Expenditures for nonspecific back injuries in the workplace

Costs associated with work-related back disability have been increasing. Worker's Compensation claims in Tennessee, finalized during 1986, were studied. There were 29,421 claims costing $160 million. Medical expenses generated 40 percent of the total cost of claims, with the remainder attributed to lost work time. Claim analysis revealed 27 percent involved back injuries, and 90 percent of these showed no objective evidence of muscle or bone impairment and were classified as nonspecific. These nonspecific back injuries accounted for 40 percent of the total cost of Worker's Compensation claims. The median interval for return to work was 31 days, but the average for the group was 72 days, indicating a highly skewed distribution. The 10 percent with the highest claim cost accounted for 57 percent of the total expenditure for Worker's Compensation claims. This study, along with other studies cited by the author, suggests that the current system of back-injury assessment and treatment contributes to the very high costs of nonspecific back-injury. There is a marked contrast between relatively low costs when a person returns to work soon after the injury, and very high costs for those who do not return for 90 days or more. The financial data presented here support the need for a reappraisal of the clinical management of nonspecific low-back pain. It has been suggested that the patient be given more responsibility for his progress, that medical management be focused more on rehabilitation than on rest, and that an early return to work is both desirable and appropriate.