Back pain: medical condition or thriving business?

With “new” treatments, drugs, scanners and high-tech therapies popping up on the web or advertised in many social networking sites it’s no wonder employees and managers are confused. Provincial governments across Canada lead us to believe that with improved access to some surgeries, MRI scanners or computerized traction units, our back injury treatment system is improving.

Unfortunately, this is not the case. And with so many parties involved in this market, compensation costs have skyrocketed, as have rates of employees taking time off for treatment and recovery. There has also been a marked increase in employees being labelled with a disability where no disability exists.

In an on-going verbal survey conducted by our firm over the last five years, we found up to 100 per cent of respondents in all types of workplaces report experiencing pain in the mid to upper back in the last calendar year.

So what is causing this change, where many employees now believe a back injury is a serious medical issue or leads to a permanent disability?

One of the reasons is some of the medical, rehabilitation and pharmaceutical companies have a vested interest in diagnosing a non-clinical entity. It used to be simply called a sore or strained back, and was often discussed in terms of “No need to worry, it will get better in a few days” or “I did too much lifting in the garden.” Now it’s turned into a major medical, compensation, insurance, human rights and employment-related problem.

When did these simple back injuries or pain become a potential “discogenic prolapse,” “degenerative disc disease” or “a potentially serious back injury” requiring medical intervention?

Sore backs are big business – and there are many people who gain financially by keeping sore backs medicalized.  In fact, North America’s back pain and associated injury costs total $99 billion per year.

We see now that back and neck pain have not disappeared from the workplace and the toll on employee and employers alike includes economic disruption and reduced profitability. Back pain is still the leading cause of lost workdays, second only to colds and the flu. Neck pain afflicts over 50 per cent of those who already have low back problems.

So why is there a lack of progress in each stakeholder’s ability to figure out neck and back pain and minimize its impact in the workplace, insurance and compensation boards?  In large part, the problem persists because back and neck pain and injury is subjected to unnecessary medicalization and subsequent recommendations for time away from the workplace and day-to-day activities. And managers, case managers and OH&S professionals are often reluctant to bring employees back to work or to allow them to return to full duties when a medical diagnosis is provided to the employer.

Managers, here is the reality:

Neck and back pain are not going to disappear. It is a normal process of living, working, playing and growing old. There is no drug, treatment or surgery that stops the pain or prevents an injury.

Having said this, the good news that needs to be conveyed is that neck and back pain and injury can be controlled and, in most cases, eliminated for long periods of time. The other important fact to understand is that day-to-day neck and back pain and injury is rarely a disability.

As well, managers & OH&S professionals should be aware that back and neck pain and injury are not solely caused by the workplace. Research indicates that two out of every three people who experience pain in the spine cannot identify any specific event that caused their problem. In the majority of cases, back pain just happens; like aging, it cannot be prevented.

The reality is back and neck pains are conditions prone to periods of spontaneous improvement. No matter how severe, every acute attack of back pain will end.

Except for an unfortunate few who are caught in the web of pain-focused behaviour and willing physicians and rehabilitation professionals, periods of pain are interspersed with longer periods of comfort. Although the recurrence rate is high (over 50 per cent within two years), each individual episode typically diminishes or disappears within a maximum of three to four months with most people improving within a few weeks and in some cases within a matter of days.

So if this is the reality in the world of medicine and rehabilitation, it is even more important for the workplace to have practices, programs and education in place that HR, OH&S managers and case managers can use toward a successful outcome.

Make sure you have the basics in place in the workplace including:

•    A full fitness and prevention program, which becomes part of the internal culture in your workplace, i.e. Employees motivated to have good musculoskeletal health;
•    An internal ergonomic program including ongoing assessments by qualified ergonomists whenever your workplace is moving, designing a new line or work area, purchasing new equipment, tools and chairs;
•    Ensure a disability prevention model is being used (as opposed to disability management, which is after the fact). This includes a greater emphasis on stay-at-work programs versus return-to-work, whenever there is a back or neck injury;
•    Early onsite intervention following back/neck pain and/or injury being reported whereby the employee does not wander off into the medical yonder to be mislabeled with a serious back injury or labeled with a disability;
•    Ongoing education sessions by a physiotherapist in the workplace to explain the normal anatomy of the spine; what happens following pain or injury; how to self-manage discomfort; why most back/neck pain resolves in three days; how activity and exercise help prevent and help treat back and neck pain;

Back pain and injury should rarely result in time away from the workplace. Putting these measures in place and being aware of the external influencers on development of a disability will help HR, OH&S and case manager bring about more effective methods to prevent disability and keep valued employees in the workplace.

If you want to learn more about this topic, look out for my new book, to be published by Carswell, coming out in the fall of 2010. Also, I invite readers to visit my blog,, for regular updates on this and related topics on ergonomics.