5 Ways Physical Therapy Helps Workers Get Back To Work

Physical therapists have routinely been involved in treating workplace injuries. Implementation of manual therapy, therapeutic exercise, and modalities have all served to resolve symptoms and improve function. We’ve highlighted some of the most effective ways physical therapists can intervene to promote Return-To-Work (RTW).

Manual Therapy

We know that the best outcomes integrate both skilled manual therapy as well as exercise. Manual therapy includes manipulation, mobilization, soft tissue release, PROM, and any other technique that involves the use of the therapist’s hands to facilitate a positive change. Why is this important? Manual therapy serves to reduce an injured worker’s pain, increase their range of motion, and promote increased tolerance to functional tasks. This means faster progression to therapeutic exercises and activities, and ultimately faster return to work.

Additionally, manual therapy is incredibly effective at facilitating patient buy-in. Injured workers can experience in-session, tangible improvements in their symptoms, which only serves to further bolster their belief that therapy can resolve their symptoms and get them back to work.

Exercise

We’ve all heard about the benefits of exercise. From improved mood to lowering the risk for health comorbidities, exercise is a treatment that benefits all. Unfortunately, when an injury is sustained, maintaining an exercise program, or even completing essential functions of a job becomes difficult if not impossible. This is where physical therapists can intervene.

As movement and exercise experts, physical therapists are incredibly apt at determining what exercises are appropriate to facilitate healing and when to implement them in the rehabilitation process. While some may feel that exercise prescription is as simple as googling “back exercises after injury,” these may not be the best exercises for a given individual. Depending on the type of injury, tissue involved, and tissue healing time anticipated, different exercises are indicated. In fact, exercise prescription is as skilled an intervention as prescribing medication. Just like the right medication needs to be prescribed and dosed, so does exercise for each injury.

Emphasis on the dose, progression and duration are all elements under review when a physical therapist intervenes with exercise (although the risks for side effects are minuscule compared to pharmaceuticals).

In the case of facilitating return to work, therapists can work with the injured worker (and often the employer) to determine the essential functions of the worker’s job. By understanding these requirements, exercise prescription can include functional tasks that prepare the injured worker for return to full duty.

Therapeutic Alliance

While physical therapists are certainly not trained licensed psychiatrists, we do often find ourselves listening to the concerns (emotional and physical) of our patients. Our ability to serve as social support for the injured worker is a byproduct of the time we get to spend with them during each treatment. This results in the development of a professional relationship focused on meeting their individual goals. While this may not sound like an important part of a return-to-work program, evidence would suggest otherwise.

As recently published in the August 2021 volume of the Journal of Orthopaedic & Sports Physical Therapy, a clinical practice guideline was released with a specific emphasis on “Clinical Guidance to Optimize Work Participation After Injury or Illness.” Within this well-researched article was a recommendation regarding the “Therapeutic Alliance.”

This is described as “the social connection between therapist and patient,” and is made up of 3 components:

• Therapist-patient agreement on goals
• Therapist-patient agreement on interventions
• The affective bond between the therapist and patient

While some may not consider this relationship between healthcare providers and the injured worker a top priority, there is actually moderate evidence that a worker’s rehabilitation experience with health providers (and potentially the health care system) can influence RTW trajectory of the worker¹. Supportive worker interactions include respecting the worker and assuming legitimacy, ongoing communication/education throughout treatment, minimizing system intrusion on the provider-worker relationship, and avoiding bias, stigma, stereotyping or hostility.

In addition to facilitating RTW, when implemented by employers and worker’s compensation stakeholders, this empathetic and supportive approach has also been shown to decrease cost to claims, decrease absenteeism, and improve productivity².

Work Conditioning

Yes, physical therapy can promote return to work. However, for injured workers who must meet certain Physical Demand Level (PDL) requirements, attending only traditional physical therapy (which is often 2-3x/week for ~60-75 minutes) may be inadequate to ensure a smooth transition back to a physically demanding job. For these individuals in the Medium, Heavy, or Very Heavy PDL categories, work conditioning can be an excellent opportunity to improve the cardiovascular, cardiopulmonary, neuromuscular, and musculoskeletal systems.

Work conditioning typically spans 2-4 hours, and the therapist overseeing the program builds an exercise circuit that closely matches the physical demands of the injured worker’s job. By seeing the injured worker 3-5x/week (in most cases), the injured worker builds more functional tolerance to job tasks, and approaches a frequency/duration of treatment that more closely replicates their work schedule (vs. what traditionally physical therapy can offer).

Examples of activities performed during a work conditioning session include: Pushing/pulling, box lifts/carries, climbing ladders/stairs, squatting/bending while performing fine motor tasks, and even bike riding/treadmill walking (to improve cardiovascular/pulmonary endurance).

Education

While therapists are experts at intervening in physical ways (exercise, manual therapy, etc.), it’s important to highlight that educating injured workers regarding expected recovery, hurt vs. harm, and the importance of RTW can all facilitate an expedited resolution of symptoms. Rehabilitating an injury is often fraught with periods of soreness or even “flare ups.” During this temporary increase in symptoms, therapists can provide reassurance and education that the injured worker’s symptoms are part of the rehabilitation process, and then intervene to reduce symptoms.

Therapists, by nature of their training, can serve to calm fears and minimize anxiety by educating the injured worker. Additionally, therapists can add context to diagnoses or decisions made by worker’s compensation stakeholders. For example, often injured workers have anxiety around RTW when the physician clears them for modified duty. Therapists can educate, using evidence-based literature, to highlight that functional outcomes are in fact better when injured workers remain on the job vs. time away³.

In summary, physical therapists can and should continue to serve as a primary clinical resource for injured workers in the workers compensation system. Allowing access to care, particularly soon after injury, ensures that worker’s get better, and costs stay minimal.

Sources

1. “Clinical Guidance to Optimize Work Participation After Injury or Illness: Using the Evidence to Guide Physical Therapist Practice.” Journal of Orthopaedic & Sports Physical Therapy, JOSPT, 31 July 2021, www.jospt.org/doi/abs/10.2519/jospt.2021.0505?journalCode=jospt.
2. “The Secret to Improving Workers’ Compensation Outcomes and How to Get Started.” The Secret to Improving Workers’ Compensation Outcomes | Texas Mutual, https://www.texasmutual.com/blog/posts/2018/11/the-secret-to-improving-workers-compensation-outcomes-and-how-to-get-started.
3. Beales D, Fried K, Nicholas M, Blyth F, Finniss D, Moseley GL. Management of musculoskeletal pain in a compensable environment: Implementation of helpful and unhelpful Models of Care in supporting recovery and return to work. Best Pract Res Clin Rheumatol. 2016 Jun;30(3):445-467. doi: 10.1016/j.berh.2016.08.011. PMID: 27886941.