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Back to normal: Why fire departments need back-injury programs

The day started out as any normal day with reports to be written and budget to be reviewed but by mid afternoon my back started to cause me some discomfort. No big deal; a couple of ibuprofen and business as usual. Unfortunately, by 9 p.m., the lower-back pain was past the stage of discomfort and a personal journey of severe lower-back pain was set in motion.

The first week of this acute episode is an experience I do not want to go through again. A position of comfort was non-existent and numerous times I found myself on the floor on my hands and knees trying to find a position that would not cause tears in my eyes. An X-ray was required to help in the diagnosis; four prescription medications were necessary to minimize the spasms, inflammation and pain, and daily visits to my chiropractor for two weeks helped me feel human. Feeling human again and being able to bend over are two different things and an additional two weeks of treatment and guidance from my chiropractor was required before I really felt healthy again.

Did you know that four out of five Canadians will have at least one episode of back pain in their lives? It is estimated that back pain causes $100 billion in annual health-care costs in North America and one in five Canadians will be disabled by it.

Firefighters can experience back pain due to repeated motions, long-forgotten injuries or the strain of wearing and carrying equipment.

In North America, back pain has become the second-leading cause of physician visits and ranks second for the use of prescription and non-prescription drugs. In a profession that places significant demands on the musculoskeletal system, more significantly the back, we need to get back to basics to prevent back injuries and back pain.

From 2004-2006 the Saskatchewan fire service averaged 20 back-injury claims a year, which does not sound like a great number for our province. Surprisingly, the total time-loss days averaged 668 per year with the direct costs totalling $725,631 from 2004-2006. Amazingly, the time-loss cost for workplace back injuries in Saskatchewan from 2004-2006 was a staggering $168.6 million. Back injuries accounted for $8.1 billion in health-care costs in Canada in 1995, which demonstrates that the economic burden from these injuries is significant and today’s fire service must take a leadership role in preventing back injuries.

The impact to a department, whether large or small, can be significant if a firefighter suffers from either acute or chronic back pain. The effects on sick time, worker’s compensation costs, department overtime and staffing levels can create significant hardship on a department. Some people view back injuries as collateral damage and part of the profession but this view cannot be tolerated in today’s fire service. The high-performance fire service will promote prevention programs to minimize back injuries and, more importantly, to decrease the pain and suffering of staff.

Back pain defined

Back pain is defined as acute or chronic and is considered acute when the pain lasts for six weeks or less.

Acute, lower-back pain can be exhibited by a very sharp pain or dull ache that is felt deep within the back. Symptoms can include limited flexibility, leg radiations and/or an inability to stand straight. The affected muscles contract and spasm while the body is trying to protect itself from further injury, creating significant pain and discomfort. A person suffering from acute back pain is usually unable to work because of the limited range of motion and pain. Some individuals will experience such severe pain that it interferes with sleep.

Chronic back pain represents only one to five per cent of back pain cases and occurs if the back pain lasts more than six weeks. Chronic back pain is described as a deep, aching or burning pain in the area of the lower back that may radiate down the legs. Individual suffering from chronic back pain may experience pain while sitting too long in one position, driving, or during periods of bending, lifting, or other physically demanding work. Unfortunately, those suffering from chronic back pain may suffer mild depression as a result of living with constant pain and limited activities.

Causes of back pain

The cause of back pain is not always evident and about 85 to 90 per cent of individuals suffering from back pain will not be able to identify the cause of the pain. Most of these back injuries are a result of the normal wear and tear of life or the result of cumulative injury (months or even years of repetitive or awkward movements such as bending, twisting or carrying heavy objects on unstable ground). Sprains and strains in the lower back are common because the spinal column is supported by large muscles called the paraspinal muscles. The paraspinal muscles support the spine and the weight of the upper body. This is a substantial mass and when these muscles are injured we are unable to perform many simple activities.
Inflammation of the soft tissues occurs when the paraspinal muscles are sprained or strained (sprain is for ligaments and strain is for muscles) and the direct result of this inflam-mation is muscle spasm. The muscle spasm can be severe, creating significant pain and forcing the individual to lie in bed for several days.

There is also some evidence that stress can cause back pain in some individuals with scar tissue from a previous injury. The spinal nerves may be restricted by the scar tissue and muscle tension brought on by stress may be all that is required to cause pain. Chronic stress causes the release of stress hormones, which creates muscle tension and painful spasms. The increased muscle tension reduces blood flow and nutrients to the tissues, resulting in a delayed healing process.

Some contributing factors to back pain are weak abdominal muscles, obesity, inactive lifestyle, and improper lifting techniques. Other causes of lower-back injuries include lifting heavy objects and twisting the back in an unusual manner, something that we see our firefighters doing on a regular basis during emergency incidents. We all know that during emergency situations personnel tend to take shortcuts to get the job done, and these are where we generally see our workplace injuries.

Those individuals with a “bad back” must exercise caution as their backs cannot tolerate even mild abuse or stress. Fortunately, over 90 per cent of people with a lower-back injury fully recover within a month.

Management of back pain

Treatment for lower-back pain varies, with the prime objective being the reduction of pain and restoration of strength and function in the back. A visit to a physician may be necessary if the back pain is severe, which will also help eliminate or diagnose a serious medical condition. A physician may prescribe anti-inflammatory drugs and muscle relaxants as initial treatment for the control of muscle spasm and pain.

A 2003 study in Canada by The Environics Research Group concluded that a chiropractor was the most popular choice for back-pain treatment. The study also indicated that there was a much higher level of patient satisfaction for chiropractor care than any other treatment, as statistically more than 69 per cent of patients were “very satisfied” and 92 per cent were “very or somewhat satisfied” with their chiropractic treatment. The other treatment scoring high in the survey for patients in Canada was massage therapy.

Chiropractic care is more than spinal adjustment or joint manipulation, and includes three components:

• Manual therapy: includes spinal adjustment, muscle testing and balancing, mobilization, traction, trigger point therapy, and deep tissue massage.

• Exercise: preventive and rehabilitative.

• Patient advice: education on prevention of lower-back injuries.

The American College of Physicians (ACP) and the American Pain Society (APS) (October 2007) provided recommendations for the diagnosis and treatment of lower-back pain. One of the key recommendations stated, “For patients who do not improve with self-care options, clinicians should consider the addition of nonpharmacologic therapy with proven benefits – for acute low back pain, spinal manipulation; for chronic or subacute low back pain, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioural therapy, or progressive relaxation.” What is interesting about the ACP/APS guidelines is the recognition of spinal manipulation and intensive interdisciplinary rehabilitation for those suffering from lower-back pain. It appears that the research methodology identified the role each profession has in the treatment of back injuries, and this may very well be the first step in decreasing the exorbitant health-care costs associated with back pain.

Return-to-work program

A return-to-work program is based on the premise that employees can perform productive work during their recovery. A return-to-work program is not for “make-work projects,” rather it is designed to provide an employee with temporary tasks that are both meaningful and productive to the department. This allows the injured firefighter to gradually work up to full-time hours and often speeds up the recovery process and provides a sense of attachment to co-workers and the department.

There is some research indicating when an employee is injured that only 50 per cent will return to work after a six-month absence, only 25 per cent will return to work after a one-year absence and only one per cent will return to work after a two-year absence. This data is not fire-service specific, but it does highlight the need for return-to-work programs. In order to be successful a return-to-work program must be a shared responsibility among the firefighter, health-care specialist and employer. With the associated costs for back injuries continuing to rise, a return-to-work program is one step in reducing the economic burden to the department, municipality, province and nation.

Conclusion

The high-performance fire service understands the difference between being reactive and proactive when it comes to back injuries. A reactive department deals with the back injuries as they occur and is uninformed about prevention programs while the proactive department recognizes the need for back injury prevention programs and embraces them as part of the department’s health and safety culture.

Daily visits to my chiropractor played a crucial part in the recovery process from my recent lower-back injury. It took four weeks to feel human again, but the treatment and guidance provided by my chiropractor helped me to understand the necessity of taking care of my back.

We need to be proactive and implement back prevention programs such as the Back Informed Program that provides education, ergonomic advice and practical exercises to maintain a healthy and fit workforce. The men and women in the fire service deserve nothing less.

References

www2.worksafebc.com/Topics/Ergonomics/RecoveringfromBackPain.asp

www.Medicalnewstoday.com/articles/42385.php

www.acponline.org/clinical/guidelines/#rpg

www.arthritis.ca

www.bigbackpain.com/stressandbackpain.html

www.ossa.com/content/resources/reducingBackInjuries.cfm

Kevin Henbid, D.C., graduated cum laude from the Canadian Memorial
Chiropractor College in 1990 and in 1995 completed his course in
acupuncture.
Les Karpluk, CFO, BAppBUS: ES is fire chief of Prince Albert, Sask., Fire and Emergency Services Department. He is a graduate of the Certificate in Fire Service Leadership and Fire Service Administration programs at Dalhousie University and graduate of the Bachelor of Applied Business: Emergency Services from Lakeland College.