Recommendations for management of uncomplicated back pain in the workers' compensation system: a focus on functional restoration.
OBJECTIVE
To present recommendations for conservative strategies to improve the management of uncomplicated back pain and to evaluate the financial crisis currently facing the workers' compensation system due in part to rapidly rising medical costs.


BACKGROUND
Medical costs in the workers' compensation system have risen at an alarming rate placing a tremendous burden on the cost of doing business in the United States. Historically, treatment for back pain in the United States has been a pathology-based approach; the literature supports a functional restorative approach for clinical efficacy and cost effectiveness.


METHODS
Narrative overview of the literature.


METHODS
Computerized databases were searched for relevant literature in the English language from the years 1994-2004, including: Alternative Health Watch; Cochrane Database of Systematic Reviews; Pre-CINAHL; CINAHL; MEDLINE; AgeLine; SPORT Discus. A narrative synthesis of the literature was written from retrieved articles.


CONCLUSIONS
A history and overview of the workers' compensation system is presented. Concerns regarding rising medical costs and recommendations for strategies to improve cost and quality of care with an emphasis on ergonomic and functional restoration recommendations are made.


CONCLUSIONS
A percentage of costs in the workers' compensation system go towards treating uncomplicated back pain; recurrences and chronicity of back pain are key contributors to these costs, which are currently increasing. Ergonomic advice plays a key role in helping the patient with musculoskeletal injuries heal faster and prevent costly flare-ups. Conservative care, which includes chiropractic manipulation, ergonomic recommendations, and exercise rehabilitation with an emphasis on coordination and endurance training, is supported by the literature as a possible method of cost containment.
Fowler
Raymond P
RP
Private practice of chiropractic.
Foot Ankle. 1980 Sep;1(2):112-6
7274897
J Occup Med. 1979 Apr;21(4):269-72
438917
Br J Ind Med. 1988 Dec;45(12):829-33
2975503
J Biomech. 1987;20(6):601-13
3611136
Clin Orthop Relat Res. 1979 Jul-Aug;(142):10-8
498621
Spine (Phila Pa 1976). 1995 Sep 1;20(17):1889-94
8560337
J Occup Rehabil. 2003 Mar;13(1):1-9
12611026
BMJ. 1990 Jun 2;300(6737):1431-7
2143092
J Manipulative Physiol Ther. 1997 Jul-Aug;20(6):372-6
9272469
Am J Sports Med. 1983 May-Jun;11(3):125-30
6869653
Med Sci Sports Exerc. 1990 Aug;22(4):453-6
2402205
Sports Med. 1985 Sep-Oct;2(5):334-47
3850616
Spine (Phila Pa 1976). 1986 Apr;11(3):241-5
2940707
N Engl J Med. 1995 Oct 5;333(14):913-7
7666878
J Bone Joint Surg Am. 1983 Feb;65(2):213-8
6218171
J Am Podiatry Assoc. 1975 Apr;65(4):315-21
1120881
Spine (Phila Pa 1976). 1987 Mar;12(2):130-7
3589804
BMJ. 1995 Aug 5;311(7001):349-51
7640538
Pain. 1993 Sep;54(3):353-359
8233552
Clin Biomech (Bristol, Avon). 1992 Feb;7(1):43-6
23915616
Occup Health Saf. 1985 Dec;54(12):16-20
2934650
Spine (Phila Pa 1976). 1994 Apr 1;19(7):858-61
8202811
Spine (Phila Pa 1976). 1997 Dec 15;22(24):2911-8
9431627
Am J Sports Med. 1980 Jul-Aug;8(4):232-4
7396052
J Orthop Res. 1991 Jan;9(1):91-103
1824571
Clin Orthop Relat Res. 1985 May;(195):178-84
3156708
Orthop Clin North Am. 1991 Apr;22(2):263-71
1826550
Ann Intern Med. 1992 Oct 1;117(7):590-8
1388006
Med Sci Sports Exerc. 1988 Oct;20(5):501-5
3193867
Spine (Phila Pa 1976). 1981 Jan-Feb;6(1):61-9
6451938
Clin Biomech (Bristol, Avon). 1995 Sep;10(6):323-324
11415574
Spine (Phila Pa 1976). 1986 Nov;11(9):914-27
3824069
Am J Ind Med. 1996 Jun;29(6):632-41
8773723
Spine (Phila Pa 1976). 1994 May 15;19(10):1111-5; discussion 1116
8059265
Acta Orthop Scand. 1977;(170):1-117
146394
J Spinal Disord. 1988;1(1):16-32
2980059
Med Econ. 2000 Mar 20;77(6):139-42
10977200
J Bone Joint Surg Am. 1984 Jun;66(5):715-24
6725318
Spine (Phila Pa 1976). 1998 Dec 1;23(23):2601-7
9854759
Ann Intern Med. 2002  Feb 5;136(3):216-27
11827498
J Occup Med. 1988 Jun;30(6):502-5
2969044
Spine (Phila Pa 1976). 1984 Mar;9(2):106-19
6233709
Ergonomics. 2001 Feb 20;44(3):280-94
11219760
J Manipulative Physiol Ther. 2000 Feb;23(2):118-22
10714540
Chronobiol Int. 1984;1(2):121-6
6600017