Physical therapy can help get workers back on job

David Metz, a registered physical therapist with 10 years of experience, operates The Rehab Co. LLC in Springfield.

Every business wants injured employees productively back to work as quickly as possible. Effective rehabilitation services can help accomplish that goal when they provide:

consistent positive results restoring function;

interaction that is easy and takes the load off the company;

prompt condition reports, especially if there's a problem; and

honesty and the ability to say "I don't see any other physical problems I can treat in this patient."

Employee injuries typically involve either repetitive stress or acute blow-outs. Acute injuries often occur in times of short staffing or after months of overtime shifts. Any joint can be at risk, but injuries most commonly occur in the spine, shoulder, knee, wrist and hand, and frequently involve the surrounding soft tissue as well.

People often adapt to their pain by limiting their function and may not even notice they have stopped lifting their arm or turning their head in order to avoid pain.

The pain is merely a symptom of an underlying problem with joints and muscles, and physical therapists study a variety of effective treatments. However, not all physical therapists employ all the available treatments, and results can vary widely.

Some treatments, such as moist heat and ultrasound, ease the pain temporarily but do nothing to address the underlying mechanical problem. Soft-tissue manipulations, including deep-tissue massage and stretching, can help reduce trauma and spasm.

However, if a joint restriction is the underlying cause, the pain will inevitably recur until the mechanical problem has been addressed.

To address the underlying problem, experience has taught me it is necessary to use hands-on treatment to mobilize the locked joint and resolve soft-tissue involvement.

Some therapists may avoid hands-on techniques for fear of injuring a patient, because they prefer to avoid physical contact, or because they lack the physical power to perform the necessary manual work. Experience is the best teacher, so it's important to choose a therapist with a proven record of positive results.

Physical therapists who perform joint mobilizations are not doing chiropractic manipulations. Even though practitioners of the two fields have begun to work together in some parts of the country, some foundational differences in theoretical approach and philosophy exist.

Chiropractic theory suggests that people need regular adjustments throughout life to correct skeletal subluxations or joints that slip out of place. Physical therapy theory, in contrast, suggests that joints simply become restricted or locked due to injury or postural influences.

Once joint and soft-tissue problems have been corrected, physical-therapy theory holds, a responsible and educated patient should be able to maintain health without repeated adjustments.

In following a medical model, physical therapists are guided by a doctor's diagnosis. On the patient's first visit, a therapist should be able to determine whether he or she can truly help the patient recover function. Be wary of a nonspecific plan of heat and ultrasound. Instead, expect to see a problem list of specific mechanical dysfunctions the therapist will address.

Also, expect the employee to receive instruction in exercises specific to the dysfunction that will help speed recovery and reduce the likelihood of recurrence. General exercises like swimming or riding a bicycle are valuable for overall health but are unlikely to improve a specific problem.

Patient responsibility is a crucial factor in healing, and although most people are honest, the occasional employee will malinger.

Here lies the biggest challenge in treating workplace injuries: Not all patients are equally motivated to recover. Because of the secondary gain of being off work, an injured worker may obediently keep every appointment with a therapist yet continue to report pain and limited function.

Patients who are serious about results will get better faster and remain healthier with a therapist who gives them the tools to stay well. The point for the business, of course, is to regain a productive employee, and a rapid recovery will reduce the negative impact on the company's bottom line.

Any business will benefit by making a critical evaluation of the results delivered by a physical rehabilitation service.