We have put together information to keep injured or ill persons informed of what to expect.
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All employers play a crucial role in the prevention and management of workplace injuries.
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Information for Psychologists, Occupational Therapists, Nurses, Exercise Physiologists and Doctors.
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Other key stakeholders are also encouraged to provide Information and comments about issues of relevance .
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Lower back injuries

 

 

According to The Statistical Bulletin, 1999/2000 New South Wales Workers Compensation, over 30% of all workplace injuries in 1999/2000 were back injures. This figure has remained quite stable over the past 9 years; however the cost associated with treating back injuries has increased by 88% in this period.

 

Permanent disability cases accounted for 22.3% cases in all workplace back injuries. Ninety six point two percent (96.2%) of permanent injury cases involved sprains and strains. Contusions, fractures and injuries to the nerves and spinal cords accounted for the remainder1.

 

Seventy eight percent of back injuries involved temporary disabilities. The highest number of back injuries was in the 35-39 age group, accounting for 15% of claims.

 

Suggested Guidelines for IMC’s and NTD's

 

 

Refer for Specialist Occupational Physician assessment if any of the following are noted:

 

  • The presence of any red flag conditions

  • The worker has had more than two weeks certified unfit for duties, or more than one month on selected duties

  • The worker has had more than three weeks off work, or on selected duties and has significant yellow flag conditions

  • Not back at pre-injury duties within six weeks of the injury

  • There are significant workplace conflicts, dissatisfaction, performance or industrial issues

 

1 (Statistical Bulletin, 1999/2000 NSW Workers Compensation). Work Cover Publications Sydney NSW

 

 

Suggested Guidelines for GP’s


Re-assess – options request information from treating GP, specialist and /or refer for independent assessment

 

 

PROCEDURE - LOW BACK PAIN

 

 

Stage 1 – Triage

 

  • History and examination

  • Perform diagnostic triage

  • Assess for red flags

  • Assess for yellow flags

 

 

Stage 2 - Assessment

 

  • Assurance and explanation

  • Advice to continue usual activities

  • Analgesics and/or manipulation if required

  • Avoid best rest (more than 2 days)

  • Consider suitable alternative duties

  • Review in 7 days if required

  • Consider referral to health professional with expertise in lower back pain

 

 

Stage 3 – Re-assessment


  • Full reassessment

  • History and examination

  • Oswesrtry screening questionnaire

  • Screen for red and yellow flags

  • Investigation as appropriate

  • Consider ongoing treatment requirements

 

 

 

 

RED FLAG CONDITIONS

 

  • Features of cauda equina syndrome (especially urinary retention, bilateral neurological symptoms and signs, saddle anaesthesia) - this requires very urgent referral

  • Significant trauma

  • Weight loss

  • History of Cancer

  • Fever

  • Intravenous drug use

  • Steroid use

  • Patient aged of 50 years

  • Severe, unremitting night-time pain

  • Pain that gets worse when patient is lying down

 

 

YELLOW FLAG CONDITIONS

 

  • Attitudes and beliefs about back pain

  • Emotions

  • Behaviours

  • Family

  • Compensation issues

  • Work

  • Diagnostic and treatment issues

  • Workplace conflict

  • Oswestry score more than 40 percent (at 4 weeks)

 

 

 

Rehabilitation Goals

 

In order of preference, you are aiming to have your ill or injured worker return to the:

  • Pre-injury/illness job, with the same employer

  • Modified pre-injury/illness job, with the same employer

  • Different job, with the same employer

  • Pre-injury/illness job with a different employer

  • Modified pre-injury/illness job, with a different employer

  • Different job, with the a different employer

 

The best outcomes are achieved through

  • An early return to work

  • A work based rehabilitation system

  • Good communication between the involved parties.

  • Medical in confidence issues must always be considered in communication.

 

Possible alternative duties

 

  • Maximum lift limit (for example 5, 10 or 15 Kg, kept close to the body and to avoid asymmetric lifting)

  • No prolonged/ repetitive bending or stooping

  • No bend/twist/lift combinations (asymmetric lifting)

  • Allow freedom to sit/stand/walk as tolerated

  • No exposure to significant whole-body vibration or impact forces

  • No prolonged driving (at work)

  • No prolonged or repetitive climbing

 

 

Workcover certificate

 

Broader details supplied on the Workcover Certificate ensure the patient has been appropriately interviewed and their particular circumstances considered. The certificate should identify the following categories.

 

  1. Tasks that the patient may safely carry out without exacerbating his/her medical condition (Eg: Light duties)

  2. Duties the patient may be able to perform (Eg: Front desk duties, stock auditing)

  3. Tasks that should be avoided (Eg: Lifting over 5 kg, bending, sitting for prolonged periods)

  4. Environments that should be avoided (Eg: Vibration or body jolting)

 

 

 

When to Refer for Specialist Opinions and Further Diagnostic Testing

 

In the absence of RED flags, radiologic investigations are not normally required in the first month after injury. A plain Xray is inexpensive and easily obtainable, but can be difficult to interpret as the normal (uninjured) population frequently have abnormalities on plain Xray. An MRI is frequently the best initial investigation as this test will give the most information about discs and nerves. Some surgeons will request a CT Myelogram to assess a patient for surgery. A CT scan is good for specifically investigating bone pathology. A bone scan is a good screening test of fractures, and can be useful at times to determine if a fracture is new or old. Nerve Conduction Studies are sometimes useful to investigate possible nerve root damage.

 

Consider referral to a specialist if:

 

  • The presence of any red flag conditions

  • The worker has had more than two weeks certified unfit for duties, or more than one month on selected duties

  • The worker has had more than three weeks off work, or on selected duties and has significant yellow flag conditions

  • Not back at pre-injury duties within six weeks of the injury.

 

 

Please also note that Sacroiliac Joint Dysfunction or SI Joint Dysfunction is a condition in which the joint is locked, partially dislocated or “subluxated” in a non-anatomically correct position due to hypermobility (too much movement) or hypomobility (too little movement) within the joint. Sacroiliac joint dysfunction is commonly characterized by low back and gluteal pain and may be accompanied with referred groin, hip, and sciatic leg pain (see “sciatica“).] The condition can affect one sacroiliac joint (left or right), or both joints. The degree of pain and disability due to the condition can vary widely, from an occasional discomfort that limits certain activities to severely debilitating and a constant source of pain. It is reported to affect between 15% and 38% of the general population, with women being 3 or 4 times more likely to be affected than men. In spite of these statistics, many patients with sacroiliac joint dysfunction go years without a correct diagnosis. The sacroiliac joints are often overlooked as a causative role in lower back pain.

 

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