Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Sprains and Strains, Lumbar Spine

sprains and strains, lumbar spine in 中文(中华人民共和国)

Related Terms

  • Low Back Injury
  • Low Back Pain
  • Lumbar Strain
  • Lumbosacral Soft Tissue Injury

Differential Diagnosis

Specialists

  • Cardiologist, Cardiovascular Physician
  • Chiropractor
  • Occupational Medicine Specialist
  • Orthopedic (Orthopaedic) Surgeon
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Physical Therapist
  • Sports Medicine Physician

Factors Influencing Duration

Duration is influenced by the severity of the initial pain and by the pain induced impairment in function, the individual's response to treatment, medical and psychiatric co-morbidity, current substance use disorders, use of opioid analgesics, and his or her job requirements and usual leisure activities.

Medical Codes

ICD-9-CM:
721.3 - Lumbosacral Spondylosis without Myelopathy; Arthritis; Osteoarthritis; Spondylarthritis
722.32 - Schmorls Nodes, Lumbar Region
722.93 - Disc Disorder, Other and Unspecified, Lumbar Region
724.2 - Lumbago; Low Back Pain; Low Back Syndrome; Lumbalgia
846.0 - Sprains and Strains of Sacroiliac Region, Lumbosacral Joint
846.1 - Sprains and Strains of Sacroiliac Region, Sacroiliac Ligament
846.2 - Sprains and Strains of Sacroiliac Region, Sacrospinatus (Ligament)
846.3 - Sprains and Strains of Sacroiliac Region, Sacrotuberous (Ligament)
846.8 - Sprains and Strains of Sacroiliac Region, Other Specified Sites
846.9 - Sprains and Strains of Sacroiliac Region, Unspecified Site
847.2 - Sprains and Strains of Other and Unspecified Parts of Back, Lumbar Spine
847.3 - Sprains and Strains of Other and Unspecified Parts of Back, Sacrum; Sacrococcygeal (Ligament)
847.4 - Sprains and Strains of Other and Unspecified Parts of Back, Coccyx
847.9 - Sprains and Strains of Other and Unspecified Parts of Back, Unspecified Site; Back NOS

Overview

The lumbar spine consists of five bony vertebrae separated by intervertebral discs. The lumbosacral region of the spine carries the upper body's weight and is responsible for much of the mobility of the trunk (back).

Sprains and strains imply stretching or tearing of the tissue involved, either muscles (strain) or ligaments (sprain). Recently it has been recognized that "sprain" and "strain" are inappropriate terms for acute low back pain. Typically, the events associated with the onset of their back pain are low force (low violence) activities the person has done multiple times in the past without injury. Physicians have historically diagnosed back "strain" as if muscles were torn, or back "sprain" as if ligaments were torn, although MRI studies in the first 48 hours after pain onset in patients who experience the acute onset of back pain have not shown either strained muscles or sprained ligaments to be present (Modic). Thus modern articles and texts discuss this problem under the heading or diagnosis of "Low Back Pain" and not as either back sprain or back strain. However, these terms have been used historically and are still used by many physicians along, with the associated ICD-9-CM code. It is quick and easy for physicians to explain to patients that back pain is present "because you pulled a muscle", while it is difficult and time consuming to try to explain that "the reason adults get episodes of low back pain is not scientifically established, and the exact structure in the back responsible for the pain cannot be determined."

Carragee et al. followed 200 persons without prior significant low back pain issues for 5 years. Each individual involved had a baseline MRI done despite no history of back problems. One-hundred-seventy of the 200 persons had episodes of minor trauma (including motor vehicle accidents, sports injuries, lifting "strains", and minor falls), as minor trauma events are very common. There were 118 minor trauma events associated with initially major low back pain, and 652 minor trauma events associated with back pain that was mild. There were even more episodes of back pain that began during activities of daily living or began spontaneously, with the person unable to recall what he/she was doing when the pain began. The only association of minor trauma with persisting disabling back pain was in those for whom the "event" was compensable (workers' compensation or personal injury). Out of the original 200 persons, 51 had a second MRI done shortly after an episode of severe acute back pain began. None of the second MRIs showed a muscle or ligament injury to be present. None of the second MRIs in those who associated the back pain with minor trauma showed a change from the baseline MRI done at the start of the study.

Sprains are ligamentous injuries typically caused by sudden movement of a joint beyond the limits of joint motion imposed by the supporting ligaments. The ligaments cannot stretch enough to accommodate the abnormal motion, and thus the ligament stretches, and if enough force is applied, the ligament tears. An example is hyperextension of a knee causing the anterior cruciate ligament in the knee to rupture. Strains are either partial or complete tears of muscle-tendon units, usually as a result of strong muscular contraction sustained in forceful stretching. The events patients associate with the onset of back pain do not typically involve enough motion to cause ligament sprains or enough muscle force to cause muscle strains.

Spinal discs have a hard outer casing (annulus fibrosis) and a softer center (nucleus pulposis). The term "annular tear", also know as "high intensity zone" is used for the MRI imaging finding of increased signal intensity in the annulus. While the name suggests that trauma has occurred and has "torn" the disc annulus, these have been shown to be common age related degenerative findings. These findings do not correlate with pain, and do not necessarily correlate with attempts to provoke pain (e.g. discography). Thus these "annular tears" have no significance and do not confirm that trauma has occurred.

Incidence and Prevalence: Low back pain is very common. Up to 84% of adults will experience low back pain their life time. In the 2002 US National Health Interview Survey, 26% of 31,044 adults reported having had at least 1 day of low back pain in the last 3 months (Deyo). In a separate epidemiology survey in Saskatchewan, Canada 50% of adults reported having had low back pain in the last 6 months, and 11% had had disabling low back pain (Cassidy).

Source: Medical Disability Advisor






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