Easing Back Pain

By Nancy Hatch Woodward Apr 1, 2008
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HR Magazine, April 2008 Prevent back injuries from crippling your business.

Back pain remains one of the most common complaints in the workplace, and it can be devastating. Just ask Linda Parrigan, who got a call in 2001 from her plant manager at Holley Performance Carburetors in Springfield, Tenn., to come in on her day off and help with inventory. When the manager asked her to check some boxes on the floor to see if they had been properly tagged, Parrigan gladly obliged. But as she started bending over, she suddenly felt a shooting pain in her back.

Since then, Parrigan has undergone two discograms—calling them “torture tests from hell”—disc surgery and two lumbar fusions. Today, at age 53, she is on disability, cannot sit for more than 45 minutes at a time, sleeps only on her right side, and gets up to walk two or three times during the night to reduce her back pain.

For tens of thousands of Americans who suffer from back pain, its effects often spill over into the workplace: Productivity losses for employers are estimated to be $7.4 billion a year, according to a December 2006 study in the journal Spine.

But HR professionals can help employers develop programs that reduce back injuries and return employees to work sooner.

Backs Out of Whack

While Parrigan’s injury was severe, most people with back problems are able to more or less return to normal activities within six weeks. That’s the good news. The bad news: Back pain is incredibly common. In fact, lower back pain is the No. 2 reason Americans visit their doctors.

According to a 2004 Survey of Physicians About Sufferers of Musculoskeletal Pain, conducted by Harris Interactive, approximately 80 percent of people will report having back pain during their lifetimes. In 2005, the U.S. Bureau of Labor Statistics reported more than 270,000 cases of back injuries and illnesses in the workplace, with those affected taking an average of seven days off from work.

Treating back pain isn’t cheap: Duke University researchers found that people with back pain incur medical expenses of almost $91 billion a year, more than twice the amount spent on people without back pain. An Ohio State University study reported that a first-time back injury can cost as much as $10,000, while treating recurring, more severe cases can run as high as $300,000.

Unfortunately, there is not much good news on how to reduce back pain. According to William Shaw, Ph.D., research scientist at Liberty Mutual Research Institute for Safety in Boston, “There has been a lot of research over the last 50 years about different sorts of treatments for back pain, but we are probably no better off now than we were then in terms of the incidence of back pain or the lost work time resulting from back pain.”

That may be changing. New prevention approaches, medical treatments and return-to-work programs for back pain are showing promise.

An Ounce of Prevention

Scott Mugno, managing director of corporate safety, health and fire prevention at FedEx Express in Memphis, Tenn., says the first step to preventing back pain calls for examining workplace practices and addressing the issue administratively.

Employers that make a good-faith effort to provide ergonomic support and try to engineer hazards out of the workplace have a greater chance of getting workers to partner with them, says Lisa Brooks, manager of ergonomics and safety programs at General Electric (GE) in Fairfield, Conn.

At FedEx, where employees must be able to lift 75 pounds, the company has found that new workers tend to have the most back problems. So the company provides ways to get them better conditioned to the job, Mugno says. Employees are taught to stretch prior to their shifts (see “ Stretch Assignments”); trained on how to properly lift packages and put them down; presented with alternatives to lifting, such as sliding and pushing or pulling; and given pointers on how to organize their trucks and routes to prevent back strain.

 

In addition, employees use back-support belts, but only in conjunction with other safety initiatives. “Belts don’t work well as a stand-alone tool, but within the process of safe lifting, we find them to be very effective,” says Mugno. “We’ve also seen good results with them for people who have had previous back injury. The frequency of re-injury has gone down dramatically.”

California researchers tried a different approach. They provided agricultural workers in vineyards with smaller picking tubs for grapes, reducing the weight by about one-fifth, to below 50 pounds. Lighter loads, however, involve more bending, velocity and twisting, also contributing to back pain. But, even with these risks, researchers found a fivefold reduction in workers’ post-season musculoskeletal symptom scores, without significant reductions in productivity. According to the study, published in California Agriculture in 2006, the results “point to a significant opportunity to reduce the risk of back injury in all jobs that require repeated lifting of heavy loads.”

Not everyone, however, agrees that prevention really works. While both FedEx and GE have seen prevention efforts lead to reductions of back-pain problems in their workforces, a study from The Netherlands questions the effectiveness of a back-pain prevention program.

In the 2007 study, researchers looked at workers in physically demanding jobs at nine large companies and how they responded to a multidimensional lower back pain (LBP) prevention program integrating three preventive measures: tailored education and training in work techniques; immediate treatment of (sub) acute LBP through an in-company physical therapy service; and, if appropriate, a workplace visit with advice on ergonomic adjustments in the workplace or extra training sessions on appropriate work techniques at the workers’ worksites. The results found no significant differences in either preventing LBP or improving cost savings under the prevention program.

Treatment Options

A New England Journal of Medicine article on back pain and sciatica noted that while acute lower back pain usually is selflimiting (90 percent of people recover within six weeks), 2 percent to 7 percent of sufferers will develop chronic pain, and 50 percent to 80 percent of those individuals will experience less severe recurrent symptoms within a year.

Traditionally, employers have left the medical treatment of back pain to employees and their doctors. In many states, workers’ compensation (WC) laws prohibit employers from requiring employees to see specific providers. But officials at some companies are trying a new approach by providing support and advice for employees who want it.

FedEx has placed athletic trainers at its highly populated facilities. Employees with sprain or strain injuries may request to be taken immediately to a trainer who will analyze the problem and work with them to resolve it. But employees can also ask for trainers to accompany them to their doctors. The results have been positive. According to Mugno, the company has seen a reduction in sprains and strains of as much as 50 percent in some business units.

GE provides employees with physical therapists and occupational health clinics on-site, but if workers need to see outside physicians, the company can offer them a list of specialized doctors skilled in occupational health.

The National Committee for Quality Assurance (NCQA), a private, not-for-profit organization in Washington, D.C., dedicated to improving health care quality, serves as one resource for finding such doctors. The committee is working with doctors on a number of new treatment methods in connection with its Back Pain Recognition Program. For instance, smokers with back pain have longer and more difficult episodes of illness that take longer to resolve, says NCQA spokesman Jeff Van Ness. So smokingcessation programs may make sense for some patients.

For some types of back pain, experts say, adopting a conservative course of care promotes outcomes that are the same as, if not better than, more aggressive measures. Because the majority of back-pain patients report that their conditions resolve themselves within the first six weeks after the onset of symptoms, the NCQA recommends using over-thecounter anti-inflammatory and pain-easing medications, says Patrick Leary, director of external relations. “Doctors should not rush X-rays, computed tomography scans or surgery,” he says, “because less than 1 percent of premature imaging studies find the cause of low-back pain.”

Physicians should incorporate mental health examinations as needed to improve the medical treatment, according to the NCQA. “If you direct the behavioral health component, whether it be dissatisfaction with the workplace or issues at home, you increase the speed at which someone would recover from the primary condition,” Leary says.

Robert Kerns, Ph.D., chief of psychology services at the U.S. Department of Veterans Affairs’ (VA) Connecticut Healthcare System in West Haven, Conn., and the VA’s national program director for pain management, agrees. His research has found that cognitive behavior therapies and self-regulatory treatments, such as biofeedback, self-hypnosis or relaxation training, prove more effective than standard care treatments for people with chronic back pain. These treatments are especially helpful for reducing pain intensity, as well as for improving health-related quality of life, work-related disability and depression.

“What is most remarkable,” says Kerns, “is that 30 years ago, we believed these kinds of treatments could help people ‘live’ with their pain. Now, we have compelling data that these interventions are effective in reducing the experience of pain itself.”

Equally compelling was the finding that, even though the average duration of the back pain was longer than seven years, more than two-thirds of those in the study were able to return to work. Unfortunately, says Kerns, most employers’ health care plans provide little or no coverage for these types of treatments. The VA and Kaiser Permanente of Northern California have started providing such services, says Kerns, and officials in both organizations are working to educate third-party payers and WC providers to consider such coverage.

Return to Work

A good return-to-work program provides temporary work for employees with illnesses or injuries until the workers can return to their regular jobs. Such programs can make a significant impact in lowering disability claims. A 2007 study by the Work Foundation in the United Kingdom found “overwhelming evidence that worklessness is, itself, bad for health,” when it comes to employees with musculoskeletal disorders.

Today’s return-to-work programs also focus on effective communication.

FedEx’s Human Capital Management Program uses operation managers to manage employees who are on medical leaves of absence. These managers work closely with employees, keeping in touch with them on a regular basis to get them back to work as soon as possible. FedEx’s Temporary Returnto- Work program finds that keeping employees engaged with colleagues and making them feel as though they are productive members of the company helps prevent them from getting into a “disability mentality.”

A 2006 Liberty Mutual research institute study published in The American Association of Occupational Health Nurses Journal confirms the importance of communication. When supervisors were trained to respond more personally to employees after a workplace injury, there was a 47 percent reduction reduction in the number of new WC claims filed, and a 25 percent reduction in indemnity costs resulting from lost work time. In addition, 19 percent to 28 percent of the overall reduction in new disability claims and claim costs could be directly attributed to training.

Supervisors need to be trained to be more compassionate, to work with injured workers on a one-on-one basis, and to talk to injured workers about what they think caused the problem and what it may take to get them back to work, says Liberty Mutual’s Shaw. For example, employees may be worried that their managers won’t help them once they come back, or they may see themselves as less capable. “You have to get ahold of that to get the right solution for getting them back to work,” says Shaw.

More Integration in the Future

Increasingly, businesses are taking a multifaceted approach to helping their employees alleviate back pain and striving to influence workers to make healthy choices when they aren’t on the job, says Mugno. “We have to start looking at how we can help our employees take better care of themselves, on the job and off, because they impact each other.”

National trends such as obesity among a significant proportion of the U.S. population and an aging workforce are expected to make back pain become an even greater issue for employers. The Ohio State University study found that, on average, people with lower back pain weighed more than their uninjured counterparts. To fight back pain in the future, employers will need to look at ways to combine safety programs with wellness, disease management and even employee assistance programs (EAP), says Renee Mattaliano, chair of the Certification of Disability Management Specialists Commission, a nationally accredited organization that certifies disability management specialists. Wellness and safety reinforce prevention, while disease management programs can help employees manage their conditions before they become disabling. EAP programs can also be important when people are unable to work, says Mattaliano, because work disruptions can cause financial and family problems that employees need help managing.

Nancy Hatch Woodward is a freelance writer based in Chattanooga, Tenn., and a frequent contributor to HR Magazine.

Web Extras

SHRM articles:
Designing an Effective Wellness Program, Step by Step
(SHRM Online Compensation & Benefits Focus Area)

Workers’ Comp: Storm Clouds on Horizon for 2008?
(SHRM Online Compensation & Benefits Focus Area)

Managing Disability Time Off Costs: Wellness, Prevention and Data Integration
(SHRM Online Compensation & Benefits Focus Area)

Chronic Pain Takes Increasing Toll on U.S. Productivity
(HR News)


Crossing Your T's

When it comes to employee back injuries, employers should make sure what’s covered under the Family and Medical Leave Act (FMLA), the Americans with Disabilities Act (ADA) and workers’ compensation (WC).

Peter Petesch, a partner in the Washington, D.C., office of Ford & Harrison LLP, offers the following advice:

Start investigating as soon as an employee reports a back injury.

Begin the necessary paperwork for FMLA and WC. Even if there is no apparent incident that triggered the injury, and the employee doesn’t notice the pain until the next day, there could still be a reason to assume the injury was work-related and that WC applies.

An employee who is out for at least three days, whether the injury is work-related or not, will probably be able to use FMLA time if he or she is eligible.

Because most back impairments are temporary, they probably won’t rise to the level of a disability under the ADA, says Petesch. In most cases, the courts have held that lifting restrictions alone do not make the back condition a disability. However, be smart: Don’t assume.

General Electric uses an integrated disability program: The company investigates whether the impairment is work-related or not, and then handles the situation appropriately, says Kathy Sanchez, program leader of GE’s health service. “We try to work out the mechanics in the background and not put the employee in the middle,” she explains.


Stretch Assignments

FedEx Express used to have its employees do a series of 16 or so stretches before starting their shifts, but employees found the routine too difficult and too confusing. So, working with the company’s health benefits provider, FedEx managers identified the best stretches, based on the types of injuries they were seeing and the work their employees do. The result was FedEx’s 4-Before program.​

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