting, or poor posture in a seated or standing position.¹

Lower Back Injury Rates

     Because of the many potential mechanisms of injury, lower back pain is one of the most prevalent workplace injuries.²  According to the Ontario Workplace Safety Insurance Board (WSIB), in 2019, the lower back was the most common site of injury in valid insurance claims, contributing to a total of 15.1% of all insurance claims.²  Additionally, lower back injuries have typically been the most common physical workplace injury since the WSIB started recording workplace injuries in 2002.

Key Factors that Predict Return to Work

     According to a systematic review from the institute for Work and Health, the duration of lower back injury symptoms is extremely variable, but is dependent on a few key factors that can predict recovery time.³  Employers can use this knowledge to both help employees recover quickly and also to help accurately predict how long an injury might last. 

• First, a worker’s own prediction of their own return to work timing is often a strong indicator of how long it will actually take to return to work. A common practice in Manitoba actually involves asking employees how long they think an injury will last at the 4-week mark post-injury, and their guess is often a good initial benchmark of return to work. 
• A worker’s self assessment of their disability and pain levels is also a good prognostic tool and can help predict a return to work, with workers reporting less pain and functional disability returning to work faster.
• Next, workers with faster initial access to good healthcare often are able to return to work more quickly than workers who avoid healthcare or seek unqualified assistance.
• Levels of radiating pain can also help predict return to work, as high levels of radiating pain often indicate neural damage which is typically slower to heal.
• Finally, some individual workplace factors have been shown to influence a worker’s return to work.
  • A job with high physical demands will often slow an injured worker's return to work, as the healing process will need to progress further in order to support increased physical requirements.
  • Job satisfaction also impacts return to work prognosis, with employees who enjoy their jobs often returning to work faster after experiencing lower back pain.
  • A job with modified duties or workplace accommodation for injury will also allow a worker to return from injury quicker.³

Prevention Factors

     An even better way to deal with lower back pain is to avoid it in the first place with preventative measures.  A warmup or exercise routine is an excellent way to prepare for heavy or repetitive lifting, as warming up before exercise can increase blood flow to relevant muscles to prevent muscle or tendon injury.⁴ Another method to prevent injury involves inspecting the workplace and identifying and changing dangerous jobs that include many high-risk movements or sitting positions with little lumbar support.  Finally, learning and practicing safe movement patterns may be a good way to prevent lower back injuries.⁴  Many of these prevention strategies can be delivered together with a musculoskeletal disorder (MSD) prevention program, which aims to prevent many of the causes of low back pain. 

References

¹Allegri, M., Montella, S., Salici, F., Valente, A., Marchesini, M., Compagnone, C., Baciarello, M., Manferdini, M. E., & Fanelli, G. (2016). Mechanisms of low back pain: a guide for diagnosis and therapy. F1000Research, 5, F1000 Faculty Rev-1530. https://doi.org/10.12688/f1000research.8105.2

²By the numbers: Open data downloads. (2021). WSIB. https://www.wsib.ca/en/numbers-open-data-downloads

³Steenstra, I. A., Munhall, C., Irvin, E., Oranye, N., Passmore, S., van Eerd, D., Mahood, Q., & Hogg-Johnson, S. (2016). Systematic Review of Prognostic Factors for Return to Work in Workers with Sub Acute and Chronic Low Back Pain. Journal of Occupational Rehabilitation, 27(3), 369–381. https://doi.org/10.1007/s10926-016-9666-x

⁴Powers, S. K., Dodd, S. L., & Jackson, E. M. (2013). Total Fitness & Wellness (6th Edition) (6th ed.). Pearson.