The general GP guidelines for lower back pain are to stay at work or return to work as soon as possible providing you are fit enough to work. Whilst I agree in general, these guidelines are rather vague and I would like to consider the question more carefully to help you decide whether to carry on working, or to stay off.
Work if you can without worsening your pain
If you can work without aggravating your pain, or vary your activities and work in lighter fashion – possibly reduce the length of time you work or take longer breaks – then it makes sense to keep working. But if you’re doing so and the pain is worsening, you may need to take time off work.
Back pain has often had a ‘bad press’ when it comes to taking time off work, considered by some bosses to be an acronym for ‘I’m taking a sicky’ and it certainly has been used as a good excuse for skiving off work. GPs are told to consider whether someone is a ‘malingerer’ or has genuine back pain. This has changed somewhat since the guidelines for back pain have evolved from rest and immobility to one of keeping moving and active, however it’s most upsetting when you do have a genuine pain and are not taken seriously!
Many of my clients are very hard working, often self-employed with no income if they are off-work, or employed but need to work through fear of losing their jobs. That is the pressure we live under nowadays. I empathise and have great respect for the genuine courage to keep going and not be defeated by the pain, but sometimes we need to stop and think rationally.
I’m all for keeping active and moving gently or even working even part-time or on light duties, if this is appropriate… but please don’t risk injuring yourself further or hurting others because you’re not fit to work or drive.
Stop and Think – ‘Stress makes us Stupid’
Sometimes, especially when we’re in pain, we don’t think clearly. The stress of needing to work due to worry of loss of income, pressure or aggression from our boss, worry about leaving our workmates or colleagues in the lurch or even concern about losing our jobs can cause us to keep working when we shouldn’t – because we’re not fit to work! Recognising that ‘stress makes us stupid’ is invaluable to help us to make a clear-headed decision, which sometimes can be best by seeking and following the advice of a professional opinion. It’s often not wanting to let others down that forces us, wrongly, to keep going and sometimes we just need to say no!
Fit to work
Being ‘fit’ to work means being safe without placing yourself or others at risk. This can be divided into two broad categories: The physical ability to move and work, and the mental ability to concentrate, focus and make clear rational decisions. If you are in pain, or even just afraid to move, both of these can be impaired, although it often doesn’t feel like it! If you have the thought you may be risking it, please stop and think! Heavy lifting, walking up the ladder, working at heights, or with electricity, gas or in any potentially dangerous equipment can so easily lead to disaster. With certain professions such as an airline pilot, fire and rescue workers which require physical exertion, it’s clear that we should not work, however there are many occupations where we can place ourselves at greater risk if we’re in pain, or under the influence of pain-killing or anti-inflammatory drugs that leave us drowsy. And sometimes, the more subtle, everyday jobs where we can think we’re ok to work, but in fact we need to stop and think.
Mental acuity
When we’re not able to think clearly, we often place ourselves at greater risk. it’s so easy to make mistakes that can create far more time, cost and resources to resolve. Think about an accountant or book-keeper who makes a mistake with the figures – finding the errors usually takes far longer to correct. Actually, it’s so much better for our employers if we consider taking time off work to heal, rather than letting the pain worsen and creating a longer-term problem.
Fit to Drive with Back Pain
If you’re in too much pain, your mind is clouded by painkillers, you can’t turn your neck to see properly, or you don’t feel safe to do an emergency stop, then please don’t drive. Be safe! Physical pain can prevent us from handling a car properly, and drowsiness can greatly reduce our reaction speeds. I write about Driving with Back Pain more fully here.
Should I stop working?
Since we are all unique, and our injuries are different, there is no one right answer. Usually it’s when the back is in severe pain or spasm that time off work might be needed. You may have severely restricted mobility and pain when moving or carrying out work activities. This phase is called acute back pain, which I have written about more fully. In general terms, if:
- You can work without making the pain worse
- You are not worse after work, or the next day
- The condition is overall not deteriorating or becoming worse
Then continuing to work may even be better than just staying at home, staying too immobile, being bored and frustrated which is a huge problem with back pain and may even prolong the condition.
It’s usually not just about stopping altogether!
Life is usually not black and white and most of the time we can keep working if we are able to adapt our work schedules. Avoid the extremes and work may be fine. The extremes could be sitting, standing, or driving all day, or excess heavy lifting or bending like a baggage handler or brick layer. If we bludgeon on at full pelt, we may end up needing to stop altogether with pain and needing to take longer off to get better, which is a shame when a little change of routine would have been all that was required.
Pain can make us tired, so more breaks and shorter work hours are often required.
- Work a little slower. Mentally give yourself a break, move slower and in a more relaxed way
- Vary your activities; do lighter duties
- Take more breaks to rest your back. Start work a little earlier and finish later if that’s an option to fit in the breaks, but don’t keep at the same activity all too long.
- Plan your work. If you can’t do a particular job then ask for help, say no and wait until you’re better. In the meantime, do the lighter jobs.
- Plan your driving. If you have a heavy commute in bad traffic then arrange to start and finish earlier or later to avoid the congestion and reduce the driving time. Take more breaks and plan to drive for less hours if you’re driving all day.
- Work part-time. Often a full off-work sick note is not required, but working shorter hours is all that’s required and helps both your back pain and your employer.
- Sit less! Many clients of mine have sitting jobs and need to either work shorter hours, take breaks, or work part-time, but this may not be required…
- Use a sit-stand desk. A friend of mine was able to continue to work during the acute back pain by standing and not sitting too long and varying his activities.
- Use a chair with active movement, like a floating tilt chair which allows the muscles to move and relax more and for longer than with a more static, passive chair.
Part-time, Reduced Hours or Light Duty sick Notes
Adapting work without stopping is much better if work allows this flexibility, especially if this can be agreed without the pressure to work more or longer hours. If you can keep active you’ll probably feel better physically and mentally – it’s so much better than mooching about at home. I understand your work may not be able to accommodate being flexible, which is a shame. If there is no option for doing light duties, the risk of injury is too high, or even the risk of making bad decisions or mistakes too prominent, then you may have to take more time off work than ideally planned. Of this is the case then you’ll have to do the best you can at home to help make the recovery a speedy one. Clear communication, sensible discussions and agreement with your work, boss or HR department is the key.
Sick notes or employer letters
I always aim to help if I can – I will write to your employer or boss and won’t charge if this is simple. This is one of my pet hates: bosses who don’t understand and pressure you to work if you’re not fully fit (either openly or subtly) which is all too common these days. Often it’s a quick email that’s sufficient. Mostly your boss wants to know you’re not just taking ‘a sickie’. I am very keen to recommend changes if they are required, a more suitable work chair perhaps. Previously, I have helped a receptionist with neck pain who required a headset since she was on the phone all day and would crook the phone under her ear. I also prescribed a van with more headroom for a tall client who was spending all his time crouching down to drive.
Self-Employed Workers
If you’re self-employed it’s often ‘not possible’ to stop working and the idea of taking time off, and therefore losing income, is not an option unless we are completely unable to work. Learning to adapt, change our routine, slow down a little and take breaks is ever more important. Please don’t over-do it and push through the pain pig-headedly. Some simple adaptations are often just what’s required.