Work Conditioning is a progressive rehabilitation program that a patient participates in up to 4 hours a day, 5 days a week doing work-simulated activities and remediation treatment including specific strengthening and stretching exercises.

Work Conditioning should be considered any time there is a question of whether a patient can tolerate returning to their prior job once they are medically stable and after they have had adequate acute therapy.

There is a tendency for therapy referrals to decrease frequency over time meaning beginning with 3-5x/week for the first month, then 2-3x/week, and lastly 1-2x/week, etc.  This is logical being the individual should need less direct therapist contact as they should be returning to normal activities and be able to handle more of their exercises independently.

Unfortunately, for many injured workers, this progression is counterproductive.  In many cases, the injured worker has not returned to work. So, there remains a very large discrepancy in their current and pre-injury activity level.  Doing exercises in therapy for 2-3 hours a week is hugely different than working a job for 40 hours a week. This discrepancy can cause physical and mental barriers to returning to full duty work.  The longer this situation goes on, the harder the barriers get to overcome.

Work Conditioning allows us to progressively close this gap both physically and especially mentally.  

There is a tendency for physicians to give more than adequate time for an individual to heal and, by all objective measures, return to work.  But the individual is not in the mindset that they can return to work which leads to symptom magnification in many cases.  The typical scenario is for a Functional Capacity Evaluation to be ordered at this point.  The FCE is helpful to sort out the current work level and presence of symptom magnification. The problem is that there is usually no time at this point to work through any of the barriers. For the insurance company, the FCE marks the end of medical treatment and understandably so. Many of these patients have been out of work for several years.

 The idea of initiating work conditioning at this point will usually not be received well by the insurance company even though the patient’s work level could be objectively improved and some of the psychological issues could be addressed.

In many cases, physicians feel like their interventions have been successful by way of imaging and experience of similar medical presentations, yet the patient continues to complain of pain and functional limitations.  It is important for physicians to realize it's not an accurate representation of their work. The individual may be a symptom magnifier!  Also, understand that most cases of symptom magnification are unconscious.  The individual is not lying, they are just inaccurate, and their perceptions of reality are skewed. We can identify many of these patients with the FCE, but there is not time during an FCE to address the misperceptions with the patient.

During the baseline testing for work conditioning, we can also identify symptom magnifying behavior and attempt in the following days to work through it. Of course, if the patient is a conscious symptom magnifier, they are less likely to respond favorably, and it is these individuals who need an FCE promptly for case closure.

So, when is the best time to order Work Conditioning?  It is recommended as soon as the patient is found to be clinically healed, has no physiologic rationale for complaints of pain (no additional surgical intervention planned), and they have had adequate outpatient therapy.  If they are judged medically to be able to attempt return to their prior job, but the patient is not in agreement and or resistant to this attempt, Work Conditioning can help to resolve the issue.

More time sitting at home will not likely resolve this dilemma.  In fact, it may make it worse. Sitting at home can lead to additional deconditioning and firmer adoption of dependent maladaptive behaviors.   The patient needs to work through their fear, resolve psychological and any legitimate physical limitations to working a full day. If they cannot reasonably reach their pre-injury work level, a tolerable work level will be determined, an FCE performed, and everyone can move to case closure sooner than later.

For more information contact CWR at 337-234-7018 or email us at info@theCWR.com