What Companies Need to Know About Musculoskeletal Injuries

By Sean Flavin January 25th, 2021

Here's a stat that may surprise you: Americans suffer 66 million musculoskeletal injuries a year — that's three out of every four injury-related health care visits. Even if you're not quite sure what a musculoskeletal injury is, chances are you've suffered a few. Musculoskeletal injuries "are soft tissue injuries caused by sudden impact, force, vibration, and unbalanced positions," including common ailments like bone fractures, muscle/tendon strains, and ligament sprains, as well as degenerative diseases like osteoarthritis.

And these injuries aren't limited to athletes. Musculoskeletal afflictions are common in the workplace, resulting in about $20 billion per year in direct costs to U.S. businesses and accounting for roughly one-third of all workers' compensation spend.

When it comes to musculoskeletal conditions, there are strategies your company can employ to reduce these costs. We invited Diane Newquist — Vice President of Clinical Operations/Workers’ Compensation at Athletico Physical Therapy — to join our Risk Control Webinar Series to explain one such strategy. Newquist's presentation detailed how partnering with physical therapy (PT) professionals can help prevent new injuries, streamline recovery times, and reduce workers' compensation costs.

How Physical Therapists Can Prevent Musculoskeletal Injuries

For employers, the best way to reduce workers' compensation costs is to stop injuries from happening in the first place. Physical therapists can play a large role in workplace training and identifying on-the-job hazards that can lead to injuries.

"It's about having therapists who are available to promote injury prevention, not to triage injuries," said Newquist.

On top of identifying hazards, physical therapists can recognize employees at risk for chronic pain or disabilities. The key, according to Newquist, is to identify musculoskeletal issues before they require medical intervention.

Mechanical vs. Medical Approach

According to Newquist, the human body is a mechanical structure, which makes it important to take a mechanical approach to pain rather than a medical one. Yet, all too often, we rely on medical and surgical interventions rather than addressing the root cause of an injury. To reduce workplace injuries, Newquist recommends working with a physical therapist who focuses on administering OSHA First Aid, which allows for "massage, exercise, stretching, and using good body mechanics to decrease the mechanical stresses."

"Consider your employees as industrial athletes," said Newquist. The mechanical approach is you taking care of your employees in the workplace like a trainer would take care of an athlete on the field.

How PT Can Optimize the Recovery Process

After employees suffer musculoskeletal injuries, timely and competent care is essential in helping them recover quickly and reducing costs for your company. Newquist covered several programs for treating musculoskeletal injuries, some of which may require your company to think outside the box a bit.

A New Approach to Pain

According to Newquist, treating many musculoskeletal injuries starts with re-wiring the way we think about pain. To set up her point, Newquist shared the following stats:

  • Two-thirds of people over 70 have a torn rotator cuff but aren't in pain.
  • 25-50 percent of MRIs show knee arthritis in pain-free people.
  • 40 percent of pain-free people have a bulging disc.

So, why are all these legitimately injured people not experiencing pain? According to Newquist, while pain is real, it may not be caused by the actual injury.

"There are a lot of factors that go into pain, (including) faulty cognitions, psychological issues, or socioeconomic factors," said Newquist. "It's important that patients understand the science behind the pain."

Physical therapists can play a large role in changing patients' cognitions, beliefs, and fears regarding pain. To accomplish this, Newquist recommends Pain Neuroscience Education (PNE). PNE sessions involve verbal, one-on-one communication with a patient to discuss the concept of pain and the brain's perception of it.

Functional Rehabilitation

If pain is not the factor preventing an employee from returning to work, Newquist recommends implementing a functional rehab approach from Day 1. When it comes to musculoskeletal injuries, injured workers must take an active role in their recovery.

"Employees are on the bench, and it's their job to get healthy and get back in the game," said Newquist. "They need to be active participants in that process."

On the employer side, it's critical to provide the therapists with accurate functional job demands (how much they lift, how often they lift it, how far they carry it, etc.). These descriptions allow therapists to develop a customized rehabilitation plan that includes the same movements and weights the employee would be expected to do on the job.

Work Conditioning

Another treatment program that physical therapists use to help employees recover from musculoskeletal injuries is work conditioning. This treatment program focuses on a job's functional requirements along with basic conditioning (strength, endurance, flexibility, and balance).

Ideal patients for work conditioning:

  • Have jobs with above-average physical requirements (lifting more than 20 pounds multiple times an hour).
  • Are compliant and willing to take an active role in the recovery process.
  • Have a fear of reinjury or have had multiple injuries.
  • Are suffering from a loss of strength or conditioning, which has limited their ability to return to work.

Functional Capacity Evaluation (FCE)

For employees with musculoskeletal injuries struggling to return to work, Newquist recommended FCE. This program examines patients' ability to perform essential functions of their job and assesses the validity of their performance in rehab. Essentially, FCE is a last resort when other rehabilitation programs haven't worked and patients are showing signs like:

  • Citing pain as their limiting factor for returning to work.
  • Complaining of pain in the absence of objective clinical findings.
  • Not complying with the therapy program in terms of attendance or effort.

The PT-First Approach

Newquist closed her presentation by stressing how important it is for many employers to disrupt their status quo by starting to think of PT as the first line of defense rather than medical interventions.

"Only 7 percent of patients with lower back pain receive PT within the first 90 days. We need to reverse this trend," said Newquist.

Several studies back up her point, showing that PT within the first 14 days of a musculoskeletal injury leads to decreased physician visits, surgeries, and opioid use. For employers, avoiding these results can lead to healthier workers and lower workers' compensation costs.

About the Webinar

This presentation was part of CRI's Risk Control Webinar Series — weekly installments of webinars to educate the group captive members we work with on topics like workplace safety, organizational leadership, and company performance. The thoughts and opinions expressed in these webinars are those of the presenters and do not necessarily reflect CRI's positions on any of the above topics.

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