Getting employees onboard to new approaches for back pain

Chronic back pain is one of the most persistent and difficult issues to deal with in Workers' Compensation. With an aging and overweight workforce, it will continue to be a dominant cause of work comp claims. Moreover, about 85 percent of lower-back pain is idiopathic - without a specific or known cause - making it difficult to separate the impact of aging or outside activities from legitimate work-related causes.

Within the last several years, the industry has shifted away from bed rest, medical imaging, pain medications, and surgery to more conservative care, such as exercise, customized ergonomic training, yoga, physical therapy, cognitive behavioral therapy, acupuncture, and anti-inflammatory medications.

A 2014 study by Liberty Mutual's Institute for Safety found that early use of MRIs on injured workers complaining of back pain may lead to unnecessary procedures and even longer disability periods. Other studies have put the cost of back-pain claims using MRIs at $12,000 more than claims that did not use early MRIs.

In some cases, an MRI can trigger a recommendation of surgery even though the changes can be attributed to a normal result of the aging process. If a physician wants to find an excuse to recommend surgery, it is there. Suddenly, for the employee, the perception of the problem escalates from annoying pain to a catastrophic condition.

In an age of MRI scans, getting employees on board with alternative approaches can be challenging. Understandably, employees are afraid of doing more damage to their spine and movement and exercise can seem counterintuitive. They anticipate worsening of symptoms with certain activities. And for couch potatoes, the prospects of activity can be overwhelming and surgery can be viewed as a cure-all. Changing the mindset is an important first step.

Provide reassurance with carefully chosen words

Speaking at the recent California Workers' Compensation and Risk Conference, Dr. Jennifer Christian, president and chief medical officer at Wayland, Massachusetts-based Webility Corp., spoke about the power of words. Don't call it "your injury," instead, call it "your recovery process." Don't say "getting you back to work." say, "getting your life back to normal." Don't ask about pain; ask about progress. She urged employers and claim handlers to be on the front line and help employees overcome their fears about how long they are going to be laid up and how they can manage their job, questions doctors often find difficult to answer.

Make ergonomic training effective

Employees will listen and buy into training if it makes them feel better. A recent article in Business Insurance highlighted a successful tailored ergonomic training program for employees of Greyhound Lines Inc. In 2010, the company saw 745 mostly musculoskeletal injuries. Most were related to material handling issues - pushing, pulling, twisting and lifting.

At the time, its training was a basic lifting program - one size fits all, regardless of what the person did. Today, safety experts study the job and come up with a tailored approach. With this customized program, the number of such claims dropped to 295 in 2016. Employees need motivation to make changes in behavior; feeling better, both on and off their job, is a great motivator.

In the article, ergonomics expert Dennis Downing, CEO of Future Industrial Technologies, Inc., noted some common, yet, ineffective practices. Likening the practice to teaching a child to swim, he said video-based training doesn't work. You wouldn't show a child a video, and then toss them in a pool. Offering a free lunch is also a no-no. "We had a hard time figuring out why companies were bribing employees with food," he said of the common practice of providing ergonomics training - how to better lift, push, pull, and stretch - over a free lunch.

There is no silver bullet

It is going to take a careful assessment of the workplace, the demographics of the employees, and an analysis of the claims related to back pain to craft an effective plan. Whereas some employees may embrace new approaches with simple education, others need a multidisciplinary approach that includes more advanced psychological informed rehabilitation.