Why physiotherapy treatment for work injuries should be focused on a return to work more than pain.

Why physiotherapy treatment for work injuries should be focused on a return to work more than pain. Work related musculoskeletal disorders are Australia’s number one work health and safety problem. They cost our economy somewhere in the region of $24 billion per year.* This blog is a very brief discussion on ‘can we do a better job with the number one problem we face…?’  Having worked in the private practice physiotherapy industry for 18 years now and having spent the last 15 years of those in the occupational health sector we still continue to see physiotherapists providing treatment for work injuries without the primary focus being a return to work. So what does a primary focus on return to work rather than pain look like? Let’s flip that question on its head. What we DO NOT want to see is an injured worker attending for 70 physiotherapy sessions with no functional improvement. No functional improvement means the injured worker is no closer to a return to work with regards to squatting, kneeling, lifting, carrying, crawling and climbing ladders etc. If a worker cannot meet the functional (physical) requirements needed to return to their job then they cannot return to their job safely and risk re-injury. As physiotherapists, YES we treat pain and WE need to treat pain! YES we need to get a worker’s pain down for them to assist them to return to work. However, if we are only focused on reducing pain and not improving function we have left the worker unsafe to return to work. What should be established early with a worker and is most important is a worker does not need to be pain-free before they can return to work. Work is good for us. If an injured worker can return to work on suitable/light duties early the evidence suggests this results in a better outcome for return to work. The longer a worker is off work the evidence suggests that this reduces the chance of a successful return to work.

If you’re off work for:

• 20 days – 70% chance of returning to work
• 45 days – 50% chance of returning to work
• 70 days – 35% chance of returning to work#

With work injuries, Physiotherapists should very early on be establishing what the functional requirements are that a worker needs to return to their job and complete all the tasks that they need to do for a full return to work in their pre-injury job. This means we need to understand 1. the tasks that a worker does, 2. what does their body need to go through on a daily basis to do their job? And 3. we should be regularly assessing their capacity against these functional requirements. This can start early on in a regressed way, which is non-aggravating to their condition. The workers exercise program should be built around the functional requirements of the worker’s job. Then we can objectively say to the worker, their GP and their employer that the worker has met the requirements to return to the job safely. It may even fall upon us to discuss with the doctor returning the worker on suitable duties rather than having them off work with no work capacity earlier than the doctor would’ve without our valuable input. This improves a workers chance of a successful return to work. What our assessments should NOT look like is simply how is your pain and can you bend forward (for a back injury as an example). Return to work is complex. There are many hazards and barriers that block a successful return to work. Many of these barriers are not related to the worker’s physical injury or tissue damage. These barriers must also be explored in the worker’s ‘treatment’. If they are not discussed they cannot be removed as barriers. Simple! Wade Brennan Physiotherapist and WHS Consultant *Work related musculoskeletal disorders in Australia, 2019, Safe Work Australia.