Back Injury at Work: What to Do Next (Avoid Delays)

Quick Answer

If you hurt your back at work, report it immediately to your supervisor and request medical evaluation. Most work-related back injuries improve with conservative care over 6–12 weeks, but the process stalls when authorization is delayed, imaging isn't ordered when needed, or work restrictions aren't clear. Here's what changes the plan: progressive leg weakness, bowel/bladder changes, or no improvement after 6 weeks of appropriate treatment. The goal isn't just to "get better"—it's to get a clear diagnosis, appropriate treatment, realistic restrictions, and a safe return-to-work timeline.

A Common Scenario I See

A 42-year-old warehouse worker lifts a box awkwardly and feels immediate low back pain. He reports it to his supervisor, gets sent to urgent care, and receives a diagnosis of "lumbar strain" with instructions for ice, ibuprofen, and light duty. Three weeks later, he's still in pain—now with shooting pain down his right leg to his foot. He can't lift his toes. His employer wants him back at full duty, but he physically can't do it.

The problem? No one ordered an MRI. No one documented the change in symptoms. No one updated his restrictions. And now he's stuck in a loop: the adjuster wants more PT, the employer wants him back, and he's getting weaker.

This is where people get stuck. Not because the injury is untreatable, but because the process breaks down. Let me walk you through how to avoid this.

Timeline: What Happens When

Work injuries don't follow a script, but there are predictable checkpoints. Here's what a reasonable timeline looks like—and what should trigger escalation.

Timeframe	What Should Happen	Red Flags / Escalation Triggers
Day 1–7	• Report injury to supervisor • Initial medical evaluation • Diagnosis documented • Work restrictions issued • Conservative care started (ice, NSAIDs, activity modification)	• Leg weakness or numbness • Bowel/bladder changes • Saddle anesthesia • Severe pain unresponsive to meds → Urgent spine evaluation + imaging
Week 2–6	• Follow-up visit (week 2–3) • Physical therapy if appropriate • Reassess symptoms and function • Update restrictions if needed • Consider imaging if not improving	• New or worsening leg symptoms • Progressive weakness • No improvement after 3–4 weeks of appropriate care → MRI + spine specialist referral
After 6 Weeks	• Spine specialist evaluation if not improving • MRI review • Clear diagnosis and treatment plan • Decision: continue conservative care, injections, or surgery • Updated return-to-work timeline	• Still no clear diagnosis • Endless PT with no reassessment • Restrictions unchanged despite worsening symptoms → Second opinion or IME

First Steps After Injury

The first 48 hours matter. Not just medically, but administratively.

Report the Injury Immediately

Tell your supervisor as soon as it happens. Don't wait until the end of your shift. Document the mechanism of injury: what you were doing, what you felt, when it happened. This isn't about blame—it's about establishing a clear timeline.

Get Medical Evaluation

Your employer will direct you to a specific provider (occupational health, urgent care, or designated clinic). Go. Even if you think it's "just a strain." The initial visit establishes baseline symptoms, documents the injury, and starts the authorization process.

Be Specific About Your Symptoms

Don't just say "my back hurts." Describe:

• Where exactly it hurts (low back, mid-back, neck)
• Does it radiate? (down your leg, into your arm, around your ribs)
• Any numbness, tingling, or weakness?
• What makes it worse? (bending, lifting, sitting, standing)
• What makes it better? (lying down, walking, nothing helps)

This matters. "Back pain" gets treated differently than "back pain with leg weakness."

Get Written Work Restrictions

Before you leave that first visit, you should have a written note with specific restrictions. Not "light duty"—that's too vague. It should say things like:

• No lifting >10 lbs
• No repetitive bending or twisting
• Sit/stand alternating every 30 minutes
• No climbing ladders

Your employer needs this to assign appropriate work. If they can't accommodate the restrictions, that's a different conversation—but you need the documentation.

Authorization & Documentation Basics (Without Legal Advice)

I'm not a workers' comp attorney, and this isn't legal advice. But I can tell you what I see cause delays—and what helps things move.

What Needs Authorization

In most workers' comp systems, these require prior authorization:

MRI or CT scans — Usually requires medical necessity documentation (failed conservative care, neurological symptoms, etc.)
Specialist referrals — Spine surgeon, pain management, neurology
Injections — Epidural steroid injections, facet blocks, SI joint injections
Surgery — Always requires authorization, often with peer review or IME

What Causes Authorization Delays

• Incomplete medical records (missing initial visit notes, no symptom progression documented)
• Vague requests ("patient needs MRI" vs "patient has progressive right L5 radiculopathy with foot drop, failed 4 weeks PT, needs lumbar MRI to evaluate for surgical pathology")
• No documentation of conservative care failure
• Requesting imaging too early (week 1 for uncomplicated back pain)
• Not updating the adjuster when symptoms change

What You Can Do

You're not responsible for the authorization process, but you can help it move:

• Show up to all scheduled appointments
• Follow prescribed treatment (PT, home exercises, medications)
• Report changes in symptoms immediately (new weakness, numbness, bowel/bladder issues)
• Keep copies of all medical notes and restriction letters
• If you're not improving after 3–4 weeks, ask your provider: "Do I need imaging or a specialist?"

Understanding Work Restrictions: What They Mean and How They Change

Work restrictions aren't arbitrary. They're based on your diagnosis, your symptoms, and what activities could make things worse or delay healing.

How I Write Restrictions

When I see a patient with a work injury, I'm thinking about three things:

What's the diagnosis? Lumbar strain vs herniated disc with radiculopathy vs compression fracture—these get different restrictions.
What activities could cause harm? If you have a disc herniation with leg weakness, heavy lifting could worsen the nerve compression. If you have a compression fracture, bending and twisting could cause further collapse.
What can you safely do? The goal is to keep you working if possible, but within safe limits. If your job involves lifting 50 lbs repeatedly and you can't do that right now, we need to document what you can do.

Common Restrictions and What They Mean

"No lifting >10 lbs"

This means you can lift up to 10 pounds occasionally, but nothing heavier. It's designed to protect your spine from excessive load during the acute healing phase. This restriction typically lasts 2–6 weeks for strains, longer for disc herniations or post-surgery.

"No repetitive bending, twisting, or stooping"

Repetitive flexion (bending forward) increases disc pressure and can aggravate herniations or strains. Twisting under load is particularly risky. This doesn't mean you can't bend at all—it means avoid repetitive or sustained bending as part of your work tasks.

"Sit/stand alternating every 30 minutes"

Prolonged sitting or standing can both aggravate spine pain. Alternating positions reduces sustained load on any one structure. This is common for office workers or assembly line workers with back injuries.

"Light duty" or "Modified duty"

These are too vague on their own. I always specify what "light duty" means: lifting limits, positional restrictions, no climbing, etc. If your employer receives a note that just says "light duty," they should ask for clarification.

How Restrictions Change Over Time

Restrictions aren't permanent. They should be reassessed at every follow-up visit. Here's a typical progression:

Week 1–2: Most restrictive (no lifting >10 lbs, no bending/twisting, frequent position changes)
Week 3–6: Gradual liberalization if improving (increase lifting to 20–25 lbs, allow occasional bending, longer work periods)
Week 6–12: Return to full duty if symptoms resolved and function restored, or continued restrictions if not improving (this is when specialist referral often happens)
Post-surgery: Restrictions restart and progress based on procedure type and healing (typically 6–12 weeks to full duty for most spine surgeries)

What to Try First: Conservative Care That Actually Works

Most work-related back injuries improve without surgery. But "conservative care" doesn't mean "do nothing and hope." It means structured, progressive treatment with clear goals and reassessment points.

First 2 Weeks: Acute Phase

Activity modification — Avoid aggravating activities, but stay as active as tolerated. Bed rest beyond 1–2 days delays recovery.
Ice or heat — Ice for first 48 hours if there's acute inflammation, then heat for muscle spasm. Use what feels better.
NSAIDs — Ibuprofen or naproxen (if no contraindications) to reduce inflammation and pain. Take with food.
Gentle movement — Walking, gentle stretching. Avoid prolonged sitting or standing.

Week 2–6: Subacute Phase

Physical therapy — Structured exercise program focused on core strengthening, flexibility, and proper body mechanics. PT should be progressive, not just passive modalities (ultrasound, TENS, etc.).
Home exercise program — Daily exercises prescribed by your PT. Compliance matters.
Gradual return to activity — Progressive increase in work duties as tolerated, within restrictions.
Medications — Continue NSAIDs if helpful. Muscle relaxants for spasm (short-term). Avoid opioids if possible.

What Changes the Plan

Conservative care should be working by 4–6 weeks. Not "cured," but improving. If you're not seeing progress, something needs to change. Red flags that trigger escalation:

• No improvement in pain or function after 4 weeks of appropriate PT
• New or worsening leg symptoms (numbness, weakness, shooting pain)
• Can't tolerate PT due to pain
• Symptoms interfering with sleep, daily activities, or safe work performance

At this point, you need imaging (if not already done) and specialist evaluation.

What I Look For on Exam and Imaging

When I evaluate a work injury, I'm looking for specific things that change management. Not every back injury needs an MRI. But some do.

Physical Exam

Range of motion: Can you bend forward, backward, side to side? What reproduces your pain?
Neurological exam: Strength testing (can you walk on heels? toes? squat and stand?), sensation (any numbness in specific patterns?), reflexes (knee, ankle, plantar response)
Straight leg raise: Classic test for nerve root irritation. Positive if it reproduces leg pain (not just back pain) below the knee.
Palpation: Tenderness over spinous processes (could indicate fracture), paraspinal muscle spasm, SI joint tenderness

When I Order an MRI

I don't order an MRI on everyone. I order it when the result will change management. Indications:

• Radicular symptoms (leg pain, numbness, weakness) suggesting nerve root compression
• Failed conservative care (4–6 weeks of appropriate treatment with no improvement)
• Progressive neurological deficit (worsening weakness, new bowel/bladder symptoms)
• Red flags (history of cancer, unexplained weight loss, fever, trauma with concern for fracture)
• Considering injections or surgery (need to see what we're treating)

What the MRI Shows (and What It Doesn't)

An MRI shows anatomy, not pain. I'm looking for:

• Disc herniations (and whether they're compressing a nerve root)
• Spinal stenosis (narrowing of the spinal canal or nerve root canals)
• Fractures (compression fractures, pars fractures)
• Instability (spondylolisthesis—one vertebra slipped forward on another)
• Infection or tumor (rare, but important to rule out)

What the MRI doesn't tell me: whether that herniation is causing your symptoms, whether you need surgery, or how you'll respond to treatment. That's why the exam matters. I'm correlating imaging findings with your symptoms and exam findings.

When Surgery Becomes Reasonable

Surgery isn't the first option. But it's not the last resort either. It's a tool we use when conservative care has failed and there's a clear structural problem that surgery can fix.

Indications for Surgery

Emergency Indications (Urgent Surgery)

• Cauda equina syndrome (bowel/bladder dysfunction, saddle anesthesia, bilateral leg weakness)
• Progressive neurological deficit (rapidly worsening weakness, foot drop that's getting worse)
• Unstable fracture with spinal cord compression

Elective Indications (Planned Surgery)

• Persistent radicular pain (sciatica) after 6–12 weeks of conservative care, with MRI-confirmed nerve compression
• Significant functional impairment (can't work, can't sleep, can't perform daily activities)
• Stable neurological deficit (weakness that's not improving with time)
• Spinal stenosis with neurogenic claudication (leg pain with walking) not responding to conservative care
• Unstable spondylolisthesis with mechanical back pain

What Surgery Can and Can't Do

Surgery is good at:

• Decompressing pinched nerves (removing disc herniations, opening up stenotic canals)
• Stabilizing unstable segments (fusion for spondylolisthesis, fractures)
• Relieving radicular pain (leg pain from nerve compression)

Surgery is less predictable for:

• Axial back pain (pain in the back itself, without leg symptoms)
• Chronic pain syndromes (pain that's been present for years with multiple failed treatments)
• Non-specific back pain (no clear structural cause on imaging)

Risks and Recovery

Every surgery has risks. For spine surgery, the main risks include:

• Infection (1–3%)
• Nerve injury (1–2%, usually temporary)
• Dural tear (CSF leak, 1–5%, usually repaired at time of surgery)
• Recurrent herniation (5–10% over 10 years for discectomy)
• Failed back surgery syndrome (persistent pain despite surgery, 10–20%)

Recovery timeline varies by procedure:

Microdiscectomy: 2–6 weeks to return to light duty, 6–12 weeks to full duty
Laminectomy (decompression): 4–8 weeks to return to light duty, 8–12 weeks to full duty
Fusion: 6–12 weeks to return to light duty, 3–6 months to full duty (depends on job demands)

Red Flags — Seek Urgent Care

Most back injuries are not emergencies. But some symptoms require urgent evaluation. Go to the ER or call your doctor immediately if you experience:

Bowel or bladder dysfunction — Loss of control, inability to urinate, or loss of sensation when wiping
Saddle anesthesia — Numbness in the groin, inner thighs, or buttocks (the area that would touch a saddle)
Progressive leg weakness — Weakness that's getting worse over hours or days, especially foot drop (can't lift your foot)
Bilateral leg symptoms — Numbness, weakness, or pain in both legs
Fever with back pain — Could indicate infection (discitis, epidural abscess)
Severe trauma — Fall from height, motor vehicle accident, direct blow to spine
History of cancer — Back pain in someone with a history of cancer could be metastatic disease
Unexplained weight loss — Unintentional weight loss with back pain could indicate serious pathology

Decision Pathway: A Stepwise Algorithm

Here's how I think through a work-related back injury:

Red Flags Present?

→ YES: Urgent imaging + specialist evaluation
→ NO: Proceed to step 2

Radicular Symptoms (Leg Pain, Numbness, Weakness)?

→ YES: Consider early imaging (2–4 weeks) + specialist referral
→ NO: Start conservative care, reassess at 2–4 weeks

Improving After 4 Weeks of Conservative Care?

→ YES: Continue conservative care, progress restrictions
→ NO: Order imaging (if not done), refer to specialist

MRI Shows Surgical Pathology (Herniation, Stenosis, Fracture)?

→ YES: Discuss treatment options (injections vs surgery)
→ NO: Continue conservative management, consider pain management referral

Failed Conservative Care + Injections (if appropriate)?

→ YES: Discuss surgical options, risks, benefits, recovery
→ NO: Continue conservative management, reassess functional goals

Surgery Indicated and Patient Agrees?

→ YES: Obtain authorization, schedule surgery, plan return-to-work timeline
→ NO: Continue conservative management, consider second opinion or functional restoration program

Frequently Asked Questions

Do I need to report my injury immediately, or can I wait to see if it gets better?

Report it immediately. Even if you think it's minor. Delayed reporting can cause problems with your claim and delay treatment authorization. You're not "bothering" anyone—work injuries are expected, and there's a system in place to handle them.

Can I see my own doctor, or do I have to go to the company doctor?

This varies by state and employer. In most workers' comp systems, your employer directs initial care to a specific provider or panel. After initial evaluation, you may have the right to request a different provider or get a second opinion. Check your state's workers' comp rules or ask your HR department.

How long does it take to get an MRI authorized?

It depends on the carrier and the documentation. With complete medical records and clear medical necessity, authorization can happen in 3–7 days. If records are incomplete or the request is vague, it can take weeks. Your provider's office should follow up if authorization is delayed.

What if my employer can't accommodate my work restrictions?

If your employer doesn't have modified duty available that fits your restrictions, you may be placed on temporary total disability (TTD) until you can return to work. This is a workers' comp issue, not a medical issue. Your doctor's job is to document what you can and can't do safely—your employer and the adjuster work out the rest.

I've been doing PT for 8 weeks and I'm not better. What now?

If you've done 6–8 weeks of appropriate physical therapy and you're not improving, it's time to reassess. You should have imaging (if not already done) and see a spine specialist. Continuing PT indefinitely without reassessment is not appropriate care.

Can I get a second opinion?

Yes. In most states, you have the right to request a second opinion, especially if surgery is being recommended. The process varies by state—sometimes you can request it directly, sometimes the adjuster arranges it, sometimes it requires an Independent Medical Examination (IME). Ask your adjuster or case manager about the process.

What if I disagree with the IME doctor's opinion?

IME opinions carry weight in workers' comp cases, but they're not final. If you disagree, you can request another opinion, provide additional medical records, or appeal through your state's workers' comp board. This is where having a workers' comp attorney can be helpful.

How long will I be off work if I need surgery?

It depends on the procedure and your job demands. Microdiscectomy: 2–6 weeks to light duty, 6–12 weeks to full duty. Fusion: 6–12 weeks to light duty, 3–6 months to full duty. Sedentary jobs allow earlier return than heavy labor jobs. Your surgeon will give you a specific timeline based on your procedure and job requirements.

What if I can't return to my old job after surgery?

If you have permanent restrictions that prevent you from returning to your pre-injury job, you may be eligible for vocational rehabilitation, retraining, or permanent partial disability benefits. This is determined through a functional capacity evaluation (FCE) and discussions with your employer, adjuster, and vocational counselor.

Should I get a lawyer?

Not every workers' comp case needs an attorney. But consider consulting one if: your claim is denied, you're not getting appropriate medical care, there's a dispute about your ability to return to work, or you're facing permanent disability. Most workers' comp attorneys offer free consultations.

Important Disclaimer

This article provides general educational information about work-related back injuries and is not personal medical advice. Every injury is different, and treatment decisions should be made in consultation with your physician.

Workers' compensation rules, authorization processes, and benefits vary significantly by state, employer, and insurance carrier. This article does not constitute legal advice. For specific questions about your workers' comp claim, consult your adjuster, case manager, or a workers' compensation attorney.

Related Resources

Procedure

Microdiscectomy for Herniated Disc