1. Technology is changing the prevention and management of workplace spinal injuries 

The integration of technology, including artificial intelligence, into occupational health physiotherapy is revolutionising the prevention and management of workplace spinal injuries. 

Wearable devices and motion capture technology can monitor workers’ movements in real time, identifying predisposing factors for spinal injury. 

This technology offers an automated assessment of hazardous manual task risks (Mudiyanselage et al 2021) while giving workers live biofeedback. 

When interpreted and applied by an occupational health physiotherapist, it helps reduce the risk of work-related spinal injury (Deloitte 2021). 

It also supports clinical decision-making in physiotherapist-led assessment and treatment by providing objective measures. 

Artificial intelligence can enhance predictive analytics in occupational health by analysing historical incident data to identify patterns and forecast potential hazards. 

This approach enables organisations to implement preventive measures, transitioning spinal injury risk management from reactive to proactive (Shah & Mishra 2024). 

Combining machine learning tools with other technologies can improve both the accuracy and the efficiency of risk assessments and enhance subsequent control measures for spinal injury prevention (Yang et al 2024). 

By leveraging these technological advancements, occupational health physiotherapists can assist workplaces in implementing targeted strategies that not only reduce spinal injury risks but also promote overall musculoskeletal wellbeing. 

2 Early return to work can accelerate lower back recovery 

Research by Sullivan et al (2018) demonstrates that an early return to work following an acute episode of low back pain (LBP) can improve pain and function in the short term. 

Returning to work can provide an opportunity to stay active, allowing for early mobilisation and promoting recovery. 

It offers a number of psychological benefits, including fewer depressive symptoms, reduced psychological distress, increased confidence and improved self-efficacy. 

It also allows for social engagement and support from co-workers and management as well as a greater time structure (Royal Australasian College of Physicians 2010, Australian Institute for Musculoskeletal Science 2014). 

Taking time off work for an extended period can negatively affect a worker’s overall health. 

Research has shown that an individual’s chance of returning to work after 20 days off following a workplace injury is 70 per cent. 

This reduces to 50 per cent after 45 days off work and to 35 per cent when the worker has been away from work for 70 days (Royal Australasian College of Physicians 2010). 

Long periods without work have been associated with an increased risk of poor physical health including heart disease, high blood pressure, chest illnesses and long-term illness and with a higher risk of mortality (Waddell & Burton 2006). 

Further consequences include poor mental health and wellbeing and an increased likelihood of suicide attempts (Waddell & Burton 2006). 

3 Not every work-related back injury requires imaging 

Physiotherapists regularly diagnose and manage spinal pain in workers of all ages and across all industries. 

When patients present with back pain, they commonly ask whether a scan will be required. 

New evidence indicates that routine medical imaging for uncomplicated LBP is unnecessary. 

When it reveals findings unrelated to the source of pain, unnecessary imaging can actually cause further harm, including invasive interventions that may not be required. 

A large percentage of the pain-free population has existing age-related changes that show up on imaging. 

In the event of an acute injury, these changes are most likely unrelated. 

As physiotherapists, we are trained to look out for any signs that a scan is required to investigate the source of an injury, such as in the case of nerve injury or fracture. 

Notably, 68 per cent of pain-free people in their 40s have disc degeneration; this increases to 88 per cent for pain-free people in their 60s. 

4 Psychological demands in the workplace can increase the risk of back pain 

Alongside physical risk factors, psychological demands in the workplace can contribute significantly to musculoskeletal problems—particularly back pain. 

Research has established a significant association between job insecurity and LBP. 

Job insecurity can drive concerns about future wellbeing and increase mental strain, leading to physiological vulnerability. 

This, in turn, can cause negative health effects including back pain, poor sleep, hypertension, depression and anxiety (Yang et al 2016). 

Workers who have low job control, work alternate or non-standard shifts and/or are exposed to a hostile work environment also face an increased risk of LBP (Shockey et al 2024, Yang et al 2016). 

Researchers hypothesise that these factors increase psychosocial strain, affecting the body’s biomechanical and physiological processes and perception of pain (Yang et al 2016). 

An imbalance between work and family life is another clear risk factor for LBP and other musculoskeletal disorders. 

Again, this can result in higher mental strain, contributing to muscle tension or other physiological processes that aggravate back pain. 

Unhealthy behaviours associated with work–family imbalance, such as reduced physical activity and alcohol or tobacco use, may also contribute to these presentations (Yang et al 2016). 

5 The work environment should be considered when looking for spinal red flags 

LBP is a common occupational health concern—often linked to poor ergonomics, heavy lifting and prolonged sitting—but not all LBP is musculoskeletal (Leclerc 2017). 

Although it is rare, occupational exposure to chemicals, infections or carcinogens can present as LBP and should be considered as part of a thorough assessment by an occupational physiotherapist. 

Workers in mining, agriculture and manufacturing may be exposed to toxic substances such as lead, arsenic or organophosphates, which can cause neuropathic pain mimicking lumbar disorders (Plouvier et al 2011). 

Particulate matter, fumes and asbestos have also been linked to increased LBP burden (GBD 2016 Occupational Risk Factors Collaborators 2020). 

 Healthcare workers, lab technicians and farm workers face higher risks of spinal infections like tuberculosis and brucellosis, often presenting with persistent pain, fever and night sweats (Andersen & Westgaard 2014). 

For those whose profession involves driving, whole-body vibration increases susceptibility to spinal infections (Bovenzi 1996). 

Chronic exposure to carcinogens like benzene, asbestos or radiation raises the risk of bone metastases and haematological malignancies, presenting as persistent, non-mechanical LBP with night pain and prolonged morning stiffness (Petit & Roquelaure 2015). 

Systemic diseases linked to carcinogen exposure can manifest as unexplained back pain requiring further investigation (Bolt 2008). 

Occupational physiotherapists must recognise that LBP is not always musculoskeletal. Identifying red flags—progressive pain, night pain,prolonged morning stiffness, weight loss, neurological symptoms or systemic illness—is crucial for timely onward referral and appropriate management. 

Quick links: 

• references
• infographic 

Courses of interest:

• Spinal physiotherapy part A (cervical)
• Spinal physiotherapy part A (lumbar)

>> Jess Hempsall MACP is an APA Titled Occupational Health Physiotherapist working for Tangibilis Physiotherapy, a private practice in Darwin. Jess also delivers onsite occupational health services across a range of industries. She is a member of the APA Occupational Health group. 

>> Daniel Edwards MACP is an APA Titled Occupational Health Physiotherapist. Daniel has worked within occupational health settings as a physiotherapist for more than 10 years and is the head of quality and improvement at Biosymm, an occupational physiotherapy business based in Perth. He is a member of the APA Occupational Health group. 

>> Charlie Baker APAM is a physiotherapist working for Biosymm. Charlie specialises in onsite physiotherapy services and ergonomic consultancy. He is a member of the APA Occupational Health group. 

>> Millie Bensoussan APAM is a physiotherapist and rehabilitation consultant at Axis, an occupational health provider in Sydney, with a background in musculoskeletal physiotherapy. Millie provides onsite and remote occupational health physiotherapy services across a wide range of industries. She is a member of the APA Occupational Health group. 

>> Jarryd Croxford APAM is a physiotherapist with six years of experience working in occupational health. Jarryd is a health and injury management adviser for Sime Motors. He is the chair of the Queensland branch of the APA Occupational Health group. 

>> Zac Lowth APAM is a physiotherapist with 14 years’ experience in occupational health. Zac is head of growth and customer success at occupational health software company Carelever. He is the immediate past national chair of the APA Occupational Health group.