Lower back pain at work:Teaching people to lift the ‘wrong way’ for back pain

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Ashley James

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Why the interest?

1. Around 17.8 million people live with an MSK condition in the UK

2. This breaks down to 7.7 million males and 10.1 million females

3. There is a direct cost to the NHS of £10.2 billion!

4. There are 30.8 million working days lost to MSK conditions every year

5. Approximately £15 billion estimated cost of injuries and ill health from current working conditions

6. MSK issues account for 39% of all work absence each year

7. LBP accounted for 40% of the total number of musculoskeletal disorders

8. Around 21% of workplace injury cases are attributed to lifting/handling or carrying

Back pain & lifting: Which way is better?

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Beliefs

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Beliefs

Nolan et al 2017

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Beliefs

Nolan et al 2019

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Beliefs

Where do these beliefs come from?

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Darlow et al 2016

Why is it important?

6.7 difference overall

Fear avoidance beliefs in those with back pain disorders went up to 54.3

Those with back pain and a high level of physical demand at work demonstrated the highest levels of fear avoidance

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Tribian et al 2017

Biomedical approach

Waddell & Burton 2000

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Fear Avoidance Model

Vlaeyan & Linton 2000

Injury Triggered

Pain Experience

No Fear

Confrontation

RecoveryDisuseDisrepairDisability

Avoidance

Pain-Related Fear

Pain Catastrophising

Threatening Illness information

Continuation & graded activity back to usual activities:

LeisureWork

Positive messages from public, media, family, friends, HCP

CommonSchema

ModifiedSchema

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Are these beliefs warranted?

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What does the data tell us?

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Bakker et al 2009

Twin Studies

CAUSATION NOT CLEAR

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Battie et al 2009

Methodology

In Vitro modelling

Animal models (most often quadrupeds – Axial loading questionable)

Lifetime of compressions in non-living tissue in a short time (5000 cycles in some cases)

Doesn’t account for recovery / rest or potential adaptations to load

Doesn’t consider anything other than the ‘Bio’ in the BPS

These studies do not address pain

Wade 2016, McGill 2014, Gooyers 2015

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What is ‘normal’?

Brinjikji et al 2015

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CurrentTraining

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Ergonomics?

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Faisting et al 2019

Traditional Manual Handling

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Hignett 2003, Martimo et al 2012, Verbeek et al 2012

Asymptomatic Population

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Asymptomatic population

Spinal curvature affects preferred lifting styles

Curvier spines preferred to stoop in a freestyle lift

Straighter spines preferred to squat lift in a freestyle lift

Individuals with a ‘curvier’ spine adapt easier to different lifting styles

Pavlova et al 2018

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Asymptomatic population

Gilles et al 2018

More than one strategy for bending is used

No specific patterns of bending were found in specific age groups

Movement variability reduced with age

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What aboutload?

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How much load?

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Coenen et al 2015/2016

Current Manual Handling Training is ineffective

The majority of physiotherapists & manual handling trainers have negative beliefs regarding lifting and spine posture

There is continued biomedical education for LBP prevalent in the workplace

We have created a fearful work environment when it comes to back pain

People in no pain don’t conform to ‘correct’ lifting methods, they have disc protrusions and disc bulges, and they lift in a variety of ways

We know load matters and approximately how much, but it has little to do with position

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Current Situation

Biomedicalalternative evidence?

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Fear Avoidance Model

Vlaeyan & Linton 2000

Injury Triggered

Pain Experience

No Fear

Confrontation

RecoveryDisuseDisrepairDisability

Avoidance

Pain-Related Fear

Pain Catastrophising

Threatening Illness information

Continuation & graded activity back to usual activities:

LeisureWork

Positive messages from public, media, family, friends, HCP

CommonSchema

ModifiedSchema

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What is the best practical advice at

present?

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Practical advice for employees & employers

LightHeavy

25kg+25 x daily +It really doesn’t matter

how you lift

Or even how many times a day you lift.

NEW TO ROLERETURNING FROM INJURY

UNACCUSTOMED LOADUNACCUSTOMED POSITION

P. Coenen 2016, D. Nolan 2014, Gillet 2018, Pavlova 2018

3-4%

Everything Else Sleep, Mood,

Previous Injury, Beliefs about what causes injury

Avoid end of rangeUse moderate / low speeds

Keep objects closer to the body

Promote ongoing movement variability

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Non-injury model education

Beginnings as early as 1998 (Indahl et al)

Based on:

Promoting messages of strength & robustness of bodyPain does not equal injury‘Normal’ movements are good for the body

Recent evidence (2010-2018) demonstrates positive results for:

Reduction of sick leave (up to 1 year)Less fear avoidance of movementLess pain related fear Reductions in pain experience

Indahl et al 1998, Werner et al 2007, Sorenson et al 2010, Ree et al 2016, Monnin et al 2017

Monnin et al 2017

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Non-injury model education

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‘Non-Injury’ Model education for Lower Back Pain at work – A new direction for prevention in the workplace? A State of the Art Review

James, A., McCarthy, C., Goodwin, P.

“This review demonstrates that utilising an approach based on ‘non-injury model’ principles may improve the outcomes for individuals regarding work

absence, pain intensity and incidence of LBP. The collective evidence particularly demonstrates that the promotion of positive messages regarding back pain can influence more positive outcomes when compared to other types of education

interventions certain exercise approaches and treatment as usual”

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ANI MAL

on njuryodelpproach toifting

Thankswww.iprshealth.com

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