WorkersBack problems, and specifically
low back pain, are the most common cause of work absence. In the USA, they
are the cause of 16% of sick leave, but they are responsible for 33% of their
global cost, and it is estimated that in any European country the expenditure
that they generate annually solely in workrelated issues is equivalent to 1.5%
of the Gross National Product. It was once thought, wrongly, that back
pain in workers was due to overstraining of the muscles, causing them to tear
or spasm, or to structural disorders of the spinal column such as scoliosis
or herniated discs. On this assumption, X-rays
or magnetic resonance were used to detect workers whose spinal column exhibited
any of these disorders and disqualify them for physical labor. If pain occurred,
the recommended treatments were repose in bed to reduce the overload and give
the muscles time to effect a spontaneous cure, or else surgery to correct the
disorders of the spinal structure. Despite that fact that this was the
habitual approach for many years, it was never supported by any quality scientific
study, and in spite of progress in surgical techniques and growing investment
in ergonomics, the problem has continued to get worse; the frequency of workrelated
back pain has continued to increase much faster than any other ground for sick
leave. In fact the measures adopted to solve the problem have probably
helped make it worse. The latest scientific evidence shows that this approach
to the problem was wrong. Procedures for selection of workers on the basis of
X-rays or magnetic resonance were useless, resting in bed was counterproductive,
and surgery of the spinal column is useful in less than 1% of patients, exhibiting
high failure rates when practiced in cases where it is not strictly indicated.
In a word, the traditional approach to workrelated back pain has been proven erroneous
and the classic means of dealing with it have failed, generating a problem of
the first importance for the health of workers, the economy of enterprises and
the public purse. In recent years there have been reports of measures capable
of improving workers' health and at the same time reducing the economic impact
of workrelated back pain. More and more scientific evidence is currently emerging
to support their effectiveness. The main problem with applying them is that they
involve a drastic change in the way the problem has normally been handled hitherto,
and it is just as hard to get rid of some prejudices as it is to fight against
the inertia of established wisdom. But to carry on using obsolete methods harms
workers' health as much as or more than it uselessly burdens the economy of enterprises
and the public purse. What is it that increases the risk of back pain
in workers?The scientific evidence currently available shows that
the origin of workrelated low back pain is multifactorial, with psycho-social
aspects intervening as much as physical (or "mechanical") aspects. Mechanical
factors influence more the risk of pain occurring, and psycho-social factors more
the risk of physical disability and work absence. Of the mechanical
factors, the following have been shown to increase the risk of back pain in
workers: Exposure to vibrations that affect the whole body.Handling
of loads (including lifting, moving, holding and carrying), especially when
these are beyond the worker's physical capacity, as this can provoke muscle lesions
or spasms.Bad postures, although for such postures to provoke
back pain they must be sustained frequently and for long periods. In this case,
they can produce muscle spasms.Weakness of the abdominal and back
muscles. Movements involving bending and twisting of the spinal
column. Such movements can increase the risk of muscle spasm if repeated very
frequently. Moreover, if executed with heavy loads, ignoring the rules of postural
hygiene, if the muscles are not powerful enough they may even increase the risk
of a fissure, protrusion or herniated disc. The psycho-social
factors that have been shown to increase the risk of physical disability and
work absence through back pain include the following: Stress at
work.Work dissatisfaction.Performance of jobs with a
low decisionmaking level.Perceived lack of social support
from workmates or employers. Once back pain appears, its
duration and prognosis are similarly influenced by medical and psycho-social factors. The
purely medical factors that can prolong the pain include: Neurological
mechanisms which can cause the inflammation and muscle spasm to persist even
although there is no cause for it.Muscular mechanisms whereby
if the muscle is previously untrained or weak, the low back pain lasts longer
and recurs more readily, since minor strains are sufficient to cause a spasm and
there is a greater tendency for it to remain in that state. Repose
can cause loss of muscle strength and endurance and hinder the coordination
of the different muscles, facilitating spasm and leaving the spinal column unprotected,
so that the subject is more liable to suffer some disorders like a herniated disc.
The psycho-social factors that have been shown to
increase the risk of persisting pain and physical disability include:
A mistaken belief that low back pain always signals a serious or persistent
lesion,Acquisition of a counterproductive attitude to pain, the main
features being: Pessimism with respect to the pain,
in that we assume that it will go on indefinitely and will always constitute a
limitation on our ability and our quality of life. Fear of pain
and limitation of activity to avoid it, overuse of symptomatic medication
and abandonment of any task which causes the slightest increase of the pain or
which the subject believes may do so even if it does not. Lack of
confidence in one's ability to control the pain and the disability that it
entails, and shifting of the responsibility for doing so on to others i.e., doctors
or other health professionals. - Reduction of physical
activity,
- A depressed state of mind,,
- A bad relationship
with one's surroundings and employer,
- Placing more reliance on
passive treatments than on treatments that require active participation, such
as physical exercise.
Can back pain have negative consequences
for workers?Yes. Much more than the pain itself, which will
normally respond satisfactorily to treatment, the main risk is permanent disability.
Studies show that physical and work disability in themselves have a devastating
effect on a worker's physical and mental health. It is therefore very
important to take whatever medical and psycho-social measures are necessary to
control the factors that increase the risk
of prolonging the disability and to administer the requisite treatments at an
early stage. An analysis of the available data suggests that if sick
leave for back pain extends to 4 weeks, specific measures are needed, since
there is a 10 to 40 per cent probability (depending on the environment) that workers
off sick for that length of time will still be off sick one year later. Virtually
noone who has been on sick leave for more than a year can return to a normal life,
regardless of the original diagnosis or the treatments that he/she has received
or are applied later. This situation is bad for the employer and for the public
purse in view of the costs entailed, but above all it is bad for the worker because
of the personal consequences. What to do to prevent or treat back
pain in workers.Following are some of the effective measures that
workers can take to prevent back pain and reduce the risk of permanent disability: Avoid
fear of back pain and the evasive, pessimistic behavior that this produces.
You should know that workrelated back pain is normally due to temporary malfunctioning
of the back muscles and not to a serious lesion or illness. Therefore, the prognosis
is in principle good, and unless you repose or take other erroneous action, it
will tend to improve and disappear without any ill consequences.Know
and observe the rules of postural
hygiene. These teach you how to adopt everyday postures and movements that
involve the least burden for your spinal column and muscles. Know and
make proper use of the ergonomic facilities available at your work. These
will help you to do your job with minimum loading on your spinal column and muscles.
Create a good working atmosphere with your workmates and employer. It has
been demonstrated that this reduces the risk of back pain, and where back pain
does occur, it reduces the risk of the pain persisting and leading to disability.
Keep as physically active as possible. Besides being effective
in preventing back pain, regular physical activity can help channel off stress
and minimize its impact. It may take as little as getting used to making daytoday
journeys on foot rather than sitting in the car, metro or bus, or taking the stairs
up a few flights rather than always taking the elevator. If possible, it is even
better to do some aerobic sports like running or swimming. With 20 or 30 minutes
on alternate days, you will begin to note a considerable difference. If you are
going to start doing a sport regularly, you should first consult a doctor to assess
your general condition and you should observe the rules of postural hygiene in
sport, with which you can do almost any of them with less risk to your back.
Maintain and develop the back muscles. Training of the muscles involved
in back function reduces the risk of spasm. If done correctly and regularly, some
aerobic exercises like swimming may be enough to keep your back muscles and your
general physical condition in good shape. Specific exercise programs for the back
are only effective for these muscles and not for general fitness, but they require
less time and can be alternated with aerobic exercises when you have time. There
is a section of this site that shows effective exercises for this.
If pain does occur, the following have proven effective: Avoid repose
and sick leave, since both have been shown to increase the risk of the pain lasting
longer and reappearing more readily, and the probability of permanent disability
of some kind. For the health of the worker, it is better to reduce
the physical effort that the job demands for a few days but to carry on working
than to take sick leave and repose. Exceptionally, if the pain is so great
that you cannot move or work for a few days, you should make the repose and sick
leave as brief as possible. Reposing for 4 days is enough to produce negative
effects on your back muscles, which will have to be rehabilitated afterward.
Stay as physically active as possible, including at work. Apply
the right treatment. This site contains a section that lists all existing
treatments for back pain, and another that indicates the common patterns of treatments
that have proven effective. |
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