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Work Conditioning vs Work Hardening

Because the human body does indeed run on the phrase, “use it or lose it,” when someone has been on leave after a work-related injury for an extended period, there is a good chance they will have lost strength, stamina, or both. Timely attention to this situation is critical as studies show the longer someone is away from work, the less likely they are to return.1

After a workers’ compensation employee has completed a comprehensive physical therapy program, he or she may need additional rehabilitative care to return to the work force if they work in a job that is a medium or higher physical demand level. Based on the needs of the employee and requirements for the job, the primary care physician will often recommend one of two programs: work conditioning or work hardening.

Upstream Rehabilitation, the nation’s largest dedicated outpatient physical and occupational therapy provider, employs the latest evidence-based techniques and highly trained healthcare professionals for its unprecedented work conditioning and work hardening programs.

Work Conditioning

Work conditioning programs focus on various aspects of the employee’s physical condition, including strengthening, endurance, flexibility, motor control, and cardiovascular function.2 A work conditioning program is not multidisciplinary. The focus is purely on restoring function from a physical perspective.

Armed with the goal of preparing injured employees to safety return to their jobs, physical or occupational therapists guide workers through the program over a period of 4-6 weeks10.

A typical work conditioning session may include:

• Lifting
• Carrying
• Pushing/pulling
• Fine motor manipulation
• Climbing
• Circuit training
• Functional training/work simulation
• Balance activities3

“Work conditioning is for patients who are limited in their duties, and the goal is to improve the physical wellbeing of the patient,” says Kristina Johnston, PT, DPT, CHT, CFE, a Certified Hand Therapist with Benchmark Physical Therapy in Newnan, Georgia, one of Upstream Rehabilitation’s brands. “It is critical that patients, doctors and workers compensation stakeholders are all on board because this is a substantial commitment—sessions start at 2 hours and can build up to 8 hours.10

Our team collaborates with providers and payers on the frequency of sessions. Dr. Johnson notes, “I structure a session such that is has cardio, stretching and strengthening—then I integrate these into tasks such as overhead lifting, pushing, and pulling, or working with fine motor skills.

Sometimes people must undergo work conditioning to learn if they can manage living and working with some amount of pain. In essence, we are teaching them to manage a one- or two-level pain (out of 10) and trying to prevent it from getting worse.”

Steven Sopher, PT, of Ergonomic Rehabilitation of Houston, one of Upstream Rehabilitation’s brands, states, “Sometimes physicians don’t understand the difference between work conditioning and the other, more holistic program known as work hardening. If someone is putting in 50 hours of work doing heavy labor, they need work hardening.”

Work Hardening

Work hardening is a highly regimented, multidisciplinary form of therapy. In addition to helping workers physically recover from injury, work hardening helps employees mentally prepare to return to their jobs.4 As such, a work-hardening regimen typically delves into behaviors, education, and safety.5

“Work hardening is a comprehensive program that addresses the physical and behavioral aspects of work and often employs the skills of many different types of healthcare professionals, including physical and occupational therapists, psychologists, and vocational specialists,” states Kristina Johnston. “It can take place in the clinic or in the workplace and may involve equipment such as ergometers, treadmills, commercial strength and exercise devices, free weights, and circuit training. Program goals are established based on the worker’s particular job demands.”

Patient education is vital to work hardening and can focus on body mechanics, work pacing, safety and injury prevention and the promotion of worker responsibility and self-management.6

Steven Sopher: “Someone may come in for a functional capacity evaluation (FCE) and it is obvious this person can’t return to the same job without further help. Sometimes there is a psychological component involved that will keep them from thriving. We often see employees that have such a high fear of reinjury and failure.”

But there is help, admits Sopher. “In work hardening, patients attend a weekly group counseling session to discuss their stressors as related to work. Patients have an opportunity to share their worries, such as financial stress or concerns about how coworkers are going to treat them upon return. We see a genuine camaraderie as well as enhanced motivation because everyone feels like they are in the same boat.”

“A work hardening program is driven by the job description/tasks,” says Sopher. We break everything down into movement patterns and can simulate all the job responsibilities whether the person is a mail carrier or an electrician.”

“If the worker is a baggage handler at an airport, for example, we use our in-house weighted luggage, having them stack the luggage and push it up a ramp. Overall, many of our patients are on their feet 14 hours a day and have functional and/or mobility issues. Part of our process is to time them on tasks and count the reps, keeping an eye on whether the pain level increases or decreases.”

“In the event that someone is an EMS worker we have stretchers so they can practice carrying people; we also have fire hoses for the firefighters. We coach patients on general body mechanics and explain why they must lift something in a specific way. I’m pleased to say that 90% of our workers return to their jobs within 30 days of the program.”

At the end of the either the work conditioning or work hardening program, the physical therapist may complete a Functional Capacity Evaluation to determine if the person is cleared to return to work.7,8

When employers refer an injured employee to work conditioning or work hardening, it sends a message that they care about their employees’ physical and mental well-being, which could in turn boost employee morale and retention.9

Upstream Rehabilitation offers specialized services and care for injured workers and nearly all of our clinics can perform work conditioning. Our physical therapists are trained in advanced orthopedic evaluation skills and treatments to assist with workers’ compensation claims.

Find an Upstream Rehabilitation location near you.


  1. ME, PT &. Functional Work Conditioning – Triple 3 Program – PT & ME. 2 Nov. 2022, Accessed 13 Mar. 2024.
  2. “Work Conditioning.” Physiopedia, Accessed 13 Mar. 2024.
  3. “Work Conditioning.” Physiopedia, Accessed 13 Mar. 2024.
  4. “Work Hardening vs Work Conditioning: Ultimate Rehab Guide.” Acuity International, 23 Aug. 2023, Accessed 13 Mar. 2024.
  5. “Understanding Work Conditioning and Work Hardening – Advantage Healthcare Systems.”, 25 Nov. 2019, Accessed 13 Mar. 2024.
  6. Work Hardening Program Standards.
  7. Work Hardening vs Work Conditioning: Ultimate Rehab Guide. 23 Aug. 2023, Accessed 13 Mar. 2024.
  8. “Functional Capacity Evaluation (FCE).” Adult Career and Continuing Education Services | NYS Education Department, 1 May 2017, Accessed 13 Mar. 2024.
  9. Work Hardening vs Work Conditioning: Ultimate Rehab Guide. 23 Aug. 2023, Accessed 13 Mar. 2024.
  10. McBee KP, Medlin C, Stern BZ, Martin S. Advanced Therapy Programs in Occupational Health. Chapter – Work Rehabilitation: Managing Prolonged Episodes of Care. Academy of Orthopaedic Physical Therapy, APTA, 2022: 33-34