Back pain is responsible for more workers compensation costs than any other type of injury. A promising new theory is that the pain is due to noxious or inflammatory effects of proteoglycans leaking through cracks in the outer layers of the disc. The leaks are more likely to occur during the hours after waking and during bending activities. Even the most effective back pain reduction approach, task redesign, can only reduce about one third of all back pain claims. That means that two thirds of the claims will persist. Future success in back pain claim and disability reduction lies in a multifactorial approach, including task redesign, but emphasizing self-care for back pain and enhancing supervisor response to injured workers.

Introduction

Back pain is responsible for about one third of all workers compensation costs, greater than any other type of injury or illness (Liberty Mutual, 2006; Hashemi, et al., 1997; Webster and Snook, 1994). A recent estimate of the cost of low back pain to the US is between $90 billon to $600 billion annually (Dagenais, et al., 2008). It has been said that the cost of low back pain is three times the cost of all forms of cancer combined (Jonsson, 2000). Over 90% of back pain is classified as idiopathic or nonspecific (Waddell, 2004) and no one knows for sure what causes it (Snook et al., 1998; Deyo and Weinstein, 2001; Campbell and Muncer, 2005). It is this nonspecific back pain that will be the focus of this paper.

For some time we have known that the most effective approach to reducing back injury claims is ergonomic task redesign – eliminating or reducing the exposure to heavy manual tasks and risk factors. Among "strenuous" manual materials handling tasks, task redesign can be expected to reduce two thirds of the associated injuries (Snook, et al., 1978). However, because not all manual tasks fall into a "strenuous" category, if task redesign were applied to eliminate all "strenuous" tasks, it is estimated that only one third of all back injury claims would be eliminated

(Snook et al., 1978). While this is good, it is not great, considering that two thirds of the claims would remain.

Despite this knowledge that task redesign can be very effective if directed toward strenuous tasks, and advances in safety and medicine, Snook (2004b) points out that there is no indication that back pain has decreased in recent years and that many researchers do not believe the pain itself can be prevented. These researchers have come to believe "that low back pain is an unavoidable consequence of life that will afflict most people at some point in their lives." (Snook, 2004b).

In this paper I will review some of the opinions of leading researchers on the efficacy of medical back pain interventions and, combining it with ergonomics research and what we now believe about the source of pain, I will suggest a strategy for reducing back pain disability.

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