Why a Medical Release to Return to Work “ain’t all that…”

[fa icon="calendar'] Jul 19, 2022 10:50:33 AM / by Deborah Lechner

Return-to-Work Physical Abilities Testing in Workers’ Compensation Cases Changes the Game

After an injured worker has received medical treatment, physical therapy, – maybe even surgery - the release to work decision is typically made by the treating physician.

Is that a good thing? Not always…

The physician is deciding whether the injury is medically resolved or, in more chronic cases, whether the person has reached “Maximum Medical Improvement (MMI).

Typically, that decision is based on some combination of x-rays, MRIs, physical examination of the injured body part, standards of clinical practice, watching the patient move, or…asking the patient if they feel “ready to go back to work.”

You might say the decision is based 20-30% upon objective information but a whole lot based on intuition.

But no one has EVALUATED whether the person still has the physical ability to do the job…

After all, the person did the job BEFORE the injury. Why can he/she/they do the job NOW?

Case Example: Let’s say it’s a severe back strain (but no surgery), and the person has been off for 13 workdays (the average for a lost time strain or sprain) – that translates into nearly 3 weeks of lost work time.

Three weeks during which, likely, the person has not sustained the physical activity required for the job. It’s also expected that they have spent time on bed rest or have experienced muscle guarding, during which the back, stomach, leg, and arm muscles have not contracted as they usually would have.

So what? (You might be thinking.) So, they got a little rest! What’s the big deal?

Muscle AtrophyWell, the BIG deal is…MUSCLE ATROPHY.

Muscle atrophy (or decline in the diameter of the muscle fibers) is real, and it occurs because of injury and immobilization or unloading the muscle (think being in a cast or on crutches or wearing a back brace). Now don’t get me wrong, I’m not criticizing immobilization – it’s a necessary transient method for healing in many cases.  

But when immobilized and when the muscle size decreases, so does the strength. Research agrees that the most significant changes in muscle size happen soon after injury, especially during the first week of inactivity or immobilization.

Remember in our example above that the person’s been off for 3 weeks. He’s had plenty of time for atrophy to occur.

If the person mainly rested for 10 days, they could lose up to 30% of their muscle mass. But even if they just decreased their activity from their previous full level of work, they could experience as much as a 12% decrease!

AND not only will the atrophy affect strength, but it will also affect fatigue as well…atrophied muscles fatigue more quickly and with less effort. So throw that person back into a 10-12 hour shift (not unusual in many work environments) to add insult to injury (pun intended).

All factors that SHOULD be considered as the return-to-work decision is made…but rarely are.

So, what can be done? What SHOULD be done but rarely is?


Return-to-Work Testing

The answer is a return-to-work Physical Abilities Test – also referred to as a “Fitness for Duty Tests” in some circles.

It’s a brief test where the person performs the 4-6 most difficult tasks of the job. Maybe it’s lifting. Maybe it’s pushing and pulling, or squatting, kneeling, bending over, reaching, climbing. It takes only 30-40 minutes but gives you some vital OBJECTIVE information about whether the person still has the physical abilities to do the job.

Not a guess, not an assumption (which you know what that makes out of you and me), but instead honest to goodness objective information that informs the return-to-work decision.

And if the test is done BEFORE the return-to-work doctor’s visit, the test results can be used by the doctor to inform his decision. Not rocket science.   Just good old-fashioned data.

Work Reconditioning 

And if the person can NOT do the most difficult parts of the job, it’s not the end of the road. Often just a couple of weeks of exercises and work simulation activities that focus on strengthening and endurance will make things right as rain…with another brief test at the end to ensure things are where they should be.

And in the process, the injured worker might even learn how to lift better, how to position the body so there’s less stress, how to work smarter, not harder, for the sake of preserving the body…heaven forbid that should happen too! But it does…we’ve seen it time after time after time.

In fact, one of our programs reports that 85-90% go back to full duty in 2 weeks, with another 5% moving to a lighter duty job and 5% never returning…and never getting re-injured. And is NOT working in chronic pain.

Return on Investment (ROI)

Is this too much to ask? A few hundred dollars and a couple of weeks to ensure there’s not another 5-6 figure injury. Certainly, the return on investment is obvious.

So why isn’t this common practice?

“Because this ain’t the way we’ve always done it.”

“We rely on the doctor’s ‘medical’ release to return to work.”

Do what you’ve always done, and you’ll get what you’ve always got…people getting reinjured or working in chronic pain and being less productive.

The “medical” release “ain’t all that,”…especially when it comes to the return to work decision.

Contact ErgoScience to learn more about how you can develop an effective return to work program.

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Topics: Workplace Safety, Injury Prevention, Risk Management, Workers' Compensation Costs, Reduce workplace injuries

Deborah Lechner

Written by Deborah Lechner

Deborah Lechner, ErgoScience President, combines an extensive research background with 25-plus years of clinical experience. Under her leadership, ErgoScience continues to use the science of work to improve workplace safety, productivity and profitability.