Occupational and Physical therapists play a key role in injured workers’ successful return to work.
According to the United States Department of Labor, Bureau of Labor Statistics, 3,063,400 non-fatal injuries and illnesses were recorded in private industries in 2010. Of these cases, 370,130 involved strains, sprains and tears. Therapists frequently treat patients who are injured on the job. The main treatment goal for the injured worker is safe return to full-duty work; however, this outcome does not depend on improved functional abilities alone. Age, gender, economic status, length of time out of work, job-specific issues and psychological factors also influence return to work post injury. After the acute stage, if physical therapy is complete, work conditioning programs are often implemented to transition the injured worker back to pre-injury work status.
The American Physical Therapy Association defines work conditioning as “a work-related, intensive, goal oriented treatment program specifically designed to restore an individual’s systemic, neuromusculoskeletal and cardiopulmonary functions. The object of the work conditioning program is to restore the injured worker’s physical capacity and function for return to work1.”
GOAL SETTING
Obtaining a current and accurate regular job description is essential**. An on-site visit with the employer and injured worker to observe the regular job being performed is ideal. After reviewing the essential duties required for regular work, specific goals are set with the worker’s input. Work related behaviors such as punctuality and active participation are expected of the worker.
**In our post recession environment, many employers were forced to lay off workers and combine job duties from two or three workers to one worker. The outdated job descriptions may not reflect the current physical expectations of combined job duties. These job duties will need to be updated, clarified and verified.
JOB SIMULATION
Work conditioning programs can be performed at the work site or in the clinic using actual tools and lifting boxes to simulate work activities. Many employers will allow the clinic to “borrow” specific equipment for use in the work conditioning program (ie- wooden slats that must be flipped; large CO2 canisters or kegs to be carried up/ down stairs; large tire chains). Strength training through functional movements rather than isolated exercise is the primary focus. For example, strengthening of shoulder flexors can be achieved with box lifting/ maneuvering vs. use of free weights or resistive band exercises. Fine motor activities like assembling, typing and object manipulation can be performed while improving sitting or standing tolerance. Timed tasks can be used to improve the worker’s production speed.
FUNCTIONAL MOVEMENTS
Functional movements such as bending, reaching, squatting, kneeling and crawling can be repetitive or sustained for periods of time as part of the worker’s job duties. Deconditioining of the cardiovascular system often occurs when workers are sedentary. In addition, non-injured extremities become weak from disuse. Treadmills, elliptical machines and stationary bikes can be used to boost the heart rate and increase muscular endurance. Timed outdoor track work or walking on Pilot Butte can also be a more functional training environment.
ENVIORNMENTAL CONSIDERATIONS
Environmental challenges including small space (grocery check-out stand or lacing tires in a truck bed), hot or cold temperatures (flatbed truck drivers or roadside flaggers), poor lighting (wood production areas or large warehouses), and decreased sensory feedback and movement restrictions (stock rooms or cubicle areas) can affect job abilities. During treatment, the worker is encouraged to wear any required personal protective equipment (PPE) – gloves, tool belt, gun holster/ bullet proof vest, hard hat, steel toed boots, backpack vacuum, etc. This will help to simulate the work environment so the worker is best prepared to return to full duty, with confidence.
RESULTS VERIFIED
Participation in a work conditioning program may reveal a worker’s inability to return to his or her pre-injury job. A Physical Capacity Evaluation (PCE) is often performed to determine the injured worker’s physical capabilities for safe job placement. Components of the PCE also identify psychological factors (validity testing) which could affect return to work. Work Capacities, LLC makes every effort to ensure that a worker is physically able to perform all of the physical demands of regular work and the worker is able to return to work with confidence.
1Luk, K., Wan, T., et al. (2010)Journal of Orthopedic Surgery, 18(2), 131-138.
Janet Kadlecik is an Occupational Therapist and Certified Weight Trainer at Work Capacities, LLC, in Bend, Oregon. She received her Bachelor of Science degree in Occupational Therapy at Colorado State University in 1977. She has been working with workers compensation clients for 30 years.
