Dealing with back injuries

Decades of working with large animals have taken their toll on the back of Dr. John W. Fields.

From shoeing horses before college to practicing bovine and equine medicine, Dr. Fields was already feeling back strain from heavy lifting. But a horse accident in 1994 and a truck accident in 2004 left his back permanently damaged—and kept him away from his practice for months each time while he recuperated.

"Now I do rehab on a daily basis. I wear a back support that my orthopedic surgeon recommended anytime I'm going to be lifting or using my upper body for anything more than sitting or walking," Dr. Fields said. "In retrospect, I wish someone had convinced me to use (a back support) 20 years ago. Hindsight is always 20-20."

Dr. Fields is far from alone in his experiences with back injuries. The Bureau of Labor Statistics reports that, at 35.5 percent, the trunk is the part of the body most affected by work-related incidents, and back injuries account for 63 percent of all trunk-related incidents.

Veterinarians are prone to back injuries. In 2006, the AVMA Group Health and Life Insurance Trust paid claims totaling more than $4 million for back disorders, which ranked fourth in costs among all diagnostic categories, after complications of surgical and medical care ($12.1 million), general symptoms ($5.9 million), and joint disorders ($5.7 million). A 2007 analysis by The Hartford of claims activity for participants in the AVMA PLIT found that the most severe injuries were associated with improper lifting, with a typical workers' compensation claim totaling $22,000, which often includes disability expenses.

Back injuries are physically and emotionally devastating. The long road to recovery can spell financial ruin for veterinarians without the kind of insurance coverage that helps them keep their practices running while they recuperate.

Dr. Fields, a Senora, Texas-based practitioner whose practice encompasses hundreds of miles, had GHLIT Disability and Professional Overhead Expense insurance to protect his practice, but the frustration of not being able to work was overwhelming.

"I feel that I have an obligation to my clients to provide them with the best veterinary medical care for their animals that I possibly can," he said. "It would have driven me nuts to know that while I was lying in the hospital or sitting at home, those people did not have adequate veterinary care just because I could not be there."

The AVMA Ergonomics Task Force identified a number of risk factors inherent in a veterinary practice, including awkward postures, highly repetitive motion, heavy or awkward lifting, moderate to high vibration, and repeated impact. The existence of one or more of these risk factors within a task creates "caution zone tasks," which the task force recommends be eliminated through the implementation of engineering controls or the application of ergonomic techniques.

Suggestions include using lift tables to reduce the exposure to injury when lifting large or heavy animals, and providing job-specific training on the proper use of equipment and techniques to reduce the risk of back injury. The ergonomics guidelines developed by the task force are available online.

The Coalition for Health and Safety in Agriculture also offers some basic rules on lifting, posture, and proper exercise to help reduce or prevent back injuries, which can be found online at agsafe.org/series_2/back_injury_prevention.htm. These include losing weight to reduce the excess force that extra pounds can place on back and stomach muscles, maintaining good posture, and carefully planning and executing lifts to prevent straining the back and surrounding muscles.

"I would counsel anyone who does large animal work, especially if you're doing equine work, to do exercises to build up the strength in your back," Dr. Fields said. "If necessary, get a back support. It may not be a belt—it may be no more than support for the lumbar region—but get something to pull those muscles tighter and aid in your efforts to do the type of lifting required.

"You have to convince yourself that this is something you've got to do in order to keep doing what you're doing three or 14 years from now."

Protecting the back is vital, but it's equally important for veterinarians to ensure they have adequate insurance to protect their practices from the financial devastation a back injury can cause. Health insurance alone is not enough protection.

That is a message Dr. Fields is thankful he was able to drive home to a close friend who also practices in Texas.

"I convinced him that he was doing himself, his wife, his practice, his clients, everyone a disservice by not having some type of clinic overhead insurance as well as disability insurance to cover his expenses and the expenses of his clinic, should he not be able to practice," he said.

"He suffered a back injury about six months ago and ultimately ended up having to have five vertebrae fused. He has thanked me multiple times over the past few months for talking him into taking out (that coverage) so he and his wife were able to (survive financially) and keep his practice open."

The AVMA GHLIT program is underwritten by New York Life Insurance Company (NY, NY 10010). For more information on GHLIT plans, including eligibility, rates, renewal provisions, exclusions, and limitations, or to find a GHLIT agent in a particular area, call the Trust office at (800) 621-6360. For more information on workers' compensation insurance and employee safety, contact the AVMA PLIT at (800) 228-7548.