Case 13: Low back injury caused by lifting, exacerbated by a trip
Major multi-site bakery company
This case study looks at the rehabilitation of an employee working in the despatch department at one of the company’s sites. The employee was employed as an order picker on 12 hours shifts on a rotation basis. He worked for the company for 6 years with an excellent attendance record. His general health was good and, apart from a 20-a-day smoking habit, he had no relevant lifestyle issues which impacted on his health. He was aged 36 years at the time of the injury.
An acute episode of low back pain prevented the employee from working for two weeks. He consulted his GP and was prescribed appropriate treatment; the problem subsided. He returned to work and his return to work interview revealed that, although he was much improved, his back was not fully recovered. As result he was allocated restricted duties and advised to take things carefully. Unfortunately a few hours after his return his foot slipped down a pothole and he jarred his back. This exacerbated his recovering back problem. As a consequence he was unable to continue work and was taken home by car in severe discomfort; he was unable to drive.
The employee consulted his GP and was prescribed standard medication for an acute back problem: strong anti-inflammatory and muscle relaxant mediation. This episode was more acute than the previous episode and prevented him from sleeping, climbing stairs and generally restricted his daily activities.
He was referred to Occupational Health and, as he was unable to drive, a home visit with Human Resources was arranged. During the visit it became evident that the problem was still very acute and that the employee would not be fit to return to his job for some time. His previous work history was in the building trade and he admitted to one previous episode of back problems following an injury at work some 8 years previously; this had been resolved quickly with the aid of physiotherapy. During the visit back care was discussed and a guidance booklet issued which contained the latest research information on how to treat back problems. He was encouraged to keep as active as possible and, to aid his recovery, he agreed to be referred for physiotherapy funded by the company.
The employee was very keen to return to work as soon as he was mobile enough to drive but, on the advice of the physiotherapist, this was postponed until his back condition had stabilised. He received a weekly physio appointment for 4 weeks and carried out prescribed exercises to aid his recovery. He attended an occupational health review prior to his return and his manager joined the discussions so that a rehabilitation plan could be put into place. It was agreed that on his return he would:
- work reduced hours, initially working 6 hours per day and then increasing over 6 weeks to his full 12 hours shifts
- be supported by changing his work to a task with less time pressure
- attend for a manual handing training course and be reassessed to ensure that he as applying good lifting techniques
- only lift one basket at a time, in order to reduce pressure on his back
- continue with the back exercise as recommended by the physiotherapist (he was now discharged from treatment).
Full rehabilitation back to his usual job took 8 weeks, following a sickness absence of 6 weeks. The employee made a good recovery and indicated he found the provision of physiotherapy and the structured rehabilitation programme most helpful. Otherwise he would have found it very difficulty to restrict his activities and the hours worked once he was back at work. He continued with the exercises advised by the physiotherapist. He has yet to address his smoking habit that will also impact on back health.
Company policy on rehabilitation
The company is proactive in terms of rehabilitation. The process usually involves a team approach involving the employee, Human Resources, the line manager, the health and safety co-ordinator, the employees GP / consultant, physiotherapist and the Occupational Health Practitioner.
For less complex cases, the key to a safe return to work rests with the line manager. In particular strict adherence to the rule that an employee does not resume work until the return-to-work interview has been completed by the manager. This ensures the employee’s fitness to return is not compromised, and that health and safety are not put at risk. As a result, adjustments to the employees work pattern are frequently put in place, as even after relativity minor illnesses such as flu it can take some time to recover fully.
More complex rehabilitation cases following longer absences are planned prior to return and a rehabilitation plan put in place. Such cases include the rehabilitation of employees following musculoskeletal problems, fractures, recovery from heart attack, post viral debility etc.. Each case has to be assessed on an individual basis as no two cases are the same. The process is similar whether the cause of the problem is job- related or not.