How Work Conditioning and Work Hardening Address Occupational Injury

David Wilsey, DPT, PT

David Wilsey

Work conditioning and work hardening are two specialized therapy services under the umbrella of work rehabilitation. These services promote return to work for employees in a chronic stage of rehabilitation who need more intensive daily clinical treatment to restore function and physical reconditioning. A chronic stage of rehabilitation is typically four weeks after an injury and after a standard course of physical therapy. Employees in this stage – a fraction of the total 2.8 million nonfatal injuries annually – are not ready to return to work due to (1) functional restrictions and/or (2) complications caused by psychosocial factors.1

How Concentra can help

The typical first step before an employee enrolls in a work rehabilitation program is a functional capacity evaluation (FCE), which serves to establish a baseline of function, consistency of effort and to document any psychosocial factors that may hinder rehabilitation progress. Concentra® performs FCEs at our medical centers to provide a guideline for creating a tailored program for the injured employee. Concentra also provides work conditioning at select locations. Concentra’s active, early intervention model of treatment inhibits the kind of psychosocial issues that may require the intervention of a multidisciplinary team, such as with work hardening. Both work rehabilitation approaches – work conditioning and work hardening – are discussed in this article.

What’s the difference between work conditioning and work hardening?

Work conditioning and work hardening are unique work rehabilitation programs and are not interchangeable, even though they share a common focus of restoring an injured employee to the functional level necessary to return to work. The critical differences between the two approaches are the types of interventions utilized and time required to achieve the goal.

Work conditioning where effort is consistent

Work conditioning is recommended when an injured employee has made consistent efforts throughout their rehabilitation process. This employee needs only to overcome a small gap in functional performance to be able to return to their pre-injury job function without restrictions.

Employees in work conditioning may participate in the program up to four hours a day. A physical therapist or occupational therapist oversees the work conditioning services but may coordinate the program with a physician and/or case manager.

Work hardening needs a multi-disciplinary team

In contrast to work conditioning, work hardening is a highly structured intervention that utilizes a multi-disciplinary team to provide services. Along with a physician, case manager, and physical therapist or occupational therapist, the treatment team may include a vocational counselor and a rehabilitation psychologist. All of these professionals are necessary to fully interpret and address the functional, behavioral, and vocational needs of the injured employee. The goal of a work hardening program is often to improve the injured employee to the highest possible functional level to aid in the vocational search. Employees in work hardening may participate in the program up to eight hours a day.

Work rehabilitation programs may be considered not medically necessary, given their rehabilitative role and not as treatment of a medical condition. Thus, we recommend consulting your state’s laws and regulations to understand the coverage that may be available for this program.

Concentra’s approach aligns with occupational needs

Concentra’s approach to acute physical therapy services is one of early intervention and active treatment. Our intimate knowledge of work processes along with access to specific equipment utilized on the job allows Concentra therapists to provide job simulation tasks that may not be available in a non-occupational setting.

Additionally, many Concentra colleagues are trained in performing jobsite analyses. This capability enables Concentra clinicians to precisely design job simulation activities in the acute and/or chronic stages of rehabilitation to improve return to work for your employees.

Learn more about Concentra physical therapy services at

David Wilsey, DPT, PT, is a center physical therapy director for Concentra in Alexandria, Virginia. He joined Concentra in 2005. He has been involved with work conditioning and work hardening programs throughout his 30-year career. David has a bachelor’s degree in physical therapy from Daemen College and a doctor of physical therapy degree from Simmons College

1 Nonfatal occupational injuries and illnesses by industry and case types, 2018. US Bureau of Labor Statistics.