Case 9: Back pain caused by slipped discs

Organisation

The company is a European convenience food group focused on the added-value sector of the food industry, and in particular the growing market for convenience and prepared foods both in the UK and Continental Europe. The site is a Food manufacturing site employing around 690 individuals.

Injury

A 28  year old worker, employed as a cold store operative, developed back pain that was caused by vertebral disc prolapse (slipped discs). Previously he had worked in the quarrying industry for 21 years.

Company policy

The referral criteria of individuals to the occupational health function is as follows:

• Sickness absence or 8 or more calendar days
• Absence review as per trigger points for short term and long term sickness absence as per policy
• On the day of an industrial injury, or as soon as possible
• On the first day of absence if it is possibly work related
• Should managers have concern regarding an employee’s fitness to work.

Intervention

The case was referred to the company’s Occupational Health Department (OHD) as the employee reported to the company’s absence line that he was suffering from back pain - a trigger for referral due to the manual nature of his job and the cold environment in which he worked, both factors known to exacerbate musculoskeletal disorders.

The employee was visited at home by his department manager and a representative from OHD. The employee resided in a flat above ground floor and was unable to get in and out due to the stairs. He had consulted his GP and been prescribed some  analgesics and muscle relaxants and was put on the waiting list for physiotherapy. On investigation it transpired that it was likely to be 6-8 weeks before he would be assessed by the NHS physiotherapist. The company agreed to fund private physiotherapy until NHS treatment was available. He was also given extensive lifestyle advice and exercise regimes.

On subsequent transfer to the NHS physiotherapy unit, a letter was sent to the physiotherapist and the GP resulting in the employee being referred to a consultant. On investigation it was revealed that some of his vertebral discs had fused and were trapping his sciatic nerve. An operation date in December 2006 was set.

The employee was regularly reviewed by OHD and, in consultation with his manager and himself, it was agreed he could return to work for 4 hours a day. As a result of a risk assessment it was agreed that:

• it would not be in a cold environment
• he would not be expected to undertake manual handling duties such as lifting, carrying, pushing or pulling loads, and
• due to his medication he was not able to drive a fork lift truck.

He returned to work on this 4 hour basis in an administrative role, such as carrying out stock control. He was able to work effectively for 4 hours a day but it was not considered appropriate to increase his hours. A letter was sent to his consultant (with his consent and awareness of his individual rights regarding access to medical reports) expressing concerns of the limitations his current disability placed on his working and social life. The consultant called him in for a further assessment 4 months before the planned date for his operation and surgery swiftly followed.  Post-operatively he was pain-free and required no analgesia. A further report was received from the consultant - the surgery had been very successful and his prognosis was good.   

Return to work

The employee returned to work in October 2006 (2 months before his original planned operation date) on graduated hours and restricted physical activity. 

Graduated Hours:

• 2 weeks at 4 hours, 1 week at 6 hours, 2 weeks at 8 hours

Restricted physical activity:

• lifting restriction of 5kg for 4 weeks (then 10kg for a further 4 weeks)
• avoiding excessive bending, twisting, pushing and pulling

The employee was reviewed by the OHD weekly and by the occupational health physician.  He returned to normal physical activities in 12 weeks.

Rehabilitation team

OHD, consultant orthopaedic surgeon, health and safety practitioner, GP, department manager, physiotherapy, human resources and the employee concerned.

Continued progress

The employee is back at work, having resumed his role and full duties, and also leads a normal life without any restrictions.

Benefits to the business

• Returned to work on reduced hours prior to his operation
• Returned to full duties early
• Reduction of total disability cost to the organization through reduced long-term sickness. Without intervention the employee would have been absent from work from May 2006 to March 2007 (10 months).  He was actually absent 6 weeks before progressive re-instatement.
• Benefit of funding physiotherapy enabled him to return to work, performing to normal capacity earlier than expected due to treatment within the NHS being delivered much sooner than was expected
• Complied with statutory responsibility in accordance with Disability Discrimination Act

This was made possible due to effective teamwork. This gentleman was treated more efficiently and returned to full time employment sooner than expected as a direct result of the effectiveness of a multidisciplinary rehabilitation team, and effective sickness absence management.

Benefits to the individual

• Restored the individual to the highest possible level of functioning as soon as was appropriate
• The employee was integrated back into the work environment as soon as it was appropriate
• Successful rehabilitation eliminated disincentives that frequently results from long separation from the work place.

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