Diagnostics and Work Injury

Three weeks ago, I evaluated a 24 year old male worker from a heavy labor construction company following a lifting injury while in a dynamic flexion and rotation position. While the patient complaint of back pain with mild spinal deviation to left, he reported no neurological nor radicular symptoms. Physical exam following history reveals muscle strain to lumbar paraspinals requiring physical therapy and possible degenerative disc without any neurolical symptoms. However, the adjuster wanted to hold off treatment Pending MRI report. Spinal MRI reveals multiple spinal disc dessications and disc bulges in all three regions of the spine.

Should third party claims administrators, persons with non medical credentials dictate treatment with authority to stop or delay recommended treatment based on pending diagnostics?

Does diagnostics lead or determine the course of treatment or should they be used as tools within the differential diagnosis process?

In my opinion, No. Because the presence of asymptomatic disc bulges does not comprise nor represent the cause of the pain. In any sample of normal adults MRI report studies, there will be a significant number of normal persons in any given population with positive asymptomatic, dessicated, and bulging disks. However, we do not treat patients without symptoms or complaint(s). As such, MRI reports help to confirm and guide treatment plans when a thorough evaluation determines that the complaint is of a direct cause to the pathology, thus a cause and effect relationship with a significant postive likelihood ratio exists.

As in the present patient, because of his high labor demand, repetitive bending, he showed multiple discs and joint degeneration throughout his spine; but because of his physique and youth, they are presently asymptomatic. What this patient needs is improvement of his dynamic posture, good lifting strategy and a proactive ongoing conditioning program. of course, he needs to gradually change his occupation to a light to moderate labor demand job from his present high labor and repetitive bending demands. Although therapy was then authorized following the result, mainwhile the patient had wasted two weeks doing absolutely nothing. Treatment was initiated and patient continue to function with less pain everyday. The patient is cautioned of positioning, lifting techniques and body mechanics.

This was an amazing observation, a significant number of asymptomatic disc bulges were seen in this young construction worker's spine. A worker with such involvement is a work liability if the worker is not matched or properly fitted to the work and encouraged to stay conditioned. Today, this worker was asked by his supervisor to work in the field even though he is supposedly on light duty. Such risks taken by employers against the doctors recommendation are of poor judgement, wrong, risky and unethical. Employers must use good judgement and good faith to protect their employees from harzardous and unsafe conditions in order to avoid risky actions when the result is catastrophic. Patients are to be allowed the necessary time to heal and must not be subjected to conditions that are harmful and in contradiction to their dctors orders and recomendations.

EZ Rehab over the years have helped significant amount of employees and employers realize a balanced process of returning the worker to the work, safely and cost-effectively. We can help, the EZ rehab process is comprehensive, fair, practical and effective.

Dr. Diallo
http://www.ezrehabsolutions.com/