Lumbar ROM beats Fear Avoidance yet again for back pain

I just had a brief conversation on the phone with a worker’s compensation case manager about a low back pain patient that I saw today.  He was seen by a colleague of mine for the first 3 visits, then transferred to me today.

The patient is improving, however, my colleague gave me heads up on psychosocial aspects as he picked up…basically yellow flags.  These are usually evident in subjective history and can be confirmed with outcome scores.  He exhibited catastrophizing behaviors, fear avoidance behaviors, and dis-satisfaction with job (works at Walmart)….the whole gamma. To confirm our hypothesis in this particular case, we used the Fear-Avoidance Belief Questionnaire (FABQ).

Results:

FABQ(work): 39/42, FABQ(physical): 24/24.

Wow, off the chart numbers!

So, back to my initial story. I told the case manager that he is improving in overall pain complaints and function slowly, but I am very concerned over these factors that I just mentioned (as these usually lead to chronic LBP and inability to return to work).

Her response: Okay, that’s nice. How is his lumbar ROM?

Me: It is better {hesitantly}… but needs more work.

Her: Good, continue and let me know when your authorized visits are up.

Me: Okay…goodbye?

I am not sure if anyone else has run into a conversation as I just mentioned, however, I have quite often in the past.  I do not know if the case managers just do not want to deal with this information I am providing as they do not think it is important, or still think lumbar ROM/strength is indicative of return to work status and overall outcomes?  What do you think?  How have you addressed it?

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