W. Va. Code R. § 85-20-37

Current through Register Vol. XLI, No. 45, November 8, 2024

Section 85-20-37 - Treatment Guidelines: Low Back Musculoligamentous Injury (Sprain/Strain)

37.1. Strains and sprains are a common cause of acute low back pain encountered in the general population. These injuries often are the result of the mechanical stresses and functional demands placed on the low back area by everyday activities. Symptoms are believed to be related to a partial stretching or tearing of the soft tissues (muscles, fascia, ligaments, facet joint capsule, etc.) The conditions, for the vast majority of injured workers, are of short duration and complete recovery is the general rule. Most injured workers with a musculoligamentous injury to the low back recover rapidly, with 50% to 60% of injured workers recovering within one week.

37.2. The appropriate diagnostic criteria consist of:

Onset of low back pain and paraspinal muscle spasm begins either suddenly after the injury occurs or develops gradually over the next 24 hours. The pain is usually relieved by rest and aggravated by motion of the back. The pain usually does not radiate below the knee, and the strain is not accompanied by paresthesias or muscle weakness in the legs. Physical findings include low back tenderness to palpation, loss of normal lumbar lordosis, and spasm of the paravertebral muscles. Straight leg raising and other tests that cause spinal motion may increase low back pain. The injured worker may stand with a list to the side or in a flexed position. The neurological examination and nerve root stretch tests usually are negative.

37.3. Appropriate and inappropriate diagnostic tests and examinations are as follows:

a. Although the diagnosis of a musculoligamentous injury is not based on radiographic criteria, plain x-rays may be indicated based on mechanism of injury (actual trauma, hyperextension, compression), a high index of clinical signs of pathology, or treatment plan for manipulative therapy. Pain, which persists (no improvement) longer than 2-4 weeks or worsens may also be criteria for x-rays.

b. Inappropriate diagnostic tests and examinations during the acute phase of the first four weeks:

1. CT scan;

2. MRI;

3. Bone scans;

4. Myelography;

5. EMG;

6. *Thermogram;

7. *Evoked Potentials;

8. *Myeloscopy; and

9. *Spinoscopy;

*Never appropriate

c. Failure to improve in four weeks warrants an appropriate second opinion.

37.4. Treatment considerations are as follows:

a. Non-operative treatment:

1. Indications: Almost all injured workers with low back musculoligamentous (sprain/strain) can be treated satisfactorily. No indications exist for the use of surgery in the treatment of low back musculoligamentous injuries.

2. Treatment options:

A. Short-term bed rest for approximately 2 days with appropriate positioning;

B. Analgesics;

C. Muscle relaxants as needed;

D. Anti-inflammatory nonsteroidal medication;

E. Referral for physical medicine (PT, OT, DC, DO, and physiatrist);

F. Physical modalities in conjunction with proper body mechanics and flexibility, endurance, and strength reactivation exercises;

G. Manipulation of spine;

H. Occasional trigger point injections; and

I. Lumbosacral corset or brace.

b. Inappropriate treatment:

1. Operative treatment is inappropriate for low back strain;

2. Prolonged bed rest beyond two days;

3. Narcotic medication for prolonged period;

4. Home traction; and

5. Inpatient treatment.

37.5. The estimated duration of care: 0 to 4 weeks; not to exceed 8 weeks.

37.6. A diagnosis of sprain/strain exceeding this 8 week period requires detailed re-evaluation. The Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable, may require an IME to verify the diagnosis and will authorize continued treatment/coverage in its sole discretion.

37.7. The anticipated outcome is resumption of normal activity without residual symptoms in most cases. Transitional activities may be required.

37.8. Modifiers (age, and co-morbidity). Co-morbidity (e.g., degenerative disc disease, spondylolisthesis, segmental instability, osteoporosis, spine deformity) may be associated with a higher incidence of persistent symptoms but are not compensable conditions.

W. Va. Code R. § 85-20-37