THE TRUTH HURTS A Closer Look At Back Injuries In The Workforce

A WHITE PAPER PRESENTED BY

SPECIALIZING IN WORKERS’ COMPENSATION

You may be aware that our nation’s economy has improved considerably

over the last several years. While this has resulted in rising home prices

and consumer spending, it has also stimulated job growth, meaning there

are now significantly more employment opportunities throughout the

private sector.

Consider a recently released report, which indicated that the United

States added an estimated 241,000 jobs in December 2014.1 Closer

to home, this report revealed that the Mountain States gained roughly

21,000 jobs in the private sector, including 5,500 here in Colorado.2

As encouraging as this has been, it must be noted that the rate of work

injuries has remained relatively static throughout this post-recession

recovery.

To illustrate, statistics from the U.S. Bureau of Labor Statistics (BLS) that

the number of reported cases of nonfatal occupational injuries and illnesses

in the private sector stood at 3,063,400 in 2010, 3,034,500 in 2011,

3,027,600 in 2012 and 3,007,300 in 2013, the most recent year for which

such data is available.3

Chief among these rather high rates of occupational injuries and illnesses

are musculoskeletal injuries, which comprised a whopping 33 percent of

cases in 2013 alone.4 For those unfamiliar with the term musculoskeletal

injury, it is used to describe injuries to the muscles, ligaments, tendons,

joints and other structures that comprise the body’s musculoskeletal

system, and which can inhibit regular, fluid movement.

While work-related musculoskeletal injuries can occur virtually anywhere

in the body from the feet and hands to the neck and shoulders, they are

especially likely to affect the back. Indeed, BLS statistics indicate that there

were 183,100 cases involving back injuries in 2011, 178,190 in 2012 and

170,450 in 2013.5

WHY ARE SO MANY WORKERS SUFFERING SO MANY DEBILITATING BACK INJURIES?

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3,007,300INJURY & ILLNESS

CASES IN 2013

170,450BACK-SPECIFIC CASES IN 2013

If you’ve been in the workforce for any significant amount of time, it’s

highly likely that you’ve witnessed a co-worker suffer some type of back

injury. Perhaps you’ve even suffered such an injury yourself. You’ve

probably even found yourself wondering why such injuries are

so common.

The reality is that the high rate of back-related musculoskeletal injuries

among workers is attributable to a variety of events and other exposures.

However, there are at least three causes to which much of this back-

related trauma can be linked: overexertion, repetitive motion and falls.

OVEREXERTIONOne of the leading causes of back injuries among private sector workers,

overexertion involves a person exceeding his or her physical limitations

during the course of employment or, perhaps more simply put, pushing

the soft tissues of his or her body too far.

To get an idea of just how common overexertion injuries

are, consider that Liberty Mutual Research Institute for

Safety’s 2014 Workplace Safety Index ranked them as

the leading cause of workplace injuries lasting a

minimum of six days in 2012.6 Furthermore, BLS data

shows that there were 322,310 cases of “overexertion

and bodily reaction” injuries, and 107,910 cases of

“overexertion in lifting and lowering” in 2013.7

Overexertion injuries resulting in back trauma are typically

related to otherwise mundane physical activities like lifting,

bending, pushing, pulling, carrying, throwing or bending at the waist.

By way of illustration, consider a nurse who hurts her back while moving

a patient from a gurney to a hospital bed, a warehouse worker who hurts

his back pulling a heavy object in the absence of any mechanical assistance

or an office worker who hurts her back bending over to reach a tangle of

computer cords.

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COMMON CAUSES OF BACK INJURIES ON THE JOB

OVER EXERTION IS THE NO. 1 CAUSE

OF WORKPLACE INJURIES

REPETITIVE MOTIONRepetitive motion injuries result when a worker engages in

uninterrupted strenuous physical activity and/or uninterrupted awkward

physical motions that push the soft tissues of the body beyond its limits.

Liberty Mutual’s 2014

Workplace Safety Index

ranked repetitive motion

injuries as the ninth-

leading cause of

workplace injuries

lasting a minimum

of six days in 2012,8

while BLS data

reveals there were

24,420 cases of

injuries related to

“repetitive motion involving

microtasks” in 2013.9

Repetitive motion injuries resulting in back trauma can typically be

attributed to activities involving bending, twisting or reaching. While

these activities often don’t cause injury when performed carefully and

sparingly, they can cause temporary or even permanent damage if they

are performed hour-after-hour, day-after-day, week-after-week or

even year-after-year.

Examples may include an assembly line worker who hurts his back packing

medium-sized items into crates all day long, twisting to pull them off the line

and then bending over to put them in position. Similarly, consider an office

worker who hurts his back after being forced to answer phone calls year

round without a headset, keeping a phone pinned to his ear with his

shoulder and stooping over to type notes.

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REPETITIVE MOTION INJURIES ARE THE 9TH-LEADING CAUSE OF WORKPLACE

INJURIES

FALLS Both falls on the same level and falls to lower levels are another leading

cause of back-related musculoskeletal injuries among workers.

Liberty Mutual’s 2014

Workplace Safety Index

ranked falls on the same

level and falls to lower

levels as the second-

and fourth-leading

causes, respectively,

of workplace injuries

lasting a minimum of

six days in 2012.10

BLS data also shows

there were 141,060 cases

of injuries related to “falls

on same level” and 47,120 cases

of injuries related to “falls to lower

level” in 2013.11

The causes of fall injuries resulting in back trauma vary from slipping,

tripping or falling on cluttered, wet or uneven walking surfaces to

tumbles from improperly positioned ladders, or into improperly secured

holes in floors and walls.

To illustrate, imagine a construction worker who hurts his back after falling

through a floor opening that wasn’t properly marked off, or an office worker

who hurts his back slipping on a wet floor en route to a meeting.

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FALLS ON THE SAME &FALLS ON LOWER LEVELS

ARE THE 2ND & 4TH LEADING CAUSES OF WORKPLACE

INJURIES

ATLAS ( C1)AXIS ( C2)

C3

C4

C5

C6

C7

CERVICALVERTEBRAE

THORACICVERTEBRAE

LUMBARVERTEBRAE

SACRUM

COCCYX

T1T2T3T4

T5T6T7T8T9

T10T11T12

L1L2L3L4L5

1

2

3

Now that you are familiar with three of the leading causes

of back-related musculoskeletal trauma among workers,

it’s time to examine three of the more common types of

these injuries: strains and sprains, and herniated discs. This

examination, however, must be prefaced by an examination

of the structures of the back itself.

THE SPINE: THE COMPLEX ANATOMY OF A MOVING MACHINEIn general terms, the spinal column is composed of 24 small

bones known as vertebrae, which stack one on top of the

other and together form the protective hollow column

through which the spinal cord runs.

These vertebrae are divided into three distinct regions.

Starting from the top, the first seven vertebrae — located in

the neck area — are known as the cervical vertebrae. These

are followed by the next 12 vertebrae — located in the chest

area — known as the thoracic vertebrae and the final five

vertebrae — located in the lower back area — known as the

lumbar vertebrae.

Situated between each of these 24 vertebrae are

gelatinous discs that serve as a sort of shock absorber and

which prevent the vertebrae from rubbing against one

another. Each of these vertebrae is held together by facet

joints that enable bending and moving, and ligaments that

serve to prevent excess movement by these same joints.

Finally, the muscles of the body are attached to the spinal

column via tendons, while 31 pairs of nerve roots branch

off the spine in the spaces between the vertebrae. These

nerve roots are responsible for carrying the messages

transmitted by the brain via the spinal cord.

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THE SPINAL COLUMN

COMMON TYPES OF BACK INJURIES ON THE JOB

(CONTINUED)STRAINS AND SPRAINSWhile you’ve likely heard the terms sprain and strain used

interchangeably in the context of back injuries, they are actually

two very distinct conditions. In the former, the ligaments

between the vertebrae are either stretched or

torn, while in the latter, the muscles and tendons

connected to the spine are either pulled or torn.

Workers typically sprain their backs

because of a sudden twisting motion, fall or

other traumatic event that moves the facet

joint outside its normal range of movement.

Conversely, workers typically strain their

backs because of either single events that

place an undue amount of stress on the back

muscles or ongoing, repetitive movements

that take a cumulative toll on the back muscles.

To illustrate, consider a worker who suddenly loses

his footing after tripping on an uneven warehouse

floor surface, wrenching his back in an attempt to regain

balance, or a retail worker who hyperextends her back muscles

while reaching overhead to retrieve merchandise.While sprains and strains can often

be treated effectively via rest, ice,

compression and over-the-counter

anti-inflammatory drugs, they can

sometimes prove to be very severe,

necessitating physical therapy or

even surgical intervention. Some-

times these interventions don’t

prove to be enough, however, as

workers are diagnosed with chronic

back pain, a condition that can side-

line them for months, years or even

keep them out of work altogether.

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HERNIATED DISCSIn the discussion of the anatomy of the spine, we mentioned the gelatinous

discs located between each of the 24 vertebrae in your spinal column. This is a

rather complicated feature of the spine. However, a helpful way to think about

the structure of these discs is to envision a jelly doughnut complete with a soft

jelly center and a harder exterior designed to keep this jelly contained.

When a disc is herniated, it means that this soft jelly actually protrudes from

the center through cracks that have developed in the exterior of the disc.

While it’s possible that this condition — sometimes referred to as a slipped

disc, bulging disc or ruptured disc — won’t even register to some, it can

irritate or put pressure on the surrounding nerves resulting in

weakness or tingling in the extremities.

For example, if a herniated disc is located between

the cervical vertebrae, a person may experience

intense pain radiating through his or her

shoulder and arm. Similarly, if a herniated disc

is located between the lumbar vertebrae

— the most common location of herniated

discs — a person may experience intense

pain radiating down through his or her leg, a

condition known as sciatica.

Workers typically suffer herniated discs

thanks to overexertion. However, repetitive

motion tasks involving pushing, pulling, bending

and twisting, as well as falls are also to blame.

Treatment for herniated discs varies from medication

and physical therapy to surgical intervention. This surgical

intervention might involve a microdiscectomy, which consists of

removing the portion of herniated disc, or spinal fusion, which consists of

removing the disc entirely and joining the vertebrae with metal hardware.

As with sprains and strains, the prognosis for workers who suffer herniated

discs varies with some returning to work in a few weeks, others needing

significantly longer recovery times and still others unable to return to

employment in any capacity.

If a herniated disc

protrudes far enough

to pinch a nerve, something

known as radicular pain

can result, meaning pain

in other parts of

the body.

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(CONTINUED)

While it’s certainly true that workers in more labor-intensive industries

see higher rates of back-related musculoskeletal injuries, it’s important to

understand that they can and do occur across a host of other industries.

Consider these very telling figures from the BLS outlining

the incidence rates of certain musculoskeletal injuries —

including sprains, strains, tears, herniated discs and

pinched nerves — within several major

private sector industries in 2013.12

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THE RATES OF BACK INJURIES ON THE JOB

50.2HEALTH CARE AND

SOCIAL ASSISTANCEWORKERS PER 10, 000

80.3TRANSPORTATION

AND WAREHOUSING WORKERS PER 10, 000

41.9CONSTRUCTION

WORKERS PER10,00041.8

RETAIL TRADEWORKERS PER

10,00036.1MANUFACTURING

WORKERS PER10,000

13.3PROFESSIONAL AND BUSINESS

SERVICESWORKERS PER

10,000

INCIDENT RATES BY INDUSTRY

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While a back-related musculoskeletal injury can incapacitate workers either temporarily or permanently,

workers’ compensation benefits can provide those in these unenviable positions with much-needed peace

of mind.

The bad news, of course, is that employers or insurance companies will often try to deny workers’

compensation claims stemming from back-related musculoskeletal injuries, perhaps arguing that it’s

unrelated to the underlying workplace accident or is not as serious as the injured worker is claiming.

Fortunately, the workers’ compensation system in Colorado is structured in such a way that an injured

worker can refute these types of claims regarding the severity of his or her injury, his or her ability to

work or his or her injury being nothing more than a temporary aggravation of a pre-existing condition.

Specifically, he or she is afforded the opportunity to present facts and other medical evidence in a hearing

held before an administrative law judge.

1 Mark Harden, Colorado Gains 5,500 Private-Sector Jobs in December, Denver Business

Journal, Jan. 14, 2015, http://www.bizjournals.com/denver/news/2015/01/14/colorado-

gains-5-500-private-sector-jobs-in.html.2 Id.3 U.S. Bureau of Labor Statistics, Occupational Injuries and Illnesses: Industry data, at http://

data.bls.gov/timeseries/IIU00000000061100 4 Press Release, U.S. Bureau of Labor Statistics, Nonfatal Occupational Injuries and Illnesses

Requiring Days Away From Work, 2013, 1 (Dec. 16, 2014), http://www.bls.gov/news.release/

pdf/osh2.pdf.

5 U.S. Bureau of Labor Statistics, Nonfatal cases involving days away from work: selected

characteristics (2011 forward), at http://data.bls.gov/timeseries/CSU00X32XXXX6P1006 Top 10 Causes of Workplace Injuries, Insurance Journal, Jan. 16, 2015, http://www.insur-

ancejournal.com/news/national/2015/01/16/354285.htm.7 U.S. Bureau of Labor Statistics, supra note 4, at 13.8 Top 10 Causes of Workplace Injuries, supra note 6.9 U.S. Bureau of Labor Statistics, supra note 4, at 13.10 Top 10 Causes of Workplace Injuries, supra note 6.11 U.S. Bureau of Labor Statistics, supra note 4, at 13.12 Id. at 7.

BACK INJURIES AND THE NEED FOR WORKERS’ COMPENSATION BENEFITS

SOURCES