Chiropractic treatment for injured workers

Back pain accounts for a significant proportion of WorkSafeBC’s injury claims and costs due to time lost from work. In terms of recommended interventions for low back pain, spinal manipulation has received international recognition.1 Compared with many other conventional therapies, manipulation is associated with better or more rapid reduction in pain and disability over time. 

In a recent systematic review of the use of manipulation for chronic low back pain2 significant benefits are evident during the first 6 months after treatment. At the 1-year mark following treatment, study groups experienced similar outcomes. But, compared with other effective interventions, return-to-work rates were modestly higher among those who had received spinal manipulation.

While approaches may vary between practitioners, evidence-based chiropractors do not use manipulation exclusively—they combine it with an emphasis on education, ergonomics, exercise, and other patient-activation strategies.

WorkSafeBC coverage
Generally, WorkSafeBC covers 8 weeks of chiropractic treatment; however, limited extensions can be auth-orized in the following cases:

•    Extenuating circumstances explaining delayed recovery (e.g., an initially severe injury or reaggravation of an injury upon returning to heavy work).
•    A documented improvement trend, suggesting that complete recovery or durable return to work is imminent within the requested extension period.

WorkSafeBC also covers chiropractors who provide preapproved job site visits to determine workers’ critical job demands, logical workplace modifications, and realistic return-to-work plans.

More information on WorkSafeBC chiropractic coverage can be found at www.worksafebc.com (click on Safety at Work, then Health Care Providers, then Chiropractors).

When to refer to a chiropractor
Consider referring workers to a chiropractor when they are suffering from mechanical neck or back pain that is either directly or secondarily attributable to a compensable injury, particularly if the symptoms are not resolving in a timely fashion. It’s also worth noting that many chiropractors use a sport medicine approach to competently treat other injuries, such as acute or repetitive overuse conditions in the extremities.

When not to refer to a chiropractor
Chiropractic treatment is not recommended for workers with musculoskeletal conditions or injuries requiring immediate surgical attention such as acute fracture or progressive neurological deficit, or neuropathic conditions like post-amputation or complex regional pain syndrome.

Some conditions like vertebrobasilar insufficiency or osteoporosis may constitute relative contraindications to spinal manipulation; however, affected patients may still be managed effectively with low-force techniques, exercise, and other evidence-based modalities.

Expectations of chiropractic treatment
Chiropractic management often focuses on correcting musculoskeletal dysfunction and pain-related disability. If treatment is effective, physicians and patients can expect to see timely reductions in pain, with a corresponding recovery of normal functioning at work. 

Frequently, a patient-centred approach is required to incorporate the psychosocial elements of recovery. Early in the course of injury, physicians play a critical role in shaping workers’ expectations for recovery through education and reassurance. However, outcomes can be further enhanced by prescribing scientifically validated treatments that simultaneously respect patients’ personal expectations and preferences. 

Concurrent treatment
The general view of WorkSafeBC is that a worker should be under treatment by only one physician or other qualified practitioner at a time. However, subject to approval by WorkSafeBC, concurrent treatment may be deemed acceptable in certain circumstances. For example, the same disability may require treatment by a general practitioner and a specialist, by multiple specialists, or by a qualified practitioner (e.g., a chiropractor), with concurrent monitoring by the attending physician. If concurrent treatment is denied, patients will be paid benefits to the date of written notification, providing they have submitted appropriate medical reports.

For more information
For more information about chiropractic services for injured workers, contact WorkSafeBC Health Care Services at 604 232-7787, or for clinical questions, contact jeffrey.quon@worksafebc.com or 604 279-8128.
—Jeffrey Quon, DC, MHSc, PhD, FCCSC
WorkSafeBC Chiropractic Consultant

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This article is the opinion of WorkSafeBC and has not been peer reviewed by the BCMJ Editorial Board.

References

1.    Dagenais S, Tricco AC, Haldeman S. Synthesis of recommendations for the assessment and management of low back pain from recent clinical practice guidelines. Spine J 2010;10:514-529.
2.    Rubinstein SM, van Middelkoop M, Assendelft WJJ, et al. Spinal manipulative therapy for chronic low-back pain. Cochrane Database System Rev 2011;16:CD008112.