Work-Related Back Pain: Diagnosis and Treatment

Back pain is a very common affliction that affects people of all ages and ranks among the top 10 reasons worldwide for a doctor's visit. An estimated 15–45% of the population experiences back pain in any given year, peaking between the ages of 35 and 55.

Although the exact incidence of work-related back pain is hard to estimate, it is believed to be higher than in the general population. Certain jobs — construction work, heavy labor, truck driving, and janitorial work — carry a greater risk. Sometimes the pain develops suddenly from a specific incident; other times it builds gradually from repetitive injury.

The structures that can be injured

The lower back is a complex structure, and many parts of it can be injured:

• Lumbar discs — the soft, gel-like cushions that sit between the vertebral bodies
• Lumbar vertebral bodies — the bones of the spine
• Lumbar facets — the joints that connect adjacent vertebrae and allow the spine to move
• Lumbar muscles and ligaments — which support and move the spine
• Lumbar nerves — which exit the spine at each segment to supply sensation and movement to the legs

How an injury presents

With age or repetitive use, injury to the lumbar disc can cause a deep-seated back pain that is worse with activity and better with rest. Facet-joint injury tends to be better with rest and worse with activity — especially bending backward. Ligament or muscle injury usually shows up as painful muscle spasms that make movement difficult. Nerve injury can cause back pain, buttock pain, or the classic radiating pain down the leg. Injury to the vertebral body itself is uncommon in the injured worker unless there's a severe accident, such as a bad fall or a serious motor-vehicle accident.

The mechanism of injury often determines the type of pain and the treatment — the more severe the accident, the more likely it caused serious injury to the discs, nerves, or bones. Whether sudden or repetitive, the injured worker may present with:

• Central lower back pain
• Lower back pain radiating to the buttock and hip
• Lower back pain with radiating leg pain
• Leg pain and weakness

Initial treatment

For lower back pain without bladder or bowel involvement, treatment is based on the worker's symptoms. For back pain without radiating leg pain, this is often a six-week course of anti-inflammatory medication and physical therapy. During this time, the worker can usually continue at their regular job or on light duty.

If symptoms resolve, the worker returns to regular duty. If there is no improvement, further evaluation is warranted — starting with X-rays of the lower back. If the worker has both back and leg pain, an MRI is ordered to look for a possible disc herniation.

When surgery is needed

For workers with no structural damage, continued physical therapy and medication is usually enough to resolve symptoms and return to work, typically over a few weeks. When studies show actual damage — such as a disc herniation or a fracture — treatment is often surgical. The goal of surgery is to repair the damaged structures, relieve pain, and restore function so the worker can return to full activity.

• Epidural injection. For a disc herniation, the next step is often an epidural injection, in which steroid medication is placed near the injured nerve. Most workers experience relief, and the injection can be repeated based on response.
• Micro-discectomy. If injections, medication, and therapy don't provide relief, a micro-discectomy removes the portion of the disc that is compressing the nerve. Thanks to specialized instruments and the surgical microscope, this is often an outpatient procedure, allowing the patient to return home the same day.
• Vertebroplasty. For a vertebral compression fracture that does not heal, bone is injected into the fractured vertebra to stabilize it, resolve pain, and allow rehabilitation.
• Minimally invasive fusion. For more severe disc injury with significant back pain, a lumbar fusion may be warranted. Using Minimally Invasive Spine Surgery (MISS) — with a small, precise incision, specialized screws, the microscope, and refined anesthesia — there is far less muscle damage and blood loss. Workers often return to work within three months, compared with the long recovery of a traditional fusion.

Physical therapy follows surgery to rehabilitate the muscles and help the worker return to work. In summary, the injured worker with a back injury can be effectively diagnosed and treated — with a range of options from conservative care to advanced, minimally invasive surgery.

Adjusters and case managers: see Dr. Tyndall’s plain-English spine terms reference — key concepts, an A–Z abbreviation glossary, and printable cheat sheets for spine claims.