Keeping you Body Wise: Workplace injuries

by TOI Admin February 1, 2011

Acute back injuries

Written By Phillip Parr, M.D.


Low back pain prevails in our society. Eighty percent of us have severe back pain in our lifetime. The vast majority of these injuries resolve within six weeks, even without treatment. Low back injuries in the workplace are the most common industrial injuries causing lost time from work.


The primary cause of most back injuries is poor body mechanics when lifting, twisting and doing repetitive motions. Many injuries result from falls from scaffolds, ladders and other unpredictable accidents. In addition, many workers doing heavy labor are predisposed to injury because they are overweight, unfit and have unconditioned core structures.


In some people, low back pain comes on gradually over a period of time, frequently after doing repetitive motions and lifting. Commonly, these symptoms do not start until one or two days after the activity.


Other workers have a sudden onset of pain, which they describe as a "catching or popping sensation" followed by severe spasms or inability to move or bend. Acute pain that goes into the buttocks or down the leg suggests an injury to the intervertebral disc. Acute catching sensations indicate mechanical low back pain. This is often associated with biomechanical abnormalities of the spine itself, such as spondylolysis or spondylolisthesis, defects in the lower lumbar spine as a result of hereditary problems.


Principles of Treatment


Acute injuries to the low back should be referred to a physician quickly for aggressive diagnosis and treatment. Sending a worker home to rest for a few days to see if his or her symptoms clear almost always fails and frequently results in delayed and prolonged treatment. Initial evaluation should always include X-rays to rule out fractures, other degenerative changes or deformities of the spine. Patients with neurological symptoms, or radicular symptoms into the lower legs should get an MRI scan to rule out a herniated disc. Acute symptoms should be treated with relative rest. Total bed rest is seldom indicated and is usually detrimental. The patient should be encouraged to get up and move around as much as possible.


Medications for acute symptoms include muscle relaxants, non-steroidal anti-inflammatory and pain medicine. Narcotics should be used prudently and for short periods of time. A semi-soft back support frequently is helpful in reducing the initial symptoms, as are modalities; ice, ultrasound and E-stim. The most important part of any treatment program for low back injuries should include early, aggressive and active physical therapy. Passive modalities, such as manipulation and massage may give temporary relief, but are of no long-term value. The emphasis should be on regaining flexibility and strengthening the core structures to support the spine. This includes the abdominal and oblique muscles and the paraspinous muscles in the lumbar area.


The other key element in any rehab program should be returning the worker to the workplace as soon as possible on some form of light duty. This keeps them in the work mode and prevents the depression and chronic pain syndrome that frequently occur with long-term lay-offs. Research has shown that workers who stay out of the workplace more than six weeks are much more difficult to return to their previous occupation.


Indications for Surgery


Fortunately, most workplace accidents do not require surgical treatment.



Unstable fractures of the spine need quick surgical stabilization, so that they can be mobilized.


Compression fractures can cause long-term disability and pain. Vertebroplasty greatly reduces long-term disability associated with this injury.


Large herniated or extruded discs compressing a nerve root, resulting in severe neurological deficit, or pain, can generally be treated with a simple diskectomy. Now, with today's modern instruments, this can generally be done as an outpatient surgical procedure using a small incision.


Early diagnosis and evaluation of acute back pain, limited use of narcotic medications and emphasis on active core strengthening exercises are the keys to returning workers to the workplace in a timely fashion.



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