'Contrary to current guidelines and common belief, new research published in The British Medical Journal has shown that recovery from low back pain is much slower than previously thought and even slower again for those with a compensable injury.'

 

The strongest predictor of delayed recovery was if the episode of low back pain was compensable: compensation halved the chances of recovery.

 

This is not surprising. I say to organisations that they need to move heaven and earth to keep their staff as far away from doctors, workers compensation clerks and case managers as they possibly can.

 

Going to their local doctor for a diagnosis of the cause of a musculo-skeletal problem is the quickest way you can feed them into the compo loop. The doctor will ask your staff member if they work. When they say they do, the doctor will tell them that work caused their problem. End of story; claim form on the way!

 

Before you can say 'Bob's your uncle' they're up on the Gold Coast with a package, 20kg lighter, back's fixed, running a Jim's Mowing round. Hello!

 

DON'TCARE

I hate to tell you this but there's a good chance that your insurer doesn't care about how much money you're spending on workers compensation insurance.

 

Like Medicare, this is the type of insurance where there is no incentive for the insurer to do anything to minimize their risk. They don't have a risk. They're escrow agents. They're betting with your money, not theirs. If your payments this year aren't sufficient to cover their outgoings, they'll just jack up your premiums next year.

 

You're on your own

As Jack Lang said to Paul Keating, 'Always bet on self interest, at least you know it's trying.'

 

Well you'd like to think so, but you wouldn't bet on many of the organisations I come into contact with. They're not trying. They're being fleeced left, right and centre.

 

'Professor Chris Maher and colleagues at the George Institute, Australia studied 973 patients with acute low back pain for one year. Each was managed by their preferred clinician; a doctor, physiotherapist or chiropractor, who followed treatment guidelines established by Australia’s National Health and Medical Research Council (NHMRC).'

 

No wonder they didn't get better. The guidelines are useless and so is any treatment that doesn't also include a regular and systematic strength and flexibility training program. There's an equation that explains what's going on here:

 

wrong guidelines + wrong treatment = slow recovery.

 

The George Institute is getting a reputation for barking up the wrong tree. This is the second time in as many months that their survey results have been less than helpful.

 

Professor Maher: 'We found that recovery from low back pain was typically much slower than previously reported - nearly one third of patients did not recover from the original episode within a year.'

 

These new findings show that even with treatment, after two months, only 50% had fully recovered from the original episode of pain. At one year about 40% reported that their back was still causing them pain. 'These results challenge the accepted view that recovery is rapid following an episode of acute low back pain. For many people back pain becomes a long-term problem that severely impacts their life. This is despite receiving what we think is the best possible care. We clearly need to rethink our approach,' Professor Maher added.

 

Well it all depends on what is meant by 'what we think is best possible care'. Going to the doctor, the radiologist, the chiro, the physio and the chemist isn't best possible care. Professor Maher should know that. He definitely needs to rethink his approach.

 

Anyway, after taking a deep breath I searched out the NH&MRC guidelines. Here's an excerpt.

 

What Causes Acute Low Back Pain? In around 95% of cases it is not possible to pinpoint the cause of the pain.   However, it is not necessary to know the specific cause in order to manage the pain effectively. NH&MRC

 

Let's replay that again in slow motion.

 

1.  in 95% of cases it is not possible to pinpoint the cause.

 

2.  It is not necessary to know the specific cause in order to manage the pain

     effectively.

 

I should have had a Bex and a lie down as well.

 

No wonder 'recovery from low back pain is much slower than previously thought'. If you don't know what the cause of the problem is any treatment will be a stab in the dark. No wonder people aren't getting better. Rub downs, ray lamps, hot pads, crunches, electric shocks; all useless if they're not treating the problem.

 

If you've got the time and inclination you can wade through the NH&MRC Guidelines on these links:

 

(Selective) Evidence-based Management of Musculoskeletal Pain

 

http://www.nhmrc.gov.au/publications/synopses/_files/cp94.pdf

 

http://www.nhmrc.gov.au/publications/synopses/_files/cp94a.pdf

 

(If you have problems opening up these files from this newsletter, particularly the first one, copy and paste the links into your internet browser.)

 

On second thoughts I wouldn't bother. The first of the publications is 259 pages of academic bunkum. I can assure you the NH&MRC won't help you to resolve these 3 questions:

 

	n	How can we protect our staff from musculo-skeletal dysfunction?
	n	How can we assist staff to restore poor function to good?
	n	How can we dramatically lower our workers compensation bill?

 

I work for a lot of organisations where people sit down in an office all day. It beats me how someone can get injured sitting down in an office.   Well of course, they can't. They're not injured, they're dysfunctional.   What usually happens is that people gradually become more and more dysfunctional as they become weaker and tighter. By far and away the majority of people don't have a regular strength and flexibility training program. The chair can't protect them from that.   And just because you've given someone an $800 chair isn't any guarantee that it will make them stronger or more flexible or that  they're going to sit in it properly.

I can tell you one thing though, when you see a lot of people sitting like this you know their work-related injury is definitely not work-related.

 

This being the case it's up to organisations to

 

1.	Put in train a 10 minute-a-day strength and flexibility training program for all staff.
2.	Audit the risk of musculo-skeletal dysfunction.
3.	Establish a regular prehab/rehab session for people already in pain from musculo-skeletal dysfunction and those at grave risk because of their lack of strength and flexibility.
4.	Put in a firewall between the personally generated musculo-skeletal genuine work-related in juries.
5.	Throw some of the responsibility for management of the problem back on managers and supervisors by including some key performance indicators in their duty statement.

THE CAUSE

Contrary to the best medical advice in this country, musculo-skeletal dysfunction does have a cause, in fact a number of causes and you can test some of them out on those of your staff who are complaining of musculo-skeletal pain. The pain is the mechanism for telling people their body is out of alignment. It's telling them to do something to get it back in alignment.

 

The reason why the medical industry can't identify the problem is because it's not a medical one, it's a fitness problem. There wasn't one fitness authority listed in the NH&MRC's 259 page document. That's why the evidence is selective.

 

The musculo-skeletal ecosystem

The musculo-skeletal system is an ecosystem. What we know about an ecosystem is that all parts are inter-related. You’ve heard of the song ‘Dem Bones’ that goes like this, ‘the thigh bone’s connected to the hip bone, the hip bone’s connected to the back bone etc. 

 

Theory of collateral damage

There’s a high likelihood that the pain experienced in one part of your body is actually due to collateral damage caused by bones in another part of the body being out of alignment.

 

It’s the positioning of the pelvis that seems to be a major contributor to collateral damage experienced in the lower back, shoulders and neck. Once the pelvis moves, the bones above it are likely to move. (The bones below it will probably move too and you end up with hip and knee pain and perhaps persistent pulling of muscles in your thighs and lower leg.)

 

Where does most of the tightness come from? It comes principally from motion starvation, in particular sitting down in a chair behind a desk, without a strength and flexibility training program. Muscles become tight and weak, bones are moved out of alignment.

 

Principles

There are four key principles underlying musculo-skeletal dysfunction.

 

1.	Muscles pull bones out of alignment. That's the bad news. The good news about this principle is that muscles can pull bones back into alignment.
2.	The cause of the pain is rarely at the site of the pain. Crunching L4 and L5 when the problem is caused by tight calf, hamstring and buttock muscles is pointless. The chiro crunches the bones back 'in', you pull them 'out'.
3.	It's a big ask expecting to get better by having someone do something to you. Sooner or later you have to do something to yourself - like strength and flexibility exercises. Delegating or outsourcing your situps and pressups doesn't work!
4.	Therapy speeds up the rehab process but doesn't take the place of the things you need to do for yourself, like strengthening and loosening various muscles and getting your body back into alignment. Therapy probably contributes about 20% to the rehab process. The other 80% comes from the exercises you do.

 

Musculo-skeletal dysfunction is certainly not caused by a lack of rub downs, hot pads or crunches.

 

Looking for clues

Here are a few of the clues to look for when people say they've got a crookback, stiff neck, 'cold' shoulder or limp wrist and want to blame work.

 

Take some photographs of people in these positions and let them see for themselves what the problem is. Get them to complete the musculo-skeletal risk factor profile.

 

When buttock muscles are loose you can sit up straight.	When buttock muscles are too tight you can't sit up straight. The bones all the way up the spinal column are pulled out alignment. Can't blame work for that one!
When hamstring muscles are too tight people can't sit up straight against a wall. The bones above the pelvis are pulled out of alignment. Can't blame work for that one either!
One hip may be tighter than the other. That's not an injury!
With one leg flat on the floor, the vertical leg should be able to get in close to the wall.   One leg will probably be tighter than the other, causing your pelvis to twist sideways as well as rotate backwards.	A vertical leg that can't get in close to the wall, is a sure sign that your hamstring muscle is too tight. If that's the case, you can be pretty certain the collateral damage is a pelvis pulled out of alignment. In turn that will mean some of your vertebrae are out of alignment. This isn't an injury either!
Good neck function with head flat back against the wall.	Poor neck function due to tight calf, hamstring and buttock muscles. That's not a work-related injury!
People are so weak they can't do a pressup or a sit up. They lack core strength. They're not strong enough to sit in a chair and tap a keyboard let along wield a crow bar.
Stacking on extra beef dramatically increases the risk of musculo-skeletal dysfunction. Mobility is reduced. The extra weight causes an imbalance that is counteracted by some muscles having to work overtime. They get stretched to breaking point. They drag bones out of alignment. Pressure is put on joints that exceeds their safe working load.