I've just recently completed my Occupational Therapy degree and am now working with a rehab provider in Tasmania. It's been a pretty steep learning curve but I am using this site to help me through the initial RTW teething phase.

I have found that I have had good success rate providing injured workers with lower back pain education, manual handling education and OT based task analysis of the daily tasks they are completing.
 
Usually these sessions with the individual workers take between 20-40 minutes. I was wondering if there is a resource on this site which may be able to help me with this education. I noticed a recent article talks of a 2.5 hour intensive session which leaves me thinking I might be leaving out some key points. Could you possibly assist me, as I'm still getting the hang of navigating my way around the site?

Simon 

Hi Simon,

Thanks for your e-mail and question. Too often we get into the swing of doing the same thing over and over again; your inquiring approach is encouraging and important.

Over the last century we have done patients with back pain a lot of harm. Back pain is often perceived to be a reason to avoid activity, and too often people are left without a good understanding of their condition – particularly what they can and can’t do. Supporting them to return to normal activity at home and work produces the best outcomes.

The patient information sessions you refer to are the work of Dr Indahl from Norway, who has done landmark research on advice and explanation to patients with back problems. The link below is a 20 minute video of Dr Indahl talking about giving advice to patients:

http://rtwknowledge.org/video/Indahl.html

The heart of his approach is explaining the back condition in a way that allows patients to understand the problem and be confident in their ability to deal with it. His approach gives patients practical advice on why they need to resume activity and why fear is unhelpful and even damaging.  

Scans of disc bulges can induce fear and cause misunderstandings about back pain, including worry that the problem will get worse, or that the patient must protect their back from further “damage.” In the video, Dr Indahl warns against fear, “The worst thing you can do to your back is to be careful.”

In Norway they are following this program up at the workplace. Aware of the wealth of research that shows fear about back pain actually causes many problems, their new program aims to address this issue early. Workers at all levels of the organisation are being educated about the best approach to back pain.

At each workplace a 'peer advisor' is elected, who is a trusted worker, though not medically trained. They are given extra education about back problems and become the contact person at the workplace for colleagues experiencing back pain. They can assist in modifying work tasks to accommodate an employee’s back condition, providing advice to them on the nature of back pain. If the case requires more attention, they arrange quick referral to a specialist clinic. This programme is currently being studied and we will inform you of the results of the research findings when available.

The first question many will ask about this is, “how can a non-medically trained person give advice about a back condition? What if something serious is missed?”

That attitude reflects the approach to back pain healthcare in general. Many people have unnecessary investigations for their back problem, just ‘in case’. In fact, a serious problem with the back is actually very unusual. Around the world, guidelines developed for back problems suggest that the focus for every day cases of back pain should be on advice and helping them understand their condition, rather than pursuing investigations for a rare condition.

Back pain affects 90% of people at some point in their lives. Five out of ten working adults have back pain every year. The approach for health professionals now is to undo the problems that have been introduced by making that common pain into a medically worrying “condition.”  As Dr Indahl said, “You are not going to do any harm to your spine if you use it normally.”

Training people in how to lift is a common approach, however the best quality “gold standard” study has shown that training people how to lift does not reduce back injuries in the workplace. In fact, people who were trained had a slightly higher rate of injuries. We spend many hundreds of thousands of dollars on training people how to lift, when it may even be counter-productive. Suggesting there is a right way takes away people’s natural approach to lifting, which may in fact be better.

Here are a few other resources  that may help.

• A summary of Dr Indahl’s study, http://www.rtwknowledge.org/browse.php?article_id=45&searchresult=true&view_type=research
• A summary of the research showing the importance of fear avoidance, including the impact of fear on a person’s approach to being active, their poorer outcomes, and the approach of the treating practitioners.
  http://www.rtwknowledge.org/browse.php?article_id=94&searchresult=true&view_type=research
• Treating practitioners can do harm by inadvertently increasing a person’s fear about activity.
  http://www.rtwknowledge.org/browse.php?article_id=68&searchresult=true&view_type=research