Treating Injured Musculoskeletal Workers: More Than Just Physical Therapy

More than 125 million Americans struggle with daily musculoskeletal issues. The musculoskeletal system includes the joints, ligaments, muscles, and nerves that support your limbs, neck and back. Musculoskeletal disorders range from chronic back pain, osteoarthritis, fibromyalgia, all the way to carpal tunnel and tendinitis. 

Healthcare spend for musculoskeletal disorders (MSDs) accounts for 10% of all of the healthcare spend in the United States. For employers, these costs are even greater, exceeding 16% of total healthcare spending. According to a 2016 study issued by the United States Bone and Joint Initiative (USBJI), musculoskeletal conditions cost an estimated $213 billion in annual treatment.

For employers across the country, MSK is the single highest medical expense and is now being recognized as a massive opportunity for cost-savings for payers, employers, and providers.

For workers' compensation programs, reducing the costs associated with musculoskeletal conditions offers great potential. So how should we be treating workers' with musculoskeletal issues and work-related musculoskeletal disorders? Are costs out of control because we're not addressing the whole patient? Is there too much focus on physical therapy in treating MSK?

To get to the bottom of why musculoskeletal conditions in the workplace (and beyond) are on the rise and are not being properly addressed, we spoke to Dr. Rupali Soeters, PT, MEd, PhD, an assistant professor in the Doctor of Physical Therapy program at the University of St. Augustine.

Treating Injured Workers with MSK Disorders: More Than Just PT?

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When it comes to a patient or a claimant with a musculoskeletal condition- whether it be osteoarthritis or back pain- the first stop is often physical therapy. Although physical therapy can be an important part of MSK injury prevention, treatment, and recovery, it's exactly that: part of the solution.

Physical therapy, as the solely recommended course of treatment or as the approved rehabilitation for injured workers recovering from surgery, isn't enough.

Dr. Rupali Soeters, PT,  explains, "I often hear people say, 'I am going to physical therapy', and they think they're going to be fixed. However, coming to physical therapy alone isn't going to fix it. The idea that physical therapy can play the sole role is a perception created by society". In other words, treating musculoskeletal issues for patients facing surgery or not, involves more than just physical therapy. Focusing on just physical methods of treatment mean that the injured worker is not being fully treated, is susceptible to reinjury, chronic pain, or the transferring of symptoms. 

Treating injured workers with MSK issues to reduce costs and promote a fuller, faster recovery, is multidisciplinary in nature.

Musculoskeletal Treatment is Multidisciplinary 

Treating an injured worker with a complex musculoskeletal issue involves the integration of experts and specialists across the entire spectrum of care. A claimant's course of treatment shouldn't be restricted to input from their primary care physician, physical therapist, or orthopedic surgeon. Instead, a multidisciplinary team of experts including social workers, pain specialists, nutritionists, mental health experts, occupational therapists, and so forth, should lend their expertise and participate in forming a complete, dynamic solution.

Dr. Rupali Soeters, explains, "Silos are a redundant approach in healthcare all over the world but we're seeing more and more institutions get away from them. Even Universities are beginning to give greater emphasis on interprofessional education (IPE) to make sure students learn the importance of inter professional collaboration during their training."

The management of work-related musculoskeletal injuries is much more than a singular approach, like physical therapy. Dr. Soeters adds that, "There are many conditions that require additional expertise besides physical therapy. For instance, as physical therapists we are not trained to treat mental health conditions. Chronic pain patients are psychologically impacted and should also be seen by a pain specialist and mental health specialist if needed."

When offering treatment to the nearly 50% of your workforce or caseload that may be impacted with musculoskeletal issues, focusing on the whole patient and their whole journey is the only way to optimize for better care, faster return-to-work times, and lower costs.

Multidisciplinary MSK: The 5 Pillars of Health

When looking for the best treatment for the increasing numbers of injured workers' who may be out on short-term disability, are facing surgery, and are looking to make a full recovery, we should start with a 'multidisciplinary' approach. A complete recovery program, like PeerWell's surgery optimization (PreHab) and recovery (ReHab) platform for injured workers', will guide patients through all of the proven factors that contribute to getting back to work the fastest and healing the whole person. 

PeerWell's surgery optimization technology for patients and injured workers with MSK, is built around the five pillars of health: Physical Therapy, Nutrition, Pain & Anxiety, Health Literacy, and Environmental Preparation. 

"PeerWell looks at the patient as a whole: their diet, level of function, mental health, social support, environmental conditions etc., and really takes all of the aspects of the human being into consideration—not just the body part. Even though the focus might be a body part, like a rotator cuff tear, they make sure the person recovers as a whole."- Dr. Soeters.

1. Physical Therapy

Treating a musculoskeletal disorder should be centered around targeted exercises and movements that support, strengthen, stretch, and improve flexion or extension. Working through daily, personalized exercises that are proven to reduce pain, and improve mobility, and kickstart healing is necessary for making a full recovery. However, physical movement is just one part to preparing for surgery and recovering from a musculoskeletal condition.

2. Nutrition

Nutrition is often overlooked in musculoskeletal recovery and pain management. With small, focused dietary changes, pain, mobility, inflammation, and mood can be improved. Better diet, weight loss, and nutrients with healing properties are proven to contribute to a full recovery. For instance, eating foods rich in calcium, vitamin D, fiber, and protein before surgery are key for recovery. Pre-op and post-op nutrition for patients with MSK is an important part of a whole recovery.

Read more about using food as medicine and 'eating for surgery', like a joint replacement.

3. Pain and Anxiety

The most underestimated element in treating MSK is mental health. Chronic pain and musculoskeletal conditions are closely linked to emotional health, anxiety, and depression. Offering an injured MSK injured worker just physical therapy or surgery, is not addressing the underlying issue or providing solutions and coping techniques for pain, anxiety, fear surrounding surgery, and the depression that is enmeshed with MSK. A full recovery means both physical and emotional healing.

Read more about overcoming depression after a surgery like a spinal fusion.

4. Health Literacy 

"Health literacy is huge. As patients go through pain management, surgery and post-surgery, it's really important for them to understand and get educated on what is going on. This can only happen if we educate them at their own level," explained Dr. Soeters. 

If your surgery nurse services team, frontline care team, or insurer isn't providing adequate support or information about a workers' MSK injury and condition, it is as though they are recovering in the dark. Properly treating an MSK condition means transparent education in a manner that is accessible. When a patient is empowered, understands the condition, and recognizes risk factors, they become active participants in their health. 

5. Environmental Preparation

An injured worker that is facing surgery, but is returning to an unsafe, unprepared, or unsupported home has major hurdles to overcome. A complete MSK surgery optimization program must assist the injured worker in creating a safe recovery space and sorting out the necessary logistics. Things like removing trip and fall hazards from the home after a knee replacement or installing proper equipment in the bathroom are often overlooked and dangerous for recovery. 

"PeerWell ensures that every aspect impacted by a medical condition is included in the treatment approach. PeerWell is well-aligned to improve outcomes and reduce healthcare costs. Value-based healthcare delivery models are currently gaining momentum, and the demand for systems like PeerWell, that provide personalized care and a multidimensional approach will be on the rise."

Reducing the rising costs of MSK for employers, payers and providers means adopting an innovative approach to treating each patient. Personalized care that is multidisciplinary and effective means offering more than just physical therapy. PeerWell helps workers' compensation programs, employer health plans, and payers treat the entire patient as they face complex procedures. 

Learn more about how PeerWell's injured worker surgery optimization breaks down healthcare silos in one simple, easy-to-integrate solution. Return injured workers to work, faster.

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Hi, I'm Grace. I write and research about hip and knee replacements, PreHab before orthopedic surgery & ReHab. Content advised or co-authored with physicians (MD) and orthopedic surgeons (OS).

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