The Identification And Prevention Of Low Back Disorders. Part 1

May 16th, 2012 · No Comments ·

The incidence of low back disorders in the U. S. has been substantially documented in the literature and described as epidemic in magnitude. The cost of low back related treatment and disability has been estimated at approximately ten billion dollars annually. With regard to patient visits for treatment and costs to the American health care industry, low back disorders are second only to cardiovascular disease. In this era of degenerative diseases and purportedly “enlightened” treatment, i. e. the preventive approach, the identification and prevention of low back disorders must be mandated as a priority in American health care.

The purpose of this article is the identification of the magnitude of low back disorders and the developmental and evolutionary bases of the human musculo-skeletal predisposition to low back problems. In addition, some very recent advances in the detection of potential low back disorders and the logically appropriate preventive measures will be provided.

The Cost of Low Back Disorders

Among the medical, safety and industrial relations specialists, there is consensus regarding the magnitude of the back disability problem. This disability must be categorized as an inclusive area comprised of disruption of production, costs of workers’ medical and disability payments and the “cost” of pain and suffering.

Some informative demographic data must be considered when constructing a foundation upon which a potential plan for prophylactic low back programs may be developed. In their landmark study, “Preventing Low Back Pain in Industry, Sparrell and McKeon report that low back pain is the cause of 20 to 25 percent of workers’ compensation cases. The cost of this compensation is more than five billion dollars annually and is on the rise.

Additionally, their findings suggest that male workers, in their 30′s and 40′s are four times as likely as their female counterparts to become disabled Interestingly, men in this age group comprise 46 percent of the total work force but account for 71 percent of lost time from work attributable to low back conditions. The highest rate of reported back disabilities are related to physically demanding jobs including, trucking, warehousing, heavy manufacturing and nursing (handling patients).

Preventive Techniques for Industrial Low Back Problems

Through the development of Low Back Schools and Occupational Therapeutic Programs, a number of preventive techniques have been proposed. Some of the categories which have been documented to be effective in reversing the job related incidence of low back disorders are: medical selection, worker and supervisor training and task analysis and redesign.

Each of these measures may be categorized as preventive in nature. However, each of these techniques provides distinctively singular disciplinary approaches to the same problem. When utilized in some combination either in clinical application or in developmental consideration, these components of preventive low back care exemplify the essence of the holistic approach to health related problems.

Medical Selection

As one of the initial risk appraisal procedures for low back disorders, a medical screening is suggested in the literature. Included in this risk analysis is a physical examination and review of medical history. Contributory elements which have been documented to be statistically relevant in the prediction of low back injuries are: past history of low back “episodes”, radiological evidence of spinal abnormalities and physical performance testing including strength and range of motion testing.

In addition to the aforementioned musculo-skeletal criteria, some form of psychological evaluation should be included in the medical selection portion of the low back screening process. The recommendations for psychological screening include: hypochondriasis, hysteria and chronic depression. The use of psychological pre-screening for the purpose of potential employment is quite complex with regard to the civil and legal rights of the prospective employee. The decision for employment suitability may be considered an infringement upon the civil right of the employee for equal opportunity and access to certain positions. In any case, the benefit of medical selection for objective risk appraisal regarding low back predilection is supported in the literature.

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