Manual Therapy Achieving an Earlier Return to Work for Injured Employees

Manual therapy, a hands-on form of physical therapy, has demonstrated benefits in work-related injury care by enhancing the injured employee’s rehabilitation process. Understanding how manual therapy addresses the body’s natural response to pain and inflammation, improves muscle strength, reduces nerve irritation, and restores muscle function can help connect the dots of manual therapy’s role in achieving earlier return to work. This is a vital need for employers confronting workforce musculoskeletal injuries (MSDs), a growing work injury concern across many industries.

Industry Pain Point: Musculoskeletal Injury

In manufacturing, where 25 percent of the workforce is age 55 or older¹, 64 percent of employers say they are very concerned or somewhat concerned about declining productivity and how to enhance the output of aging employees. Nearly one-third of employers express this same level of concern about the potential need to alter the design or layout of their facilities to accommodate an aging workforce. These findings were presented in a July 2019 Manufacturing Institute report, “The Aging of the Manufacturing Workforce: Challenges and Best Practices.”²

Manufacturing is not the only industry adjusting to an aging workforce. The average age of construction workers is 43 and rising at a faster pace in recent years.³ In transportation, aging drivers are increasing the risk of workers’ compensation claims for trucking companies.⁴ In wholesale trade, employees over age 55 increased by 35 percent in a seven-year period, and the Sloan Center on Aging & Work at Boston College observed that many employers in the wholesale trade sector are uncertain about how to address challenges related to aging employees.⁵

Paradoxically, aging employees generally are safer and more risk averse on the job than their younger cohorts; but their injuries, when they occur, are more severe. The effects of MSDs can be more extreme for older employees; but the impact on workplace productivity (the percentage of MSDs and number of days away from work per injury) actually begins much sooner – with employees age 30 and older.6 This may make a treatment option like manual therapy worth investigating for all industries concerned about productivity, not only those with an aging workforce.

How Manual Therapy Can Help

Manual therapy involves skilled hand movements and skilled passive movements by a therapist in treating joints and soft tissue with the goal of restoring normal function, range of motion, and strength.⁷ Manual therapy techniques include joint mobilization or manipulation (high velocity thrust), manual joint traction, muscle-energy, mobilization with movement, and soft tissue mobilization. A physical therapist trained in manual therapy can illustrate the various movements used, but the terminology is less important for employers than understanding the principles involved in manual therapy’s effectiveness.

If you have ever felt your lower back "lock-up,” experienced a "kink in your neck" upon awakening or jammed your finger between the proverbial rock and a hard place, you are painfully familiar with what therapists call a joint restriction. Essentially, a joint restriction is when a joint is unable to move through its normal, full range of motion without pain. This can occur due to a strain or sprain, falls, lifting a heavy object improperly, or using repetitive motion. Frequently, if the joint restriction is not addressed and mobility restored, other therapy treatment, such as stretches or strengthening, are less effective. That can mean a longer healing process.

Four Reasons Manual Therapy is Effective.

1. Manual therapy lessens muscle tightness. Muscles respond to pain and inflammation by tightening around a restricted joint in an act of self-protection to prevent motion at that joint. This is called muscle guarding.
2. Manual therapy improves muscle strength. When muscles tighten around a restricted joint to prevent stress and react to pain, they are unlikely to work at normal, full capacity. Manual therapy helps address this need.
3. Manual therapy reduces nerve sensitivity and nerve irritation. Our bodies are wired with an intricate network of nerves that serve various purposes. Some control muscle activity and movement. Others carry pain signals to the brain. When a joint is restricted, nerve sensitivity to pain shoots up and nerve irritation soars, sending pain traveling to other body parts.  For example, if a nerve in your lower back becomes irritated, the pain may spread along the length of your leg, traveling down the sciatic nerve and along its many branches.
4. Manual therapy increases function and promotes earlier return to work. By restoring normal muscle activity and decreasing nerve irritation, manual therapy can rehabilitate a body unable to move correctly into one that moves flexibly and comfortably when performing normal activities.

Manual Therapy in Workers’ Compensation: Case Example*

*Results like this positive outcome are always Concentra’s goal, but are not promised for, or indicative of, every patient’s experience.

Research has demonstrated that using manual therapy in treating acute musculoskeletal injuries leads to better outcomes in the short-term and decreases the likelihood of injury in the long-term^8,9,10.  Because the research is so supportive of manual therapy’s effectiveness, physical therapy education programs now include manual therapy as a mandatory component.

What is especially exciting for employers is how manual therapy incorporates well into the injury care model Concentra® uses, which features early intervention treatment, close collaboration between the treating clinician and the physical therapist, and clear communication among all parties. Let’s look at an example pulled from Concentra’s workers’ compensation case files.*

An employee came to Concentra with an acute lower back injury after lifting a heavy object at work. The pain was immediate, intense, and required medical examination. A clinician found no abnormalities in the lower back X-rays and determined that the patient met Concentra’s objective criteria for a referral to physical therapy. The clinician discussed the medical findings with the physical therapist. Since the employee’s musculoskeletal injury required work restrictions, therapy commenced the same day.

The employee had severely limited range of motion in the lower back and significantly limited mobility. A muscle spasm throughout the lower back rendered the employee unable to meet functional job demands. Due to the level of pain and muscle guarding, the physical therapy examination was limited.  The therapist consulted with the treating clinician, who dispensed a strong anti-inflammatory and muscle relaxer, which the employee took, then waited in the center as the medications took effect, enabling further examination.

Once the employee was more comfortable, the therapist was able to determine the injury was due to an acute joint restriction in the lower back. The therapist provided manual therapy, specifically, joint manipulation to significantly decrease the muscle spasm and improve range of motion.

Two days later, the employee returned to therapy and reported an 80 percent improvement in pain and movement. Additional exercises were prescribed, including functional training that simulated the employee’s job demands.

On the third therapy visit, the employee was pain-free, had full function, and was released to regular duty by the clinician. Without manual therapy, this injury normally would take two to three weeks to resolve. With manual therapy, the employee was back at work in less than a week.

Concentra's Expertise in Manual Therapy

As the nation's occupational health leader for more than 40 years, Concentra demonstrates expertise in many clinical areas, including manual therapy. Concentra’s leading edge approach in providing training and resources to our physical therapists includes:

• In-house Communication. Concentra provides the latest research on manual therapy throughout our national network of more than 1,200 affiliated physicians and 1,000 physical therapists. This effort helps ensure all Concentra clinicians and therapists are practicing evidence-based medicine and continually aware of support for existing and new treatment interventions and approaches.
• Trailblazing Training Program. Concentra partners with the Manual Therapy Institute (MTI) on a manual therapy certification program that requires two-and-a-half years of coursework and encompassing 17 individual continuing education classes. The MTI program is credentialed through the American Physical Therapy Association and is offered to all full-time Concentra physical therapists. Additionally, Concentra supports and encourages our therapists to complete a manual therapy fellowship program, which consists of 400 hours of clinical training. Only about one percent of physical therapists nationwide achieve the credential of Fellow of the American Academy of Orthopedic Manual Physical Therapists (FAAOMPT) and Concentra proudly boasts several of them as members of our therapy team. Concentra also partners with the Mid-Atlantic Manual Therapy Consultants (MAMTC), which offers another 10-15 courses annually. 

• Resources. All Concentra therapy leaders are licensed physical therapists and most have completed the MTI program. The focus on clinical excellence does not end at the center level. Concentra believes in leading by example. All full-time therapists also receive a free subscription to Medbridge, an online therapy continuing education provider, to maintain continual, immediate access to training modules.
• Research. Concentra's physical therapists participate in active, ongoing research studies by partnering with colleges and universities, as they seek to develop new relevant and effective treatment approaches.  Concentra has a physical therapy medical expert panel, consisting of content experts from across the country, to provide guidance on policies and procedures in the centers.  We also have members of the Occupational Health Special Interest Group (OHSIG), which is a specialty group of the American Physical Therapy Association.

Concentra’s Approach Works and Can Work for Your Employees

Concentra’s injury care model is designed so that clinicians and therapists work side-by-side to provide effective care and efficient return to function. Evidence shows that if an injured employee requires physical therapy the earlier they start care the better the outcome will be ^11,12.  Manual therapy for acute musculoskeletal injuries is an essential tool to help employers achieve a healthy and resilient workforce for optimal productivity.

Find a Concentra medical center near you to learn more about the benefits of manual therapy from Concentra.

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Jeff Rogers Jr., PT, DPT, FAAOMPT, is the director of therapy operations for Concentra in eastern Pennsylvania, Delaware, Maryland, and northern Virginia. Jeff is a leader in manual therapy research and advancing industry knowledge to achieve positive outcomes. Since joining Concentra in 2004, Jeff has conveyed physical therapy practices and trends as a guest lecturer to employers, workers’ compensation insurance companies, and universities. He is involved in manual therapy research at the University of the Sciences in Philadelphia (USciences). Jeff has a doctor of physical therapy degree from USciences and is a Fellow of the American Academy of Manual Physical Therapists (FAAOMPT). His most recent research was nominated for an orthopedic poster presentation of the year at the American Physical Therapy Association's Combined Sections Meeting.

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NOTES:

1. “What to Do About the Aging Workforce?” Industry Week, August 1, 2019. Accessed October 23, 2019.
2. “The Aging of the Manufacturing Workforce: Challenges and Best Practices,” Manufacturing Institute, July 2019. Accessed October 23, 2019.
3. “How Companies Are Adapting to the Needs of an Aging Workforce,” Engineering News-Record, August 28, 2019. Accessed October 23, 2019.
4. “Aging Driver Workforce Increases Workers’ Compensation Risks for Fleets, Experts Say,” Transport Topics, May 8, 2019. Accessed October 23, 2019.
5. “Talent Pressures and the Aging Workforce: Responsive Action Steps for the Wholesale Trade Sector,” The Sloan Center on Aging & Work at Boston College, October 2010. Accessed October 23, 2019.
6. “The Workforce is Aging – We Need to Keep It Healthy and Safe,” EHS Daily Advisor, October 15, 2019 (data cited is from the Mine Safety and Health Administration). Accessed October 23, 2019.
7. “Manual Therapy Techniques,” Guide to Physical Therapist Practice, American Physical Therapy Association. Accessed October 23, 2019. http://guidetoptpractice.apta.org/content/1/SEC38.extract
8. Wand, Benedict M., et al. "Early intervention for the management of acute low back pain: a single-blind randomized controlled trial of biopsychosocial education, manual therapy, and exercise." Spine 29.21 (2004): 2350-2356.
9. Gellhorn, Alfred Campbell, et al. "Management patterns in acute low back pain: the role of physical therapy." Spine 37.9 (2012): 775
10. Gatchel, Robert J., et al. "Treatment-and cost-effectiveness of early intervention for acute low-back pain patients: a one-year prospective study." Journal of occupational rehabilitation 13.1 (2003): 1-9.
11. Dudek D, Morgan M, Studebaker C, Stultz S, and Warner S, Physical Therapy Early Intervention in the Work Place, Orthopaedic Practice, Vol. 28; 2:16 (2016), Retrieved from
12. Linz, Douglas H., et al. "Effectiveness of occupational medicine center-based physical therapy." Journal of occupational and environmental medicine 44.1 (2002): 48-53.