Zoe Argeros
Exercise Physiologist & Dietitian, Corporate Bodies International
Many of us will experience low back pain at some point in our lives. This is defined as pain or discomfort localised between the lower sternum and the bottom of the hips, with or without the presence of leg pain. Low back pain is classified according to its duration with acute pain lasting less than 6 weeks, subacute pain lasting 6-12 weeks and chronic low back pain extending beyond 12 weeks. The incidence of low back pain in the workplace has a significant impact on employee productivity, workplace culture, workers compensation costs, and absenteeism; while also having a considerable impact on the quality of life of the individual suffering. However, there are many options when it comes to prevention and treatment of this debilitating condition, beyond the conventional engineering controls and education approach.
Low back pain and the resulting disability continues to plague all workplaces, including the mining industry. In 2013/2014 alone, back injuries accounted for over 20% of injuries in the sector; this is not considering unreported, non-specific low back pain problems. From a personal perspective, the stats are also not in our favour. The World Health Organisation estimates up to 70% of the population will have back pain at some point in their lives, with a pain reoccurrence rate of 40-80%. To top it off, 85% of cases cannot be associated with a direct causal mechanism of injury, making it a complex beast to deal with. So how can we prevent or manage low back pain for ourselves and our employees?
Currently, workplaces rely on manual handling training and engineering controls to minimise severe mechanical back injuries. However, what about other non-specific low back pain? For an individual to take ownership of their own health, including keeping their spine in shape, we need to start considering a wider view, understanding how broader health risk factors play a part in our pain and disease progression. These factors include exercise, obesity, smoking and psychosocial considerations.
Exercise
Spinal posture and spinal loads play a role in degenerative back pain and injury. For example, the literature supports the need to minimise repeated spinal flexion to reduce disc herniation injuries. It also supports the promotion of maintaining a neutral spine during loaded movements to prevent injury and reduce spinal wear. In theory, concepts behind manual handling training are spot on (for the most part). However, educating workers to “lift with your legs, not your back” does not result in a change in movement patterns or behaviour. The good news is, exercise does! Therefore, instead of relying solely on staff education to reduce injuries, we need to also be promoting exercise to help prevent and manage back pain.
Research has shown that simply walking can help to strengthen the legs, hips and torso to improve the stability of the spine, preventing and minimising pain. Exercises that focus on strengthening the torso and pelvis have also been shown to improve movement patterning, and thus behaviours. For those with subacute or chronic back pain, studies have found no exercise technique is more superior to another in reducing pain, with all the following providing benefits:
• Aerobic exercise
• Pilates
• Yoga
• Core exercise and stabilisation
• Strength exercise
Community-based programs have also been shown to be effective for preventing lower back pain. As every individual and their pain triggers are different, it is important individuals seek advice from an Accredited Exercise Physiologist to create an exercise regime specific for you.
Obesity
Research has shown a positive association between obesity and lower back pain. A variety of mechanisms can explain this relationship. Firstly, greater body weight increases the mechanical load on the spine and shearing load on the lumbar vertebrae during movement. Abdominal obesity, particularly common among males, has also been found to impact on pelvis position, which can exacerbate back pain. Lastly, studies have also identified an association between hypertension, hyperlipidaemia and back pain, risk factors commonly attributed to the metabolic effects of obesity.
Identifying obesity as a risk factor for developing and sustaining back pain allows us to better appreciate that by making small lifestyle changes, we can improve our back health and reduce pain levels. In fact, this association is strong enough to recommend weight reduction as an effective treatment option, complementing conventional treatment protocols.
From a workplace perspective, we also need review how our engineering controls may be impacted by an individual’s weight. For example, we have engineered operator seats with suspension to limit vibration (a known risk factor for back pain). If our seat has a limit of 120kg yet the operator is 150kg, are they supported? Alternatively, what happens to the operator who is only 80kg? In both situations, the engineering controls to limit vibration are not effective, enhancing whole body vibration and putting workers at risk.
Smoking
Despite declining tobacco use throughout Australia, approximately 21% of the population in the mining industry continue to smoke. This is 8% greater than the Australian population. To promote smoking cessation, we are educated on the impact of smoking on developing cancer, heart disease, stroke and lung disease. However, the association between cigarette smoking and low back pain often remains unacknowledged in the aetiology of the condition.
The following have been identified as physiological mechanisms for the potential impact smoking has on back pain:
• Reduced blood supply to spinal region increasing spinal degenerative disc disease
• Increased osteoporosis
• Impaired bone healing
• Impaired wound healing leading to inflammation
• Altered pain pathways increasing pain sensitivity and duration
The incidence of low back pain is not only greater amongst current smokers but smoking itself is also strongly linked with chronic back pain. Smokers report longer duration and intensity of pain compared to non-smokers. This considerably impacts on their occupational and social function, further highlighting the importance of encouraging and supporting individuals to quit smoking.
Psychosocial factors
Personal and occupational psychosocial factors should not be overlooked with regards to their relationship with low back pain. A study published in 2003 found job dissatisfaction, low supervisor support and high scheduling demands were greater predictors of new back pain, compared with the actual manual task of lifting 20kg every day. Depression and anxiety have also been shown to promote a cycle of pain, increasing the duration of pain and potentially leading to chronic symptoms. Unfortunately, this becomes a vicious cycle, with mental health disorders not only contributing to symptoms of back pain but with back pain itself exacerbating poor psychosocial health.
Call to action
Low back pain may be complex, but there is a lot that can be done to help reduce pain beyond conventional controls. It is essential that individuals working in the mining industry are educated on strategies to personally prevent and manage pain, including maintaining a healthy lifestyle. Exercising regularly, maintaining a healthy weight, quitting smoking and looking after their mental health are all important aspects to minimise back risk, while also improving employee morale, productivity, and overall quality of life. Employers also have a responsibility to support individuals to make healthy choices and minimise the impact of both physical and psychosocial factors in the workplace. What can you be doing to reduce your risk?
Zoe has always had a passion for sport and health. These interests lead her to a career as an exercise physiologist and dietitian where she loves helping people make a positive difference in their lives. She now works with Corporate Bodies International who partner with coal mines in central Queensland to help prevent injuries and promote health. She loves educating onsite and seeing people get excited about their health!
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