Low back pain (LBP) is one of the most pervasive medical conditions in the U.S. An estimated one-quarter of American adults say they have experienced LBP for at least 1 day in the past 3 months; so it’s no wonder it is one of the most common ailments we see among the injured workers we treat.

In addition to the pain experienced, the costs associated with LBP can be astronomical. The government reports two-thirds of the $100 billion attributable to LBP in 2006 were indirect costs of lost wages and productivity. Since that was more than 10 years ago, surely, those costs have risen.

There are a variety of treatments to deal with this common problem. Unfortunately, medications, especially opioids, became the treatment of choice among many physicians over the past couple of decades. But recent research has proven that other, non-pharmaceutical remedies are better for most people to address their pain and get them back to function — and work.

New Directive

The American College of Physicians recently developed an updated Guidance for medical clinicians to help their patients with LBP. The recommendations support the use of medications to treat LBP only when other treatments have failed. Instead, many procedures we employ are looked upon as preferred remedies.

The recommendations address both acute/subacute and chronic LBP. Acute is defined as pain for less than 4 weeks; subacute is pain lasting 4 to 12 weeks; and chronic LBP persists for more than 12 weeks. Two of the 3 recommendations included in the new guidance call for initially treating acute/subacute and chronic LBP without medications, unless absolutely necessary.

For acute/subacute, the guidance recommends massage, acupuncture or spinal manipulation. It also suggests using superficial heat, although the evidence on using heat is inconclusive. There is evidence suggesting ice is best during the first 24 – 48 hours after soft tissue injuries. Some research indicates heat may help with lower back muscular strain

For chronic LBP, the recommendations additionally include exercise, multidisciplinary rehabilitation, mindfulness-based stress reduction, tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, and psychological remedies such as operant therapy and cognitive behavioral therapy.

It’s important to remember that each person is different and, therefore, each person responds differently to the various treatments. It’s vital to have a well-educated, highly trained physical therapist working with the injured worker to make sure he gets the best treatment for him.

In the workers’ compensation space, it’s also very important to have a therapist focused on getting the injured worker back to work. It requires a deep understanding of the nuances of a person’s particular job tasks and tailoring the therapy to those, rather than just taking a cookie cutter approach to therapy.

Getting to Best Outcomes

In treating injured workers, we first need to determine whether the condition is acute, subacute, or chronic. That helps us develop a starting point for the treatment.

For acute and subacute LBP, we want to make sure the person has some mobility. In addition to the ACP’s suggestions, we also want to include soft tissue mobilization, such as massage. Low intensity, gentle, strengthening exercise is also important to help the injured worker get back to function. The exercises should not be jarring, but instead involve a gentle range of motion.

The injured worker should also have some rest, but not too much. It is a myth that moving about will exacerbate the injury. Over-rest or inactivity can actually make the pain worse. The injured worker needs to keep moving.

For chronic LBP I agree with the recommendations of the ACP. However, I would add that perhaps the most important thing to do is work on core stability and core strength. The injured worker must have the stability to do her job tasks and other movements to function well. Exercises that help stabilize the low back and interior abdominal muscles are a must.  General core strengthening, abdominal strengthening, and stability strengthening exercises are crucial.

Exercises

There are some great low-intensity, low impact core strengthening exercises that can help the injured worker return to the job. For example, full on sit-ups are not advisable to someone with LBP, but partial crunches can help relieve the pain.

Hamstring stretches — where the injured worker lies on the floor with one leg up held up straight and uses a towel to gently pull the leg closer to the body are also helpful.

Leg lifts using both legs simultaneously while lying on the back are not wise, because that movement is very demanding on the core. But doing the same exercise using one leg, while keeping the other bent at the knee can be good.

Weight lifting exercises that target the core are also useful. Aerobic exercises – especially swimming — are a great way to strengthen the core without straining the back.

Any of these exercises and activities should be done slowly at first, until the core muscles are built up. It’s important to make sure these and any other exercises are done correctly and with the right posture. Working one-on-one with a physical therapist who works exclusively with injured workers will get you the best outcomes.

Low back pain (LBP) is one of the most pervasive medical conditions in the U.S. An estimated one-quarter of American adults say they have experienced LBP for at least 1 day in the past 3 months; so it’s no wonder it is one of the most common ailments we see among the injured workers we treat.

In addition to the pain experienced, the costs associated with LBP can be astronomical. The government reports two-thirds of the $100 billion attributable to LBP in 2006 were indirect costs of lost wages and productivity. Since that was more than 10 years ago, surely, those costs have risen.

There are a variety of treatments to deal with this common problem. Unfortunately, medications, especially opioids, became the treatment of choice among many physicians over the past couple of decades. But recent research has proven that other, non-pharmaceutical remedies are better for most people to address their pain and get them back to function — and work.

New Directive

The American College of Physicians recently developed an updated Guidance for medical clinicians to help their patients with LBP. The recommendations support the use of medications to treat LBP only when other treatments have failed. Instead, many procedures we employ are looked upon as preferred remedies.

The recommendations address both acute/subacute and chronic LBP. Acute is defined as pain for less than 4 weeks; subacute is pain lasting 4 to 12 weeks; and chronic LBP persists for more than 12 weeks. Two of the 3 recommendations included in the new guidance call for initially treating acute/subacute and chronic LBP without medications, unless absolutely necessary.

For acute/subacute, the guidance recommends massage, acupuncture or spinal manipulation. It also suggests using superficial heat, although the evidence on using heat is inconclusive. There is evidence suggesting ice is best during the first 24 – 48 hours after soft tissue injuries. Some research indicates heat may help with lower back muscular strain

For chronic LBP, the recommendations additionally include exercise, multidisciplinary rehabilitation, mindfulness-based stress reduction, tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, and psychological remedies such as operant therapy and cognitive behavioral therapy.

It’s important to remember that each person is different and, therefore, each person responds differently to the various treatments. It’s vital to have a well-educated, highly trained physical therapist working with the injured worker to make sure he gets the best treatment for him.

In the workers’ compensation space, it’s also very important to have a therapist focused on getting the injured worker back to work. It requires a deep understanding of the nuances of a person’s particular job tasks and tailoring the therapy to those, rather than just taking a cookie cutter approach to therapy.

Getting to Best Outcomes

In treating injured workers, we first need to determine whether the condition is acute, subacute, or chronic. That helps us develop a starting point for the treatment.

For acute and subacute LBP, we want to make sure the person has some mobility. In addition to the ACP’s suggestions, we also want to include soft tissue mobilization, such as massage. Low intensity, gentle, strengthening exercise is also important to help the injured worker get back to function. The exercises should not be jarring, but instead involve a gentle range of motion.

The injured worker should also have some rest, but not too much. It is a myth that moving about will exacerbate the injury. Over-rest or inactivity can actually make the pain worse. The injured worker needs to keep moving.

For chronic LBP I agree with the recommendations of the ACP. However, I would add that perhaps the most important thing to do is work on core stability and core strength. The injured worker must have the stability to do her job tasks and other movements to function well. Exercises that help stabilize the low back and interior abdominal muscles are a must.  General core strengthening, abdominal strengthening, and stability strengthening exercises are crucial.

Exercises

There are some great low-intensity, low impact core strengthening exercises that can help the injured worker return to the job. For example, full on sit-ups are not advisable to someone with LBP, but partial crunches can help relieve the pain.

Hamstring stretches — where the injured worker lies on the floor with one leg up held up straight and uses a towel to gently pull the leg closer to the body are also helpful.

Leg lifts using both legs simultaneously while lying on the back are not wise, because that movement is very demanding on the core. But doing the same exercise using one leg, while keeping the other bent at the knee can be good.

Weight lifting exercises that target the core are also useful. Aerobic exercises – especially swimming — are a great way to strengthen the core without straining the back.

Any of these exercises and activities should be done slowly at first, until the core muscles are built up. It’s important to make sure these and any other exercises are done correctly and with the right posture. Working one-on-one with a physical therapist who works exclusively with injured workers will get you the best outcomes.