Back Pain Among Horticulture Workers - Need for Prevention Strategies

Although back pain is common among horticulture workers, effective prevention and management strategies are lacking. The first phase of a study using the Exploration, Preparation, Implementation, and Sustainment Framework is described with aims to characterize stakeholder perceptions of: 1) the need to address back pain, 2) attitudes towards pain medication including opioids, 3) contextual factors, and 4) preferences for training related to musculoskeletal injury prevention.

In-depth interviews were completed in English or Spanish (n = 14) with consultants, owners, supervisors, and workers and in English or Spanish. Transcripts were recorded, transcribed, and coded, followed by qualitative inductive-deductive thematic analysis.

While back pain is widespread, productivity requirements and working through pain may lead to de-emphasizing awareness and practices to prevent and manage back pain. Nursery and landscape workers tend to work regardless of pain, often using over-the-counter pain relievers to get through the day. Use of pain medication is seldom discussed, including risks of opioids and owners and consultants were hesitant to provide Naloxone in the workplace. Non-modifiable but variable contextual factors to consider when designing training are seasons and weather, type of horticulture, business models, productivity goals, and income needs. Training, policies, administrative controls, and worker knowledge and attitudes towards pain are potentially modifiable. Most current training is informal and on-the-job, and supervisors play a critical intermediary role. Integrating training into current work practices could minimize reductions in work time.

Proactive interventions to limit and manage back pain and increase awareness of medication risks are needed for horticulture workers. Themes will be useful to design horticulture-specific training: 1) variability in contextual factors (weather, seasons, business models) requires training options that can be used at down-times and in different locations, 2) productivity drivers and worker tendencies to work through pain to protect their income require short, practical strategies and training without disrupting workflow, and appropriate messaging, 3) need for a supportive workplace culture, and 4) importance of involving supervisors. The non-modifiable and modifiable contextual findings from this study will be helpful for designing prevention training in the horticulture industry and could potentially apply to other outdoor physically challenging occupations.