How to Treat the Work Injured Patients Like an Athlete

Apr 22, 2020
8 min read
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Where we start with an athlete and a work injured individual will first vary based on their severity of the injury. We don’t try to waste time when meeting the maximum benefit of the patient. Usually lower level work injured patients will have similar exercise compared to an athlete who is in a similar stage of injury.

Work comp and the Athlete

What is an Athlete?

An athlete can have many definitions which will vary on who you speak too. An athlete essentially is someone who participates in an athletic event by performing specific tasks pertaining to that sport to achieve a certain goal. According to google there are roughly 200 sports that have international recognition through an international governing body, but there are estimated 8000 sports played worldwide.

What is a Worker?

A worker is someone who is employed by a certain company or self-employed to provide a service or product for some type of benefit in return, the majority of the time for money. A person who performs a specific type of task in a certain way. There are millions of different occupations all with different types of physical demands.

Similarities?

Both work related injuries and sport specific injuries are similar in the sense that they can be traumatic or can be due to constant chronic movement. They both have a task to achieve to get certain results. For example, a baseball player needs to throw a ball to get the ball from point A to point B whereas a warehouse employee needs to carry a box from point A to point B. Both can get injured for repetitive movement resulting from their everyday exposure to specific goal related movements. Creating repetitive stress to certain tissues and creating microtrauma on a daily basis. All related due to muscular imbalances, movement dysfunctions, overexertion, or all of the above.

Differences?

An athlete usually requires a higher level of mobility and skill to be able to complete sport related tasks. They usually have off-seasons, pre-season, in-season, post-season and are usually guided by a coach. They are motivated by winning games to hopefully get to a championship event. They usually train almost every day to play an athletic event for a certain number of hours. For example, an NFL football player will train 4-5 days a week, for 2-5 hours, to play 1 game for the week and repeat every week for 17+ weeks. Injury prevention and performance is very important to help achieve victory.

A worker usually works all year round with some days off that will vary on paid time off (PTO), business needs, holidays, sick days. They might not be as motivated as an athlete to return to work, usually motivated by money and self-occupational enjoyment. Lower demand required for work related mobility in most cases. Prevention and performance might not be the highest priority to company and/or that individual.

SAID Principle

Specific adaptation to imposed demands (SAID) principle is when you attempt to assert that the human body adapts specifically to imposed demands. It demonstrated that given stressors on the human system whether biomechanically or neurologically. For a work injured individual in a worker compensation clinic our duty as Physical therapist is to relate those demands and make sure they can return to those functional tasks without any further risk. If your job is to climb ladders, lift boxes, and walk all day.

Then we make sure you are able to do those tasks by making them our long term goals. We have all the related equipment to help provide work related situations. The only difficulty item to achieve is time, most of our work injured patients work 6-9 hours a day for 5 days out of the week. Our sessions are usually an hour 2-3 times a week. Limiting how much we can accomplish from a time component.

Is it Work Conditioning?

Work conditioning or also known as work hardening are high levels of therapeutic interventions to help regain enough function to perform work activities. Work conditioning programs are supervised by a Physical therapist usually for 2-4 hours a session, 2-5 days per week, for 2-8 weeks. Emphasizing on job specific tasks to help return to work. Performed on labor-intensive professionals (police officers, FBI, construction workers, firefighters, delivery drivers). All programs are individualized to treat the patient’s specific injury and dependent on what the treating therapist prescribes. This is usually completed after we performed regular physical therapy visits. Work conditioning ensures they can meet all labor intensive conditions to return to work.

Insurance/Work-comp insurance

Workers’ compensation is an insurance benefit for employees with work-related injuries and illnesses. Only covered by work related incidents. The patient will not occur any out of pocket expenses. Medical benefits are paid directly to the health care provider who provides the medical care. Workers compensation is governed by state and federal laws. It protects the employee and employer of work injury incidents. Each state has its own set of compensation laws and programs. For more details refer to https://www.dol.gov/general/topic/workcomp

Back to Work vs Back to Sports

For work injured individuals they have different motivational factors which can vary internally based on company procedures and disability level. Some companies will pay a certain percentage of disability due to having a work related injury from 30-70% of their normal income, some won’t be qualified to work due restrictions and will get time off, while others might need 100% of their check to pay bills.

Motivational factors usually will vary when dealing with work compensation patients. Athletes on the other hand might risk participating earlier than expected to be able to attain bragging rights, trophies, and to participate in an athletic event. They don’t want to let down their teammates, coaching staff, and fans. Usually “when can I play” is their main concern after getting injured.

Do Exercises Differ?

Where we start with an athlete and a work injured individual will first vary based on their severity of the injury. We don’t try to waste time when meeting the maximum benefit of the patient. Usually lower level work injured patients will have similar exercise compared to an athlete who is in a similar stage of injury. Once they reach a higher level, we create specific exercises related to their work related functional mobility.

A warehouse employee will work on squatting, lifting, carrying different weights related to work from various levels multiple times without losing body mechanics. This will promote endurance, strength, and mobility related to work. For a basketball player we create exercises that incorporate plyometric phases, speed drills, and agility drills preferable with a basketball during the exercise to help with sport specific movement incorporation involving the whole body.

Creating Exercises

Exercise prescription will vary on initial evaluation and overall impairments. Like any other Physical therapist, we will look at physical work demands, past medical history, comorbidities, personal factors, system review, special tests, strength, range of motion, and functional movement patterns. Once we gather all their impairments, we formulate exercises based on job specific requirements, safety consideration during work duties, and injury prevention.

Some considerations with athletes are;

  • Where are they in the season?
  • What sport do they play?
  • What position?
  • What movements are required to be successful in their sport?

Some considerations with a worker are;

  • What do they usually do on a typical workday, is rest/breaks available if needed?
  • How long do they have to perform intensive physical tasks?
  • Does there work injury affect return to work?
  • Depending on tissue irritability level we meet the work athlete on their level based on what we see objectively and what is reported subjectively.

How Do You Keep Workers Engaged?

Keeping work injured patients engaged it important by providing education from day one of their evaluation to their final day. It all starts in the front office with the office staff answering questions regarding the process. Most work injured individuals don’t understand the process and have multiple questions regarding how it will affect their work. It affects their livelihood, income, family and like discussed earlier they might want to prolong their injury for other incentives.

We try to make it fun as possible by being positive at all time, making small achievements into major progress, and honesty. Honesty is very important in this line of work. They need to return to work as soon as possible with the highest % of functional ability. Work injured patients are aware at all times whether we believe they need further imaging, to see a specialist, or if they are 100% ready to return to work duties. If they know what is going on through their medical process and their physical therapy plan of care, they stay engaged. Living in pain and not being able to work is the last thing anybody wants. Usually if they don’t have any positive incentive to stay off of work they want to return as soon as possible.

References

https://www.safetysign.com/help/h109/safe-lifting-tips

https://www.dol.gov/general/topic/workcomp

Cook C. Orthopedic Manual Therapy, An Evidence-based Approach. Prentice Hall; 2010.

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About Luis Mejia, PT, DPT

Luis Mejia PT, DPT is from Brownsville, Texas with experience in work compensation and sports therapy. He is a certified strength and condition specialist (CSCS) with NSCA, certified sport and orthopedic manual therapist (CSOMT), and pursuing his Fellowship (FAAOMT) with the Institute of Athletic Regeneration.


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