Big rig driving down a long highway.

Injury Care in the Transportation Industry

By Michelle Hopkins | 11/27/2019

Professional truck drivers are becoming more focused on what they can do to mitigate the potential effects of their chosen career on their health, including cardiovascular disease, obesity, diabetes, stress-related concerns, and more.1,2 The health challenges are most conspicuous in long-haul truck drivers, who spend weeks or months away from home, have little opportunity for exercise or social interaction, sit for long hours behind the wheel in static postures, and use their muscles in more extreme ways than many people as they work to secure and manipulate heavy loads in transit.

Long-haul truck drivers alternate between two extremes: they are either practically immobile behind the wheel in the confined space of the truck cab or they are stretching ligaments, tendons, and muscles to the extreme and using repetitive motions getting in and out of the cab, tarping, chaining, loading, and unloading.3 The result is a heightened risk of injury or musculoskeletal disorders, also known as MSDs due to a poor load tolerance of these tissues. In fact, long-haul truck drivers experience three-and-a-half times more MSDs than the national average. Injuries to the shoulder and back are two of the most common, based on a National Institute of Occupational Safety and Health survey of 1,265 long-haul truck drivers at 32 truck stops in the 48 contiguous states.4

Concentra®achieves positive outcomes in musculoskeletal injury care and injury prevention by taking a specialized approach to help keep your drivers on the road – healthy, safe, and productive.

Why Concentra Injury Care?

“Concentra treats one in every five injured employees in the United States. There is no organization that is more focused on the health and well-being of the American workforce,” says Giovanni Gallara, PT, senior vice president of therapy and ancillary services.

Given the high incidence of musculoskeletal injuries among long-haul truck drivers, sooner or later, you are likely to have an employee referred to a physical therapist, if you haven’t already. Referrals to physical therapy can make some employers skittish if they have worked with practices that send a vast majority of patients to physical therapy and step back from monitoring the patient’s progress.

You can rest assured, that is not Concentra’s approach when there is a referral. Concentra clinicians and physical therapists work under the same roof, enabling a close, tandem support of recovery progress.

“There is a warm hand-off from clinicians to therapists of patients referred for physical therapy. That means the injured employee gets to hear what the clinician and therapist discuss about treatment and can actively engage with them, which is something Concentra encourages. Additionally, Concentra physical therapists document progress based on objective measures of function to assist medical clinicians in progressively reducing work restrictions and efficiently move forward to a full return to work,” says Sarah Stultz, PT, DPT, OCS, FAAOMPT, associate director of therapy operations.

As a result, Concentra outperforms the industry on several metrics. Concentra’s average number of physical therapy visits per case is 30 to 45 percent lower than the industry-at-large. Referrals to surgery and associated indemnity costs are lower, and just five percent of the patients seen are recommended for time away from work. Concentra clinicians continually work to keep these performance metrics high.

Distinctions in MSD Injury Care

Early intervention. Concentra favors early-intervention physical therapy and a function-based treatment approach because they start the healing process before tissues worsen. That means a faster return to optimal function. In most cases and where state laws allow, Concentra physical therapists see employees the same day as their referral, with no waiting for an authorization.

Clear communication. From the initial visit to development of a treatment plan and throughout the duration of the case, Concentra emphasizes clear, consistent communication with everyone involved: the injured employee, physician, therapist, employer, and insurer. Good communications supports efficient care and helps hold down costs. We are happy to advise you on how to get the best value from MSD injury care, so we compiled five tips to maximize the value of physical and occupational therapy.

Telemedicine. On average, a long-haul truck driver works 60 hours per week and drives more than 107,000 miles per year.5 By law, drivers of commercial vehicles and trucks in the United States are permitted to work a maximum of 14 hours and are required to take a 10-hour break before they can drive again for work.5 Your drivers press hard and can spend much time waiting because many shippers elect to unload the trailer and do not permit drivers on the loading dock.6 They don’t need to wait on treatment, too. Concentra was the first to use telemedicine for workers’ compensation cases. As many as one-third of initial visits and 60 percent of follow-up visits can be done via technology with Concentra Telemed® and Concentra Telerehab®. With this option, injury care is extended beyond the 9-to-5 work day and available where it’s convenient to you. A very good match for the trucker lifestyle.

Holistically promotes recovery. “At Concentra, our clinicians, physical therapists, and specialists work together to deliver a best-in-class standard of care and patient experience. Our evidence-based approach to workplace injuries incorporates early intervention and hands-on therapy to safely and effectively return the employee to full function,” says Stultz. “We are devotedly patient-centered. Concentra physical therapy holistically promotes recovery as we empower individuals to invest – heart, mind, and body – in the healing process.

“Concentra is unique in that we involve injured employees in developing the treatment plan, rather than making them passive recipients of care. Doing so improves health outcomes, patient compliance, and overall success,” she says.

Injury Care That Prevents Injuries, Too

Concentra physical therapy isn’t just for injury care. It may also help prevent injuries in the first place by spotting risks and addressing them early. When your long-haul driver is putting a heavy burden on one group of muscles and other muscles are not doing their share of the work, there is a heightened risk of musculoskeletal injury or tissue overload. Concentra physical therapists can help prevent a first-time injury or a recurrence by strengthening optimal muscles to decrease the load on other nerves and tendons.

Stultz gives shoulder injuries (one of the two leading MSDs for long-haul truck drivers) as an example. “There are many things that can be done to promote motion of both the affected and unaffected shoulder to help injury recovery. One of the most important parts of rehab is adapting and modifying load tolerance of the tissues of the shoulder. The majority of rotator cuff-related shoulder pain can be resolved through conservative care,” she explains.

“Activity and symptom modification are usually the key to allowing aggravated structures to calm down. Promoting motion in the joints surrounding the affected region and focusing on the injured employee as a whole person can lead to a successful recovery,” Stultz says.

Now, with an understanding of Concentra physical therapy and injury care, let’s explore two leading types of musculoskeletal injury for long-haul truckers.

Shoulder Injuries

Common injuries of the shoulder include shoulder instability, rotator cuff tear, frozen shoulder, strains, and arthritis.7

Shoulder instability. Athletes experience this injury when they use force and stretch ligaments to perform motions used in pitching a baseball or throwing a football. Long-haul truck drivers, likewise, experience shoulder instability and its recognizable signs (pain, a feeling the shoulder is loose, and arm weakness). It’s not from throwing a ball. It’s from motions like tarping a load, tying it down, or moving it back in place after it shifts in transit.

Rotator cuff tear. A group of four upper-arm muscles, called the rotator cuff, is attached to the bone by tendons and allows the arm to move up and down. When tendons tear, movement becomes difficult and painful. Rotator cuff tears can happen when lifting, trying to prevent a fall, or catching a falling object. Falls are the single-most common cause of MSDs in long-haul truck drivers.4 Also, tendons can lose strength with age. Concentra’s physical therapists can treat rotator cuff injuries and also show your drivers how to prevent them with muscle-strengthening exercises and movements that won’t compromise the tendons.

Frozen shoulder. Researchers are learning more about frozen shoulder. What we do know is that the risk of this inability to move the shoulder in any direction without pain increases with age, and it is more likely in people with comorbidities of diabetes and heart disease.7 It can occur when the shoulder is kept immobile for a long period of time, which is one risk factor that makes long-haul truck drivers vulnerable.

Strains. These injuries can occur with overuse of muscles, especially when there is little opportunity to exercise regularly, as is the case with long-haul truck drivers.

Arthritis. Overuse and age are major contributing factors.

Oftentimes, a physical therapist’s expertise and a minor change in a work practice are all that’s needed to prevent a trucker’s shoulder injury. Here is one example:

A study led by Washington State’s Department of Labor and Industries showed that a simple adaptation in the cranking motions truck drivers use to raise and lower the trailer can reduce shoulder injuries. The study found that standing parallel to the trailer when raising it (sagittal cranking) is safer because of more full-body involvement, which means less burden on the shoulder. When lowering a trailer – an activity with lower resistance – drivers should face the trailer and crank the handle in a perpendicular fashion (frontally) to the crank rotation.8

Back Injuries

When commercial drivers have musculoskeletal injuries requiring days away from work, injuries to the back are the biggest culprit. The U.S. Bureau of Labor Statistics reported in 2016 that back injuries represent 32.4 percent of MSDs with days away from work for heavy and tractor-trailer drivers. After back injuries came injuries to the shoulder (19.2 percent), leg (16.3 percent), abdomen (5.3 percent), and arm (5.1 percent). The remaining MSDs with days away from work were due to either multiple body parts injured or other/unknown.9

Over time or done improperly, movements that may lead to back pain for long-haul truck drivers include bending, lifting, pushing and pulling, carrying, and holding, as well as sitting for long periods of time. The types of injuries that can result, particularly if an employee is not conditioned for the physical demands of the job, include strains, sprains, adverse neural tissue, and disc injuries.

Concentra provides fitness-for-duty physical exams, which have been shown to reduce the incidence rate of low-back injuries in commercial truck drivers by 54 percent and associated workers’ compensation costs by 45 percent.10

Concentra also is a leader in DOT physical exams, regulated drug testing, expertise in DOT disqualifying conditions, and electronic pre-placement physicals for commercial drivers (DOT) and all employees.

Conclusion

Some states go to lengths to provide amenities for long-haul truck drivers, such as well-furnished rest stops with showers, healthy meals, and a relaxing atmosphere. After many hours on the road, navigating adverse weather, road closures, and traffic congestion, pulling into a rest stop with an array of valued services is especially rewarding for the long-haul driver. That’s the experience we work to create in our medical centers when it comes to injury care and injury prevention. We encourage you to find a Concentra near you  and experience the patient-centered care and excellent outcomes we’ve built our reputation on for more than 40 years.

Notes:

  1. Greenfield R, Busink E, Wong CP, Riboli-Sasco E, Greenfield G, Majeed A, Car J, Wark PA. Truck drivers’ perceptions on wearable devices and health promotion: a qualitative study. BMC Public Health. 2016; 16:677. Accessed October 11, 2019. https://www.ncbi.nlm.nih.gov/pubmed/27475984
  2. Sieber WK, Robinson CF, Birdsey J, Chen GX, Hitchcock EM, Lincoln JE, Nakata A, Sweeney MH [2014]. Obesity and other risk factors: the national survey of U.S. long-haul truck driver health and injury. Am J Ind Med 57:615-626. Accessed October 10, 2019. https://www.ncbi.nlm.nih.gov/pubmed/24390804
  3. “Preventing trucker shoulder,” TruckNews.com, February 4, 2019. Accessed October 10, 2019. https://www.trucknews.com/features/preventing-trucker-shoulder/
  4. Combs B, Heaton K, Raju D, Vance DE, Sieber WK, A Descriptive Study of Musculoskeletal Injuries in Long-Haul Truck Drivers: A NIOSH National Survey, Workplace Health Safety. 2018; 66(10):475-481. Accessed October 9, 2019. https://www.ncbi.nlm.nih.gov/pubmed/29502497
  5. Long-Haul Truck Drivers: Injury and Safety, National Institute for Occupational Safety and Health, March 13, 2018. Accessed October 10, 2019. https://www.cdc.gov/niosh/topics/truck/safety.html
  6. Loading and Unloading: Who Is Responsible?” NorthAmerican Transportation Association. Accessed October 10, 2019. https://ntassoc.com/Loading_and_Unloading_-_Who_is_Responsible.aspx
  7. University of Rochester Medical Center Health Encyclopedia. Accessed October 10, 2019. https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=1&contentid=832
  8. Lin JH. Occupational cranking operations: The scapula perspective. Applied Ergonomics. February 2019. 75(2): 129-133. Accessed October 2, 2019. https://www.sciencedirect.com/science/article/abs/pii/S0003687018304137
  9. “Back injuries prominent in work-related musculoskeletal disorder cases in 2016,” TED: The Economics Daily, U.S. Bureau of Labor Statistics, August 28, 2018. Accessed October 10, 2019. https://www.bls.gov/opub/ted/2018/back-injuries-prominent-in-work-related-musculoskeletal-disorder-cases-in-2016.htm?view_full
  10. Berestnev KV, Moffitt GL, Vancil DS, McKenzie J. Outcomes of the introduction of a standardized fitness-for-duty evaluation of commercial truck drivers on the incidence of low back injuries and workers’ compensation costs. Journal of Occupational and Environmental Medicine. 2014; 56(4): 431-4. Accessed October 11, 2019 https://www.ncbi.nlm.nih.gov/pubmed/?term=fitness+for+duty%2C+drivers%2C+back+pain