Work hardening after injury

Katie5 · Jul 18, 2011

Work hardening definition

Work Hardening is an interdisciplinary, individualized, job specific program of activity with the
goal of return to work. Work Hardening programs use real or simulated work tasks and
progressively graded conditioning exercises that are based on the individual’s measured
tolerances. Work hardening provides a transition between acute care and successful return to
work and is designed to improve the biomechanical, neuromuscular, cardiovascular and psychosocial
functioning of the worker.
http://www.lni.wa.gov/ClaimsIns/Files/ReturnToWork/WhStds.pdf. Looked it up for you.Sorry about your back.

kainos · Jul 18, 2011

I have wondered about these types of cases also. It appears that there is often a not-so-subtle conflict of interest with employee/occupational health outfits. Their revenue is obviously tied to employers being happy with them and using their services. How do they get employers to be happy with them? By pushing hard to reduce the amount of time employees are on worker's comp and light duty! I have seen distugusting examples of these rent-a-docs saying employees who are still obviously severely injured are somehow capable of returning to full duty! I'm sure you can challenge the opinion of these docs by getting a second opinion from a spine specialist and perhaps getting a lawyer. It shouldn't be difficult to defeat the incompetent "opinion" of a general practice rent-a-doc with the opinion of a recognized specialist, but I don't know how the power dynamics play out in those cases.

brandy1017, ASN, RN · Jul 18, 2011

I'm afraid work hardening will probably only make the injury worse at this point if you still have a tear and are limited to 10 pounds. They most likely want to get you lifting alot more than that and see if you can do it.

Employee health is not for the worker! They are not concerned about our safety, only getting the worker back to work quickly or getting rid of them and saving the hospital money.

I was injured awhile back, and we have very high injury rates do to a lack of lifting equipment. The employee health nurse only documents the injuries and pushes to get us back to work, but doesn't speak up to get us adequate lift equipment.

She harassed one worker and went to that person's doctor and got the lift requirements changed to force her back to work. Is that even legal?

I think you really need to get a lawyer to protect your back and your rights. In my experience you only have so much time before you either return to work or they get rid of you. I don't know of any case where a worker was kept and given a modified job without lift restrictions. Even when such jobs exist they aren't reserved for injured workers by any means. You have to apply for them and hope you are chosen.

Before you agree to a work hardening program, please see a workers comp injury lawyer! Remember back injuries can be permanent and disabling and protect yourself from any further harm!

As much as you feel grateful for your manager know this. When it is a work related injury the hospital has to pay you workers comp and they would rather you were at least working "light duty" than sitting at home and getting paid. They are not giving you a light duty job out of the goodness of their hearts. It's the other way around, they don't want you to get paid to sit at home and have a "vacation".

If your manager really has your back then he/she would help you get a permanent non-lift position at the hospital.

I've seen too many coworkers injured over the years, many are living with chronic pain and some are totally disabled and in chronic pain. One was an 18 year old nursing assistant who had a neck injury from a freak accident. I ran into her recently and she was totally disabled and going on her third surgery. This accident happened many years prior when I was a new nurse.

You have to take your health seriously and see a lawyer about your rights before you put your back in harms way again.

brandy1017, ASN, RN · Jul 18, 2011

If they are willing to offer you a permanent non-lift position that would be great, but I would be surprised. If you have to find another job don't advertise your injury because discrimination is out there.

My first job after high school was for an insurance company and they were hiring for a claims adjuster when an older, very professional woman applied and the manager who I worked for said he wouldn't hire her because she had a history of back problems. Then he complained that he wanted to hire a man but no men applied. In the end a young college student who was an acquaintance of another claims adjuster was hired. That was a real eye-opening experience especially that he felt so free to share all these opinions with me. The work world is not fair and you have to protect yourself!

Good luck to you and may your back heal quickly! Just protect yourself!

KayRN910 · Jul 18, 2011

I can relate to your story. I had a shoulder injury in January I had terrible pain. Through my treatments, I continued to keep my NM updated with what was going on, injections, PT, everything. After months of this, I told him I needed some break for the last 4 hours of my shift, so if I could work our fast track (I'm in ER) or triage or whatever, it would help, because I didn't feel like doing PT 3 days a week would help if I was killing it 3 more days a week. I got nothing.

Ended up having surgery, that's when they found a rotator cuff tear along with a few other things. Rotator cuff recovery alone is 6 weeks in a sling, and I am JUST NOW going to be released for full work in 2 days. My surgery was April 1st.

My work has put so much pressure on me, it breaks my heart to hear you going through the same thing. I know the pressure. I have had serious anxiety trying to balance between right and wrong, job vs shoulder. My doc told me "if you tear this again, esp while its healing, you will never work as a nurse again." I have never, EVER felt so low and frustrated.

I'm 24. I have been a nurse for 1 year. I dont know what your situation is, but I do know how unfair it feels to want to take care of people and feel like it could be taken away from you. My heart really, *really* goes out to you.

I think the solution for everybody is different. I will say that I had to come to the conclusion that my shoulder will be around a lot longer than that job will. And I have to do what is right for me.

On the plus side of this, I found a WONDERFUL new job. The only thing I can think of is God made me go through this to push me in the direction I have needed to go in. I can say that now, but in the moment I felt like,"why would God make me only want to be a nurse since I was a child, only to take it away after only a year of doing it?" So I do know it's hard to see the light at the end of this terrible tunnel.

Sorry this was so long, I just wanted to share my story and let you know, even though I dont know *exactly* what you are going through, I can relate to the struggle when your body is failing you and your job doesn't understand. Good luck to you. ((hugs))

merlee · Jul 18, 2011

Get a lawyer. You need to protect your back. Back injuries can be permanent. I have never worked at a hospital that had light duty for nurses - - it's all or nothing, usually.

If you are at work, and something happens, you will be expected to help, back or no back.

Save yourself.

Best wishes!

nurseprnRN, BSN, RN · Jul 18, 2011

I did work comp case management for 17 years and saw a lot of various physicians, therapists, work hardening programs, and came to some pretty good conclusions....which served me well when I blew out my back.

Numbah A-one is this: Learn the difference between dangerous and nondangerous pain. People are naturally afraid of pain. Pain hurts. It sucks. Bites. But fear makes it worse. When your physiatrist (and this is what you need, a physiatrist with a specialty in back rehabilitation.... FIND ONE) tells you what's dangerous and what's not, go with it. When your back bites you, if you do not have some specific danger signs (which I will not enumerate here, but they have to do with actual radiculopathy with impingement, not just pain) tell it to knock it off and then ignore it. Keep going. Fear does more damage than anything in rehab.

Numbah two is: Stay active. It is natural to want to restrict movement and lifting when you have back pain. But we all remember from fundamentals about range of motion-- a muscle that you don't stretch out gradually contracts; then when you stretch it, it hurts, so you restrict it more....and before you know it, you have pain on normal ROM and you are certain you are damaged for life. I have seen this more times than I can count. You don't think you can get contractures? You don't have to be all twisted up in a chair post CVA to have tightness. That counts.

Work hardening is a specific program designed by a physical therapist with expertise in occupational med. If there is a big rehab hospital near you, that's where you want to start. They have books full of info that tell them what physical needs of jobs are. They then design a program that duplicates those physical activities, and your program starts at a low level, properly 4-6 hours per day, 3-5 days per week, doing those things with professional supervision, guidance, and training as your muscles build up. Hint: Your muscles will not like this. Tell them that's too darn bad.

Remember: backs are fairly stupid when it comes to localizing pain. Unlike your face or your fingers, backs are not designed to discriminate between stimuli very accurately-- when they are ****** off, they just hurt-- bullets, knives, muscle tears, fractures, ligament strains, chemical reactions from muscle tears or disc contents annoying nerve roots, bruises all feel pretty much the same. If you are armed with the knowledge that you are not doing anything dangerous, you can proceed with the knowledge that there is pain, but it is not dangerous and it will not last as your core muscles (which are shot to heck now, if you've been on a 10# restriction for any period of time) regain normal strength. This is why it is perfectly OK for an increase of 10 to 12#. In a month, they'll put you to 15#, and the same thing will happen....but you'll be able to lift 15#. And you will have the experience of success.

You CAN do this. FWIW, there was a great study done with many people age 18-60 who had never had back pain (where they found them I have no idea-- it's the human condition to have a back ache now and then). They ran them all through MRI to see what their backs looked like....and 40% of them had annular "pathology": tears, herniations, bulges, and asymmetries. And yet they had no pain. This tells us that although it sounds scary (and the attorneys will tell you it IS), a lot of back pain has nothing to do with discs. If one of them had tripped on the curb on the way out and gone right back in with back pain..and had no previous MRI to document their "pathology," how many of them would be convinced that now they were damaged goods? See?

Get a good physiatrist (physician with rehab specialty) who really knows backs and will explain about danger/nondanger, that's affiliated with a great PT department that will keep you going despite the nondangerous pain, grit your teeth, and plan for the future when your muscles will have been pulled against their will into fitness and you will know how to deal with flares for the rest of your life. It DOES work. ::see me flex now?::

DSkelton711 · Jul 19, 2011

Just wanted to say good luck and glad you will be going to grad school which will hopefully open other doors for you. I am in a bad situation with no job and barely surviving on disability. I managed to find an unusual job situation but unfortunately it is temporary. Not sure what to do myself! Take care of yourself.

SnowShoeRN · Aug 3, 2011

I wanted to thank everyone for their help and input. I've spoken with HR and have been told I only have a few more weeks "left" of doing restricted duty before I'm out of there.

As for the work hardening, the PT doing it took one look at my back and said that he couldn't believe my back was still this swollen and he wasn't comfortable doing any kind of weight training with me unless the swelling was down. He seemed to think it could take 6-12 weeks.

Honestly I don't really see the point of even finishing out the few weeks I have left, but whatever.

I'm feeling all kinds of things; sad, angry, disappointed, frustrated, but also hopeful that things will eventually turn out for the best. In the meantime, I'm continuing work conditioning with the hopes of eventually getting back to work. I just don't think my job will wait.

I guess I'll see.

xtxrn, ASN, RN · Aug 3, 2011

I wanted to thank everyone for their help and input. I've spoken with HR and have been told I only have a few more weeks "left" of doing restricted duty before I'm out of there.
As for the work hardening, the PT doing it took one look at my back and said that he couldn't believe my back was still this swollen and he wasn't comfortable doing any kind of weight training with me unless the swelling was down. He seemed to think it could take 6-12 weeks.
Honestly I don't really see the point of even finishing out the few weeks I have left, but whatever.
I'm feeling all kinds of things; sad, angry, disappointed, frustrated, but also hopeful that things will eventually turn out for the best. In the meantime, I'm continuing work conditioning with the hopes of eventually getting back to work. I just don't think my job will wait.
I guess I'll see.

Do you have disability insurance? (your employer more than likely won't bring this up).... IF so, this would qualify, and is way different than qualifying for Social Security (been there, done that! and have both). All you need for a private disability insurance is your doctor saying you are disabled to do the job you were hired to do. With the complications, it adds to the disability- it doesn't just apply to the original injury.

For those who don't have disability insurance, get it- nobody plans to become disabled- and it absolutely wipes out any financial cushion you may have. :)