Effects of Lower Back Pain on the Workplace
Lower back pain has a significant effect on productivity and healthcare costs in the workplace. The total cost to employers for back pain amounts to $34,600 per 100 employees annually.1 This includes both direct medical and disability claims, as well as indirect effects on the overall productivity of the organization.
Taking steps to increase the health of your workforce and reduce back pain can be extremely beneficial to your company. Healthy employees tend to be more productive, happier, and less costly in terms of health care expenses.1 5 6
The medical costs of back pain
Healthcare costs in the United States are among the highest in the world, and are only rising. This has wide ranging effects. Many employers have chosen to reduce the rate at which they increase salaries in order to offset these rising costs. Between 2004 and 2014, health insurance costs rose by 51 percent.
This has led to both employees and employers putting more money towards healthcare costs.3 And yet there is little evidence that this increase in spending has increased overall health. The United States still ranks behind many developed countries in terms of health outcomes, access to services, and quality of care.4
Clearly, organizations must remain proactive in the fight to improve the health of their workers.Back pain is a significant contributor to the rising costs of healthcare. The total direct costs of back pain related healthcare utilization are $96 million a year. And because lower back pain often exists with other symptoms, such as depression and chronic fatigue it means back pain sufferers are among the most expensive patients.
Healthcare costs for people with back pain are on average 60 percent higher than for those without back pain.5 Employer costs are further increased by back pain's contribution to disability and worker compensation claims. Lower back pain is the leading cause of work related disability in the US.2
This has led to considerable direct costs from the condition. Per 100 employees, back pain costs employers $7,100 in short term disability, $4,200 in long term disability, and $1,900 in worker compensation.1
The productivity costs of back pain
Although the medical costs of back pain are significant, costs to lost productivity are even greater. Of the estimated $100 billion that lower back pain costs the United States annually, two-thirds is due to lost wages and lost productivity.5 This amounts to a considerable drag on companies and to the US economy as a whole. But what is driving this immense cost?
Absenteeism - When employees do not attend work because of illness, there can be significant costs in lost wages and lost productivity. Workers with back pain are absent an average of 4 days more each year than those without back pain. This amounts to a total cost in lost productivity of $13,100 per 100 workers annually.1
Presenteeism - Negative effects on productivity are not just limited to employees being absent from work. Presenteeism, or the act of attending work while sick, can be nearly as costly to business as absenteeism. When employees are distracted by discomfort, they are much less likely to be focused on the work at hand.
Workers may also have to spend time treating their pain while at work, which can further reduce productivity. The costs of presenteeism related to back pain add up to $8,300 per 100 workers annually.1
Employees that suffer from back pain are also much more likely to suffer from depression and chronic fatigue5, both of which also significantly reduce productivity. Depression alone is estimated to cost US workplaces $23 billion each year in absenteeism.6
Secondary costs of poor health
Poor health, whether caused by back pain or other illness, can have a range of other negative effects. It could lead to reduced satisfaction with the employer, increasing turnover rate, reducing creativity and new ideas in the workplace, and reducing the effectiveness of customer service. There is a statistically significant correlation between health and job satisfaction.
Although the correlation is particularly strong with mental health problems such as depression (which lower back pain is also associated with), job satisfaction also shows a strong correlation with physical health problems.20 Although these effects are much more difficult to calculate in terms of financial impact on the company, they almost certainly have major implications for overall performance and turnover rate.
The Rising Lower Back Pain Epidemic
Back pain incidence has grown considerably in recent history. This is particularly true in cases of chronic back pain, which increased from a rate of 3.9 percent of those surveyed in 1992, to 10.2 percent in 2006. The severity of the cases may also be rising, as the proportion of those that experienced lower back pain seeking medical help also rose, from 73.1 percent in 1992, to 84.0 percent in 2006.7
Low back pain affects everyone, from children to the elderly. However, its peak in prevalence is between the ages of 35 and 45. Rates in children are lower, but have also been rising.10
What is causing the Lower Back Pain epidemic?
Researchers speculate as to the cause for the increased rates of lower back pain. Although it was initially thought to be related to the overall ageing of the population, this is not likely true, as lower back pain rates have increased across all age groups. It may, however, be due to increases in obesity rates in the United States, as lower back pain is known to be correlated with obesity.
Lower back pain is also correlated with depression, which has seen similar increases in prevalence over the past two decades.7 There is also some evidence that the rising rates of lower back pain may be in part caused by lifestyle changes. People now spend most of their waking hours sitting, whether they're working at a desk or watching TV.8
Long periods of staying in the same position can be a major contributor to both acute and chronic back pain.9 Sitting for extended periods of time may also have other negative effects on long term health, such as increased risk of obesity, diabetes, heart disease, and early death.8
Reducing Lower Back Pain in the Workforce
What is Lower Back Pain?
Low back pain, or LBP, is usually defined as pain, muscle tension, or stiffness below the lower edge of the chest (costal margin) and above the buttocks. The pain can be classified into two general types, specific and non-specific. Specific LBP is defined as having a particular and identifiable root cause, such as arthritis, inflammation, or osteoporosis. Non-specific LBP does not have a known anatomical cause as an origin.
What causes back pain?
Back pain can be caused by a variety of factors including strain, injury, congenital conditions or more serious medical issues, such as ruptured discs. This can result in conditions that are either chronic, defined as pain lasting three months or longer, or acute. Acute causes of back pain may be from specific incidents, such as falling or lifting a heavy object. This can cause ligament and muscle strains that can lead to debilitating, but usually short term pain. The most commonly reported causes of LBP include:
- Prolonged sitting (at desk, driving, etc.)11
- Operating a machine that vibrates11
- Injuries relating to lifting heavy loads11
- Stress & anxiety19
As is evident from this list, back pain can be related to a wide range of activities and occupations, from office worker to construction worker. This may be part of the reason why it has become such a common problem and represents such a large portion of work related disability claims.
Preventing back pain - There are a wide range of activities that may help reduce and prevent back pain. Healthy lifestyle choices, care when sitting and regular exercise and physical activity can often reduce back pain, or even stop it before it starts. Some techniques that could help reduce the risk of developing back pain include:
- Exercising - Staying active reduces obesity (a major contributor to back pain), strengthens muscles (making injury from lifting less likely to occur), and reduces inflammation (easing pain). It is one of the most effective ways to prevent back pain as well as increase overall health.
- Eating well - Obesity is one of the major contributors to rising rates of back pain. Eating moderate, well balanced meals can help maintain a healthy weight and reduce back pain and other health problems.
- Quitting Smoking - Studies show that smokers are more likely to develop chronic back pain than those who do not smoke.12 Educating employees about the risks of smoking can help reduce back pain and improve overall health.
- Proper lifting - Lifting heavy loads can lead to overly strained back muscles. Use proper lifting techniques such as using leg strength, rather than back strength.
- Workplace safety - Workplace accidents such as strains, falls, and car accidents can lead to injuries that result in back pain. Make safety a priority at your company to reduce the risk of potentially dangerous incidents.
- Walking and standing - Sitting for prolonged periods causes back pain.9 If employees work at desks, encourage them to take regular five minute breaks and walk around the office or stand up while on the phone instead of staying in their chairs all day.
Methods of treatment - Most back pain does not require surgery. It can often be treated with medications and physical therapy. An effective program for treatment of pain includes:
- Active exercise therapy - A range of exercises and physical therapy techniques may be effective at reducing and even eliminating back pain. Strengthening exercises for back muscles and core muscles can help reduce pain and prevent injury from occurring.13 Beyond the exercise of superficial muscles through classical strength training, though, the focal point should also include the activation of deep core muscles and the mobilization of the spine. Low impact aerobic conditioning can help with long term pain reduction.
- Home based exercises - Home based exercises have been shown to act as a complement to physical therapy, helping to increase their effectiveness.13
- Lifestyle changes - Weight loss, a more active lifestyle, and increased safety awareness can all help reduce back pain and prevent injury from occurring. Educating employees about back pain and risk factors is among the most important steps in reducing rates of lower back pain.
- Passive therapy - Modalities such as ice packs, heat packs, and ultrasound are often able to reduce pain associated with back injuries temporarily.
Adherence is key-
Physical therapy techniques and home based exercises rely on strict adherence to be effective. Adherence to home exercises shows a moderate, positive correlation with the reduction in average pain and a tendency for greater reductions in disability.13
However, traditional exercises are often considered monotonous, which has been found to lead to preemptive discontinuation, particularly when done at home.14 This has significantly reduced the effectiveness of treatment programs, as many recurrent cases of low back pain could have been avoided if patients had adhered to their home programs.15, 1
Improve adherence and outcomes with gamification-
Up to 70 percent of all patients do not consistently adhere to their home based exercise program.17 This may be having a major effect on the programs' outcomes. The monotonous and boring nature of many effective back movements and exercises decreases one's motivation to exercise, despite the known benefit. There are exercise videos and app's out there to help and motivate the back pain sufferer.
However they lack in engagement. One way to increase adherence is through gamification. This makes exercising more stimulating and less monotonous, increasing the likelihood that patients will actually do it. Research shows that back pain sufferers will exercise two times longer using game therapy than using normal techniques.18 Given the importance of adherence in physical therapy, this could translate to significantly improved outcomes for patients.Based on research found in studies it is understood that the use of game therapy:
- Increases adherence to exercise treatment 18
- Can positively affect treatment effectiveness 17
- Can positively increase average pain reduction, as well as costs 13
About the Authors
Curt Finckler, Manager of Consumer business with Hocoma, works passionately toward improving employee back health through the addition of the innovative wearable device Valedo within workplace wellness programs. With an extensive background in medical device and OTC medicine business development and marketing he holds a thorough understanding of healthy living and corporate wellness.
Rogier Keemink, Associate Product Manager with Hocoma, uses his knowledge as a former physical therapist, his passion for incorporating technology into back therapy and his product management skills to successfully create and launch, together with the Valedo team and medical experts, a new solution to help people suffering from back pain, called Valedo.
Rogier moved from the Netherlands in 2010 to Switzerland to aid with the development of the physical therapist version of back therapy, called ValedoMotion. In 2013 made the transition to product management and joined the Valedo team to bring the Valedo for home use on the market.
Hocoma is the global market leader for the development, manufacturing and marketing of medical devices for functional movement therapy. The company improves people's quality of lives with unique combinations of movement and advanced medical technology. Hocoma's newest product, Valedo, offers a personal medical device for the low back that combines physical sensors with sophisticated, yet intuitive software to help non-specific low back pain sufferers achieve sustained back health. Valedo transforms biomechanical exercises developed by physical therapy professionals into fun, interactive games presenting direct feedback for tablets and smartphones. Research shows that back pain sufferers home exercise for treatment on average 2 times longer using game therapy, like Valedo.18
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 Witters, Dan et al. Depression Costs U.S. Workplaces $23 Billion in Absenteeism. Gallup. July 24, 2013. http://www.gallup.com/poll/163619/depression-costs-workplaces-billion-absenteeism.aspx. Accessed March 2014.
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