'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 a sure fire way to enter 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!

 

'Australian researchers at The George Institute for International Health proved that prognosis from acute (or recent) lower back pain is not as favourable as claimed in clinical practice guidelines and challenges the common belief that 90% of patients recover within four to six weeks, with or without treatment.'

 

'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 a couple of equations that explains what's going on here:

 

No strength and flexibility training program = crook back

 

Wrong guidelines and wrong treatment = slow recovery.

 

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 (my emphasis). We clearly need to rethink our approach, 'Professor Maher added.

 

We sure do. And of course it all depends on what is meant by 'best possible care'. It's obvious that just going to the chiro or the physio, the chemist or the doctor isn't best possible care. There's a difference between treatments that palliate and those that restore poor function to good.

 

The movie, 'The Castle' turned on the meaning of the phrase, 'on just terms'. Maybe a sequel could be based on the phrase 'best possible care'.

 

The epidemic of chronic musculo-skeletal dysfunction suggests that 'best possible care' is indeed falling far short of the mark. The reason is that the evidence is selective. If medical researchers spend a bit more time in the gym and the yoga studio it wouldn't take long for the penny to drop.

 

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.

 

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.

 

That's bunkum, pure bunkum, on both accounts.

 

No wonder 'recovery from low back pain is much slower than previously thought'. Just as if you don't know where you're going, any road will get you there, 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. Pills, rub downs, ray lamps, hot pads, crunches, electric shocks; all useless if they're not treating the cause of the problem.

 

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

 

http://www.nhmrc.gov.au/publications/synopses/_files/cp94.pdfhe NH&MRC document on

 

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

 

On second thoughts I wouldn't bother. It's bunkum and I can assure you they won't help you resolve the question which is probably in the front of your mind, which is,

 

how can we protect our staff from musculo-skeletal dysfunction and how can we dramatically lower our workers compensation claims?

 

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. 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.

Slump dog: 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 strength and flexibility training program for everybody that takes 10 minutes a day.
2.	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.
3.	As I've said a number of times before, this is the process of putting in place a firewall that stops the personally generated musculo-skeletal dysfunctions from being treated as work-related injuries.

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 them out on some of your staff. The reason why the medical industry can't identify the problem is because it's not a medical one, it's a fitness problem.

 

In the first case the body is an ecosystem.

 

 

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.  So, misalignment of a bone in one part of the body will probably mean a misalignment of a bone or bones in another part of the body

 

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 of musculo-skeletal dysfunction.

 

1.	Muscles pull bones out of alignment.
2.	The cause of the pain is rarely at the site of the pain.
3.	It's a big ask expecting to get better by having someone do something to you.
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.

 

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.

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.	If leg can't get in close to the wall, hamstring is too tight. Vertebrae get pulled out of alignment.
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.