FUNCTIONAL INFORMATION: BETTER RETURN TO WORK MANAGEMENT
By Russell Green MD
Work Health Solutions, Owasso OK

I’m a pretty smart person. I have studied pretty hard and with effort have received a Master’s in Biomedical Engineering, an M.D., board certifications in different medical specialties, and licenses to practice in 2 countries and 5 different states. I have visited all manner of work places since I was 10 years of age. (Fire had just been discovered and Isaac Newton had a theory about something he called gravity).

…and yet, (even being a pretty informed sort of person) I really don’t know what people do functionally when they do their jobs. I would like to think I am better informed than some because I am interested in the worker, have visited many workplaces, and have spent a lot of time learning about ergonomics and biomechanics. But, you know, I have found that may not be the case.

My engineering tells me to quantify and it tells me to be methodical. Even though much about medicine is artful, there are some very important underlying scientific principles that define anatomy, physiology and tissue mechanics. As I have used job function testing results more widely, I am finding that I can recommend safe performance of certain job tasks even when people are hurt, coming to work for the first time, or even after an illness. After the therapists do functional testing, my patients seem more accepting of my advice because it is based on what they really do. Recently, a worker, after performing a job function test said, “that test makes me feel like I am at work” and another said, “this is exactly what I do during my day."
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VIEWPOINT: ARE WORK CONDITIONING AND WORK HARDENING STILL RELEVANT? IS THERE A BETTER ANSWER TO RETURN TO WORK?
By Susan J. Isernhagen PT
DSI Work Solutions inc

Twenty years ago physicians, rehabilitation providers and employers worked on methods to improve a worker’s capability to return to work.  Workers with chronic medical conditions were off work for long periods because of complex case management. Functional Capacity Assessment and Work Hardening/Work Conditioning became popular during those times.  Both FCA and Work rehab programs provided outcomes studies that demonstrated effectiveness in returning workers back to productive employment.

Beginning in the 90’s forward thinking medical/rehab providers and employers recognized that being off work was counterproductive.  (see “Is it healthier to work or be off work by Michael Erdil MD in the DSI newsletter archives,. March 07).  Medical providers focused on earlier return to work and many employers developed transitional duty programs.  With earlier intervention, referrals for work hardening or conditioning substantially decreased and many programs closed.

Simultaneously, however, advancements in diagnostics and treatment technologies lead to increased use. This somewhat offset the early return to work progress as workers were often delayed in return to work for more diagnostics.  With the time delays, uncertainty in work abilities surfaced for all parties: the worker, the employer, and the medical providers.
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ARE INJURY PREVENTION AND STRETCHING THE SAME??

In the May issue of the Journal of Rehabilitation Medicine (Vol 40, No5), a systematic review by daCosta and Vierira, faculty of University of Alberta, Canada, reviewed stretching as a component of work injury prevention.

Studies on the effectiveness of stretching for prevention revealed that effectiveness measures were in reducing discomfort and pain and preventing some musculoskeletal disorders.  Previous reviews of similar studies have also demonstrated relief of discomfort with no reduction in productivity (Hess and Hecker in Applied Occupational and Environmental Hygiene Vol 18 (5): 2003).

Thus, the experience of many working in industry has been verified.  With stretching, workers do experience less discomfort with no loss of productivity and some possible reduction in work injury reports.  When worker comfort and work satisfaction is considered important, stretching can play an important role.

This JRM study, however, also raises some important issues. In reducing discomfort, the stretching may suppress awareness of risks. With the work risks not being addressed or changed, there is a likelihood of more debilitating injuries. Also, if inadequately performed (as is the case with any inappropriate exercise), stretching may cause or aggravate injuries.
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AGING: WISDOM AND SCIENCE
By Susan J. Isernhagen PT
DSI Work Solutions Inc.

Paraphrased from Thad Franklin CWCP
“Age is only a number:  Old is an attitude”

Observations from multiple speakers on aging:
“When I was young, I went to bed injured and was able to wake up fine. When I am old, I go to bed fine and wake up injured!”

Now for the science:
With age, the progression toward diabetes and heart disease increases dramatically.  Scientists have found that there are two main factors: 

• Overweight:  Diet and exercise are primary answers
• Poor physical fitness and activity levels: Exercise is a primary answer

With two of the three causations related to activity and exercise, employers, workers, and health care providers are encouraging healthy activity in the workplace and at home.  Actions being taken by employers include:

• Studying the physical demands at work.  While physical demands can create stressors related to work injury, the lack of physical demands can contribute to the sedentary lifestyles of workers.  Employers today are having their job demands analyzed to increase safe physical activity for general health improvement.
• Providing more on-site fitness options as many workers will not be able to go to an offsite facility once they leave work. 
• Providing employee benefits of discounted or free fitness facility memberships
• Education on health awareness that includes fitness, diet and aging healthfully
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