Bearing the Load: Back Pain at Work

Six stiff, stooped senior managers stood before me. All men in their fifties, they wore short-sleeved white shirts and dark ties only long enough at the bottom to point at portly rounded masses that protruded above pant belts slung low to hold up the heft above. The big bellies and thick wrists betrayed the ages of men, who had worked at this facility since they graduated high school. In those days, they were young, carefree, long, lean boys. The years at the plant had slowed their pace and thickened their torsos.

We were in middle America at a distribution center for a major North American retail chain. The guys on the "management team" all knew each other as children, knew each others' children, and often gave them jobs. This plant was the center of the local community and was its major single employer. Town allegiance went hand-in-hand with company loyalty. In fact, a few years ago, the mayor (whose small business was also a subcontractor to "The Company") named a town park in honor of the company's generous donation. The enterprise advertised itself nationally as the maker of products that were "reliable, dependable" things you could count on. In this town, employment at the company was as certain as the sun rising each morning.

Clouds would soon block the sunlight.

These men and I shared a secret yet untold to the workers. Corporate headquarters in Chicago had sent an uncomfortable message that we alone knew. Troubled times, increased competition and rising labor costs led to a decision to cut 8 percent of the positions at this plant. This group of six men was charged with creating the plan to cut the jobs of people they likely knew well, changing the fates of their friends and neighbors. I was asked to help them recover from the shock and assist them in their task.

When I was a child, no one ever used the term "downsizing." Now, it is a common term as American industry strives for ever-greater efficiency, for every possible cost saving, for any and all chance to get the most productivity from fewer and fewer people. There are almost always rational reasons to do it, and it is always painful for those involved.

People's lives revolve around their work. People socialize at work; share goals, successes and failures; care about each other; learn and mature together; and share aspirations. Many people care about what they do as much as they care about each other. So, when a stable workplace changes radically, so do most of its players.

These six men were no exception. We sat together for a series of meetings in which they groped with loss while attempting to preserve hope. They called the process "planning."

During the first meeting, I noticed a subtle change in each of them. Once proud, strong men, they progressively hunched more and more as they came to grips with the situation. The burden of their work, initially perceived as cutting jobs, weighed more heavily than those big bellies. One of them winced visibly but said nothing. Later, he quietly took a painkiller. Still later, he braced his back using both hands, continuing to work all the while.

Four of the others followed suit, and before the second day's meeting, five of the six had significantly debilitating back pain. Two left work at the start of the second day to see their doctors (rare for men who seldom missed work). Once energetic men, three of them also complained of fatigue.

One of them asked me, "Dr. Post, why do you think the pain is worse now? I've had back pain for years and only now is it flaring up."

What is the pain saying? I asked myself. The anatomy of stress is quite simple and well-documented. Stress responses kick in when the brain realizes that something is happening that can damage a person. Designed to protect and mobilize us in times of danger, stress responses follow two pathways: one neural (though nerves) and one hormonal, stimulating the release of hormones from glands. These pathways overlap in producing a response.

In threatening times, these men endured "neuroendocrine" responses in which the brain's hypothalamus stimulated the release of adrenaline from the adrenal glands. The continued hyperfiring led to deficiency in the Kidney, which led to the pains. In addition to helping them find appropriate support, I saw my job as helping them reduce their fear, diminishing the stress response, thus mobilizing (rather than draining) their energy.

There are studies that show why some people suffer (and some thrive) when stresses hit. One study, written by Susan Kobasa, found that people who are physically well (in spite of stress) have a particular constellation of personality characteristics that she labeled "hardy." Hardy people 1) Have a strong commitment to work, family, friends, religion, political or altruistic endeavors; 2) View change as a challenge; and 3) Experience a sense of personal control over their lives. The three Cs - commitment, sense of control, and challenge, are essential ingredients of psychological and physical hardiness. (Kobasa, 1979)

We worked with the three Cs in our gang of six. By day three of this engagement, we built a commitment map for the team whereby the men built a mission they could believe in. This included creating ways to downsize that helped people find new jobs, strengthened community commitments and reduced trauma for families. We then talked about the challenge of the assignment and listed elements that could be controlled. The men took pride in the challenge, began to stand taller, and took fewer painkillers. In a short week, we had mobilized these men who now felt they had a mission, rather than aching backs. Once mobilized, four of them decided that exercise and weight loss would improve their energy and outlook. I stayed in contact with them for another six months while the changes were approved and implemented, flying out another time to help them at a particularly difficult juncture - when the first layoffs were announced.

We are healers. We can't change the cause of our clients' stress, and we certainly can't change the economic conditions of these times, but we can respond to (and even prevent) some pain caused by work-related stresses. We can help people stand up for themselves and stand up with each other when the burdens of work are too heavy.