Embed Size (px)
Citation preview
Lower back pain at work:Teaching people to lift the ‘wrong way’ for back pain
@ashjamesphysio
Ashley James
@ashjamesphysio
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?
@ashjamesphysio
Beliefs
@ashjamesphysio
@ashjamesphysio
Beliefs
Nolan et al 2017
@ashjamesphysio
Beliefs
Nolan et al 2019
@ashjamesphysio
Beliefs
Where do these beliefs come from?
@ashjamesphysio
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
@ashjamesphysio
Tribian et al 2017
Biomedical approach
Waddell & Burton 2000
@ashjamesphysio
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
@ashjamesphysio
Are these beliefs warranted?
@ashjamesphysio
What does the data tell us?
@ashjamesphysio
Bakker et al 2009
Twin Studies
CAUSATION NOT CLEAR
@ashjamesphysio
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
@ashjamesphysio
What is ‘normal’?
Brinjikji et al 2015
@ashjamesphysio
CurrentTraining
@ashjamesphysio
Ergonomics?
@ashjamesphysio
Faisting et al 2019
Traditional Manual Handling
@ashjamesphysio
Hignett 2003, Martimo et al 2012, Verbeek et al 2012
Asymptomatic Population
@ashjamesphysio
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
@ashjamesphysio
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
@ashjamesphysio
What aboutload?
@ashjamesphysio
How much load?
@ashjamesphysio
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
@ashjamesphysio
Current Situation
Biomedicalalternative evidence?
@ashjamesphysio
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
@ashjamesphysio
What is the best practical advice at
present?
@ashjamesphysio
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
@ashjamesphysio
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
@ashjamesphysio
Non-injury model education
@ashjamesphysio
‘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”
@ashjamesphysio
ANI MAL
on njuryodelpproach toifting
Thankswww.iprshealth.com
@ashjamesphysio
@ashjamesphysio
