FEW in the manufacturing industry are strangers to back pain, so it’s important to know what to do if and when it strikes.
The effectiveness of old remedies – such as inactivity – have been disproven by modern research. Today we know there are better and safer ways to manage one of the most common industry health complaints.
Here, I share with you a case study and back pain myths that can get in the way of a faster recovery and return to work.
Mr AF is a factory worker in a large factory where he’s worked for 12 years. Two months ago he bent to pick up an object and as he straightened up experienced severe pain in his back. He’d not previously experienced any bother in his back.
Over the following six weeks his back problem improved a little, but he continued to be troubled by pain in certain positions which would flare-up easily. There was obvious muscle spasm in his back on examination.
Two return to work attempts were unsuccessful, both lasting less than two days.
A CAT scan showed disc bulges, but the return to work co-ordinator at his workplace said that that was not significant as lots of people have disc bulges. Mr AF thought the return to work coordinator was frustrated with him not being back at work.
Mr AF spent nights worrying about his job and his future, and about how he would support his children if his back pain stopped him from working.
He tried to “be careful” not to do any lifting or other activity that he felt might do him more damage.
Myths About Back Pain
Myth 1 – The level of pain is an indication of the severity of back problems.
Severe back pain is common. In any one year about 4% of the population indicates they have an episode of back pain which is severe and disabling.
People naturally think the severity of the pain is a sign of the severity of damage in their back, but medical evidence tells us otherwise. Mr AF had obvious muscle spasm, which gives severe pain, but – like a cramp in the calf – it is not a particularly worrying medical problem.
Of course with the severe back pain, he struggles to do a number of activities, but that does not mean he should directly avoid them.
Good research tells us that people who are advised to return to normal activities do better in the longer term.
Mr AF needed to know that activities that caused him pain were not harming him, and that in fact in the long term it was better for him to return to those activities and become more active and mobile.
Myth 2 – Scans are helpful with non-specific back pain
Research tells us that so-called abnormalities on scans, such as disc bulges or facet joint degeneration, do not have a lot of meaning.
They certainly do not tell us about what is going to help the person in terms of treatment or return to work, and they do not assist in terms of the prognosis.
Myth 3 – Mr AF was hoping that a specific diagnosis or problem could be identified
If a person in Australia goes to the doctor with a headache, they are not looking to find out if they have “temporomandibular joint dysfunction” or “occipital neuralgia”.
A headache is a headache and people do not ask their doctor to identify a specific cause.
Yet with back problems people are looking for a specific diagnosis. People with back pain get different diagnoses or labels from different practitioners: a disc problem, a facet joint problem, muscle spasm or the back is “out”.
People are left confused and lose confidence in their treaters.
Myth 4 – The back problem is not as bad as the person is making out
There is a residual belief system in the community that back pain can be used as a way of getting out of work. Employers and others, who cannot see the pain, can communicate their disbelief subtly. This has a negative impact on the person experiencing the problem.
Myth 5 – Research tells us that patient expectations about return to work are the best predictors of the outcome
Mr AF has had back pain now for just over six weeks and is very worried about his long-term future. This alters his expectations about return to work.
Back problems are common and most people do well, even if the pain is severe. He needs advice to give him a better understanding and more realistic expectations about his back problem.
Myth 6 – Looking for a treatment that is going to cure the condition
Keeping active, self-management and education about back problems are the best forms of management for someone in Mr AF’s situation.
He needs a doctor or physiotherapist who can help him understand what he can do to improve his back problem and appropriate duties and work to do, and if necessary pain tablets to get him through the periods when the pain is worse.
Evidence tells us that treatment can assist the level of pain, but the back problem is going to follow its natural history.
* Dr Mary Wyatt is an occupational physician, editor of RTWMatters.org, online resource for RTW practitioners, and chair ResWorks, non-profit in work disability knowledge transfer.