Your back pain programs may not be effective: Use these strategies

Stretching and exercise are proven solutions

Back injuries are the most frequent source of workers' compensation claims nationally, accounting for one of every five claims, according to the National Council on Compensation Insurance. The average cost of each claim is about $13,300.

"As the workforce ages, companies may find an increase in the number of workers experiencing back pain," says Clete Lewis, corporate director of environmental, health and safety for Madison, NJ-based Quest Diagnostics.

Your employer probably spends a significant amount of money and resources to prevent work-related back pain, such as training programs to teach specific lifting methods.

However, a new review of 11 studies involving more than 18,000 employees suggests that these methods may not be effective in reducing disability claims or sick leave.1 According to the researchers, a possible explanation for the findings could be that "safer" lifting techniques don't really exist or that back pain might not be caused by lifting or moving heavy objects.

"Undoubtedly, companies are wasting money on ineffective approaches to low back pain prevention," says Christopher Maher, associate professor of physiotherapy at the University of Sydney in Australia. "It is important that people look long and hard at this review."

Work-related low back pain is a "public health disaster," says Maher. "The solution to this health problem will only come about if government and industry fund research to address it. At the moment, low back pain is not a high priority for research, and that is a key reason why we are in the mess we are in," he says.

There are "many unknowns" about low back pain, adds Maher. "For many people, we cannot identify the incident that caused their low back pain, and for 90% of people, we cannot identify the structure in their back that is causing the pain," he says.2 Until more is known about back pain prevention, occupational health professionals should "do the only thing that has been shown to be effective," advises Maher: Provide a work-site exercise program. "Every trial that has tested this intervention has shown that it is effective," he says.3

Collene Van Mol, an occupational health nurse at RoyOMartin in Alexandria, LA, says, "Prevention of low back pain is indeed a challenge for us, as it is for employers of all sizes." RoyOMartin is a wood products company with approximately 1,200 employees at eight sites. RoyOMartin has seen a 46% decrease in low back injuries since 2002, reports Van Mol. "I believe providing a safe work environment, continually raising the level of awareness, and promoting personal responsibility for coming to work healthy and fit have made a tremendous difference in employees' working safely," says Van Mol. To reduce work-related back pain, use these strategies:

  • Screen newly hired employees.

RoyOMartin's employees are given annual training on back injury prevention, safe lifting techniques, and the importance of proper body mechanics, says Van Mol. "Actually, we begin training employees on back health and safety before their first day at work," she says.

New hires at RoyOMartin go through a "post-hire, pre-placement functional test" before the first day of work. Employees are asked to perform various physical tasks in a simulated work atmosphere to determine if they can safely perform the essential functions of their position, says Van Mol.

Occupational and physical therapists perform the screenings at local physical therapy centers and at the same time, teach employees proper lifting, pushing, and pulling techniques, says Van Mol. "Employees often refer to what they learned in these sessions," she says.

At Waterbury, VT-based Green Mountain Coffee Roasters, all new hires attend ergonomics classes during their first week of employment, says spokeswoman Sandy Yusen. "After that, the physical therapist and ergonomics expert set up one-on-one sessions with employees to evaluate specific workstations," she says.

  • Offer programs specifically for back pain.

Cisco, a San Jose, CA-based provider of Internet solutions, is developing a disease management program specifically for musculoskeletal pain, according to Pam Hymel, MD, the company's corporate medical programs director. An occupational health nurse helps employees manage their condition with healthier eating, exercising, taking medications properly, and managing stress, says Hymel.

In addition, a telephone health coaching program is being implemented for employees who identify on a personal health assessment that they have back pain. Nurses, registered dieticians, and exercise physiologists contact employees at their convenience via phone or e-mail, says Hymel. "While in general our employees don't report significant problems with back pain, our second highest medical claim cost is musculoskeletal pain," adds Hymel.

  • Ask employees to stretch before work.

Exercise programs that emphasize strengthening and stretching can help reduce back pain and perhaps prevent the conditions that cause it, says Lewis. "Many of our facilities have on-site walking clubs whose members walk daily or near daily," she notes. "While we have not studied the issue, we believe promoting fitness among our employees will help them to be healthier and more productive."

Before every shift, employees at Green Mountain's plant and distribution center take part in a five-minute "industrial athlete" stretching program. "The program was created by a yoga instructor, a physical therapist, and a cross-functional team of employees," says Yusen. "This is done with the goal of reducing the risk of on-the-job injury."

RoyOMartin is piloting a workstation stretching program, says Van Mol. An occupational therapist analyzed each job position and developed warm-up stretching exercises for employees in all departments, she says. "We will soon begin training all employees on the stretching exercises specific to their workstation. Supervisors will lead daily stretches and keep employees motivated," says Van Mol. "It will be interesting to see the impact this will have on the incidence of low back pain experienced at work."

  • Observe employees doing physical tasks.

At Golden, CO-based Coors Brewing Co., physical therapists observe employees working in production areas and offer advice on how to prevent injury, says Christine McCallum, MPT, physical therapist at the company's wellness center. "Employees can request this or safety might look at some numbers and tell us that musculoskeletal injuries have been a problem for a certain area," she says. "We look at the job and find the risk factors to that particular job." For example, McCallum recently advised workers to front-load a drying machine instead of side loading.

After each training session, McCallum says she sees increased numbers of employees exercising in the wellness center. "The biggest thing to overcome is the attitude of 'My job is already hard work. I don't need to work out,'" she says. "I explain that they need to be stronger to avoid injury or strain, and if they do get injured, it's much more quickly healed."


1. Martimo KP, Verbeek J, Karppinen J, et al. Manual material handling advice and assistive devices for preventing and treating back pain in workers. (Review). Cochrane Database of Systematic Reviews 2007, Issue 3. DOI: 10.1002/14651858.CD005958.pub2.

2. Koes BW, Van Tulder MW, Thomas S. Diagnosis and treatment of low back pain. BMJ 2006; 332:1,430-1,434.

3. Maher CG (2000): A systematic review of workplace interventions to prevent low back pain. Austr J Physio 2000; 46:259-269.


For more information on prevention of work-related back pain, contact:

  • Clete Lewis, Director, Environmental, Health and Safety, Quest Diagnostics, 7814 Carolyn Drive, Castle Rock, CO 80108. Phone: (303) 779-1597. E-mail:
  • Christopher Maher, Associate Professor, Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, PO Box 170, Lidcombe, NSW 2141 Australia. E-mail:
  • Christine McCallum, MPT, Physical Therapist, Coors Physical Therapy, 1109 Ford Street, Golden, CO 80401. Phone: (303) 277-3305. Fax: (303) 277-5008. E-mail:
  • Collene Van Mol, RoyOMartin, 2189 Memorial Drive, Alexandria, LA 71301. Phone: (318) 445-7574. E-mail: