THE TRUTH HURTS
A Closer Look At Back Injuries In The Workforce
You may be aware that our nation’s economy has improved considerably over the last several years. While this has resulted in rising home prices and consumer spending, it has also stimulated job growth, meaning there are now significantly more employment opportunities throughout the private sector.
Consider a recently released report, which indicated that the United States added an estimated 241,000 jobs in December 2014.1 Closer
to home, this report revealed that the Mountain States gained roughly 21,000 jobs in the private sector, including 5,500 here in Colorado.2
As encouraging as this has been, it must be noted that the rate of work injuries has remained relatively static throughout this post-recession recovery.
To illustrate, statistics from the U.S. Bureau of Labor Statistics (BLS) that the number of reported cases of nonfatal occupational injuries and illnesses in the private sector stood at 3,063,400 in 2010, 3,034,500 in 2011, 3,027,600 in 2012 and 3,007,300 in 2013, the most recent year for which such data is available.3
Chief among these rather high rates of occupational injuries and illnesses are musculoskeletal injuries, which comprised a whopping 33 percent of cases in 2013 alone.4 For those unfamiliar with the term musculoskeletal
injury, it is used to describe injuries to the muscles, ligaments, tendons, joints and other structures that comprise the body’s musculoskeletal system, and which can inhibit regular, fluid movement.
While work-related musculoskeletal injuries can occur virtually anywhere in the body from the feet and hands to the neck and shoulders, they are especially likely to affect the back. Indeed, BLS statistics indicate that there were 183,100 cases involving back injuries in 2011, 178,190 in 2012 and 170,450 in 2013.5
WHY ARE SO MANY WORKERS SUFFERING
SO MANY DEBILITATING BACK INJURIES?
3,007,300
INJURY & ILLNESSCASES IN 2013
170,450
BACK-SPECIFIC CASES IN 2013If you’ve been in the workforce for any significant amount of time, it’s highly likely that you’ve witnessed a co-worker suffer some type of back injury. Perhaps you’ve even suffered such an injury yourself. You’ve probably even found yourself wondering why such injuries are so common.
The reality is that the high rate of back-related musculoskeletal injuries among workers is attributable to a variety of events and other exposures. However, there are at least three causes to which much of this back-related trauma can be linked: overexertion, repetitive motion and falls.
OVEREXERTION
One of the leading causes of back injuries among private sector workers, overexertion involves a person exceeding his or her physical limitations during the course of employment or, perhaps more simply put, pushing the soft tissues of his or her body too far.
To get an idea of just how common overexertion injuries are, consider that Liberty Mutual Research Institute for Safety’s 2014 Workplace Safety Index ranked them as the leading cause of workplace injuries lasting a minimum of six days in 2012.6 Furthermore, BLS data
shows that there were 322,310 cases of “overexertion and bodily reaction” injuries, and 107,910 cases of “overexertion in lifting and lowering” in 2013.7
Overexertion injuries resulting in back trauma are typically related to otherwise mundane physical activities like lifting,
bending, pushing, pulling, carrying, throwing or bending at the waist.
By way of illustration, consider a nurse who hurts her back while moving a patient from a gurney to a hospital bed, a warehouse worker who hurts his back pulling a heavy object in the absence of any mechanical assistance or an office worker who hurts her back bending over to reach a tangle of
COMMON CAUSES OF BACK INJURIES
ON THE JOB
OVER EXERTION IS THE NO. 1 CAUSE
OF WORKPLACE INJURIES
REPETITIVE MOTION
Repetitive motion injuries result when a worker engages in
uninterrupted strenuous physical activity and/or uninterrupted awkward physical motions that push the soft tissues of the body beyond its limits. Liberty Mutual’s 2014
Workplace Safety Index ranked repetitive motion injuries as the ninth-leading cause of workplace injuries lasting a minimum of six days in 2012,8
while BLS data reveals there were 24,420 cases of injuries related to
“repetitive motion involving microtasks” in 2013.9
Repetitive motion injuries resulting in back trauma can typically be attributed to activities involving bending, twisting or reaching. While these activities often don’t cause injury when performed carefully and sparingly, they can cause temporary or even permanent damage if they are performed hour-after-hour, day-after-day, week-after-week or even year-after-year.
Examples may include an assembly line worker who hurts his back packing medium-sized items into crates all day long, twisting to pull them off the line and then bending over to put them in position. Similarly, consider an office worker who hurts his back after being forced to answer phone calls year round without a headset, keeping a phone pinned to his ear with his shoulder and stooping over to type notes.
REPETITIVE MOTION INJURIES ARE THE 9TH-LEADING CAUSE OF WORKPLACE
FALLS
Both falls on the same level and falls to lower levels are another leading cause of back-related musculoskeletal injuries among workers.
Liberty Mutual’s 2014 Workplace Safety Index ranked falls on the same level and falls to lower levels as the second-and fourth-leading causes, respectively, of workplace injuries lasting a minimum of six days in 2012.10
BLS data also shows there were 141,060 cases of injuries related to “falls on same level” and 47,120 cases of injuries related to “falls to lower level” in 2013.11
The causes of fall injuries resulting in back trauma vary from slipping, tripping or falling on cluttered, wet or uneven walking surfaces to tumbles from improperly positioned ladders, or into improperly secured holes in floors and walls.
To illustrate, imagine a construction worker who hurts his back after falling through a floor opening that wasn’t properly marked off, or an office worker who hurts his back slipping on a wet floor en route to a meeting.
FALLS ON THE SAME & FALLS ON LOWER LEVELS ARE THE 2ND & 4TH LEADING
CAUSES OF WORKPLACE INJURIES
ATLAS ( C1) AXIS ( C2) C3 C4 C5 C6 C7 CERVICAL VERTEBRAE THORACIC VERTEBRAE LUMBAR VERTEBRAE SACRUM COCCYX T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11 T12 L1 L2 L3 L4 L5 1 2 3
Now that you are familiar with three of the leading causes of back-related musculoskeletal trauma among workers, it’s time to examine three of the more common types of these injuries: strains and sprains, and herniated discs. This examination, however, must be prefaced by an examination of the structures of the back itself.
THE SPINE: THE COMPLEX ANATOMY
OF A MOVING MACHINE
In general terms, the spinal column is composed of 24 small bones known as vertebrae, which stack one on top of the other and together form the protective hollow column through which the spinal cord runs.
These vertebrae are divided into three distinct regions. Starting from the top, the first seven vertebrae — located in the neck area — are known as the cervical vertebrae. These are followed by the next 12 vertebrae — located in the chest area — known as the thoracic vertebrae and the final five vertebrae — located in the lower back area — known as the lumbar vertebrae.
Situated between each of these 24 vertebrae are
gelatinous discs that serve as a sort of shock absorber and which prevent the vertebrae from rubbing against one another. Each of these vertebrae is held together by facet joints that enable bending and moving, and ligaments that serve to prevent excess movement by these same joints. Finally, the muscles of the body are attached to the spinal column via tendons, while 31 pairs of nerve roots branch off the spine in the spaces between the vertebrae. These nerve roots are responsible for carrying the messages transmitted by the brain via the spinal cord.
THE SPINAL COLUMN
COMMON TYPES OF BACK INJURIES
ON THE JOB
(CONTINUED)
STRAINS AND SPRAINS
While you’ve likely heard the terms sprain and strain used interchangeably in the context of back injuries, they are actually two very distinct conditions. In the former, the ligaments between the vertebrae are either stretched or
torn, while in the latter, the muscles and tendons connected to the spine are either pulled or torn. Workers typically sprain their backs
because of a sudden twisting motion, fall or other traumatic event that moves the facet joint outside its normal range of movement. Conversely, workers typically strain their backs because of either single events that place an undue amount of stress on the back muscles or ongoing, repetitive movements that take a cumulative toll on the back muscles. To illustrate, consider a worker who suddenly loses his footing after tripping on an uneven warehouse floor surface, wrenching his back in an attempt to regain balance, or a retail worker who hyperextends her back muscles
while reaching overhead to retrieve merchandise. While sprains and strains can often
be treated effectively via rest, ice, compression and over-the-counter anti-inflammatory drugs, they can sometimes prove to be very severe, necessitating physical therapy or even surgical intervention. Some-times these interventions don’t prove to be enough, however, as workers are diagnosed with chronic back pain, a condition that can side-line them for months, years or even keep them out of work altogether.
HERNIATED DISCS
In the discussion of the anatomy of the spine, we mentioned the gelatinous discs located between each of the 24 vertebrae in your spinal column. This is a rather complicated feature of the spine. However, a helpful way to think about the structure of these discs is to envision a jelly doughnut complete with a soft jelly center and a harder exterior designed to keep this jelly contained.
When a disc is herniated, it means that this soft jelly actually protrudes from the center through cracks that have developed in the exterior of the disc. While it’s possible that this condition — sometimes referred to as a slipped disc, bulging disc or ruptured disc — won’t even register to some, it can irritate or put pressure on the surrounding nerves resulting in
weakness or tingling in the extremities.
For example, if a herniated disc is located between the cervical vertebrae, a person may experience intense pain radiating through his or her
shoulder and arm. Similarly, if a herniated disc is located between the lumbar vertebrae — the most common location of herniated discs — a person may experience intense pain radiating down through his or her leg, a condition known as sciatica.
Workers typically suffer herniated discs thanks to overexertion. However, repetitive motion tasks involving pushing, pulling, bending and twisting, as well as falls are also to blame.
Treatment for herniated discs varies from medication and physical therapy to surgical intervention. This surgical intervention might involve a microdiscectomy, which consists of
removing the portion of herniated disc, or spinal fusion, which consists of removing the disc entirely and joining the vertebrae with metal hardware. As with sprains and strains, the prognosis for workers who suffer herniated discs varies with some returning to work in a few weeks, others needing significantly longer recovery times and still others unable to return to employment in any capacity.
If a herniated disc protrudes far enough to pinch a nerve, something
known as radicular pain can result, meaning pain
in other parts of the body.
(CONTINUED)
While it’s certainly true that workers in more labor-intensive industries see higher rates of back-related musculoskeletal injuries, it’s important to understand that they can and do occur across a host of other industries. Consider these very telling figures from the BLS outlining
the incidence rates of certain musculoskeletal injuries — including sprains, strains, tears, herniated discs and pinched nerves — within several major
private sector industries in 2013.12
THE RATES OF BACK INJURIES
ON THE JOB
50.2
HEALTH CARE AND SOCIAL ASSISTANCE WORKERS PER 10, 000
80.3
TRANSPORTATION AND WAREHOUSING WORKERS PER 10, 00041.9
CONSTRUCTION WORKERS PER 10,00041.8
RETAIL TRADE WORKERS PER 10,00036.1
MANUFACTURING WORKERS PER 10,000 PROFESSIONAL13.3
AND BUSINESS SERVICES WORKERS PERINCIDENT RATES
BY INDUSTRY
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While a back-related musculoskeletal injury can incapacitate workers either temporarily or permanently, workers’ compensation benefits can provide those in these unenviable positions with much-needed peace of mind.
The bad news, of course, is that employers or insurance companies will often try to deny workers’ compensation claims stemming from back-related musculoskeletal injuries, perhaps arguing that it’s unrelated to the underlying workplace accident or is not as serious as the injured worker is claiming. Fortunately, the workers’ compensation system in Colorado is structured in such a way that an injured worker can refute these types of claims regarding the severity of his or her injury, his or her ability to work or his or her injury being nothing more than a temporary aggravation of a pre-existing condition. Specifically, he or she is afforded the opportunity to present facts and other medical evidence in a hearing held before an administrative law judge.
1 Mark Harden, Colorado Gains 5,500 Private-Sector Jobs in December, Denver Business
Journal, Jan. 14, 2015, http://www.bizjournals.com/denver/news/2015/01/14/colorado-gains-5-500-private-sector-jobs-in.html.
2 Id.
3 U.S. Bureau of Labor Statistics, Occupational Injuries and Illnesses: Industry data, at http://
data.bls.gov/timeseries/IIU00000000061100
4 Press Release, U.S. Bureau of Labor Statistics, Nonfatal Occupational Injuries and Illnesses
Requiring Days Away From Work, 2013, 1 (Dec. 16, 2014), http://www.bls.gov/news.release/
5 U.S. Bureau of Labor Statistics, Nonfatal cases involving days away from work: selected
characteristics (2011 forward), at http://data.bls.gov/timeseries/CSU00X32XXXX6P100
6 Top 10 Causes of Workplace Injuries, Insurance Journal, Jan. 16, 2015,
http://www.insur-ancejournal.com/news/national/2015/01/16/354285.htm.
7 U.S. Bureau of Labor Statistics, supra note 4, at 13. 8 Top 10 Causes of Workplace Injuries, supra note 6. 9 U.S. Bureau of Labor Statistics, supra note 4, at 13. 10 Top 10 Causes of Workplace Injuries, supra note 6.