How do we bridge the gap between clinical guidelines for low-back pain and workplace lifting guidelines?

Both types of guidelines aim to reduce the incidence of LBP, but they are based on different understandings of pain and can provide conflicting recommendations, potentially confusing patients, workplaces, and healthcare providers. 

The paper uses a case study involving "Joe" to illustrate how contradictory messages can affect a worker's health and return to work after a period of sick leave. Joe worked as a welder and developed low-back pain, which led to time off work and early signs of social isolation. Medical treatment and physiotherapy showed little effect, so Joe was referred to a multidisciplinary treatment program. This program combined physical training, workplace support, and patient education, which was crucial for his recovery. 

The researchers address several issues to consider when developing guidelines for preventing and treating low-back pain among active workers, summarized in four key points: 

1. The two types of guidelines are based on different models of pain. Workplace guidelines rely on a biomedical model, focusing on reducing physical strain to prevent injuries, while clinical guidelines use a biopsychosocial model, viewing pain as the result of physical, psychological, and social factors. 
2. Recommendations about lifting and maximum load limits are designed to protect employees from excessive strain on their backs. However, there is limited evidence that lifting alone causes low-back pain. Fear and misunderstandings about back injuries can be exacerbated by recommendations to restrict lifting, potentially leading to avoidance behavior. 
3. Clinical guidelines are not comprehensive. Staying active, including an early return to work, is considered beneficial for managing LBP. However, clinical guidelines do not always account for the physical demands of the workplace, such as lifting. This raises the question of when an early return to work might be too early. 
4. Consequences of conflicting recommendations for workers. Conflicting recommendations can create confusion and frustration for workers with LBP, who may be unsure whether they should lift or avoid lifting altogether. 

To ensure consistent recommendations, the researchers propose harmonizing workplace and clinical guidelines with a focus on: 

• A holistic approach that addresses both physical activity and workload.
• Positive communication to avoid fear and misunderstandings about back injuries.
• Close collaboration between clinicians, employers, and workers to create flexible and individualized solutions.

Michiel F. Reneman, Pieter Coenen, P. Paul F. M. Kuijer, Jaap H. van Dieën, Andreas Holtermann, Chinonso Nwamaka Igwesi-Chidobe, Romy Parker, Roland Reezigt, Mette J. Stochkendahl, Morten Hoegh. Tensions of Low-Back Pain and Lifting; Bridging Clinical Low-Back Pain and Occupational Lifting Guidelines. Editorial, Journal of Occupational Rehabilitation 2024.