A systematic review on acute low back pain (0-6 wks) showed that the following factors were negatively associated with return to work:

1) Poor recovery expectations

2) Radiating pain into leg

3) Severe pain (self reported)

4) High disability (self reported)

5) Physically demanding work

6) Older age

7) Females

8) Social isolation

9) Receiving a high level of compensation

So after reading these 9 factors, what is a PT to do to help return patients with acute LBP back to work? Which one of these 9 factors can we positively influence?

I suggest starting with the only factor that we have a chance of changing which is factor #1: Recovery expectations.

After an acute LBP episode, generally the sooner a patient returns to regular duty work, the better. I therefore assumed that if patients cannot return to their regular duties within 6 weeks of their injury, then returning to some kind of modified/light duties would obviously be better. However, this review concludes that there is moderate evidence that early return to work to light duties may actually prolong sick leave in some workers, which seems counterintuitive.

Perhaps “forced” return to light duties should not be used too early in the course of acute LBP. However, after 6 weeks (during the subacute and chronic phase), the studies do support return to light duties work IF regular duties is not yet possible!


Reference: Steenstra I et al Prognostic factors for duration of sick leave in patients sick listed with acute low back pain: a systematic review of the literature. Occup Environ Med. 2005 Dec; 62(12):851-60.

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