Musculoskeletal diseases are conditions that affect the locomotor system. They can involve different musculoskeletal areas:

  • joints and associated tissues like tendons and ligaments (e.g. osteoarthritis, rheumatoid arthritis)
  • bones (e.g. osteoporosis, fragility or traumatic fractures)
  • muscles (e.g. sarcopenia)
  • the spine (e.g. back and neck pain)
  • nerves (e.g. sciatica)
  • multiple body areas or systems, such as regional or widespread pain disorders and inflammatory diseases

Musculoskeletal conditions are large contributors to disability. Here we describe back pain, which is a significantly common condition among musculoskeletal diseases.

The case of back pain

Name: Pedro
Age: 57 years old
Job: Factory Worker

The case of Pedro who suffers from back pain

Pedro is a factory worker; his work involves standing several hours a day, and always repeating the same movements, sometimes lifting heavy objects. Recently he has developed back pain and he realizes that the movements he carries out at work worsen his condition. Pedro thinks that he will not be able to go on in this way for long and would like to talk to his manager to ask him if he could have mechanical or human help, or a change of job. He is afraid to go and ask as the company is undergoing the recession and they might not find a new position for him, however, he cannot cope with the pain and is taking many painkillers to no real effect. He does not know with whom to share his concerns, as he is worried he might be made redundant also due to his age and he still needs to work to maintain his family.

Back Pain

1 What is it

Back pain is characterized by the presence of pain felt in the lower or upper back. About 80% of adults experience back pain at some point in their lifetimes.

Back pain can result from injury, improper physical activity and medical conditions, and usually derives from a problem with one or more parts of the back (e.g. ligaments, muscles, nerves, spine, disks or vertebrae).

Back pain can affect people of any age and gender, for different reasons. Some conditions and factors are linked to back pain or might lead to a greater risk of developing the disease:

  • As people get older, starting around 30 or 40, the chance of developing low back pain increases
  • Females have higher chances of developing lower back pain
  • Inactivity, unhealthy lifestyle including smoking, poor eating and drinking habits and lack of exercise
  • Presence of widespread pain
  • Skeletal irregularities, arthritis, osteoporosis, bulging or ruptured disks
  • Improper lifting, muscle or ligament strain, backpack overload

2 Symptoms

Signs and symptoms of back pain can include:

  • Muscle pain
  • Dull aching sensation
  • Shooting or stabbing pain
  • Pain that radiates down the leg (sciatica or
  • irritation of the sciatic nerve)
  • Pain that worsens with bending, lifting,
  • standing, walking or sleeping (morning
  • stiffness is a very common problem with
  • back pain)
  • Pain that improves with reclining
  • Reduction of flexibility and mobility

Pain can involve the upper back, but more frequently, it involves the lower back.

Acute back pain is the most common presentation and is usually self-limiting: it is brought on suddenly and lasts less than three months regardless of treatment.

The majority of acute lower back pain is traumatic and mechanical in nature, caused by a fall or heavy lifting.

Chronic back pain is a more difficult problem, which often causes strong psychological and social issues, such as work dissatisfaction, boredom, and a generous compensation system. Fewer cases of chronic back pain are due to specific causes; most cases are idiopathic and non-specific.

3 Treatment

It is generally possible to take preventive measures to avoid or relieve most back pain episodes by improving one’s physical condition, learning and practicing proper body mechanics. The following are some good practices, only when done under supervision of a trained coach (physiotherapist):

  • Exercise: regular low-impact aerobic activities like walking and swimming
  • Building muscle strength and flexibility: abdominal and back muscle exercises

Maintaining a healthy weight also plays an important role.

If prevention fails, simple home treatment and self-care often will heal the back within a few weeks. If pain does not improve in that time, a medical examination is recommended to verify and exclude other conditions as back pain may signal a serious medical problem.

Adequate back pain treatment must include different levels, according to a biopsychosocial model. Typical treatment for back pain include:

  • Home remedies: hot compress or cold packs, activity and physical exercise to improve posture and strengthen core muscles and self-management
  • Medication: analgesic and anti-inflammatories, cortisone steroid injections, antidepressants
  • Complementary therapies: massage, chiropractic adjustments and physiotherapy, yoga and relaxation techniques, acupuncture, ultrasound or electrical stimulation (TENS), biofeedback, cognitive behavioral therapy.

4 Psychosocial issues and impact of the disease on employment

Back pain is one of the most common reasons people go to the doctor’s or miss work, and it is a leading cause of disability worldwide.

It can be uncomfortable and debilitating, making it hard to concentrate on job, thus it often leads to absenteeism and presenteeism and interferes with quality of life.

Some causes of back pain may be related to the workplace. A number of factors can contribute to back pain at work, depending on what job entails. For example:

  • Force: exerting too much force on the back, for example by lifting or moving heavy objects, can cause injury.
  • Repetition: repeating certain movements, especially those that involve twisting or rotating the spine, can injure the back.
  • Inactivity: an inactive job or a desk job can contribute to back pain, especially for people who have poor posture or sit all day in a chair with inadequate back support.

To manage workers with back pain and help them continue working or returning to work, employers can promote some interventions.

Interventions to prevent or reduce back pain should be a priority for employers; it is their responsibility to foresee a safe and healthy work environment.

Interventions may be applied in the workplace on different levels:

  • raising awareness (e.g. through guidelines for employees about how to prevent back pain in everyday life)
  • promoting prevention (e.g. promotion of good practices, such as healthy weight, activity and physical exercise)
  • Providing reasonable accommodations, depending on the specific features of the back pain and of the job. Mobility problems: if walking is painful, the employer might provide accommodations such as moving the workspace closer to important areas the employee needs to use. Force or repetition: if the job requires moving heavy items, the employer should provide mechanical or human help, or space rearrangement. Problems sitting or standing: if the employee must sit at a desk all day, the employer can provide an ergonomics consultant and specially designed furniture to make the workspace more comfortable. If the job requires standing, the employer may provide a stool or something to lean on, floor mats aimed at reducing fatigue and other similar equipment.

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