Occupational low back pain: Evaluation
- Michael Erdil, MD, FACOEM
Michael Erdil, MD, FACOEM
- Assistant Clinical Professor of Medicine
- Division of Occupational Medicine
- University of Connecticut School of Medicine
Back pain in working individuals is a common presenting complaint in primary care settings. Many occupations have been anecdotally linked to certain musculoskeletal disorders, such as "policeman's heel" or "deliveryman's back." For some pain disorders, such as carpal tunnel syndrome, the relationship of the condition to specific patterns of work is better established . For other disorders, however, the relationship between the work environment and the patient's symptoms, though clearly perceived by the patient to be causative, may be less certain.
Determining whether a patient's low back pain is a consequence of his or her occupational activity, and how best to treat symptoms to maximize functionality and potential for a return to full employment capacity, can be challenging. Many physicians, including those practicing in primary care settings where back pain is most often seen, lack training and confidence in addressing workplace issues.
This topic will address evaluation of work-related low back pain. Treatment of work-related low back pain is discussed separately. (See "Occupational low back pain: Treatment".) The evaluation of low back pain in the general setting is also discussed separately. (See "Evaluation of low back pain in adults".)
THE INJURY MODEL
The injury model of an occupational disorder proposes that specific work activities are the cause of the patient's pain. The injury model for low back pain, implicating a causal connection with specific work activities, is complex and controversial [2-4]. Multiple factors and lines of evidence challenge this model, including:
●Low back pain is a ubiquitous complaint, with particularly high prevalence among people in their working years [5,6].
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- THE INJURY MODEL
- THE DISABILITY COMPENSATION SYSTEM
- Initial assessment
- Psychosocial factors
- Functional impairment
- Occupational impact
- PHYSICAL EXAMINATION
- DIAGNOSTIC TESTING
- COMPLETING THE ASSESSMENT
- Activity prescription
- SUMMARY AND RECOMMENDATIONS