By definition, regional musculoskeletal disorders interfere with function. Take the example of a backache. Attempts to lean forward, even while seated, exacerbate the pain. Lifting is problematic and more so when the object cannot be held close to the body. All of this follows from an understanding of the biomechanics of the lumbar spine. Dramatic increases in intradiscal pressure are associated with minor shifts in posture, shifts that are part of daily living. Leaning forward while seated places as much stress on the lumbar spine as would modest materials handling. Furthermore, only total recumbency unloads the lumbar spine. Even passive flexion while recumbent, such as propping one’s head on pillows to read or watch television, entails major increments in force. No wonder we hear from patients that their backache is worse even when they do no more than write at their desk, and that bed rest was neither restful nor palliative. Biomechanical considerations alone would predict such. And biomechanical considerations alone suggest motions and postures to be avoided when hurting.

The challenge is not just to the worker faced with materials handling; the housewife vacuuming or lifting her child is faced with a dilemma as is the physician hunched over a desk or operating table. All of us face the potential for the illness of work incapacity. Most of us, apparently, meet the challenge because we can adapt our task to the incapacity. Sometimes this involves postponing vacuuming, raising the height of our desk relative to the chair, or taking advantage of the empathy of our supervisors or coworkers. These are some of the homeostatic mechanisms available to most of us in coping. However, what happens if such mechanisms fail us either because they are inadequate or they are exhausted by the duration of our illness?

America provides access to one of three avenues of recourse for any of us who are unable to cope with an illness of work incapacity and who are willing to apply. All avenues are gantlets operated in the belief that without a gantlet, no system could distinguish deserving from undeserving applicants. Two of the programs
demand an element of culpability; the illness of work incapacity must be a consequence of some harm that befalls you as a result of the actions of another. If such actions did not occur in the context of your employment, the mechanism of recourse is the legal remedy known as a tort. A tort is a suit brought to right a wrong whether you experienced a discrete forceful insult or were damaged by a manufactured product. Relevant to our considerations are product liability (“toxic tort”) suits that have been pursued when workers believe that they were harmed because the tools they were expected to use were hazardous.

If your injury arose out of and in the course of your employment, you are solely indemnified by your Workers’ Compensation Insurance policy. Workers’ Compensation Insurance programs are administered on a state-by-state basis and are particularly relevant to regional backache and other regional musculoskeletal illness. If the backache is deemed to be an “injury” that arises out of and in the course of employment and occurs by accident, the person is entitled to coverage under Workers’ Compensation Insurance. These policies not only provide all medical care but also supplement income until the employee is as well as he or she is going to get. Then the policy provides fiscal compensation for compromised wage-earning capacity or for the actual decrement in wages earned as a consequence of any persisting disability. The Workers’ Compensation Insurance model is “no fault” in design and has largesse that far outstrips the disability program administered by the Social Security Administration. Workers’ Compensation Insurance programs are efficient in providing benefits (and potentially efficient in monitoring safety) to people who are injured as a consequence of discrete traumatic events involving external forces. These comprise the majority of the claims. The bulk of the remainder of claims relate to regional backache and, recently, regional arm pain. These are responsible for the majority of the indemnity cost of this system.