Case Study

Jim is a 47-year old sheet metal worker who injured his lower back lifting a large sheet of metal weighing an estimated 60 lbs. Jim had been distracted by a noise in the warehouse when he was lifting one of the metal sheets and turned to look in the direction of the sound. While he was turning he felt a searing pain run from his low back to his scapula. The injury was 3 weeks ago, and he has been off work since then.

Jim has been with the company for 25 years and has worked his way up through the various warehouse positions. Jim has been in his current job for the past 10 years. Jim only misses work if it is absolutely necessary because he prides himself on a sound work ethic, even if this means performing his job while he is not well. In his current job Jim works from 7:30-3:30, with 2x15 minutes coffee breaks (one in the morning and the other in the afternoon) and a 30 minute lunch break. The sheets of metal range from 20-60 lbs. What is observed in the job video represents a 5 minute snapshot of his day.

Jim has a history of low back pain. His first low back injury occurred when he was a warehouseman responsible for lifting and organizing containers of sheet metal – he experienced an L4/L5 disc herniation that eventually required surgery. After surgery he had a 6-month course of rehabilitation, which included both physiotherapy and occupational therapy. Jim was off work for 12 months. After the injury and upon his return to work Jim was feeling down and withdrawn. He had difficulty engaging with family and lost interest in fishing with his friends, completing home renovations, and playing with his kids, who were 5 and 7 at the time. In addition, he continued to experience low back pain and found his job difficult. Work friendships gradually began to erode and he kept to himself at work. Rumours spread that he had ‘faked’ his injury to spend more time working on his house. He and his wife began to argue and eventually they separated. After his separation Jim was diagnosed with clinical depression. His wife and kids continue to live in the same town however he sees them only on Sundays. They are now 15 and 17 and are busy with their own lives.

His current injury has been diagnosed as a ‘soft tissue injury’. He has been completing his daily stretches, but spends most of his time lying in bed. He takes a range of pain medication to manage his pain and some days is so drugged that he hardly knows how the day passed. He has stopped taking his medication for depression 2 years ago, and has become even more withdrawn and flat. Just prior to his latest injury he had a run-in with a fellow worker who accused him of being ‘lazy’. Jim prides himself on his quality work and was greatly hurt by this comment. As well, he feels he has never been accepted since his initial back injury 10 years ago.

He has been off for 3 weeks and has just been contacted by the occupational health nurse at the factory who has asked him about his injury and when he expects to return to work. The following day, Jim received a call from Tom, a case worker at a disability management company - a private firm that the company contracts with in order to facilitate a return to work for injured workers. Tom asked Jim a number of questions about the type of work he does, what other jobs he has done in the company, and Jim’s plan on how he is going to return to work. After the phone call Jim became very anxious and worried that he is going to be ‘forced back’ before he is ready. To add to his anxieties the WSIB adjudicator, Neil, also contacted Jim and set up an assessment with an occupational therapist at a private practice. The occupational therapist is scheduled to perform a full ‘functional evaluation’ and provide recommendations on his functional status and his ability to return to work.

The OT utilized a standardized evaluation protocol (Matheson approach) and from this she determined that Jim is able to stand for 30 minutes before requiring a rest break and for a total of 3 hours during the 6 hour assessment. Jim is able to lift 30 lbs from knee to waist height and carry 30 lbs over a distance of 100 feet. Gait is slow, but still within normal speed, and he is able to walk for 20 minutes. Facial grimacing and massaging of his lower back were noted throughout the assessment. Jim reports his pain score of 6 out of 10. Pain descriptors from the McGill Pain Questionnaire include tight, aching, and cramping. Jim states there is no way he can handle the demands of his job.

After the assessment the OT contacts the employer to discuss Jim’s job and the demands. A meeting has been called at the employers to discuss Jim’s return to work plan. The OT will be expected to provide his/her findings and make recommendations as to his ability to meet his job as a sheet metal worker. In addition to the OT and Jim, the occupational health nurse, the case worker from the disability management company, the WSIB adjudicator, and the client’s immediate supervisor will be present.

You recommend a gradual return, the adjudicator and disability management company are pushing for a full return. A recent document from Jim’s orthopaedic surgeon has recommended no further medical treatment be pursued and that Jim attend a chronic pain program to address issues of chronic pain.