Written By D. Troy Trimble, D.O.

Many injured workers have pre-existing degenerative conditions. Many times, these degenerative conditions have not produced symptoms up until an injury. This injury could occur at work or at home, but in many cases, was not producing symptoms until some precipitating event. At this point, the question becomes – “Who is responsible?” 

In the world of spine conditions, we know that almost 50 percent of individuals in their 50’s have degenerative findings on lumbar MRI. This occurs even in a subset of study individuals who have never had complaints of back pain. What this shows is that degenerative conditions do not necessarily produce symptoms.

The main issues in the injured worker then become the all-important, major contributing cause or major contributing factor. In my practice, if a patient has never presented for a neck or back injury to any type of spine care practitioner prior to a work injury, then I consider the work injury the major precipitating event. However, if this individual has been treated for prior back or neck problems, then the work injury is considered an exacerbation of a pre-existing condition (if the pain goes back to baseline) or an aggravation of a pre-existing condition (if the pain stays at an elevated level).