Low back pain

What is it?

There are two main types of low back pain; this guidance covers only the most common:

Non-specific back pain or mechanical back pain – pain not caused by serious damage or disease, but by sprains, muscle strains, minor inflammation or a pinched or irritated nerve

Specific back pain – pain associated with an underlying health condition or damage to the spine and is very much less common

Low back pain is a common cause of discomfort, and often a cause of absence from work
Most adults (60-80%) will experience low back pain at some time during their lives; it can be persistent and recurrent
There is no direct relationship between the physical demands of work and the incidence of low back pain
Most “injuries” are related to normal everyday activities such as bending and lifting and there is usually little evidence of tissue damage

How does it affect people?

Discomfort caused by back pain commonly reduces mobility, disrupts sleep and generates anxiety about longer term problems. However:

Most non-specific back pain eases and resolves quickly, usually within a week or so
In about 7 in 10 cases, the pain has either gone or has greatly eased within four weeks
In about 9 in 10 cases the pain has gone or has greatly eased within six weeks

Longer term pain and disability can have an adverse effect on an individual’s mood. This can sometimes lead to the onset of other health conditions such as depression.

How is it treated?

The majority of cases of low back pain will resolve without the need for any specific medical treatment. Initially, painkillers or anti-inflammatory medication may be required under guidance from the GP. These are usually taken regularly for a few days to help to maintain mobility.

There is strong evidence that continuing with ordinary activities as normally as possible despite discomfort results in faster recovery than an approach which focuses on rest, sometime for prolonged periods. It is now recognised that this can generate further problems
Various treatments for longer term low back pain such as Physiotherapy or Osteopathy may produce some improvement in the condition but there is no clear evidence as to which treatment is preferable
For someone having difficulty returning to normal activities at 4 -12 weeks there is evidence that a structured functional restoration programme can produce a faster return to work, less chronic disability and less sickness absence
Lifestyle factors, such as smoking, low levels of physical activity and obesity all slow recovery or tend to predispose toward back pain
A clear ‘medical diagnosis’ is often impossible, and neither x-ray nor other scans give much helpful information – although a scan might be valuable in long term cases
Some of the most important factors affecting recovery are the person’s beliefs (e.g. the belief that back pain is potentially disabling or that work might make things worse)

How might it affect work?

Most workers with low back pain are able to continue working or return to work within a few days, even if they have some residual or recurrent symptoms, although the work may require short term modifications to allow this. Indeed getting back to ‘normal’, including work, is crucial to good recovery.

The symptoms vary widely from one individual to another, making generalisation difficult. However employees may experience discomfort with some of the following tasks:

Lifting and handling
Bending and twisting
Sitting for prolonged periods (may affect driving)
Standing for long periods without movement
Walking long distances
Climbing up stairs

Discuss the problems with your employee specifically in respect of the tasks above and how they relate to work activities. Identify what tasks they can and cannot perform and the length of time that they can perform them. Where changes can be reasonably accommodated you should modify duties to enable the employee to return to or continue at work. It is likely that their capability will improve quite quickly so you should review the work with the employee every 2-3 days. Make sure that they are able to cope and where possible increase their workload in stages to help facilitate their return to full duties.

Focus on support; helping them to remain at work or to return to work as rapidly as possible
Employees do not need to wait until they are pain free before they return to work
Evidence suggests that an early return to work or continuing at work with symptoms does not increase the risk of ‘re-injury’ but actually reduces recurrences and sickness absence over the following year
Modified duties should be a temporary measure and not normally last for more than 4 weeks
In case of an absence of more than 4 weeks, or difficulty in returning to normal duties after 4 weeks, refer to Occupational Health for advice

Points to remember

Fit notes

If an employee produces a fit note indicating that they require modified duties, discuss this with them and consider if the modification recommended can be reasonably accommodated.

Job tasks and risk assessments

Review the risk assessment for the employee’s job role and work tasks including the ability to drive safely where required. Take into consideration any temporary modification that may be required to accommodate their reduced ability to undertake certain tasks. Manager may need to consider if any updates are required i.e. instruction and training.

General guidance

If you require further information, refer to the general advice on managing attendance.