Pain of spinal origin forms the basis for an extremely high number of workcover claims. No condition is responsible for more time off work, more cost in terms of lost revenue, and more psychological upset than back pain. No condition is less suited to be covered by workers compensation claims than back pain. Except for very rare instances where a work injury has caused a fracture in the spine, or an acute disc prolapse in a previously normal disc, most work injuries causing back pain simply represent an aggravation of some underlying degeneration.
It is imperative that any person with a workcover claim for back pain read the pages on spine anatomy and mechanics and the causes of back pain and radiculopathy. Without reading these pages it is impossible to understand how workcover claims get handled, assessed and treated.
When the underlying degenerative process has been aggravated at work, even if the patient has never had symptoms before, it is very hard to distinguish between what proportion of the symptoms are due to the underlying degeneration, and what are due to the work event. When a suitable period of time has elapsed for the effects of the aggravation to cease (often 4-6 months) it is usually reasonable to assume that ongoing symptoms are due to the underlying degeneration. At this time most workcover institutions consider the work-related component to be stable and stationary and liability is ceased. This however does not mean that no more treatment is required - merely that no more is required for the work component. More often than not patients do remain symptomatic after this period of time and find it hard to accept that the liability of workcover is over. Often it is in the best interest of the patient that the work-related component gets sorted out and finalised as soon as possible so that necessary and definitive treatment can be instituted before the symptoms become permanent.
To this end, at South Coast Spine, a dedicated workcover clinic operates twice monthly on alternate Wednesdays in conjunction with specialists from CORE Injury Management. This clinic by virtue of early intervention, education and management has now an unprecedented rate of over 90% of returning injured workers to some form of gainful employment. It also rapidly sorts patients who require surgery from those who do not and prevents spinal injured patients from being unfairly assessed by non-spinal specialsts.
Patients generally fall into three categories:
1. Those that do not require surgical intervention but simply education, and management in the form of physical therapies and occupation rehabilitation. These patients are almost universally managed by CORE Injury Management. Examples are muscle strains, aggravations of long-standing arthritic pain, aggravations of long-standing degenerative disc pain, minor whip-lash injuries etc.
2. Those that do not require require surgery to manage the work injury/strain but will predictably require surgery in the future to manage the underlying condition (usually degenerative). These patients are managed in the short term by CORE Injury Management but are kept under observation by myself until such time is appropriate to consider surgical intervention. Examples are patients with 2 or 3 level disc disease who predictably in the future will need disc replacements or fusions but whose immediate problem is a acute episode to one of those discs. Another example is a severe whiplash injury which often shows no sign of real damage until 18 months or 2 years after the accident. Such patients are STRONGLY advised to take out private health insurance as third party insurers are not required under the current legislation to pay for treatment for underlying degenerative conditions.
3. Patients who obviously require surgery before it is possible to rehabilitate them. Examples include acute disc prolapses with neurological defecits or vertebral body fractures which are unstable. These patients are managed by myself and then rehabilitated with CORE Injury Management.
