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Bending the Rules about Back Pain and Disability

The American Medical Association (AMA) uses range of motion to decide which back patients are ready to go back to work. The same low back (lumbar) motions are used to agree on disability. Lumbar flexion or forward bending is the test used most often. Well-known researchers in Canada question this method.

The concern is that decreased lumbar range of motion (LROM) and actual back tissue problems aren't connected. In fact, more than one study reports there's no link between tissue changes due to low back pain and LROM. This study agrees with those findings.

These Canadian researchers found that LROM isn't any different in workers going back to work from those on disability. What the workers thought they could do and what they could actually perform didn't match either. Scientists also note that while the AMA's method looks for motion in the spine, research shows that too much motion is a risk for injury.

These authors conclude that it may be time to rethink the AMA's way to decide disability. The authors suggest that function be measured by a worker's ability to carry out tasks, rather than using LROM. Functional ability to do the job can be tested using grip strength, heart rate, lifting and carrying loads, and time spent seated or standing.

References: K. A. Parks, BSc, et al. A Comparison of Lumbar Range of Motion and Functional Ability Scores in Patients With Low Back Pain. In Spine. February 15, 2003. Vol. 28. No. 4. Pp. 380-384.

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