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Work Recommendations and Understanding 
Spine Resource Clinic 
University of Washington 
Patient Name: _______________________________ 
You need to take this to your boss or supervisor to see if you can work with the following recommendations. 
   ____Unrestricted no need to be debilitated by inactivity        Or  
 ____Restricted to minimize irritation while avoiding the debilitation caused by inactivity with alternative recommended activity to maintain some endurance (home program 15-30 min/day).         
   According to the AHCPR LOW BACK GUIDELINES   Bigos, et. al. 12/8/94* 
Other Comments:        ________________________________________________ 
____________________________                                          __________________ 
Clinician                                                        Date 
* Call 1-800-358-9295 for copy of AHCPR Guideline #14                     (over for Understanding) 
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Page 2 
Understanding for Work Recommendations - SRC 
As physicians we provide medical recommendations for patients when treating spine problems.  Commonly, activity recommendations are needed for patients who feel they cannot tolerate their job.  This is combined with an alternated activity to reduce the debilitating impact of being away from normal activity.  You avoid loss of activity tolerance by not resting too much or for too long.  Exercises are an alternative to avoiding regular activities in the acute stages or after a surgical procedure.  The basis is as follows:  We negotiate limitations when patients feel normal activity recommendation will be intolerable.  Such limitations that can be applied to the individual's work are similar to the activity recommendations we make about sports, at home or play to people with limiting symptoms.  Spine activity limitations rarely involve safety as much as comfort issues for the vast majority of the workforce.   
Limited activity recommendations from a medical standpoint are not a safety issue for spine problems unless we are dealing with fracture or dislocation or perhaps conservatively for patients over 50 years of age.  Using administrative terms we provide activity recommendations at work to avoid any undue discomfort for as short a period as possible but to avoid risks of debilitation we try to maintain or build activity tolerance so that any limitations at work can be eliminated or minimized as soon as possible.  Cadaver testing is only capable of dealing very loosely with extremely conservative recommendations as based upon pre-1965 data about 50+ years old specimens.  These were modified for the AHCPR Low back guide #14 Example for Limitations for spine problems.  Limitations are only provided at the patient's request to deal with issues of comfort rather than safety after being informed about risks of inactivity.  Such limitations are not needed for young working patients. 
Following spine surgery for a disc hernia, a professional can usually return within two weeks to his or her activities.  A clerk, returns within four weeks, a department store worker within six weeks, a light laborer within eight weeks, a heavy package delivery person within ten weeks, and twelve weeks for anyone doing extremely heavy labor.  Expect some individual variation with this activity limitation schedule. Older patients commonly take longer to regain muscular protection as a twenty-year old may have twice as much muscular capacity for protection than a fifty-year old.  The sooner we can get back to normal activity less the debilitation and the less re-conditioning ("spring training") will be required to regain  tolerance for regular activity.  The safety of other is to be determined by the employer. 
We do not tell someone to work or not but make recommendations about work activities.  To minimize discomfort we encourage patients to limit bending, reaching and twisting, especially when lifting as much as is reasonably possible.  Normal recovery usually eliminates all limitations in a short time.  The longer patients are away from regular duties, more interactions become more adversarial, usually problems with return to work become greater and the number of additional sources interfering with return to work increases. 
Stanley J. Bigos, MD Professor - Orthopedics & Environmental Health- U of Washington-Seattle, Washington 
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