One of the most common types of injuries for workers is back pain. Back pain can occur in almost every profession. Any worker who does physical labor such as construction work, agricultural work, or industrial work is relying on their back almost constantly. Workers who stand most of the days such as waitresses, nurses, and other workers often develop back pain. Even if you sit all day using the computer or doing clerical work, you’re likely to develop back pain.
Back pain can occur due to a specific accident – such as when you lift, pull, carry, or move an object – and you wrench, twist, or bend your back. Back pain can also develop over time – and that one extra motion or force can launch you into a lifetime of chronic pain. Some workers with back pain can return to work after extensive physical therapy and other treatments. Some workers may be able to return to work but only if they shift to lighter duty work or even clerical work. And some workers find back pain intolerable to the point that they have a permanent injury and are no longer able to work.
According to Spine-Health, back pain can come and go, flare up on occasion, or be a constant source of agony.
What are the causes of back pain?
According to the May Clinic, some of the common causes of back pain are:
- Strained muscles or ligaments. This back injury is often caused by repeated lifting of heavy objects or a “sudden awkward movement” that can strain the muscles and ligaments. Workers who constantly use their back are at risk of a muscle or ligament strain.
- Disks that bulge or rupture. The disks act like cushions – “between the bones (vertebrae) in your spine. The “soft material inside a disk can bulge or rupture and press on a nerve.”
- Osteoporosis. As you age, the vertebrae of your spine can become brittle and porous which can cause fractures that are painful.
- Arthritis. “In some cases, arthritis in the spine can lead to a narrowing of the space around the spinal cord, a condition called spinal stenosis.”
- The facet joints that connect the vertebrae along your spine may become damaged.
How is back pain classified?
According to Spine-Health, back pain is normally classified in one of the following three ways:
- Axial pain. This type of back pain is also called mechanical pain. Axial pain usually confines itself to one part of the body. Workers who have back pain often state that the pain is “sharp or dull, comes and goes, constant, or [is] throbbing. Axial pain can be caused by a strained muscle, annular disc tears, or due to facet joints.
- Referred pain. Injured workers describe this type of back pain as – “dull and achy.” Referred pain generally moves around the body and can vary in intensity. “As an example in the lower back, degenerative disc disease may cause referred pain to the hips and posterior thighs.”
- Radicular pain. Radicular pain is also called “sciatica’ or “radiculopathy (when accompanied by weakness and/or numbness).” Injured workers describe radicular pain as “electric shock-like or searing.” This type of pain “follows the path of the spinal nerve as it exits the spinal canal. “Common causes of radicular pain include compression and/or inflammation of a nerve root of the spine. If radicular pain occurs in the lower back, the pain can expand into your leg. Causes of radicular pain include spinal stenosis, a herniated disk, or spondylolisthesis.
How do doctors diagnose back pain?
Back pain can be difficult to diagnose. For example, Spine-Health states that “a torn or herniated disc may feel similar to an arthritic facet joint due to their close proximity. In some cases, the same nerve root can be compressed or irritated by different structures, such as a disc or bone spur.”
Common diagnostic tests for back pain, according to the Mayo Clinic, are:
- X-ray. This test is used to examine your back for broken bones, arthritis, and shifts in the alignment of your bones.
- MRIs and CT scans. These imaging tests “can reveal herniated disks or problems with bones, muscles, tissue, tendons, nerves, ligaments and blood vessels.”
- Blood tests. These tests may disclose if an infection or other problem is causing your back pain.
- Bone scan. This test can reveal if you have a bone tumor or whether osteoporosis is causing a compression fracture.
- Electromyography (EMG). This test studies your nerves and looks for how your muscles respond, spinal stenosis, and whether a herniated disk is causing compression of a nerve. If the signal between two leads is proceeding slower than normal, that could indicate that the nerve is being compressed by a herniated disc.
For some injured workers, determining the cause of your back pain can still be difficult to find.
What are the treatments for back pain?
The possible treatments for back pain include:
- Over-the-counter drugs such as Nonsteroidal anti-inflammatory drugs (NSAIDs) may help. Examples include – ibuprofen (Advil, Motrin IB) or naproxen sodium (Aleve).
- Muscle relaxants which require a doctor’s prescription such as Flexeril or Tizanidine;
- Prescription NSAIDs such as Meloxicam or Diclofenac can be effective;
- Prescription drugs which tend to reduce nerve pain due to sciatica such as Neurontin (Gabapentin) or Lyrica (Pregabalin);
- Topical pain relievers – creams, ointments, and patches such as Lidocaine;
- “Narcotics. Drugs containing opioids, such as oxycodone or hydrocodone, may be used for a short time with close supervision by your doctor. Opioids don’t work well for chronic pain, so your prescription will usually provide less than a week’s worth of pills.”
- Your doctor may also prescribe antidepressants.
- Physical therapy. These are exercises “to increase your flexibility, strengthen your back and abdominal muscles, and improve your posture.”
- TENS units which provide muscle stimulation and may reduce pain. Cheaper versions can be found over-the-counter, or your doctor may prescribe a more professional unit
In some cases, if those less invasive things do not help, surgical and other procedures may be required. These can include:
- Cortisone injections
- Epidural steroid injections
- Radiofrequency neurotomy This procedure uses essentially microwaves transmitted by a probe inserted into a spinal disc to heat up and deaden the nerves that are the source of pain;
- Implanted nerve stimulators, also known as spinal cord nerve stimulators or an SCS. These include a battery-operated device and controller with which you can adjust the nerve stimulation to decrease your pain;
- Surgery – usually for structural problems such as a narrowing of the spine, or to trim or pull out a severely herniated disc. This can include either a laminectomy, where part of your spinal bone at the rear of your spine called the lamina is removed to make more room for the disc and spinal cord, or a diskectomy, where the disc is simply trimmed back so it is no longer pressing on the spinal cord, or a more involved surgery such as a spinal fusion, where hardware is implanted to stabilize the spine after a complete disc removal. The fusion can be at one or sometimes multiple levels of the spine. In those cases of a spinal fusion, typically some bone from your hip or a cadaver is harvested to fill in the space after the disc is removed. The idea is to “fuse” the two spinal bones together so that they form one, larger spinal bone. Although there are no guarantees, patients who have been suffering from severe sciatica often report immediate relief from those symptoms after these surgeries.
Are there any Special Rules or Benefits for Back or Lumbar Spine Injuries in Workers Compensation?
Yes, back injuries entail some special consideration in both Virginia and North Carolina. The strange thing is that the laws differ significantly as to the treatment of back injuries in a workers compensation case in each State in some respects.
So one thing that is clear is that in both Virginia and North Carolina, one cannot recover at all for a purely “wear and tear” injury to the spine, or just about any other body part, for that matter. There must have been, as is stated in Virginia, a “sudden anatomical change” resulting from a traumatic event, or there is no “accident,” and therefore no recovery. In other words, saying that your job is hard and caused you to have back injuries over many years is not something you can recover money for under Workers Compensation Law. For that, you may have to look to Social Security Disability Law.
The main way in which VA and NC treat back injuries differently is with respect to permanent partial impairment. This is a potential benefit that is sometimes available, after the injured employee reaches maximum medical improvement. Testing is performed and if permanent impairment is found in the body part tested, then a permanency rating is assigned, which could entitled the injured worker to additional money.
But in Virginia, there ARE NO PERMANENCY RATINGS permitted for the back or any part of the spine under Virginia’s workers’ compensation laws. If an injured worker is unable to return to work due to a spinal injury, then the claim may be negotiated to settlement for the remainder of the 500 maximum weeks available plus possible future medical bills. But if a Virginia worker suffers a spine injury and then returns to work, there are no permanent partial ratings benefits available to that worker under Virginia Law. The only exception might be if the sciatica down legs or arms is so severe that it creates permanent partial impairment in any of those extremities. That would be compensable.
Contrast this with North Carolina, where any injury to the “back” (which under NC Law means any part of the spine) has the HIGHEST available number of potential weeks for permanent partial impairment of any body part—up to 300 weeks.
Why the stark difference between the two states on this issue? I leave that to legal scholars to discuss.
One more important point with respect to back injuries. In North Carlina, one must typically have suffered a “slip, trip, or fall” in order to recover for a work accident. A sudden pain, such as a “pop” or “crack” while lifting something heavy would not be sufficient to recover—UNLESS that injury is to the spine. In those cases, NC has carved out an exception to the “slip, trip or fall” rule, and, very similar to Virginia, only require a “specific traumatic event” in order to recover for spinal injuries suffered at work. Therefore, in our example above, an injured worker who suffered a sudden “pop” in his or her spine due to heavy lifting at work would be able to recover under NC Workers Comp Law.
North Carolina and Virginia workers’ compensation attorney Joe Miller has helped many back injury victims get the workers’ compensation benefits they deserve. He works with your treating doctors and independent doctors when permitted to fully analyze just how serious your work injury is. He fights to try to ensure the employer doesn’t force you back to work before you’re healthy. To discuss your back injury claim with an experienced workers’ compensation lawyer, call lawyer Joe Miller, Esq., at 888-667-8295. or fill out my online contact form to schedule an appointment.
North Carolina and Virginia employees can also now fill out our New Electronic Case Review. The link is a new way of communicating with clients that we’re offering – to allow workers to contact us remotely during the pandemic.