Back school is in session.

Not everyone who works has back pain. And not everyone with back pain works. So whether you're trying to get safely back to work, recreation, or hobbies, you'll find helpful tips to work smart in this session. As you go through this session, you'll see many references to workers and the workplace. But similar principles may be applied when people are attempting to return safely to a particular sport, activity, or hobby.

The activities and work we do influence our chances of having back pain. Researchers are still trying to determine which activities pose the most risk for back trouble. Is it harder on your back to sit all day, or is it better to be on your feet? Does being sedentary at work pose greater problems than doing physically challenging work? Many questions remain unanswered.

One unanswered question is whether people in jobs that require heavy lifting, bending, and twisting tend to report back symptoms and back injuries more often than people in less demanding jobs. Notably, scientists believe that the risks from these heavy activities probably have a smaller role in back problems than other factors in workers' lives.

• Do the workers smoke heavily?
• Are they physically unfit?
• Do they routinely recreate or do hobbies that put an even bigger strain on the spine?

In this lesson, we'll look at these and other factors that may have a role in back problems at the workplace. But what about people who've had a back injury or experienced back pain at work? Today's advice is that if they are working, they should probably stay on the job. And those who are off work due to back problems should attempt to get back to work sooner, rather than later. Recall from Lesson One that people generally recover faster when they stay active and resume normal activities as soon as possible after having back pain or a back injury.

The longer people stay off work, the greater their risk for long-term pain and disability. And the longer they're off, the smaller the chance they'll get back to work. It is important that employees with back pain return to work as soon as they can, even if they're still feeling some pain.

There are many good reasons why staying on the job is a good idea. People at work tend to stay more active. They enjoy the social interaction of being at work. Their self-image is raised because they see themselves as productive workers. They sense that they are well, not "ill." And they find that their pain, though often annoying, is not disabling. Sometimes there are barriers that keep people from getting back to the job. This lesson will look at these barriers and what people can do to overcome them as they attempt to get back to work.

Connecting the Dots from Work to Low Back Pain

Back injuries are the most common work-related injury. They are one of the most frequent reasons for work absence. What is the connection between working and the onset of back pain? In industrialized nations where vast amounts of money are spent on work-related back pain, this is a multibillion dollar question. The connection isn't always clear. But today's research shows that numerous factors are at play, many of which probably work together as the real causes of back pain.

Obvious factors in back pain include smoking and obesity. If you smoke or are overweight, help is available so you can face these problems. By addressing these issues, you immediately improve your outlook for improved spine health. Talk to your healthcare provider for suggestions.

Influences on Work-Related Back Pain

• Obesity
• Smoking
• Low job satisfaction
• Low education levels
• Working lots of overtime
• Sedentary work conditions
• No influence on work conditions
• Work that involves whole body vibration
• Driving more than one-half of the work day
• Dealing with extremely heavy loads at work
• A past episode of back pain or previous back injury

The physical demands of the job can also contribute to back pain among workers. Back injuries are more often reported by workers who have to deal with extremely heavy loads at work. As you'll recall from Lesson Four, lifting is often blamed as a cause of back pain.

But lifting itself is not necessarily a risk factor for back pain until other variables are added. For example, lifting becomes a risk when poor technique is used, such as lifting when the back is bent and especially when it is twisted. People who must lift more than half of the work day or who must repeatedly lift 50 pounds or more are also at risk for work-related back pain.

There is also some evidence that workers who are exposed to whole body vibration are at risk for back pain. Driving is the main culprit for this type of vibration. It is estimated that people who drive more than half their work day may be at greater risk of work-related back pain.

There is a connection between back pain and peoples' attitudes at work. Where there is high job satisfaction and good relationships throughout the company, there are generally fewer problems with back pain and back injuries. Stressful jobs and jobs where people don't feel they have any influence on what happens at work tend to report more back problems.

Employers have a growing awareness about how they can help combat back problems at work. Many are beginning to work more closely with employees to identify problem areas, to encourage greater communication through the workforce, and to address potential problems. Developing this type of "safety culture" is showing modest results. Companies with this model in place sometimes see a drop in the reported number of back problems.

Jumping Hurdles to Get Back to Work

People with back pain sometimes run into barriers that keep them from returning to work. Being warned about these barriers can help you know ahead of time what to look out for and where you may need extra help. If you see barriers that may be holding you back, talk with your healthcare provider and supervisor. They will attempt to help you around any obstacles.

People who've injured their back while doing their job may be afraid of hurting themselves again. Their fear of re-injury strongly predicts that they'll have a harder time getting back to their jobs. Studies show that this type of fear accounts for about 25 percent of work disability. This means that in at least one-fourth of all workers with back pain who don't get better, psychological and emotional factors are the key. If you have similar concerns, talk them over with your doctor and physical therapist. Helping you overcome this fear is an important step in getting you safely back to work.

Barriers to Getting Back to Work . . .

• Older age
• Depression
• Poor fitness
• Heavy smoking
• Fear of re-injury
• Previous back injury
• Higher pain intensity
• Pending legal action
• Sciatica (leg pain coming from the back)

Researchers know that low back pain is often linked with anxiety or depression. The relationship is especially strong in patients whose pain doesn't get better. No one is exactly sure how this relationship works. Does the pain and inactivity cause anxiety and depression? Or does anxiety and depression set people up to have pain? The answer probably depends on the patient. But either way, it has become clear that healthcare providers must deal with the psychological distress associated with low back pain in some patients.

A stressful job can deter a person from wanting to go back to work, especially for older workers. Older workers are particularly prone to the challenges a workplace can put on health. Stress can be a barrier for getting back to work, regardless of age. But for older workers especially, a stressful work setting makes back pain less tolerable and potentially more disabling. And older workers may be less free to change jobs to relieve the mental or emotional strain of work. Seek advice from your healthcare providers about possible stresses at work that may be keeping you from wanting to go back to your job. If they don't have answers, they'll attempt to get you the help you need.

Join the Team

Everyone on the healthcare team is pulling for you. They want the best for you and your back. They'll help in every way to improve your safety at work (and play). You're on the team, too!

What steps are you taking on your behalf?

• Are you applying the information, skills, and exercises you've been learning in BackCare 101?
• If you smoke, have you taken steps to stop?
• If you are overweight, have you taken steps to lose weight?
• Are you trying to use safe posture, body mechanics, and lifting strategies?
• Have you discussed fears that may be keeping you from resuming normal daily and work activities?

You can also make a difference by taking note of your work tasks. How is your work or hobby environment arranged? Take a look at the items you must grasp, lift, and carry. Are they in a convenient spot? Or do you have to reach awkwardly to get them? Are the items bulky, heavy, or unpredictable? If you work long hours at a bench or in a chair, you may need to be taught how to adjust them. If you have any questions or concerns about the safety of your work station or job tasks, let your supervisor and healthcare providers know. They'll work with others on the team to help you.

Work Fitness

Have you noticed that when you feel good about your mind and body, life and work are easy? That's where work fitness comes in. It plays a significant role in reducing injuries at work (and play). Promoting wellness and fitness are two important ways to keep life and work in proper perspective. The goal is to keep your body and back healthy.

Wellness

Wellness is not the absence of disease. It's doing the best with what you've got. And it means taking action and making decisions to deal with problems. For instance, smoking is a known risk factor for back trouble. Taking steps to stop a nicotine habit is a major step toward improved wellness. Many resources are now available to help people who want to quit their habit.

You have some control over your spine health. One strategy for improved health and wellness is to know the risks for back problems and how to avoid them. Review the risks outlined earlier in this lesson. Which ones can you control? Attempt to deal with the risks within your control. Seek help when you need it. By taking action, you'll have an immediate impact on your quality of life and on the health of your back.

Ignoring known risk factors is a roadblock to improved wellness. It's your back and your body. Improving wellness requires your involvement. It's your responsibility to make decisions and take actions to improve the health of your body and your back.

Physical Fitness

Examples of Moderate Activity . . .

• Washing and waxing a car for 45-60 minutes
• Washing windows or floors for 45-60 minutes
• Playing volleyball for 45 minutes
• Playing touch football for 30-45 minutes
• Gardening for 30-45 minutes
• Wheeling yourself in a wheelchair for 30-40 minutes
• Playing wheelchair basketball for 20 minutes
• Playing basketball for 15-20 minutes
• Shooting baskets for 30 minutes
• Bicycling five miles in 30 minutes
• Fast dancing for 30 minutes
• Pushing a stroller 1.5 miles in 30 minutes
• Raking leaves for 30 minutes
• Walking two miles in 30 minutes
• Swimming laps for 20 minutes
• Bicycling four miles in 15 minutes
• Jumping rope for 15 minutes
• Running 1.5 miles in 15 minutes (10 min/mile)
• Shoveling snow for 15 minutes
• Walking stairs for 15 minutes

(From the Surgeon General's Report on Physical Activity and Health)

People who are physically fit benefit from improved energy, alertness, and self-esteem. They are also generally better able to deal with stress, control body weight, and combat a variety of diseases. A well-rounded physical fitness program addresses flexibility, strength, aerobic conditioning, and relaxation.

The Surgeon General recommends 30 minutes of moderate activity on most days of the week. (Refer to the section above for examples of moderate activity.)

Being physically fit may not prevent a back problem. But people who stay active and who work on flexibility, strength, and endurance seem better able to manage back pain once it strikes. People who are sedentary and unfit are subject to back trouble, along with a host of preventable diseases such as colon cancer, joint problems, and heart disease.

Symptom Awareness

You can take an active role in heading off long-term back problems. Know the signs and symptoms that need attention and report problems early.

By reporting problems early, you may be able to head off a major back problem. Too often, people rationalize their back pain by saying, "It'll go away in time." That's not always true. Sometimes, reporting the problem early will let your supervisor help you find solutions. Perhaps minor changes can be made in the way you do your job. Or maybe you need a checkup with your healthcare provider. You'll get advice on what changes you can make to help you recover, and tips to keep the problem from happening again.

Know these symptoms of back pain. They signal changes in your body that should act as a trigger for seeking help.

• Back discomfort that seems to be getting worse.
• Back pain that doesn’t change when you rest or when you move around.
• New or increasing pain, numbness, tingling in one or both legs.
• Changes in bowel or bladder function.

Talk to your supervisor and healthcare provider if you discover new back discomfort or pain. If you neglect the signals your body gives you, you may be headed for even bigger problems. If symptoms are left to linger, they may not go away. Worse yet, they may snowball. Get help early, rather than later. Solutions may be easier in the early days or weeks of a back problem, before they mount into a more challenging situation.