“30 years ago, as a young physician I was taught, as many of our parents were, that if you have an injury you must have complete rest. We have discovered over the years that that is a fallacy and leads to other problems. I often joke with patients that as a young doc we used to hospitalize patients with back pain and put them in bed for a week or two at a time, and many of them are still there. The sports medicine specialists were in the forefront of changing that idea. They began treating their athletes by resting only the injured part while continuing to actively use the rest of the body. They found that people healed quicker, and were back in the game sooner. Well, we have finally realized that workers are just a different type of athlete, an “Industrial Athlete” and they also need to be kept with their team while healing so they can get back up to bat again sooner.”
Work must be a component of any injured worker’s recovery.
Maybe you are an employer who wants a healthy, productive employee back to work or you're the spouse of an injured worker who wants things at home to return to the way things used to be. Maybe you’re a physician who wants to help your patient recover and achieve the best possible outcome. Graded work exposure may help you attain these goals by making work a part of the recovery process.
What is graded work exposure?
It’s a predetermined plan agreed upon by an injured worker’s occupational therapist and the injured worker’s supervisor that returns injured workers to job duties in which the hours and duties are gradually increased until the injured worker can return to their pre-injury duties.
An example is when an injured worker returns to work four hours per day, five days per week for two weeks. After two weeks, the injured worker’s hours are increased to 6 hours per day for two weeks, and then eventually eight hours per day. Graded work exposure may involve the injured worker only performing certain aspects of their job that are more physically challenging for just a portion of their day. Graded work exposure can be particularly helpful for injured workers who question their ability to return to their pre-injury job, or are fearful of getting injured again. Making progress toward goals through graded work exposure can help both employers and injured workers restore their confidence in the injured worker’s physical abilities.
In a 2000 study conducted on therapeutic return to work (TRTW), researchers found that work rehabilitation programs that linked graded work exposure with traditional physical therapy for chronic low back pain resulted in 93% of participants working at two-year follow up. More telling of the success of this program is that none of the participants reported back pain recurrence from working during the period of the study (p. 59, 2000). Of those participants who underwent traditional functional restorative therapy, 73% of participants were working at two-year follow up. Participants in the TRTW group also indicated lower average disability scores, lower average pain intensity scores, and lower scores on fear avoidance beliefs measures (p. 60, 2000).
Speaking of industrial athletes…
Do you remember the first time you jumped off the diving board? Your thoughts preceding that jump probably focused on every time you nearly drowned before that. You’re teetering at the edge of the fiberglass board hoping that you won’t sink like a rock, hoping that someone will come to your aid if you suddenly swallow half the contents of the pool, and hoping that it will all be worth it. The people on the side of the pool are telling you to just do it already, to trust them -- they’ve done it a hundred times before and it will be great. Something tells you to linger on the board just a little longer, inch a little closer to the edge, and that you’ll decide when you’re ready.
Returning injured workers to modified duty requires trust. Employers and injured workers are concerned about re-injury. There may be doubts in either party’s minds about whether or not the return to work will, well, work. These feelings of anxiety, uncertainty and doubt are also experienced by employers and injured workers who are contemplating a return to work after a work injury. No matter how many times a doctor tells an injured worker or an employer they can do x, y and z, they haven’t seen it done yet and they aren’t really sure of the outcome. Without an attempt no one will ever know.
When planning the return of an injured worker, focus on setting it up for success and consider graded work exposure as an option.
References:
Durand, M. J., & Loisel, P. (2001). Therapeutic return to work: Rehabilitation in the workplace. Work, (17), 57-63.
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