Work-related back pain is a common cause of worker absenteeism and loss of productivity. The prevalence of back pain in workers is related to the specific job description and tasks being done. Work-related back injuries range from simple strains and sprains to herniated disks, fractures, neurologic problems, and other injuries. Diagnosis and treatment are similar to that of other causes of back injury and pain.
Work-related back pain is usually due to falls while standing, falls from heights, or direct blunt trauma to the back. Workers claiming compensation for on-the-job back injury often claim injuries involving low back strain, herniated disks, fractured vertebrae, pinched nerves, and spinal cord injury. Malingering may be a concern with regard to work-related back injury and back pain.
Specific work activities, including operating motor vehicles, heavy lifting, repetitive lifting (both heavy and light items), overhead work, and whole-body vibration, have a higher risk of work-related back injury. Specific psychosocial issues may contribute to work-related back pain. These issues include job dissatisfaction, tedious or monotonous work, a perceived heavy workload, tasks with a demanding deadline, and a perceived lack of input to decision-making.
Smoking and obesity are linked epidemiologically to nonoccupational back pain; both are common among workers and thus may also increase the risk of work-related back pain.
A past history of work-related back injury and pain is an important predictor of future back injury.
Diagnosis of Work-Related Back Pain
Clinical evaluation
Sometimes imaging tests
The evaluation of work-related back injury is similar to that for any other back problem. Medical history should include a focused occupational history emphasizing the patient's specific job task and exactly what the patient was doing when injured. A thorough review of the patient’s past occupational medical history is essential. A physical examination should include a focused musculoskeletal and neurologic examination.
If the injury was caused by direct trauma (eg, a significant direct blow to the back, a fall from a height) or if justified by clinical findings (eg, neurologic deficits, findings suggesting fragility fracture), imaging (plain x-rays, CT, MRI) is indicated; however, for injury without such causes, imaging is not indicated. Plain x-rays have a notoriously low yield when done to assess work-related back injury and pain.
In many industries, preemployment plain x-rays of the back used to be done for workers at risk of back injury. This practice is no longer recommended because it provides little or no clinically helpful information and exposes workers to unnecessary radiation.
Pearls & Pitfalls
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Taking detailed notes when obtaining the history and doing the physical examination is critical. In the US, work-related back injuries may become legal issues in workers’ compensation programs, and in these cases, detailed physician notes often guide the outcome. Disability assessment, as in any other case, may also be done but is a separate assessment.
Treatment of Work-Related Back Pain
Similar to nonoccupational-related back injuries
Strategies to prevent further and future injury
Treatment of work-related back injury is similar to that for any other back injury; it depends on the type of injury (eg, fracture; strain, sprain, tendon injury, herniated disk, spinal cord injuryTreatment of Back Pain)
Prevention of Work-Related Back Pain
Risk of work-related back injury can be reduced, eliminated, or controlled by use of the following:
Engineering controls: Strategies include changing the way materials and products are transported (eg, using mechanical assist devices for lifting or carrying heavy loads, changing to packages with handles or to packages with slotted hand holes, moving packages to areas that are easier to reach).
Administrative controls: Strategies include reducing the length of shifts, limiting the amount of overtime, and/or scheduling more breaks. Such strategies reduce the risk of work-related back injuries but do not eliminate the hazards that may cause them. Engineering controls are more effective, but administrative controls can help until engineering controls can be implemented or when engineering controls cannot be implemented.
Personal protective equipment (PPE): PPE includes back braces, back belts, and similar devices. Whether PPE can protect against ergonomic hazards is unclear. Although these devices may help, they may make it harder for workers to do the task (eg, a back brace may make doing a task that requires bending at the waist difficult).
Ergonomics: Ergonomics aims to reduce stress and eliminate injuries and disorders caused by overuse of muscles, bad posture, and repetitive tasks.
Key Points
Work-related back injury (and resulting pain) is a common cause of worker absenteeism and loss of productivity.
Diagnostic evaluation for work-related back injury is similar to that of non–work-related back injuries and requires meticulous recording of details, including work-related details.
Plain x-rays have a notoriously low yield when used to image work-related back injury.
Imaging with CT or MRI is typically used for patients with neurologic deficits or findings suggesting fragility fracture.
Encourage early mobilization after a strain or sprain involving the back for the best clinical results and most rapid return to work.
