1. Lowe, John MPT

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Workplace injuries have been and will continue to be a significant problem in modern society. In 2006, there were 4.1 million reported nonfatal workplace injuries and illnesses in the United States. This was equal to 4.4 cases per 100 equivalent full-time workers. There were 357,160 work-related musculoskeletal disorders in 2006, with sprains and strains being the most common medical diagnoses (Bureau of Labor Statistics, 2006). Physical rehabilitation is often a primary component in the return-to-work process; however, there is no generally accepted consensus regarding when referral for physical or occupational therapy is appropriate.


Conservative management of work-related musculoskeletal disorders might involve rest, medication, modification of work duties, and referral for physical and/or occupational therapy. Referral patterns for physical rehabilitation can vary widely. State workers' compensation laws, the severity of the injury, the physical requirements of the job that the injured worker is expected to return to, the quality of case management, and individual physician referral preferences all influence the timeliness of referrals. Early referral for rehabilitation is often indicated to the following:


1. Minimize range-of-motion losses to the injured body part.


2. Accelerate the healing process through the use of manual therapy techniques and modalities.


3. Minimize loss of strength and conditioning.


4. Educate the injured worker in postures and movement patterns that minimize abnormal mechanical stress.


5. Advise in the use of protective equipment such as splints or workplace modifications that may encourage the return-to-work process and minimize lost time days.


6. Promote healing patterns that correspond to the physical stresses the injured worker will be subjected to upon return to work.



Research regarding value of early referral to physical therapy for injured workers with low back injuries has indicated that patients who receive early physical rehabilitation had fewer physician visits, fewer restricted workdays, fewer days away from work, and shorter case durations (Zigenfus, Giang, & Fogarty, 2000), and result in a greater improvement in perceived pain (Nordeman, Nilsson, Moller, & Gunnarsson, 2006). Early physical rehabilitation intervention was also found to result in superior psychosocial benefits as measured by administration and readministration of validated self-assessment questionnaires (Wand et al., 2004). Early referral has also been found to be beneficial for extremity injuries, resulting in significantly fewer treatment sessions compared with delayed referral ("Fracture," 2007).


Physical and occupational therapists evaluate and treat disorders that interfere with the performance of functional activities. In the context of workers' compensation, this can involve functionally evaluating an injured worker relative to his or her work demands, setting treatment goals that are specific to the return-to-work process, and providing a physical rehabilitation program that is structured to successfully enhance the injured workers' return to work.




Bureau of Labor Statistics, 2006. [Context Link]


Fracture (proximal humeral): Physiotherapy treatment. The Joanna Briggs Institute. Sep 25, 2007. [Context Link]


Nordeman, L., Nilsson, B., Moller, M., & Gunnarsson, R. (2006). Early access to physical therapy treatment for subacute low back pain in primary health care: a prospective randomized clinical trial. The Clinical Journal of Pain, 22(6), 505-511. [Context Link]


Wand, B. M., Bird, C., McAuley, J. H., Dore, C. J., MacDowell, M., & De Souza, L. H. (2004). Early intervention for the management of acute low back pain: a single-blind randomized controlled trial of biopsychosocial education, manual therapy, and exercise. Spine, 29(21), 2350-2356. [Context Link]


Zigenfus, G. C., Yin, J., Giang, G. M., & Fogarty, W. T. (2000). Effectiveness of early physical therapy in the treatment of acute low back disorders. Journal of Occupational and Environmental Medicine, 42(1), 35-39. [Context Link]