Musculoskeletal case study

Mr Jones, a full-time cleaner, was referred by his employer to our rehabilitation team following a 7-month absence from work with lower back pain and sciatica. 12 weeks before his referral to our rehabilitation team, he underwent a microdiscectomy – surgery to remove part of a disc in his back – following a diagnosis of lumbar disc prolapse.

Lumbar disc prolapse – or herniation – occurs when the nucleus pulposus (central gel part) of an intervertebral disc protrudes through a tear in the surrounding annulus fibrosus – the outer fibres of the disc.

Symptoms include pain in the back or leg, and numbness or weakness in the leg or foot to varying degrees. The diagnosis is confirmed by an MRI scan which can visualise both the disc and adjacent nerves in detail. In most cases it’s treated conservatively with analgesia, physiotherapy and then possibly injections if the symptoms do not improve.

Microdiscectomy is a surgical procedure to remove the part of the disc which is compressing the nerve. This can be done if the symptoms do not improve with conservative treatment.

At the time of referral, Mr Jones was reporting some ongoing leg and back pain with sleep interruption and some limitations in his day-to-day functions. This included only being able to stand or walk for 20 to 30 minutes and not lifting anything more than about 1kg. The symptoms were being managed with analgesia and he was also attending physiotherapy. 

Mr Jones’ surgeon advised that a return to work should not be considered any earlier than 12 weeks post-surgery. 

How Zurich was able to help

We spoke to Mr Jones and his employer to understand his current level of function and symptoms, as well as an outline of his work tasks and what his employer could accommodate.

Due to the nature of the job role and the extent of his ongoing symptoms, it was suggested that Mr Jones’ work should initially be limited to one particular task that avoided any awkward positions or lifting. The number of working hours was agreed, starting with 2 hours a day on non-consecutive days.

We agreed a graded return to work plan (GRTW), covering a 10-week period, with graduated increases in both working hours and progression of work tasks after the first few weeks. We had regular review calls with Mr Jones and his line manager to review his progress and symptoms and to give guidance on progression of work tasks at appropriate points.

Mr Jones continued with his physiotherapy, and focused on regaining normal movement, muscle strength and postural awareness. Midway through the GRTW plan, he had stopped all analgesia and his sleep was undisturbed. He still suffered with some residual pain but he found ways of effectively managing this by changing position, exercise and postural awareness.

No amendments were required to the GRTW plan as the reviews suggested the progression of hours and work tasks was appropriate. Whilst not pain-free, he was managing the symptoms effectively.

Returning to full working hours

Mr Jones completed his GRTW plan and returned to his full working hours and role. We had a review call with him and his employer two weeks after the end of the plan, to ensure he was able to sustain the full-time hours and manage the residual symptoms before the case was then closed.

Mr Jones was advised to continue with the physiotherapy exercises for a minimum of three months in order to regain strength. He was also advised to continue with some form of regular exercise in the longer term to help reduce the risk of recurring back pain.