Back Sprain Research Articles

The Burden of Back and Neck Strains and Sprains in Professional Baseball Players.

A retrospective case series study. To analyze the epidemiology of diagnoses of back and neck strains and sprains among Major League (MLB) and Minor League (MiLB) Baseball players. Baseball players perform unique sets of repetitive movements that may predispose to neck and back strains and sprains. Data are lacking concerning the epidemiology of these diagnoses in this population. De-identified data on neck/back strains and sprains were collected from all MLB and MiLB teams from 2011 to 2016 using the MLB-commissioned Health and Injury Tracking System database. Diagnosis rates of conditions related to cervical, thoracic, and lumbar musculature and their impact on days missed due to injury, player participation, and season or career-ending status were assessed. Injury rates were reported as injuries per 1000 athlete exposures (AEs). There were 3447 cases of neck/back strains and sprains in professional baseball players from 2011 to 2016. Seven hundred twenty-one of these occurred in MLB versus 2726 in MiLB. Of injuries 136 were season-ending (26 in MLB, 110 in MiLB); 22 were career-ending (2 in MLB, 20 in MiLB). The total days missed were 39,118 (8838 from MLB and 30,280 from MiLB). Excluding season or career-ending injuries, the mean days missed were 11.8 (12.7 and 11.6 in MLB and MiLB, respectively). The median days missed were 4 (3 and 5 in MLB and MiLB, respectively). Combining MLB and MiLB, the pitcher injury rate was 1.893 per 1000 AEs versus 0.743 per 1000 Aes for other position players ( P < 0.0001). There was a high incidence of neck/back strains and sprains in MLB and MiLB players, with nearly 40,000 aggregate days missed in our 6-year study period. The median days missed were lower than the mean days missed, indicating rightward outliers. Pitchers had over double the rates of injuries compared with other position players. Level III.

Efficacy and Safety of Naproxen Gel in Musculoskeletal Pain Management: A Prospective Cohort Study

Introduction: Naproxen is effective for various musculoskeletal conditions and has a longer half-life, making it a favourable choice for sustained relief. Additionally, there is a potential unmet need for guidelines on the usage of topical Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) in the Asia-Pacific region. A study on naproxen 10% gel aims to address this need and increase awareness of its therapeutic potential in the region. Aim: To assess the efficacy and safety of naproxen 10% gel in relieving pain associated with lower back, knee, cervical, synovitis, bursitis, muscle sprain, and tendinitis. Materials and Methods: This prospective, cohort, observational, open-label, single-arm, multicentric study was conducted at 458 centres in India, including Ahmedabad, Bengaluru, Chandigarh, Chennai, Delhi, Guwahati, Hyderabad, Indore, Jaipur, Kolkata, Lucknow, Meerut, Mumbai, Patna, and Pune, between February 2023 and May 2023. The data was collected from outpatient settings/clinics of orthopaedicians and clinicians who have been prescribing topical naproxen 10% gel to their patients. The study included patients aged 18 to 60 years of either sex who were suffering from back pain, muscle pain, sprains, frozen shoulder, arthritis, acute low back ache (non-specific), or pain. The data was captured during the scheduled follow-up visits planned by the treating clinician, with data recorded at 3, 5, 10, and 15 days. At the baseline visit, demographic details (age, sex, weight, height, body mass index, and symptoms), Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain subscale score, pain intensity on movement score, Visual Analogue Scale (VAS), and overall pain score were obtained. Results: Out of 10,587 patients, 10,265 completed the present study. The majority of patients had lower back pain (n=3386, 32.99%) and knee pain (n=3184, 31.02%). The average pain intensity on movement score of patients with bursitis significantly decreased from the baseline to 15 days {mean change {95% Confidence Interval (CI)}: 6.04 (5.89, 6.20); p&lt;0.001}. Post-naproxen treatment, the average pain intensity, WOMAC pain score, VAS, and overall pain score significantly decreased from baseline to day 15 in patients with knee pain and lower back pain. A significant improvement in WOMAC, WOMAC pain (5.42 vs 17.98), WOMAC stiffness (1.49 vs 5.75), and WOMAC physical function score (18.93 vs 56.21) at day 15 was observed in patients with a muscle sprain. Adverse Events (AE) were reported in 173 (1.69%) patients overall, with dryness (n=125) being the most common, followed by erythema (n=20) and pruritus (n=17). Conclusion: Naproxen 10% gel is an effective topical treatment for lower back pain, knee pain, cervical pain, synovitis, bursitis, muscle sprain, and tendinitis. It could prove helpful in patients where the side-effects of oral NSAIDs are to be avoided.

Chiropractic Services and Diagnoses for Low Back Pain in 3 U.S. Department of Defense Military Treatment Facilities: A Secondary Analysis of a Pragmatic Clinical Trial

ObjectiveThe purpose of this study was to describe the diagnoses and chiropractic services performed by doctors of chiropractic operating within 3 military treatment facilities for patients with low back pain (LBP). MethodsThis was a descriptive secondary analysis of a pragmatic clinical trial comparing usual medical care (UMC) plus chiropractic care to UMC alone for U.S. active-duty military personnel with LBP. Participants who were allocated to receive UMC plus 6 weeks of chiropractic care and who attended at least 1 chiropractic visit (n = 350; 1547 unique visits) were included in this analysis. International Classification of Diseases and Current Procedural Terminology codes were transcribed from chiropractic treatment paper forms. The number of participants receiving each diagnosis and service and the number of each service on unique visits was tabulated. Low back pain and co-occurring diagnoses were grouped into neuropathic, nociceptive, bone and/or joint, general pain, and nonallopathic lesions categories. Services were categorized as evaluation, active interventions, and passive interventions. ResultsThe most reported pain diagnoses were lumbalgia (66.1%) and thoracic pain (6.6%). Most reported neuropathic pain diagnoses were sciatica (4.9%) and lumbosacral neuritis or radiculitis (2.9%). For the nociceptive pain, low back sprain and/or strain (15.8%) and lumbar facet syndrome (9.2%) were most common. Most reported diagnoses in the bone and/or joint category were intervertebral disc degeneration (8.6%) and spondylosis (6.0%). Tobacco use disorder (5.7%) was the most common in the other category. Chiropractic care was compromised of passive interventions (94%), with spinal manipulative therapy being the most common, active interventions (77%), with therapeutic exercise being most common, and a combination of passive and active interventions (72%). ConclusionFor the sample in this study, doctors of chiropractic within 3 military treatment facilities diagnosed, managed, and provided clinical evaluations for a range of LBP conditions. Although spinal manipulation was the most commonly used modality, chiropractic care included a multimodal approach, comprising of both active and passive interventions a majority of the time.

Neck and Back Sprain and Hand Flexor Tendon Repair Are More Common in Victims of Domestic Violence Compared With Patients Who Were Not Victims of Domestic Violence: A Comparative Study of 1,204,596 Patients Using the National Trauma Data Bank.

Introduction:The purpose of this study was to determine the most common orthopedic diagnoses and procedures among patients who experience domestic violence (DV) and to determine whether these were more common in patients who experienced DV compared with those who did not.Methods:We performed a retrospective cohort study of all patients identified in the National Trauma Data Bank. Patients were divided into two cohorts for comparison: victims of DV and all other patients. The main outcome measurements were a diagnosis of an orthopedic injury and/or a procedure performed for an orthopedic diagnosis.Results:In total, 1,204,596 patients were included in the analysis, of whom 3191 (0.26%) were victims of DV. Adult trauma patients with DV were more likely to have a diagnosis of neck and back sprain (odds ratio 1.98, 95% confidence interval 1.60 to 2.44, P < 0.0001) and more likely to undergo surgical repair of the flexor tendon of the hand (odds ratio 2.76, 95% confidence interval 1.75 to 4.35, P < 0.0001) than patients without a diagnosis of DV.Discussion:Patients who experience DV were more likely to have back and neck sprain and more likely to undergo repair of flexor tendon of the hand than those who do not experience DV.

Proportion of neuropathic pain in the back region in chronic low back pain patients -a multicenter investigation

Neuropathy can contribute to low back pain (LBP) in the region of the back. Our study investigated the proportion of neuropathic pain (NP) in low back region in chronic LBP patients from multicenter and clinics in China and identified associated factors. Assessment was made using a questionnaire and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS, only tested in low back region), as well as Quantitative Sensory Testing (QST, merely applied to the low back region), the Hospital Anxiety and Depression Scale (HADS) and the Oswestry Disability Index (ODI). Our questionnaire collected demographic information, behavioral habits and medical records. 2116 outpatients over 18 years old complaining of LBP lasting more than 3 months were enrolled in this study. The NP proportion in low back region in chronic LBP patients was 2.8%. Multivariable logistic regression analysis showed that histories of lumbar surgery, abdominal or pelvic surgery, and drinking alcohol were independent positive predictors for LBP of predominantly neuropathic origin (LBNPO), while history of low back sprain and frequently carrying weight as independent negative predictor. Using these parameters may help the identification of patients with chronic LBP likely to develop NP leading to improved treatment outcomes.

Epidemiology of Dance-Related Injuries Presenting to Emergency Departments in the United States, 2000-2013.

Data were obtained from the nationally representative National Electronic Injury Surveillance System from 2000-2013. National estimates of injuries were determined using complex sample design. Trends using 2-year intervals were calculated using linear regression and injury proportion ratios using Pearson's X2. The average annual incidence of dance-related injuries requiring emergency medical attention was 17,145 per year. The number of injuries grew from 14,204 in 2000/1 to 21,356 in 2012/3, a change of 33.4% after accounting for population growth. Lower limb injuries were most common, particularly ankle and knee sprains. Females presented with a greater proportion of ankle (injury proportion ratio [IPR]=1.34, p=0.029) and foot sprains (IPR=2.11, p<0.001) but a lower proportion of shoulder sprains (IPR=0.41, p<0.001) and face lacerations (IPR=0.13, p<0.001). Younger dancers presented with a lower proportion of knee (IPR=0.79, p=0.006) and low back sprains (IPR=0.68, p=0.019). The average annual incidence of dance-related injuries of a serious enough nature to require presentation to the emergency department in the United States was 17,145 per year, with ankle and knee sprains being the most common. Injury numbers have increased in recent years.

The Epidemiology of Musculoskeletal Injuries in 2015-2016 Kuwaiti Track and Field Athletes

Objective: To describe the epidemiology of the type and severity of musculoskeletal injuries sustained by Kuwaiti track and field athletes from different sporting clubs during a one-year period from October 2015 to October 2016, and to compare their rates of overuse and acute injuries. Design: Descriptive epidemiology study. Setting: All injury data was reported and recorded by Sports Medicine and Health Awareness Center (SMHAC) - Public Authority for Sports in The State of Kuwait.Participants: Track and field Kuwaiti male athletes from different sporting clubs during a one-year period from October 2015 to October 2016. A total of 54 Subjects consisted of 19 sprinters and hurdles, 18 middle and long distance, 10 jumpers and 7 throwers.Main Outcome Measure(s): All injury data was obtained and analyzed from The (SMHAC) computer software. Results: During the study period a total of 334 musculoskeletal injuries from different sports were diagnosed and recorded by physiotherapists in (SMHAC). A total of 54 injuries were reported from male track and field athletes, which accounted for 16.2% of the total of 334 musculoskeletal injuries during 2015-2016 sports season. Track athletes (sprinting and running) suffered more injures 37 (68.5%) than field athletes (throwing and jumping) 17 (31.4%). In addition, sprinters, hurdlers, and middle-distance runners sustained more acute type injuries, whereas jumpers and throwers experienced more overuse type injuries. The most common sites of injury was the knee 20 (37.0%), thigh 9 (16.7%%), ankle 7 (12.9%), back 5 (9.3%), elbow 5 (9.3%) and shoulder 3 (5.6%). The most common major musculoskeletal injuries were muscle strains 19 (35.2%), stress fractures 13 (24.1%), sprains 15 (27.7% including 11 back sprains), and cartilage and ligaments ruptures 7 (12.9%).

Effect of a pain diary use on recovery from acute low back (lumbar) sprain.

The aim of the study was to examine the effect of a daily pain diary on recovery from acute low back sprain. Pain diaries are often recommended to or used by patients suffering with acute lumbar (low back) sprain. Diaries have been shown to be associated, however, with a slower rate of recovery after whiplash (neck) injury. The effect of diary use on recovery from low back injury is unknown. Subjects with acute lumbar (low back) sprain were randomly assigned to one of the two groups: a diary group and control group. A total of 58 out of 62 initially recruited subjects were seen in follow-up 3-month post-injury, 29 in the diary group, and 29 in the control group. Data were gathered within 1 week of injury on sex, age, and Oswestry Disability Questionnaire (ODQ) scores. The diary group was asked then to keep a record of their overall pain experience, rating their pain on a scale of 1-10 on a daily basis for 4 weeks. At the outset, both groups had similar mean age, sex distribution, and mean ODQ scores. After 4 weeks of pain diary use, fewer diary group subjects reported recovery at 3 months compared with the control group (52 vs. 79 %, respectively, p < 0.05). The use of a pain diary for 4 weeks in acute lumbar sprain subjects is associated with a reduced rate of recovery.

Improving Quality, Preventing Disability and Reducing Costs in Workers' Compensation Healthcare

Problems of poor quality and high costs are worse in the workers' compensation system than in the general medical care system, yet relatively little work has been done to improve performance in workers' compensation healthcare. To evaluate the effect of a quality improvement intervention that provided financial incentives to providers to encourage adoption of best practices, coupled with organizational support and care management activities, aimed at reducing work disability for patients treated within the Washington State workers' compensation system. Prospective nonrandomized intervention study with nonequivalent comparison group using difference-in-difference models to estimate the effect of the intervention. Two cross-sections of data representing 33,910 workers' compensation claims filed in the baseline (preintervention) period from July 2001 to June 2003 and 71,696 claims filed in the postintervention period from July 2004 to June 2007 were analyzed. 46,928 (44%) of these 105,606 claims represent patients treated by over 275 providers recruited through Centers of Occupational Health and Education (COHEs) at 2 pilot regional sites. Outcomes, measured at 1-year follow-up, included work disability status, number of disability days, disability cost, and medical cost. COHE patients were less likely to be off work and on disability at 1 year postclaim receipt (OR=0.79, P=0.003). The average COHE patients experienced a reduction in disability days of 19.7% (P=0.005) and a reduction in total disability and medical costs of $510 per claim (P<0.01). For patients with back sprain, the reduction in disability days was 29.5% (P=0.003). Patients treated by providers who more often adopted occupational health best practices had, on average, 57% fewer disability days (P=0.001) compared with patients treated by providers who infrequently adopted best practices. Financial incentives, coupled with care management support, can improve outcomes, prevent disability, and reduce costs for patients receiving occupational healthcare. Owing to important disability prevention capacity, workers' compensation healthcare may be especially fertile ground for continued quality improvement innovation.

Opioid Prescriptions in Canadian Workers’ Compensation Claimants

Historical cohort study. We investigated the prescription of opioids in injured Canadian workers to determine recent trends in use and the association between early prescription and future recovery. Opioid analgesia is effective for reducing chronic nonmalignant pain, and opioid prescriptions for musculoskeletal pain seem to have increased over the past years. However, recent evidence indicates early opioid use may be associated with delayed recovery in patients with back pain. Data were extracted from the Alberta Workers' Compensation Board administrative database, and information was obtained on all time loss claims for sprains, strains, fractures, dislocations, amputations, or burns between January 1, 2000 and December 31, 2005. Information on all narcotic prescriptions was obtained along with demographic data and duration of time loss benefits. Injury severity was controlled for via nature of injury coding. Analysis included multivariable logistic and Cox regression. Data were obtained for 137,175 subjects. The majority were males ( approximately 70%) with back sprains (approximately 35%), and a mean age of 37 years. Between the years 2000 and 2005, all opioid prescriptions within the first year of claim decreased from 11.4% of claimants to 8.3%. Older males with fractures, dislocations, or amputations were more likely to receive narcotics. Claimants receiving early opioid prescriptions experienced delayed suspension of benefits. However, this association was also seen in claimants prescribed early non-narcotic analgesics. Prescriptions for opioid analgesia appear to be decreasing within workers' compensation claimants in Alberta, Canada. As expected, claimants with more severe injuries were more likely to receive opioids. An association was observed between early opioid prescription and delayed recovery, however, this is likely explained by pain severity or other unmeasured confounders.

Further Evidence on the “Monday Effect” in Workers' Compensation

An analysis of data from the Workers' Compensation Board of Ontario reveals evidence of a “Monday effect”—more workers' compensation claims on Mondays than on other days, especially for back injuries and sprains/strains—similar in magnitude to that found in U.S. studies. Because Canadians, unlike most Americans, have universal health care, this similarity across the studies' core results disfavors the hypothesis that workers post-date weekend injuries in order to obtain medical care via workers' compensation insurance. A second moral hazard explanation that is not ruled out, however, is that some workers represent non-work-related injuries as work-related in order to exploit the earnings loss indemnification provided by workers' compensation. Finally, the results are not inconsistent with the strictly physiology-based hypothesis that time off during weekends and holidays simply makes workers more susceptible to injuries of all types, but especially back injuries and sprains and strains.

Poster 63: Work-related low back injuries: an analysis of workers’ compensation claims in Virginia

Objectives: To describe the frequency of low back injury in workers’ compensation claims in the Virginia Workers’ Compensation Commission (WCC) database; to analyze correlations of low back injuries to select demographic data and injury characteristics; and to describe the rehabilitation cost of the claims and to compare cost with other types of injury. Design: Cohort study. Setting: Database of claims submitted to the Virginia WCC. Participants: Claims involving low back sprain, strain, or contusion (N=76,025) resulting in ≥7 days of missed work or total compensation paid of at least $1000 from 1985 to 2000. Interventions: Not applicable. Main Outcome Measures: Low back injury claim frequency and rehabilitation costs. Results: The low back was the most common injury location (9.1%) in the database. The mean age of low back claimants ± SD was 37.2±10.4 years with a peak at 34 years of age. The male to female ratio of low back claimants was 2:1. Injury to the low back was associated with mechanism of injury (χ 2=42.26, P<.0001). Worker motion and exertion were the primary mechanisms of injury in 87% of low back claims versus 44% of all other injury claims, whereas motor vehicle collisions and falls were less often associated with back claims compared with other injuries. Cross-tabular analysis showed no meaningful predilection of back claims by industry, occupation, or sex compared with other injuries. Rehabilitation cost analysis showed low back claims had higher mean rehabilitation costs compared with other injuries ($388 vs $338, P<.05). Rehabilitation costs were associated with industry ( P=.0016), with the highest relative cost in construction, agriculture, forestry, and fishing. Conclusions: This data describe nonspecific low back injury claims made to the WCC in Virginia. Injury prevention strategies should target worker motion and overexertion.

Improving the quality of occupational health care in Washington State: new approaches to designing community-based health care systems.

The need for concerted action to improve quality was stressed in the recent Institute of Medicine report, Crossing the Quality Chasm: A New Health Care System for the 21st Century. This article describes an innovative community-based delivery system initiative designed to improve quality and health outcomes for occupational health conditions. Known as the Occupational Health Services (OHS) project, this Washington State initiative focuses on three targeted conditions: low back sprain, carpal tunnel syndrome, and fractures. To fulfill its purpose, which is to provide clinical resources and training opportunities and foster quality improvement activities on a community-wide basis, the OHS incorporates several key delivery system components, including systems to track patient and employer satisfaction and health outcomes; formal physician agreements that will provide incentives for using best-practices; and community-based Centers of Occupational Health and Education (COHEs) that will function as a resource for providers, patients, and employers. Our experience in developing the OHS quality improvement initiative should have relevance for health care clinicians, administrators, policy makers, and researchers engaged in similar pursuits outside the field of occupational health.

Ligamentum flavum hematoma in the thoracic spine

We report a case of a hematoma of ligamentum flavum at T11–12 in a 66-year-old man who presented with progressive weakness of the right foot and numbness of both legs. Past history was negative and no precipitating episode of lower back sprain or trauma. The resected T11 and T12 laminas showed old hematoma with degenerative changes in the ligamentum flavum. Hematoma occurring in the thoracic spine has never been reported previously.

Back Sprain Sustained in Motor Vehicle Accidents: Factors Influencing Time Off Work

Abstract500 cases of back sprains sustained in motor vehicle accidents were studied over a period of 5 years to determine which factors affected the length of time off work. Radiation of back pain into the lower limbs was associated with a longer mean time off work than those in whom the pain was confined to the back. Those in the younger age groups took relatively less time off work than those in the older age groups.There was little relationship between occupation and mean time off work. Those who drove for a living took the greatest mean time away from work but this trend was not statistically significant. Work of a heavy manual nature did not militate against a relatively early return to work.

Oral contraception and other factors in relation to back disorders in women: findings in a large cohort study

The Oxford-Family Planning Association contraceptive study includes 17,032 women, initially aged 25–39 years, recruited at 17 British family planning centers during the interval 1968–1974 and subsequently followed-up for periods up to 26 years. This article examines the pattern of referral to hospital for back disorders among these women. Certain back disorders have been reported to occur more frequently in oral contraceptive users than in other women, and back pain has also been reported in some women consequent to using an intrauterine device. The disorders considered were spinal osteoarthritis, displaced cervical disc, displaced lumbar disc, other and unspecified displaced disc, cervicalgia, unspecified back pain, and sprains and strains of the back. Spinal osteoarthritis and unspecified backache were the only two conditions significantly related (both positively) to age. Displaced lumbar disc and other and unspecified displaced disc were strongly positively related to height and weight. Unspecified backache showed similar, but less striking (in terms of the magnitude of the relative risks), associations with height and weight. Little evidence was found of any association between oral contraceptive use and any of the back disorders, and the same was true for intrauterine device use.

The effects of prework functional screening on lowering an employer's injury rate, medical costs, and lost work days.

The data in this study were gathered retrospectively after the progress of program development in terms of employee outcomes within an organization. This design characterizes a retrospective longitudinal study. To determine whether prework functional screens are effective in lowering the incidence of work-related back sprains or strains, related medical costs, and lost work days within an organization. Musculoskeletal injuries are considered the leading cause of disability for people during their working years. Back injuries are the most common reason for workers' decreased work capacity and reduced leisure time. The increased rate of injury and escalating workers' compensation costs are are a major force motivating companies to implement a tool that can be effective in lowering back sprain or strain injuries and containing their workers' compensation costs. The U.S. Department of Health and Human Services reports a major objective of increasing the number of companies offering back injury prevention programs by the year 2000. The study follows the effects realized when a medical center institutes close case management, early return to work policies, and prework functional screens in three stages over the course of 10.5 years. The severity of back sprains or strains, related medical costs, and lost work days were significantly lower with the use of prework functional screens on all new employees hired into physically laborious jobs. This study offers employers a proven effective tool that can be used to help lower the severity of on-the-job back sprains or strains, resulting medical costs, and lost work days in their organization.

Does Workers' Compensation Encourage Hard to Diagnose Injuries?

Worker-generated claims-reporting moral hazard is said to occur when, in order to collect workers' compensation benefits, workers report on-the-job injuries that never occurred or that occurred off the job. Using newly available injury micro data from the Bureau of Labor Statistics on all cases with days away from work, this article assesses the hypothesis that claims-reporting moral hazard is more likely to occur for hard-to-diagnose injuries than for easy-to-diagnose cuts and fractures. Consistent with the hypothesis, multinomial logits indicate that an increase in the wage-replacement rate and a decrease in the benefit-waiting period increase the fraction of carpal tunnel syndrome cases relative to cuts and fractures, while a decrease in the waiting period increases back sprains relative to fractures. Contrary to the hypothesis that claims-reporting moral hazard differentially affects the timing of reported injuries, binomial logit estimates indicate that workers' compensation does not increase the probability of a Monday back sprain relative to a Monday cut or fracture. Rather, an increase in the wage-replacement rate and, possibly, worker choice of doctor increase the probability that an injury of any type is reported on Monday (or the day after a long weekend) relative to other regular workdays.

Risk Factors Associated with Occupational Back Sprain in Mexican Workers

"Risk Factors Associated with Occupational Back Sprain in Mexican Workers." International Journal of Occupational and Environmental Health, 2(4), pp. 327–328

Is Workers' Compensation Covering Uninsured Medical Costs? Evidence from the "Monday Effect"

A growing fraction of U.S. workers face a dual system of medical insurance, with generous coverage through the Workers' Compensation system for work-related injuries, but limited or non-existent coverage for off-the-job illnesses or injuries. Uninsured and under- insured workers have an economic incentive to report off-the-job injuries as work accidents. Many analysts have interpreted the high rate of Monday injuries -- especially for hard-to-detect injuries like back sprains -- as evidence of this incentive. We combine administrative data on workplace injury claims with Current Population Survey data on medical insurance coverage to compute the fraction of Monday injury claims for workers who are more and less likely to have medical insurance. We find that workers with lower medical coverage rates are no more likely to report a Monday injury than other workers.