Page 63 - Occupational Health & Safety, April 2017

make safe, incremental gains. If rest alone worked, no one would use opioids or need surgery. The reality is, most muscu- loskeletal problems do not go away when ignored, they get worse. If someone hears an engine rattle in her car, she does not ex- pect that issue to correct itself; the human body is no different.
Safety professionals play an important role in identifying musculoskeletal injuries that would benefit from physical therapy. Safety professionals and physical therapists also work together to implement feasible ergonomic changes that will decrease stress on the injured body part and allow the em- ployee to continue working in some capac- ity during recovery or to return to work in a transitional duty capacity.
If an injury occurs in the workplace, the employee should receive the appropri- ate physical therapy intervention as soon as possible. Did you know that many muscu- loskeletal injuries can be treated in as little as three to four physical therapy visits, if the employee is seen with 24 to 48 hours after injury? Unfortunately, most employ- ees do not have immediate access to physi- cal therapy. Instead, this common scenario unfolds: An employee gets injured on the job site and goes to a doctor in the commu- nity. The doctor puts the injured employee on an opioid pain medication and bedrest, then restricted duty, and a few weeks or months later, he finally ends up in physi- cal therapy because he is still experiencing pain. The problem? The underlying causes were never addressed and, because of the delay, the initial issue worsens and becomes much harder to treat.
Early Prevention
Workplace musculoskeletal injuries are often caused or worsened by repetitive motions or static positions that are er- gonomically incorrect and create muscle and joint stress and imbalance. Employees often overwork some muscles and under- work others, so some muscles become weak while others become tight. Imbal- ances in the neck and back, for example, can cause alignment issues in the small joints of the spine, causing a variety of painful conditions.
Preventing injuries from happening in the first place is even better than early treatment. Injury prevention via work site prevention programs have been shown to
be an effective way to prevent injury on the job. Work site prevention programs utilize a variety of methods, including but not limited to ergonomics, employee training, stretch breaks, or job-specific exercises and job rotation. However, a relatively new in- jury prevention strategy that includes work site “first aid” for musculoskeletal discom- forts—before they deteriorate into full in- juries and pain—seems to be taking hold in many industrial settings.
Non-Recordable Versus
Recordable Techniques
The Occupational Safety and Health Ad- ministration (OSHA)-approved preven- tion techniques that can be used for non- recordable discomfort are strictly defined and include:
■ Hot and cold therapy: Hot and cold therapy consists of compresses, soaking and non-prescription skin creams for pain relief. According to OSHA, regardless of the frequency of application, hot and cold therapy is considered first aid and therefore a non-recordable case. Hot therapy ad- dresses the discomfort by increasing blood flow to the affected area, bringing nutrients and oxygen, whereas cold therapy decreas- es circulation in order to reduce inflamma- tion and discomfort.
■ Massage: Massage is another effec- tive first aid intervention. It works by us- ing pressure to release tension in muscles and joints, resulting in increased flexibil- ity and mobility of muscles, tendons, and joints and decreased muscle restrictions and spasms. Massage helps to free adhe- sions, break down scar tissue, and decrease inflammation. Massage improves muscle tone and balance, reducing the physical stress placed on bones and joints. It in- creases blood circulation and promotes rapid removal of toxins from the muscle, which reduces fatigue and soreness.
■ Application of non-rigid support: Ac- cording to OHSA 29 CFR 1904.7, first aid treatment includes “any non-rigid means of support, such as elastic bandages, wraps, non-rigid back belts, etc.” In the early stages of discomfort, non-rigid support can go a long way toward preventing a joint or muscle injury. In July 2015, OSHA clarified that the “use of kinesiology tape and other types of elastic taping is included within the definition of first aid treatment” and is not considered medical treatment. Ath-
letic or kinesiology taping is the process of applying tape directly to the skin in order to maintain a stable position of bones and muscles during athletic activity. Taping re- duces pain and aids recovery by restricting the motion of the injured joint, compress- ing the soft tissues to reduce swelling, and supporting the anatomical structure in- volved in the discomfort. Taping may also help employees recover from overuse and muscle imbalances.
According to OSHA, exercise is a medi- cal treatment and does not qualify as first aid if it is prescribed after an injury has oc- curred. Therefore, it is important for em- ployers to proactively develop company- wide exercises that are job-specific (e.g., stretch breaks, movement breaks, or warm- ups before work and during work) to pre- vent injuries. If an employee experiencing muscular discomfort is reminded of previ- ously recommended job-specific exercises, they are not considered medical treatment and thus are non-recordable.
Safety plays an important role in en- couraging employees to self-identify early, before a discomfort becomes an injury. As with post-injury recovery, the employee must work together with physical thera- pists to develop ergonomic interventions that minimize muscular stress so that any potential issues do not develop into injuries.
As you can see, there are many alterna- tives to prescribing dangerous opioids to employees. The first and best line of defense against injury is to implement a workplace injury prevention program, including work site first aid interventions. If an employee gets injured on the job despite the preven- tion efforts, early physical therapy that directly treats the underlying cause of the pain is much more effective than a drug that merely blocks the brain’s perception of pain. Through collaboration, safety profes- sionals and physical therapists can achieve optimal results with both prevention and post-injury management—creating a solu- tion that does not include opioids.
Deborah Lechner, PT, MS, president of ErgoScience (www.ergoscience.com), com- bines an extensive research background with 25-plus years of clinical experience. The company continues to enhance its offerings through on-going research and development, and serves clients all over the world with a growing international network of clinics.
www.ohsonline.com
APRIL 2017 | Occupational Health & Safety 57