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Physical Therapy: Getting the Job Done Right, Health Matters, Fall 2009

In this day and age of the great healthcare debate, the impact of injury and illness on one's financial wellbeing is on nearly everyone's mind. The healthcare crisis is real, and there is near unanimous agreement that the "system" is in dire need of fixing.

According to a 2005 report on U.S. health spending projections in Health Affairs magazine, the amount of Gross Domestic Product spent on healthcare is projected to increase from 15.3 percent in 2003 to 18.7 percent in 2014. Additionally, the U.S. Workplace Wellness Alliance reports that employee health benefits are the fastest growing expense for employers.

While our politicians attempt to purge our healthcare system of its maladies, workplace injury and illness continue to play a prominent role in skyrocketing healthcare costs.

John Farahmand, founder and CEO of Balance Physical Therapy in Salinas, agrees.

"I see [workplace injury] placing more and more of a burden on small business owners," says Farahmand. "Prevention is absolutely the way we should be going with not only our profession as it pertains to worksite injury, but for the general health and wellbeing of the entire population."

Each year, repetitive muscle strain in assembly line workers, musicians, computer data entry personnel and others leads to tens of thousands of repetitive stress injuries such as carpal tunnel syndrome, tendonitis and bursitis, costing industry $20 billion per year (www.workplace-wellness.com). And lower back injuries are the largest workstie injury claim in the U.S. that affects our Gross Domestic Product, says Farahmand, accounting for $90 billion of lost revenue annually.

Christopher Tinker, owner of Pacific Grove Physical Therapy, concurs.

"Workers' Compensation is a huge aspect of healthcare costs," says Tinker. "[Yet] many workplace injuries, whether due to repetitive stress or some other injury, can be prevented with education and early intervention."

Prevention, health risk reduction and disease management programs in the workplace can have a positive impact not only on an employee's health, but on the company's bottom line. Thus, workplace wellness programs are a strategic focus for many employers, and physical therapists play a crucial role in their implementation in the workforce.

A Healthy State of Mind

Tinker defines workplace wellness as "being able to perform your job duties without hurting yourself or others, which includes having a [healthy] state of mind." Good mental health correlates with physical wellbeing, increased job productivity and less work-related injury.

An informed employee benefits everyone.

"Most [physical therapy] programs are aimed at preventative education," says Farahmand. "They consist of didactic lectures and on-site evaluative procedures to look at individual workstations. ... Educating people with regard to how to identify common injuries that befall most workers given their particular environment is probably the most important thing that can be done for them. ... People need to understand how their bodies function optimally, and they need to be aware of when they are experiencing pain that is indicative of pathology."

Farahmand cautions, however, that the concept of workplace wellness, which he defines as minimizing variables that potentially pose a threat to the health and wellness of employees, is somewhat misunderstood.

"There's really no such thing as a perfect work environment. ... What you have to do is give every human being a fair shot at minimizing the risks posed to them by educating them about steps they can take to empower themselves to minimize their potential risk or exposure at work."

But once an injury does occur, the physical therapist also helps expedite a worker's safe return to work.

According to the American Physical Therapy Association, therapeutic exercise and functional training are the cornerstones of intervention. Pain reduction, restoration of function and injury prevention are three key areas of focus.

"Movement impairment is what we treat," Farahmand says, "[but] physical therapists aren't pain managers ... [although] our goal is always 100 percent reduction in pain and restoration to an active lifestyle free of any movement impairment."

Patient Education

Nevertheless, Farahmand believes the most important intervention is patient education.

"You can educate someone out of becoming a statistic or out of becoming one of those unfortunate people who has to file a claim because ... they were injured at work or they're suffering because they didn't take proper steps to prepare themselves for their job," says Farahmand.

Tinker agrees: "Patient education is probably our number one [emphasis]. ... It's not our job to try and treat someone every day for the rest of their lives. ... There's so much you have to be able to do on your own, and that's where the education comes in."

So which treatment modalities are used by physical therapists? Largely, they consist of manual therapy, which is comprised of range of motion maneuvers and massage to restore joint mobility and functional activity; strength and flexibility training; posture mechanics; and the use of hot packs and ice, along with fitness and wellness programs.

Although ultrasound and electrical stimulation are used for deep heating and pain reduction, both Farahmand and Tinker explain that these are passive modalities that may or may not be used in physical therapy.

On-Site Education

On-site education occurs through in-services on proper lifting, posture and body mechanics. It includes classes in injury prevention as well as ergonomic evaluation to reduce the risk of muscle overuse. Education can be accomplished through mandated workforce exercise and prevention programs as well as workforce safety meetings.

While physical therapy has its roots in the rehabilitation of World War I soldiers, it slowly grew as a recognized medical profession during the polio epidemic of the 1940s and '50s. Today physical therapists assist patients of all ages and with a variety of health conditions. The physical therapist's role has changed from that of an "allied or adjunctive healthcare professional," says Farahmand, "to more of an entry point into the healthcare system."

"We have to be the gatekeepers," Tinker says, explaining that physical therapists help patients navigate the healthcare system.

As healthcare costs are exponentially influenced by the health risks and chronic illnesses associated with an aging workforce, the impact of workplace injury continues to expand. When workers bring chronic injuries to the jobsite, flare-ups of preexisting conditions can occur, depending upon the demands of a particular job. The physical therapist's role is to help that individual adapt his or her work environment to these preexisting conditions through ergonomic evaluation and safety training.

"Additionally," says Farahmand, "more and more people are participating in extreme sports and needing rehabilitation following catastrophic injuries. And every single human being walking the planet will at some point or another have a degenerative process affect the way they move."

As the Baby Boomer generation ages and our elderly population expands, as technological and medical advances continue, the need for physical therapists also grows.

"We're the helpers," says Tinker. "We're the ones that help people help themselves. ... Whether you're typing on a computer, swinging a hammer or stocking groceries," education is the key to wellness in the workplace.