Case History:

Ms D is a 49 year old lady with ongoing low back pain which began around three years ago.

At the time, Ms D was working as a factory assistant, and her duties involved constant repetitive lifting and handling of a range of objects, from small single items to larger boxes of items.

At the onset of her back pain Ms D reported having soreness for several days before experiencing acute pain upon bending over.

She was initially provided with physiotherapy treatment and pilates, which she said made her symptoms worse. She then moved on to hydrotherapy and chiropractic treatment. She reports having great benefit from the chiropractic treatment, which she has continued with until the present time.

Ms D was off work for several months after the onset of her back pain. When she returned to work she did so on restricted duties. However her hours were variable with gradual increases and decreases relating to episodes of exacerbation. At her best, she managed to return to 30 hours per week before her pain was aggravated and she was reduced to 15 hours per week.

Late last year she was made redundant and has not returned to work since that time, though she has recently been actively seeking work.

Her back pain has continued and is aggravated by actions including lifting heavy objects and attaining and maintaining awkward positions. She continues to see her chiropractor on a fortnightly basis and undertakes a daily walking regime.

She spends most of her time at home, doing housework, cooking and job seeking.

Key Learnings:

An early return to work after back pain will assist rehabilitation.

Long term back pain affects about one in six in the community. The most common time for males to develop back complaints is in their 20s and 30s, and the most common age for women is in their 40s and 50s.

It is vital to support people to return to function as early as possible, including maximum productivity at work and maximum activity at home.

Hands-on treatment can help in the early stages, but helping people back to work means that they need to understand the nature of the back problem.

Hurt does not mean harm, and activity is an integral part of management. In Ms D's situation, return to full hours of work would be expected within a few months at the most. When people remain on part-time restricted duties for a long time with a sprain or strain problem, it is unlikely they will be successfully rehabilitated.

A graduated return to work with identified goals should be set-up in the first few months. In Ms D's case her hours of work went up and down, with further periods of time off for exacerbations and reduction in hours after flare-ups in the back problem. Work habits and expectations about return to work play major roles in the success of RTW programs. When an employee has regular spells off work with pain, with an up and down regime of hours of work, the likelihood of a successful program is significantly reduced. Motivation goes down, others become frustrated with the situation, and the employee employer relationship is damaged. Breaking this cycle is vital. Further, reducing activity is not supported by good medicine, increasing back fitness is better management.

Approaches that may assist include:

• Clear advice that flare-ups are common and normal, and return to good levels of function should occur as soon as possible.
• Activity is not likely to do harm and in many ways helps recuperation.
• Hands-on treatment is appropriate in the short term, but beyond a few months self-management strategies should be the focus of management. Stretch and strengthening, regular walking and keeping the back mobile are appropriate
• Teaching Ms D how to do a range of tasks will help her return to everyday activities. For example, vacuuming one room at a time is generally easier on the back, using one hand to take her weight when bending forward, such as reaching into a supermarket trolley or reaching for something at work.
• Ensuring work colleagues are helpful and support Ms D remaining at work and increasing her levels of activity are important in this setting.