Undoubtedly every clinician has at some point attempted to return an injured worker to light duty. While this allows the patient to continue employment, the question arises: Exactly what is light duty, and how does the clinician determine what the patient can or cannot do while on the job? In a previous article we discussed the issue of returning an injured worker to the job. It is imperative that every effort be made to keep injured workers on the job whenever possible.
The circumstances under which injured workers may return to work vary from company to company. Some insist that workers may only return when they are fully recovered and ready to resume all of their usual work activities. Others provide for an earlier return by allowing the injured worker to perform light duty. This enables individuals to continue working but, theoretically, places them in a situation that would compromise the recovery. Some companies may not allow injured workers to return to work at all. While this practice is illegal, workers in such companies know that an injury equates to dismissal.
The question facing the clinician is, under what circumstances may an injured worker return to work? When told that he or she may return to work on a light duty basis, it is the responsibility of the clinician to assist the worker and the company to provide reasonable work modifications. Unfortunately, exactly what constitutes a reasonable work modification or reasonable accommodation is often unclear. Workers involved in material handling may be restricted from heavy lifting for a specified period of time. Some workers with lower back pain may be given a seated work assignment temporarily. While not uncommon, this is a particularly questionable modification given the fact that many individuals with back pain actually feel worse when sitting.
The following list provides a variety of work modifications that may be useful.
Restricted manual material handling
The practice of restricting injured workers from lifting heavy objects is not new. The question of how much lifting to limit the worker to and for how long is often difficult to answer. Often the problem may not be the amount the worker has to lift. Instead, it may be the circumstances that he or she must lift that need to be modified. Any lifting restrictions must be based on an appreciation of the physical demands placed on the worker.
Restricted postural stress
Workers who must sit or stand in a certain position for long periods of time are at increased risk of injury. To minimize this it may be helpful to limit the amount of time that they are allowed to maintain a specific position. For example, a grocery checker may find it difficult to stand at a checkout stand for hours at a time. A work modification might include limiting the time in the checkout stand to 30 minutes. This should be followed by 30 minutes of a different activity, perhaps stocking shelves with light weight goods or retrieving shopping carts from the parking lot. It is also helpful to teach the injured worker some exercises to reduce the postural stress.
Restricted exposure to vibration
Exposure to vibration has been shown to increase the rate of a variety of work-related injuries including back pain and wrist and hand problems. The use of power tools on-the-job may need to be restricted in workers with hand and wrist injuries. As before, a reasonable work modification might include the time of exposure to 30 minutes followed by at least 30 minutes of a different type of activity.
Restricted repetitive activities
The incidence of musculoskeletal injuries, induced or aggravated by the constant repetition of certain activities or groups of activities, is increasing at an alarming rate. Workers who are recovering from a variety of cumulative trauma disorders, such as carpal tunnel syndrome, often need modifications in their work environment. These may include ergonomic changes, frequent short breaks, specific exercise programs, and task rotations.
In addition to those modifications listed above, many other changes may allow the injured worker to safely return to work. Some workers may not be ready for a full eight-hour day, but may find it reasonable to work half days. Others may find that a shorter work week, perhaps three or four days, may allow them to return to work. Modifying the time of work may help others. For example, an office worker who has back pain while sitting may find that working at a different time reduces the time spent commuting to a tolerable level.
One of the primary objectives of the clinician involved in the evaluation and treatment of injured workers is to return the individual to the job as soon as possible. While it is not suggested that clinicians compromise any health concerns, it is not generally in the best interest of workers to allow them long periods off work to recover. Those individuals who do require long periods off work should probably be in some type of guided rehabilitation program. Workers who are unlikely to return to the same job due to the nature of their injuries should be placed in occupational therapy programs and/or retrained for some type of work they can perform.
Paul Hooper, DC
Diamond Bar, California
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