Returning to work – removing barriers and reducing anxiety

Risk Matters - Winter 2023

Work is a large part of our identities, and being away from work for a long time can deeply impact an individual.

A major return to work barrier, following a long absence due to an injury or health concern, is a worker’s ability to keep up with the physical demands of the role. Every job role has a unique footprint that requires different physical and cognitive capabilities.

To make sure that they’re ‘fit for work’ after a sustained period away, many employees are required to do a fitness for work assessment. This includes several medical assessments that help the employer and worker determine they will be able to complete the role safely.

But how can the worker be sure that they will pass the assessment?

Medical requirements are often expensive for the worker to complete, and can cause anxiety. Workers may have concerns about their future employment if they don’t pass the required tests.

Case study: Effective medical intervention to help a worker pass their fitness for work assessment.

A situation where a worker is suffering from an injury that happened outside of their workplace.

A worker suffers an injury outside of work, at a weekend adventure that went horribly wrong. Imagine the worker is a parks and gardens general hand working in a physically demanding role, and one of the major requirements of their job role is to use a chain saw.

In addition to breaking their arm they develop long-term conditions – the first being adhesive capsulitis (frozen shoulder), a condition that restricts the movement of the shoulder, and the other being complex regional pain syndrome (CRPS). This condition elevates pain as your body tries to regulate the source of the pain almost like a protective mechanism. How can the worker be sure that they will be ready to go back to work and use a chain saw when required?

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Medical help before assessment

An accredited exercise physiologist (AEP) can help prepare for medical assessment. In this case, an exercise programme was designed that includes a range of movements for the upper limb and neck. There’s a focus on the stability of the upper limb specifically looking at the muscular recruitment patterns of the upper body. Desensitisation through mirror box therapy was also introduced to help calm down the nervous system. Lastly, usage of biomechanical analysis helped provide education on correct movement patterns. Through a six-week supervised exercise program, the worker progressed towards the requirements of the medical assessment.

Medical assessment against requirements of the job role

At the initial assessment of the worker, some standard measurements were taken. However, for the purpose of the pending medical assessment, some key functional measures were taken.

  • Lift floor to waist – a task that was undertaken up to 4kg at the time of the assessment, with the requirements of the medical set at 15kg.
  • Lifting above shoulder height – a task that could not be completed to full range of movement due to the frozen shoulder, and a reduced load of just 4kg, with the medical requirements being 10kg.
  • Sustained outreached postures with vibration (i.e using a chain saw).
  • Horizontal pushing at 5kg – with the final requirement to return to work being 15kg.
  • Final measure of pulling – starting at 5kg, with the final requirement being 15kg.

Working towards the problem with AEP

The worker built towards these final medical requirements week by week attending one supervised session per week with their AEP, and two independent sessions in a gym-based environment weekly, combined with some at-home activation and stretching exercises.

It became clear in the first couple of weeks of the programme that the sticking point would be using a chain saw. Not only is there a repetitive loading element, but also a vibration component with the required sustained posture and upper limb movements.

The AEP began to target this movement with gym-based equipment including a vibration plate, through which the patient could start to practice. This continued to increase with volume and speed. The AEP filmed the weekly attempts of the chain saw task with the worker’s consent. This allowed the patient to see their weekly progress along with the increasing load and vibration frequency seen on the vibration plate.

A win-win situation for both worker and employer

In addition to developing safer working biomechanics, confidence began to grow, and with each session the likelihood of passing the medical increased. The result was a confident worker who would not only pass their medical, but also in their first attempt. Although the worker did not injure themselves in the course of their work, they were confident they would not aggravate their injury by returning to work. The programme gave them the confidence that they were fully recovered, and also strategies to better manage their physical conditioning for their job role.

Whether a job role is highly active or sitting down for prolonged period, everyone needs the confidence that they will be able to perform their role when returning from a period of absences. An AEP can provide a targeted programme to improve function and confidence for both worker and employer to seamlessly fit into their previous job role.

By Ingrid Hand (AEP ESSAM), Clinical Director for Absolute Balance. Ingrid specialises in exercise rehabilitation for workers’ compensation and motor vehicle accidents, she supports injured workers by understanding their unique needs to deliver a favourable outcome.

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