Acute Low Back Pain: Be Careful what you Assume  

Understanding Pain, Part 1

One of my physical therapy professors concluded a lecture by emphatically stating that the biggest piece of career advice he would impart was to never assume anything. As we exited the lecture hall, a classmate and I were skeptical, remarking that we found his comment to be, well, underwhelming. How could assumptions impact our careers?

'How Long 'til it Grows Back?'

Fast forward to a Saturday morning a few years later.

Working as a physical therapist, I was reviewing an orthopedic patient’s chart when, directly in front of me, two orthopedic surgeons exited a patient’s room – the patient I was there to evaluate. The surgeons collapsed into two chairs at the nurse’s station in obvious distress. The patient’s nurse hurried toward them and after a brief hushed exchange, all three were visibly agitated. Before continuing my chart review, I joined their conversation. The patient – a man in his early 20s – had sustained a severe injury in a workplace accident the day before and his lower leg would need to be amputated. The orthopedic surgeons delivered the news to the young man and his parents that the blood supply to the leg couldn’t be salvaged and there was no alternative.

The room was silent for a moment before the patient’s father calmly asked, "Doc, how long 'til it grows back?"

The orthopedists were stunned at this question. The patient encounter became much longer as the orthopedic surgeons explained that the lower leg wouldn’t grow back and outlined the sequence of planned medical treatment, fielding many more questions than they’d initially expected. The orthopedists and nurse were insistent -- there should be no assumptions with this patient or his parents. 

More Info than Ever, More Need for Communication

We are living in remarkable times. Cutting-edge medical and research advancements, technological capabilities exceeding our wildest imaginings with near daily AI developments, influence from social media, and enormous access to resources. The internet, for example, offers more information than ever before. Yet, none of these advancements ensure that decisions are based on the most accurate or up-to-date information.

My physical therapy professor’s advice remains exceedingly relevant. Never assume anything.

Dialogue and communication are critical to uncover bias, judgments, misconceptions, and knowledge gaps. Pause to consider if the orthopedic surgeons hadn’t stayed in the patient’s room to discover the enormous misunderstanding of the planned surgery and its consequences? And yet, is this patient or medical encounter unique? How often are assumptions made that complicate claim management, negatively impact medical outcomes, or introduce legal challenges?  

What do you Know about Low Back Pain?

Low back injury is one of the most prevalent workplace injuries, as well as one of the most common reasons for primary- and emergency-care consultations.¹ It’s estimated that roughly 80% of adults will experience low back pain at some point in their lives and roughly one quarter of U.S. adults have back pain at any given time.²

Low back pain has multiple risk factors, including genetic profile, lifestyle factors such as increased body weight and smoking, physical factors such as poor posture and sedentary lifestyle, psychological factors such as stress, anxiety, and depression, comorbid conditions, and work-related factors such as heavy lifting, prolonged sitting, and physically demanding jobs.

Natural aging of the spine is a risk factor for back injury for which many, including the employees on the job and injured workers and are largely unaware. The spine begins to age in the 20s and 30s, continuing a process of age-related deterioration throughout life. Vertebrae that compose the spinal column decrease in bone density and discs between the vertebrae gradually lose water content, becoming thinner and less flexible. Coupled with loss of core muscle strength as we age, an aging spine can become more stooped or curved.  

Why is this Important?

Low back pain is one of the most prevalent medical conditions in worker’s compensation. Treatment of low back injury consumes a large percentage of workplace medical costs and can lead to costly and potentially unnecessary surgery. Add to this a provider’s plan for treatment and ability to potentially tease out patient-related misunderstandings or expectations for a return to "pain-free living, as well as myriad issues for the employer and payer.

All parties involved -- injured workers, providers, payers, employers, and courts and attorneys -- make decisions based on our educational and professional experiences, our personal experiences, and our own bias, judgments, and assumptions, many times without realizing what’s contributed to our thought process or decision-making. It’s not surprising that low back injury can be an overwhelming and thorny condition to manage and direct to a successful outcome. 

What's to Come

Five additional articles will be presented in this series for each of the stakeholders in workers’ compensation: the injured worker, the provider(s), the employer, the payer, and potentially, the attorney. Despite unprecedented advancement in medical treatments, access to information or system improvements from artificial intelligence, successful outcomes require dialogue and communication to uncover bias, judgments, misconceptions, and knowledge gaps.

Are assumptions being made that are unknowingly derailing a claim and leading to dissatisfaction for an injured worker and potentially resulting in litigation? Or a poor surgical outcome? This series will examine how these factors contribute to a familiar topic in workers’ compensation.

Stay tuned!     

References 

1. https://www.ncbi.nlm.nih.gov/books/NBK538173/   

2. https://pubmed.ncbi.nlm.nih.gov/17077742/ 

Share This Article: