The typical concept in return-to-work is the reduction of symptoms, along with light-duty restrictions until the patient/employee is believed to have the capacity to return to the normal activities of the job prior to the injury or development of the symptoms. The concept of "transitional return-to-work" is the management of capabilities, correction of weaknesses within the musculoskeletal system, evaluation of the work process(es) that partially or wholly contributed to the weakness developing, and gradual reintroduction of the worker to the work environment.
Management of Capabilities
Deconditioning of the body takes place at an unfairly rapid rate.The older one gets, the faster deconditioning takes place. Aconscious effort must be made to minimize deconditioning. Theareas of the body that are not injured should continue to be usedin a manner that closely resembles the normal activities of theperson's job as much as possible. Do not allow total bodydeconditioning to take place. Make every effort to userestrictions as little as possible. If severe restrictions areneeded for any part of the body for more than three days, addactivities to the noninvolved areas to minimize total bodydeconditioning. Again, add activities that closely mimic theactivities normally performed on the job by the injured worker.
Correction of Weaknesses
Many injuries related to work develop from nonbalanced activities: disproportional flexion in relation to extension; using only one extremity; repeated twisting in one direction; etc. If an athletic sprinter has trouble with hamstring problems, the good sports chiropractor looks at the quadriceps and the hamstrings to determine "balance" and, if necessary, continues to look at the mechanics of the joints above and below the hamstrings. Every effort is made to balance the mechanics of the lower extremity and torso as a whole. Use this same concept with your injured employee to re-establish balance.
At-Work Evaluation
The patient needs to be walked through the steps that contributed to the development of the symptoms. Once there is a good understanding of the cause/mechanics of the injury, making changes in the worker's job becomes possible. There must be a transition from the worker feeling little control over the work to accepting responsibility. Again, using sports as an example, good trainers first break down the process that makes up the athlete's activity. The trainer then educates the athlete on why performance is not at the desired level. Once the athlete understands why a change is necessary, that more efficient mechanics leads to better performance and a decreased load on the body, the patient is more receptive to the proposed changes.
The carrot for the athlete is better performance. The carrot for the patient is less discomfort. Know that change in behavior at any level only takes place when there is a shift in the perception of need. Changing behavior is not easy. The practitioner must, as everyone else must, place a high value on affecting behavioral changes. If you do not, you will be left with the day-to-day grind of treating pain rather than people.
Reintroduction into the Work Environment
Too often the purpose of light duty work is to maintain productivity by keeping the person working while the injury heals. In the return-to-work transition, light duty is part of the rehabilitation. The purpose of transitional work is to maximize capabilities by making sure as much of the body is used in a fashion that closely resembles the normal work performed by the injured employee. Transitional work is work hardening performed within the industry.
Again, if we bring sports medicine concepts into the industrialarena, you will notice that in professional sports every effort ismade to keep the athlete in the best possible condition while theinjury heals. No football player stops all weight lifting, etc.,while the knee heals. The athlete is not assigned a desk jobfor six weeks while the knee is rehabilitated and then plays theentire four quarters of the first game after the rehabilitation iscompleted.
Never lose focus that after the knee is ready to play, the rest of the body must also be ready. The football player does not focus on swimming for six weeks to rehabilitate the knee, but a swimmer would. For the football player, rehabilitation activities will increasingly mimic the activities associated with football. With an injured worker, light duty needs to also mimic the normal duties of the job as much as possible. Performing "normal" work does not mean immediately returning the worker to full eight-hour work capacity. Doctors need to work with industries regarding the concept of performing normal duties under restricted hours and duties (e.g., work two hours normal duty, then four hours light duty, followed by two hours normal duty).
Conclusion
Industries need solutions to the ever-increasing cost of workers' compensation. It is time for new ideas for old problems. The doctor of chiropractic is well-equipped to be part of the solution. Get educated and treat people rather than pain. Seize the opportunity!
