(RxWiki News) Many people with low back injuries avoid activity for fear of aggravating their condition. However, being too careful can worsen stiffness and pain. Can guidance from a medical professional on how to safely remain active help those with fear of pain go back to work?
A recent study examined whether receiving professional guided advice during disability helped injured workers with low back pain return to work more quickly.
This research study found that combining counseling and disability evaluations resulted in higher rates of workers returning to work, than those with just an evaluation alone.
"Do not let low-back-pain slow you down."
Mar Du Bois, MD, and Pater Donceel, MD, PhD, of Katholieke Universiteit Leuven in Belgium studied 506 workers on sick leave with an official diagnosis of low back pain. Half of the workers were randomly assigned to receive counseling and disability evaluation while the other half received a standard disability evaluation only.
The workers receiving counseling were encouraged to avoid bed rest and stay active with daily normal activities. They were also reassured that back pain is likely to resolve itself with time.
Within two weeks of diagnosis, the counseling group was assigned a medical examination. Follow-up physical examination occurred at intervals of three to four weeks until work was resumed for up to one year.
The control group received the disability evaluation at three months after sickness. They did not receive any other oral or written feedback.
Researchers collected data on return to work rates, sick leave recurrence, subsequent surgery and sick leave duration.
The groups contained both blue collar and white collar workers although almost 80 percent of all participants were blue collar workers.
The study found that receiving counseling and disability evaluation by a medical advisor resulted in less sick leave than disability evaluation alone. At the end of the study, four percent of workers in the counseling group had not returned to work compared to eight percent in the control group.
The result is due to lower rates of repeated medical leave episodes in the counseling group. Only 38 percent in the counseling group experienced a relapse compared to 60 percent in the control group.
The groups had a similar rate of surgery and duration of sick leave.
Researchers hypothesize that a medical professional’s advice to remain active makes the claimant more positive and optimistic about their diagnosis. This optimism decreases mental stress, spinal loading and risk of injury.
Diane Shiao, PT, MSPT, DPT of Revive Physical Therapy and Wellness in Edison, New Jersey points out that this study included patients who likely had cases of muscles strain, ligamentous sprain, stress, or inflammation. These cases are mild in comparison to more serious conditions like sciatica.
"The milder the case of low back pain the easier the healing," said Dr. Shiao.
"The body is always on the mend and can compensate quickly for an injured area. If sufficient blood flow is maintained through active but careful movement and the patient is generally positive, a mild case of low back pain can resolve on its own."
The article was published in the August issue of Spine.
The authors do not report any conflicts of interest.
