Tai Chi for Preventing Recurrence of Low Back Pain in Healthcare Workers

Abstract

Work-related Low Back Pain (LBP) is estimated to occur in approximately 5% of industry workers each year, resulting in the loss of 100 million work days and 9 billion dollars annually in the United States [1,2]. Approximately 34% of people who experience acute LBP will have recurrent episodes [3], with a resultant work disability rate of 17%. Recurrences are typically more severe than the initial episode of LBP and have longer lengths of disability and higher associated healthcare costs [3]. LBP not only has physical, but also psychological consequences. For example, affected individuals may be unable to perform their jobs or may require modifications or restrictions in order to return to work. Further, untreated and/or inadequately managed acute pain can lead to chronic pain [4], further contributing to LBP-related morbidity. As a result of its substantial impact, LBP is considered to be a national health problem [5].Healthcare workers, who are involved in direct patient care i.e., nursing professionals, have an increased risk for and a higher prevalence of LBP. According to one study, [6] working-life incidence rates and prevalence of LBP were 65% and 30% respectively for Orthopedic nurses. Activities such as turning and lifting patients and prolonged standing make this group particularly susceptible to work-related LBP and recurrent LBP.Conventionally it is often claimed that up to 90% of LBP episodes spontaneously resolve within one month, despite the lack of strong and supporting evidence [7,8]. In addition, 80-90% of acute LBP cases are non-specific, without an identifiable structural pathology at the time of diagnosis, and the exact cause or mechanism of injury is not fully understood despite considerable research [9,10]. Further, the experience of pain is not only a result of physiologic factors, but it can also be due to cognitive, behavioral, socio-cultural, spiritual, and environmental factors. Thus treating acute and preventing recurrent LBP is complex.Studies have demonstrated that chronic and/or recurrent LBP occurs significantly less frequently among patients who exercise regularly following the initial LBP treatment phase compared to those who are inactive [11]. Work absenteeism is also significantly lower among patients who are physically active. Stretching and strengthening exercises are linked to a reduction in disability and improved pain and functional outcomes [12][13][14]. Specifically, exercises which target the spinal stabilizing muscles, especially the lumbar multifidus group, have been found to significantly lower the risk of recurrent LBP [15][16][17]. In addition, when recurrent low back pain did occur, it was less severe than the initial injury. Exercise is a low-cost treatment option with too little to no side effects, but systematic reviews of the literature indicate a mixed view of its value [18][19][20][21].Tai Chi is a form of exercise that is particularly well-suited for retraining and strengthening the lumbar stabilizing muscles. Tai Chi has been shown to relieve stress and t...