Occupational Related LBP

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Prevention and Management of Occupational Related LBP:

Prevention and Management of Occupational Related LBP Brittany Holmes, Maiela Martinez, Caleb Melde, Matt Gieringer


Etiology According to Delitto et al. 1 risk factors are multifactorial, population - specific , and weakly associated with the development of pain. It is also the leading cause of activity limitation and work absence throughout the world. 1

Etiology Cont.:

Etiology Cont. According to 2010 US labor statistics, back injuries made up 45.4% of all musculoskeletal disorders in US occupations. 2

Etiology Cont.:

Etiology Cont. According to Shaw et al. 3 seven workplace variables have been identified including: Heavy physical demands Ability to modify work Job stress Social support Job satisfaction Return to work expectation Fear of re-injury

Etiology Cont.:

Etiology Cont. Low back pain can affect anyone: Delitto et al. 1 found that LBP was found in 39% blue collar workers (material workers) 18.3% white collar workers (sedentary workers)

Etiology Cont.:

Etiology Cont. Gender differences: Male and female showed conflicting evidence 2 Overall soreness (including the back) was 13.3% For back pain only, it was more prevalent in men 4.4% than women 3.6% Delitto et al. 1 found that women had a higher prevalence than men, but reported varying differences.

Etiology Cont.:

Etiology Cont. Age differences: The most common age affected was 2 : 35-44 years old at 4.6% Delitto et al. 1 found that as age increases so does back pain until about age 60-65.

Occupations with the Highest Percent of Back Injuries in 2010 2:

Occupations with the Highest Percent of Back Injuries in 2010 2 55.7% Nursing aides, orderlies, and attendants 55.1% Registered nurses 49.4% Laborers and freight, stock, and material movers using hand s 45.9% Janitors and cleaners, except maids and housekeeping cleaners 37.4% Truck drivers, heavy and tractor trailer


Symptoms Walker et al. 4 found that: Movement or activity-related symptoms are usually mechanical low back pain Pain at rest is more indicative of inflammatory low back pain

Prevention and Treatment Options5:

Schaafsma et al. 2011 Compared the effectiveness of work hardening ( physical conditioning ) programs in reducing time lost from work in workers with low back pain 7 Prevention and Treatment Options 5

PowerPoint Presentation:

Physical Conditioning (Work Hardening) 5 Exercise related to job demands Exercise intended to improve neurologic, musculoskeletal, cardiopulmonary, or a combination of systems Physical conditioning intended to improve work status Usual Therapy = Regular PT treatment Schaafsma et al. 2011

Schaafsma et al. 2011:

Schaafsma et al. 2011 There is no significant difference between work hardening and usual therapy for decreasing disability in workers with acute low back pain There is moderate quality evidence that an intense physical conditioning program has a small positive effect on sickness absence compared to usual care at long term follow up in patients with chronic low back pain

Schaafsma et al. 2011:

Schaafsma et al. 2011 Physical conditioning with cognitive behavioral therapy showed no difference when compared with physical conditioning alone. When the workplace was involved, there was a significant decrease in the amount of sick days lost in workers with low back pain.

Verbeek et al. 2011:

Verbeek et al. 2011 Determine the effectiveness of manual material handling (MMH) advice and training, and the use of assistive devices in preventing and treating back pain in workers

Verbeek et al. 2011:

Verbeek et al. 2011 MMH advice and training, with or without assistive devices, is similar to no intervention, minor advice, professional education, exercise or back belts.

So what...?:

So what...? We are doing a poor job managing and preventing occupational related back pain More research is need ed to discover and improve preventative and treatment strategies

Functional Capacity Evals7:

Functional Capacity Evals 7 Schult, Ekholm found agreement between ICF Core Sets and Functional Capacity Evals . Domains evaluated: BODY FUNCTIONS BODY STRUCTURES COMPONENTS OF ACTIVITY & PARTICIPATION ENVIRONMENTAL FACTORS

Defining Occupational Related LBP as...:

Defining Occupational Related LBP as... Schult & Ekholm found that an onsite examination provides more information than FCE's . 7 Gouttebarge et al concluded that FCE's need more research to determine reliability . 8 Therefore, Occupational Related LBP is best treated as Non-specific LBP . For Non-specific LBP TBC should be implemented. 1

Functional Presentation1:

Functional Presentation 1 2 Categories make up the Examination : Physical Examination Mental Impairment Measures

Physical Examination1:

Physical Examination 1 Lumbar AROM Segmental Mobility Assessment Pain Provocation c Segmental Mobility Test Centralization During Movement Prone Instability Test Aberrant Movement SLR Slump Test Trunk Muscle Power/ Endurance Test Passive Hip IR/ ER/ FLEX/ EXT

Mental Impairment Measures1:

Mental Impairment Measures 1 FABQ OMPQ (Örebro Musculoskeletal Pain Questionnaire) PCS (Pain Catastrophizing Scale) STarT (Subgroups for Targeted Treatment) Back-Screening Tool 9


Diagnosis 1 TBC Updated by Delitto 2012 et al. LBP c Mobility Deficits LBP c Movement Coordination Impairments LBP c Releated LE Pain LBP c Radiating Pain LBP c Generalized Pain LBP c Cognitive or Affective Tendencies


Diagnosis 9 Active Hip Abduction Test- only test to successfully differentiate between pain-developer groups 9 43 Participants 2 hr Standing --> 40% developed LBP (2 o sustained position) May be good predictor of risk for LBP Level 2b Evidence

Prognostic Factors:

Prognostic Factors Melloh et al (2011) "Resigned attitudes towards the job" increased the likelihood of persistent LBP at 6 months "Social support at work" is a potential for preventing persistent LBP Hayden et al (2009) Found only a small number of prognostic factors to be consistently associated with disability in LBP Godges et al (2008) Education regarding back pain in addition to PT proved more effective than PT alone

Melloh et al (2011) :

Melloh et al (2011) Study Design Cohort study assessing at baseline and at 6 months after first episode of acute/subacute or recurrent LBP Results: Subjects with "resigned attitudes towards the job ” increased the likelihood of persistent LBP at 6 months Subjects experiencing "social support at work" were less likely to develop persistent LBP at 6 months

Melloh et al (2011) :

Melloh et al (2011)

Hayden et al (2009):

Hayden et al (2009) Study Design: Systematic Review of 17 LBP prognosis reviews from 2000-2006 Results: Small number of prognostic factors were consistently reported

Hayden et al (2009):

Hayden et al (2009)

Godges et al (2008):

Godges et al (2008) Study Design: 34 subjects unable to return to work following work-related LBP with FABQ scores of 50 points or higher alternately assigned to PT (Comparison Group) and PT plus Education (Education Group) effectiveness was measured by number of days before return to work without restriction

Godges et al (2008):

Godges et al (2008)

Bottom Line Summary:

Bottom Line Summary Occupational Related LBP is a vast, multifactorial and complex issue without evident causality. Therefore the Treatment-Based Classification approach is the current best option for diagnosis and treatment. Currently, proven preventative measures have yet to be determined.


References 1. Delitto et al. Low Back Pain: The Orthopaedic Section of the American Physical Therapy Association presents low back pain clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health (ICF) . J Orthop Sports Phys Ther. 2012;42(4):A1-A57. 2. Bureau of Labor Statistics. Nonfatal occupational injuries and illnesses requiring days away from work. United States: Department of Labor, 2010. 3. Shaw W, Main C, Johnston V. Addressing Occupational Factors in the Management of Low Back Pain: Implications for Physical Therapist Practice. Physical Therapy . May 2011;91(5):777-789. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed April 27, 2012. Walker B, Williamson O. Mechanical or inflammatory low back pain. What are the potential signs and symptoms?. Manual Therapy . June 2009;14(3):314-320. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed April 27, 2012. Schaafsma F, Schonstein E,Whelan KM, Ulvestad E, KennyDT , Verbeek JH. Physical conditioning programs for improving work outcomes in workers with back pain. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD001822. DOI:10.1002/14651858.CD001822.pub2 . Verbeek JH, Martimo KP, Karppinen J, et al. Manual Material Handling advice and assistive devices for preventing and treating back pain in workers. Cochrane Back Group 2011. DOI: 10.1002/14651858.CD005958. pub3 Schult ML, Ekholm J. Agreement of a work-capacity assessment with the World Health Organisation International Classification of Functioning, Disability and Health pain sets and back-to-work predictors. Int J Rehabil Res. 2006;29:183-193. http:// dx.doi.org /10.1097/01. mrr. 0000210057.06989.12 Gouttebarge V, Wind H, Kuijer PP, Frings-Dresen MH. Reliability and validity of Functional Capacity Evaluation methods: a systematic review with reference to Blankenship system, Ergos work simulator, Ergo-Kit and Isernhagen work system. Int Arch Occup Environ Health. 2004;77:527-537. Nelson -Wong E, Flynn T, Callaghan JP. Development of active hip abduction as a screening test for identifying occupational low back pain. J Orthop Sports Phys Ther . 2009;39:649-657. http:// dx.doi.org /10.2519/ jospt. 2009.3093 Melloh M, Elfering A, Chapple C, et al. Prognostic Occupational Factors for Low Back Pain in Primary Care. Int Arch Occup Environ Health. 2012 March 21. [ Epub ahead of print] PubMed PMID: 22434236 . Hayden J, Chou R, Hogg-Johnson S, et al. Systematic Reviews of Low Back Pain Prognosis Had Variable Methods and Results – guidance for future prognosis reviews. Journal of Clinical Epidemiology . 2009: 6: 781 - 796 Godges J, Anger M, Zimmerman G, et al. Effects of Education on Return-to-Work Status for People with Fear-Avoidance Beliefs and Acute Low Back Pain. American Journal of Physical Therapy . February 2008; 88(2): 231-239.

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