Not only is low back pain a major cause of absence from work, it’s also a condition that’s likely to return, with the rate of recurrence within the first year estimated at 50%.
But there hasn’t been a lot of definitive research into how to prevent low back pain, according to the authors of a recent meta-analysis published in the Journal of the American Medical Association — Internal Medicine. By analyzing results from 23 previous studies, the authors found that the best approach for preventing back pain is a combination of exercise and education.
Approaches that weren’t effective in preventing low back pain, the analysis found, were back belts, shoe insoles or education alone. Exercise by itself might reduce the risk of a low back pain episode or time away from work, but the quality of evidence was low to very low, according to study authors Daniel Steffens of the University of Sydney in Australia and colleagues.
The 23 studies had sample sizes ranging from 30 to 12,772 participants. Many of the studies involved participants in the workplace, including the U.S. Postal Service, a Veterans’ Administration hospital, distribution centers and home health caregivers.
The study has caught the attention of some in the workers’ comp field.
“Lower back pain is a constant on workers’ comp injury lists across all industries,” according to a blog post from CorVel, a provider of workers’ compensation claims management services.
And David Lupinsky, CorVel’s vice president of medical review services, said he was pleased to see a study that focused on alternatives to other treatments for back pain, such as injections or spinal stimulators.
Lupinsky said education and exercise are approaches that CorVel uses for treating injured workers with low back pain. Education includes making a patient aware of their back’s limitations. Lupinsky said patients are told to think of their back as a bank account: Withdrawals, in the form of back exertion, must be balanced with deposits such as strengthening exercises.
“One thing for patients is accepting a new normal,” Lupinsky said.
In addition, biopsychosocial factors are examined to see if there are issues that could interfere with recovery, such as an avoidance of activity for fear of making the injury worse, he said.
CorVel physical therapists will educate patients on back biomechanics and introduce exercises such core strengthening. Tips are offered for preventing future work injuries, based on the worker’s occupation.
Often, Lupinsky said, the focus of the injured worker, and the provider, is to just take care of the acute injury and not think about preventing future injuries.
“Fee for service encourages you to just treat what’s in front of you,” he said.
The results of the JAMA meta-analysis also drew commentary from researchers at the University of North Carolina, who discussed the research in the same edition of the journal.
The meta-analysis “provides us with concrete evidence on the value of exercise,” Dr. Timothy Carey and physical therapist Janet Freburger said in their opinion column, calling the reduction in risk for subsequent episodes of low back pain “impressive.”
“If a medication or injection were available that reduced LBP recurrence by such an amount, we would be reading the marketing materials in our journals and viewing them on television,” they said. “However, formal exercise instruction after an episode of LBP is uncommonly prescribed by physicians.”
They said the situation is similar for other musculoskeletal problems, in which lower-technology treatments that are effective often cost less are underused.