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Proactive Intervention, Part I: Rethink Recovery

A three-part series on proactive intervention by BIOKINETIX

The aftermath of an occupational injury can be predictably arduous and time-consuming for all parties involved. Regardless of severity level, it is in the interest of both employer and employee to ensure they recover properly and resume their job tasks. But many return-to-work programs are stuck in a reactive cycle of poor recovery, recurrent injuries, and accumulating workers’ compensation costs.

The traditional return-to-work approach reflects three main assumptions:

  1. Recovery is passive
  2. Recovery has to happen away from work
  3. The recovery process ends as soon as the employee is able to function without pain.

A growing number of companies are rejecting these assumptions in favor of proactive intervention: a modern approach to occupational injury management that leverages the science of sports medicine to protect employees from debilitating injuries. The operating idea behind proactive intervention is that recovery should be treated as an ongoing process, rather than a shift from one extreme to another. Although classifying injured employees as either “off duty” or “full duty” may be practical from an HR standpoint, it oversimplifies a complex situation. While the end goal of many traditional programs is to return an injured worker to full duty, proactive intervention redefines this objective as restoring and maintaining normal function.

Incomplete recovery is a risk that neither injured workers nor their employers should have to take. Continue reading for a breakdown of the most prevalent myths about occupational injury, along with best practices in proactive intervention that facilitate efficient, early recovery for your employees.

Myth: Recovery is passive

Understanding the mechanisms of muscle injury and repair is a crucial aspect of the proactive intervention approach. One of the most common injury-related misconceptions is that rest = recovery. Initially, it makes sense to stop using an injured limb after musculoskeletal trauma; people instinctively want to avoid pain and are cautious about inflicting further damage. But while resting might temporarily relieve pain, it also causes the injured muscle to grow weaker. In fact, we lose measurable amounts of muscle mass and strength within just 24 to 48 hours of inactivity.

Performing job tasks in a physically weakened state is a serious risk, especially to those who work in industrial settings. When an employee’s ability to perform work has decreased, but the workload itself has not, it puts excessive stress on the body and interrupts the healing process. This is why most employees have trouble resuming previously tolerable job tasks when returning to work—not only after an injury, but also after long periods of inactivity. Take seasonal employment as an example: workers who revert to sedentary habits during the off-season often struggle to reacclimate to the physical demands of the job upon returning.

In addition, poor tissue healing directly affects the movement and load-bearing capabilities of the affected limb.  When one muscle is weakened, the surrounding muscles, ligaments, and joints compensate to make up for the resulting loss of strength. Over time, this imbalance causes the body to develop poor patterns of movement. What often follows is a cycle of weakened capacity, persistent pain or soreness, and increased vulnerability to injuries. In short, poor recovery puts injured workers at risk of being injured again.

Myth: Recovery has to happen away from work

Instead of letting the injury cycle continue, proactive intervention programs seek to facilitate the healing process by stimulating tissue repair and strengthening muscles. The best way to do this is through optimal loading: engaging in early, controlled movement by limiting (and gradually increasing) the workload as physiological capacity is restored [1,2]. Functional recovery starts once the employee regains full range of motion without pain, which can be as early as three days after injury. The severity of each injury and the demands of each job task vary greatly from case to case, which is why optimal loading is best facilitated by a medical professional who can determine an appropriate, safe amount of activity.

Unlike traditional rehabilitation, optimal loading takes place on the job. Observing the movements that workers perform on a daily basis lends an opportunity to directly identify the source of pain or discomfort, and then mitigate in real time. It’s about re-educating the body to perform job tasks—not only to preserve the healing process, but also to prevent the same pain or injury from happening again. If injured employees are sent to a rehabilitation clinic, the recovery process is confined to an artificial environment in which it is difficult to precisely replicate the movements involved in job tasks. Because optimal loading incorporates movements that are relevant to job tasks, it prepares employees’ bodies for work far more thoroughly and efficiently. In practice, proactive intervention actually reduces lost time by facilitating proper recovery on site.

Myth: Recovery ends when the employee is pain-free

Ideally, a proactive intervention program will prevent at-risk behavior from progressing past the early complaint stage, but the approach can also help injured employees recover better, faster, and at a much lower risk of being injured again. In a return-to-work situation, the worst mistake an employer can make is expecting an injured employee to resume their full workload immediately upon returning. Just because the employee is back in the building does not mean they’ve suddenly regained normal function, especially if only a few days have passed. We know that athletes don’t stop preparing their bodies after pre-season conditioning—they continue to strengthen and condition throughout the entire season.

“The most important information that the clinician must convey to the athlete and the coach is that return to play following a muscle strain does not usually coincide with full recovery and healing from the injury” (Orchard, 2002, p. 4)

When it comes to musculoskeletal function, those who engage in physically demanding labor are no different than athletes. That’s why proactive intervention programs focus on helping injured workers build up strength even after normal function is restored. These programs should ideally be implemented by an athletic trainer or other licensed medical professional, who first evaluate how the individual’s physiological capacity has changed, and then temporarily modify the employee’s job tasks to ensure optimal loading. While light duty may be an inconvenience, it is ultimately the smartest option for everyone involved given the alternatives: put the employee on full duty and risk another injury, or take them out of work completely and suffer lost time and productivity. By gradually transitioning employees back into regular work activities with ongoing support, proactive intervention effectively protects both the company’s bottom line and the well-being of its employees in the long term.

More advantages of proactive intervention

Intervenes in the early complaint stage. Musculoskeletal injuries are almost always preceded by warning signs: while mild soreness often follows a hard day’s work, pain is the body’s way of signaling something is wrong. It’s normal to experience muscle soreness after physical activity, but only as long as it is temporary and symmetrical. For example, an employee who spends a good part of their day walking up and down stairs is likely to experience a mild soreness in both legs, which should take only a few days at most to recover from. On the other hand, if the same employee were to experience chronic soreness or even pain in just one leg, it is a likely indicator of overuse and/or improper body positioning. That’s where proactive intervention comes in—licensed medical professionals are trained to pick up on these warning signs and intervene to reduce the risk of injury. The earlier the intervention, the better chance there is to prevent further musculoskeletal damage.

Maximizes the influence of medical expertise. After evaluating the employee’s impairment and providing initial treatment, the physician’s role in the return-to-work process rarely extends beyond communicating with a case manager [4]. Proactive intervention programs effectively bridge this gap by facilitating communication between employees and medical professionals. Unlike traditional rehabilitation, this approach brings proactive medical support to the very place where injuries often occur: the workplace.

Musculoskeletal injuries continue to affect profitability and employee well-being in businesses across the United States. Supporting injured workers throughout the recovery process is the most effective way to prevent and contain these injuries–which makes proactive intervention such an important aspect of occupational health.

 

References

  1. Khan, K. & Scott, A. (2009). Mechanotherapy: how physical therapists’ prescription of exercise promotes tissue repair. British Journal Of Sports Medicine, 43(4), 247-252. http://dx.doi.org/10.1136/bjsm.2008.054239
  2. Jones, M. & Amendola, A. (2007). Acute Treatment of Inversion Ankle Sprains. Clinical Orthopaedics And Related Research, 455, 169-172. http://dx.doi.org/10.1097/blo.0b013e31802f5468
  3. Orchard, J. & Best, T. (2002). The Management of Muscle Strain Injuries: An Early Return Versus the Risk of Recurrence. Clinical Journal Of Sport Medicine, 12(1), 3-5. http://dx.doi.org/10.1097/00042752-200201000-00004
  4. Mathematica Policy Research. (2015). The Role of the Physician in the Return-to-Work Process Following Disability Onset (pp. 1-21). Washington, DC: U.S. Department of Labor. Retrieved from https://www.dol.gov/odep/topics/pdf/RTW_Role%20of%20Physician_2015-03.pdf
Jon F. Kabance, RKT
President at BIOKINETIX
Jon’s thought leadership has helped businesses save tens of millions of dollars through strategic prevention, safety and wellness programs.

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