Back problems are divided into two broad groups: back pain, and disc prolapse with sciatica.  Here we talk about the common, everyday problem of low back pain, or having a sore back. 

Although it is a common problem, individuals’ experience of ‘everyday’ back pain varies widely. Back pain can be mild and bothersome or it can be excruciating. In fact, most people tell you that their back pain varies from day to day and week to week. 

People have all sorts of experiences with sore backs: stiff after sitting, sore in the mornings, aching all day, or worse with bending slightly, such as bending over the basin to shave.  Some say they are better after nine holes of golf; others say they couldn’t play one hole of golf, let alone nine. 

Unfortunately, dealing with pain isn’t the only difficulty of living with a sore back. Frequently:

• The person, their co-workers, supervisors and family, even sometimes their doctor, misunderstand the problem;
• Treatments help less than expected;
• X-rays  and scans, which the person expects will identify a precise, treatable problem, often result in further confusion; and
• The back problem doesn’t settle as quickly as expected, leading to frustration and disappointment. 

So what can the workplace do to help? Plenty! In fact, you better stock up on brightly coloured lycra, because you’re about to become a SUPERHERO!

Superheroes...Inspire activity

The prescription of bed rest for garden-variety back pain is as done as the dinosaurs. We now know that activity is the best medicine and that excessive rest actually prolongs pain and disability. One of the kindest things you can do for a worker with back pain is to encourage him or her to stay active both at work and at home.

Superheroes...Anticipate common restrictions

Medical certificates relating to back pain are likely to include one or more of the following restrictions:

• Change positions regularly – for example, alternate between sitting and standing;
• Avoid constant awkward postures;
• Avoid heavy lifting;
• Take regular short breaks to stretch; and
• Avoid awkward lifting.

Think about how these common restrictions might be applied to your workplace – that’ll give you a head start on brainstorming meaningful and safe modified duties.

Superheroes...Collaborate to get the job done

Sometimes, looking over the list of restrictions provided by a treater might leave you – and the worker – scratching your heads. This is where a little collaborative common sense comes in handy. No one knows their pain, or their injury, better than the worker. Ask:

• What tasks give you the most difficulty?
• What can we do to make things easier?
• How could we change the job to make you more comfortable?

We’re not suggesting that you ignore the restrictions from the doc. In fact, once you and the worker have identified potential modified duties you should run them past the treating practitioner, either verbally or through a return to work plan.

This simple, direct approach is often the most successful because it combines medical knowledge with practical, workplace know-how. It also gives the worker ownership over their rehabilitation and return to work, and that is really good for motivation. 

Superheroes...Get the right expert assistance

Not all medical practitioners understand the principles of good care when it comes to back pain. This can wreak havoc on the RTW prospects of a worker. Treatments for back pain can be divided into two broad categories:

• Passive –  The practitioner massages, manipulates or operates on the person’s back, and the person expects this treatment will fix the problem for them; and
• Active – The person learns about their problem, and understands most of the solution is in their hands.  They may have some hands on treatment such as massage, but the core approach is staying active, and getting into a routine of exercise and stretches.

Hands on treatment, such as physio, can be helpful for acute episodes of back pain but in the longer term this can stop the person understanding that managing the pain is primarily their responsibility.  Continued passive treatment that doesn’t fix the problem usually leads to frustration, confusion, negativity, and worry.

Within a month of the problem flaring up, active treatments should be taking centre stage. After all, it is active treatments that tackle the causes – not just the symptoms – of back pain. Active treatments for pain are the most empowering and the most effective. If this isn’t what the worker’s treater is advising, it may be appropriate to encourage them to seek a second opinion.

Superheroes...Have super-acute hearing (and aren't afraid of pain)

Most people have heard a back pain horror story. “Harriet Hurts slipped a disc at work and she’s been stuck at home ever since. She can hardly move. Two years of it!” These kinds of stories breed fear – and misinformation.

People have all kinds of belief about pain, including beliefs that hamper recovery. Keep an ear out for these rehab-hampering catch cries in the workplace:

• “This kind of pain means that my spine is damaged”;
• “If it hurts so much I must’ve done something bad”; and
•  “I shouldn’t move too much until it stops hurting”.

In fact, back pain of one sort or another is a normal part of life, and, while pain is undoubtedly uncomfortable, it isn’t usually dangerous.

Unhelpful fears and beliefs about back pain can lengthen the road to recovery. If “pain beliefs” are a big problem, getting the worker to talk to a treating practitioner with an up-to-date understanding of back problems is a good solution.  You might also consider enrolling the person in a specially designed program to educate them about their back problem. When done well, this type of approach can be worth its weight in gold.

Superheroes...See the big picture and the whole person

A person's experience of back pain is certainly impacted by physical factors, like lifting and straining.  However, some of the major influences on back pain are social and psychological. Things like conflict with co-workers, boring, repetitive, low-control, high-demand tasks and stress about job security can all contribute to the outcome of back problems.

Taking a narrow, medical perspective on back pain – or any RTW situation – means that you’re missing a huge part of the picture. Back pain happens to people and “people factors” play a huge role in how the person copes with the problem and their return to work.  

For this reason, it is really important to:

• Get the supervisor on board. Their attitude makes a huge difference in outcomes. If they’re enthusiastic, accommodating, informed and supportive these things are likely to rub off on the person with pain.
• Ensure that co-workers are supportive.  Nothing is so damaging as co-workers who are unhelpful, resentful or make light-hearted comments that can be taken the wrong way, for example:
  • “It must be nice to have some time off”;
  • “I wish I got to do the easy jobs”; and
  • “Aren’t you better yet?” 

Superheroes...Are really, really flexible

Because back pain comes in as many shapes and sizes as there are personalities and bodies, there is no cure-all solution to the challenge of sore backs at work. The best you can do is:

• Ask the worker about their problem and possible solutions;
• Make every effort to accommodate them;
• Be understanding; and
• Get started on some superhero stretches, because flexibility is your secret weapon!