Returning to work after an episode of low back pain

How can an Occupational Therapist help?

by Pauline Robinson – Occupational Therapist & Certified Yoga Instructor

Evidence-Based Therapy Centre – Galway

 

Meet Peter

Peter is a 48-year-old man who works as a builder in the construction industry. He has had a ‘bad back’ for years. Peter put this down to the heavy lifting demands of his job. He typically can do his job despite the achiness he feels in his mid and low back. He pushes through the pain and sometimes takes non-prescription pain killers to help get him through his day.

While lifting a heavy unit at work, he felt a sharp pain in his low back that became more intense and his legs gave way from under him. He left work that day and expected that his condition and mobility would improve after a few days of rest. This had happened before, without any long-term pain.

Unfortunately, Peter had ongoing low back pain for the following 6 months. Peter had a course of physiotherapy treatment which helped him improve his strength and flexibility. Unfortunately, his pain did not reduce. Peter describes the pain as ‘aching’ and ‘throbbing’ and now tends to travel down his legs over his knees. Peter tried going back to work, however he has not been successful due to pain flare-ups and reduced mobility.

Pater has tried heat, ice, paracetamol, nurofen and a back support without much pain relief. He is having difficulty sleeping. He is starting to think that his pain will never get better. He is feeling under pressure due to the financial strain of being out of work. Peter tries to get out for a walk every day, but he has been finding it more difficult to motivate himself to do this over recent weeks.

 

Why did Peter get referred for Occupational Therapy?

Peter returned to his family doctor for a review. Peter was not keen to take stronger pain killers, as he has never liked taking medication of any type. Peter’s family doctor suggested that he consider getting input from an occupational therapist to guide him in better managing his ongoing pain, to see if he could be helped in doing every day tasks with less pain and fatigue and to see if he could be helped with getting back to work.

 

What is an Occupational Therapy Assessment?

The assessment started with a discussion where Peter was encouraged to tell his story; how the injury happened, the rehabilitation he has received to date, the things he struggles with daily, a description of his work environment and what his main concerns and goals are at this stage.

Peter’s general movement was then looked at including his ease in walking, standing, bending to pick something from the floor and reaching.

Peter was also asked to complete some questionnaire’s that provides more information on how his pain condition is affecting his life and to gain a full understanding of how Peter’s injury is affecting his mood and relationships.

 

What are the things the Occupational Therapist can help Peter with?

The OT sessions were focused on Peter’s priorities, values, and goals. Peter was unsure how to set goals, as this was new to him. The OT helped guide Peter in deciding what was most important to him in his life and what he wanted to achieve in the coming week, month and 3-6 month time frame. The most important thing for Peter was being able to get back to full-time work. He wanted to complete household tasks that he had stopped doing because of his pain; particularly cutting the lawn and taking out the rubbish. He also hoped to be able to go out for dinner with his wife, which he had not been in the form for since his injury.

Pain Education

Peter was helped in understanding what is happening in his body and nervous system when pain persists for longer than 6 months. Factors that are known to play a role in chronic pain are introduced; with a focus on identifying specific factors that may be relevant for Peter. Research has found that gaining an understanding of what happens in the body and nervous system when pain persists can significantly help reduce pain and improve function and quality of life.

 

Movement

Peter was introduced to specific stretches and strengthening movements to complete at home daily. Peter had a membership to the local pool which he had not used since before his injury. He stated that he liked to swim but was unsure if it was safe for him to do anymore. The OT provided him with a series of movements and stretches to do in the pool. Peter was happy to be able to start going back to the pool and started to go twice per week. While he was not yet swimming in the pool; he liked the low impact nature of the water and enjoyed doing a portion of his ‘movement health’ programme in the pool. It is hoped that as Peter builds more confidence and physical endurance that he will be supported in gradually returning to swimming.

Peter was supported in beginning a daily walk. This was chosen as an activity as Peter felt like he was not leaving the house much anymore and he was also feeling bad that the family dog was not getting a walk as often as he needed. The OT helped Peter figure out how many minutes of walking he could comfortably complete and then guided him in gradually increasing the time and distance week by week.

Once Peter had built up his endurance, the tasks of cutting the lawn and taking out the rubbish were included in Pater’s short-term goals for the week. Peter was guided in how to modify and pace these tasks to aid his success.

 

Planning and Pacing

Peter was helped in planning his day and week to get a balance between activity and rest. This helped in minimising pain flare ups and allowed Peter to get an understanding of how he could modify a task to aid his success. For example, Peter found that if he cut the lawn in sections and gave a rest day in between, he could manage to cut most the lawn. This helped build Peter’s confidence in his ability. Use of planning and pacing allowed for a gradual increase in activity in a graded manner; which is the most beneficial way of increasing activity when recovering from chronic pain.

 

Breathing Techniques

Peter needed some help coping with the stress he was feeling. He was frustrated with the length of time his recovery was taking and he was worried about what his future would look like if he didn’t get better. He was also under financial strain which he found came into his head when trying to sleep at night. Peter was coached in using breathing (longer, slower inhales and exhales) as a technique to help calm his body and mind.

With practice, Peter found that breathing practices helped to make him feel more relaxed and gave him a break from the constant worry he was feeling. He also found it useful to do before bed to help prepare for sleep.

 

Support to Return Work

As Peter progressed in his rehab, the sessions become more focused on preparing for a successful return to work.

The OT talked with Peter’s employer to determine the supports that could be put in place to help Peter get back to work. Peter’s employer was keen to have some help from the OT as he wanted to get Peter back to work due to his years of experience in the industry and reliability as a worker.

The OT met with Peter and his employer at the workplace to look at typical tasks that Peter is responsible for at work. Peter was coached in ways he could do some of the more challenging tasks differently. Based on the OT recommendation, the employer provided an industrial trolley to minimise lifting of heavy weights throughout the day.

A gradual return to work plan was agreed upon with Peter and his employer- this means that a modified schedule of hours was devised for the initial four weeks of his return to work. Peter’s work hours were increased over a four-week period, to allow him to gradually become accustomed to the intensity of his work tasks and to provide him with rest opportunity after his shifts.

The OT provided support throughout the process and regularly talked with Peter and his employer to ensure there were no concerns. The OT provided advise and support when needed to help Peter manage fatigue and some of the concerns he had as his hours increased.

Long-term, Peter continued to work full-time. He modified some of the ways he completed tasks, and while he had minor pain flare-ups at times, he had the skills to manage during these periods. He continued to swim regularly and complete some basic stretches to help him maintain his physical fitness and mobility.

 

If you would like to book an Occupational Therapy session with Pauline Robinson, you can call the clinic on 091 727777 or get in touch via the contact page

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