As physical and occupational therapists, we continually rely upon our problem-solving skills and knowledge of the human body to help our patients in rehabilitation from injury and restoration of function. In an industrial rehab setting, our skills and knowledge are commonly applied at the end of the work injury process in an effort to rehabilitate a worker back to maximal function. For patients, this can often be a frustrating process, especially if they are unable to return to their previous job and function level. For therapists, it seems to be business as usual—attempting to put Humpty Dumpty back together again. This is again another example of a reactive rather than a preventative medical model. But there is a more proactive way, allowing therapists to use their skills to further serve our communities—ergonomic training.

Ergonomics is the enhancement of all aspects of job performance accomplished through the appropriate design and use of workstations, work processes, and the overall organization of work. Developing a successful ergonomic program is dependent on identifying a need for training or intervention. This is typically accomplished with minimal effort. The need for intervention is often identified by patients during the history portion of the exam. A clinic can also review charts from a series of patients from a company to look at commonalities of job tasks leading to injury. Another method is to directly contact local companies and inquire about some of the challenges they are experiencing with workplace injury. Safety managers, human resource managers, and company medical staff are an ideal starting point for this communication.

The next step is to become familiar with the company’s workplace and jobs. This normally requires observation of actual workers performing a targeted job or job task. This is where the true problem-solving nature of the therapist comes to life. While performing a job analysis may not seem natural at first, it actually fits perfectly into our realm of expertise. We are the experts in recognizing functional and potentially dysfunctional movement patterns. This is really no different than observing our patients in the clinic performing exercise techniques or functional activities. In addition to observation, the job analysis can involve discussions with safety managers, supervisors, engineers, and workers performing the job. Information obtained may include review of data pertaining to previous injuries at the job, areas of the body most commonly affected, pace of work, employee training programs, and current ergonomic interventions or training.

Listen to the podcast by Susan Isernhagen for a discussion of functional testing and job analysis innovations.

The final step is to quantify the physical demands of the job. This involves objective measurement of forces (lifting, push and pull, grip), positional demands (forward bending, low level, elevated reaching), and frequency of job task performance (continuous, frequent, occasional). One aid to help therapists in performing this analysis is continuing education. Our company requires all therapists performing job-site analysis to be trained in a standardized method of analysis and functional measurement skills. This allows for a more efficient job analysis, as well as standardization of reports among clinical staff.

After an analysis is performed, a plan of action is developed. This could involve a variety of intervention strategies involving multiple industry team members. The therapist’s primary role in this process is educator. Take the example of a material handling job requiring gripping and lifting of parts at a high repetition and an injury history of cumulative trauma involving the upper extremities. One example of ergonomic training could involve training the individual workers in rotating grip and lifting between upper extremities as well as neutral wrist position and body positioning when handling parts. Another could involve educating supervisors on a job rotation schedule that allows workers to switch between job tasks with different physical stressors to help decrease the overuse risk. This could generate such solutions as the use of mechanical lifts to decrease lifting forces, process redesign that lessens the number of lifts performed by workers, or simple line height and reach changes that may allow employees to lift parts closer to their body and at a more optimal height. Safety personnel training could involve identification of specific safety equipment or programs. A therapist’s role in ergonomic training is to evaluate physical stressors present in a particular job and to facilitate discussion regarding potential solutions with the appropriate audience. As with any intervention, outcome tracking is also important.

In summary, therapists possess a unique skill set that can offer the industrial world an asset in reducing workplace injury. Our ability to help ease the interface between worker, work, and workplace via ergonomic training and education can improve a company’s viability while also improving the worker’s quality of life and productivity. In the current economic environment, the need for our services may never be as great.

Ben Sanford, MS, PT, is a physical therapist and worksite strategies specialist at Advanced Rehabilitation Inc, Evansville, Ind. He can be reached at .


In today’s economic times, it is essential for experienced workers to stay on the job after a work-related injury. The cost to replace them and train and secure new hires is in the billions every year. How can we help workers with neck and back injuries to regain function, return to their jobs as quickly as possible, and prevent a reoccurrence?

Several studies present solid evidence that staying at work while the injured worker is healing is beneficial for the individual and the organization, and decreases the overall recovery time.

Return to work outcomes studies have shown that the sooner the injured worker is treated for a neuromuscular disorder, the sooner they return to full duty.

Staying at work while healing does bring some challenges. One of the main concerns is the potential for reinjury. This can be addressed by having injury prevention protocols in place so upper management can create ergonomic opportunities to allow employees to continue to work and produce at their current level of ability.

Another challenge is to decrease the wide array of mechanical risk factors. This includes repetition, force, contact stress, awkward postures, and vibration. Accumulative exposure to these risk factors can lead to neuromuscular disorders by impeding the nutrient pathway to the stressed tissues. As the tissues absorb stress, they react by either breaking down or recovering. Failure to address these risk exposures at work opens the door to reinjury. Therefore, reducing or eliminating the risk factors altogether is a key to injury prevention.

How are work-related injuries handled in the clinic while promoting a stay-at-work program?

Rehab is an intricate part of the return to work process. The therapist must assess the types of job demands and risk exposures of the employee’s working environment and develop a treatment plan accordingly.

The initial goal toward recovery is to restore range of motion and correct biomechanics for the injured area, such as the neck or back. The focus then moves toward controlled movement patterns that will carry over to strength and endurance. Finally, there are additional areas that need to be assessed during this phase.

First, the therapist needs to identify the specific risk factors the employee is exposed to and educate them on how to reduce their exposure without interrupting their work cycle. It can be as easy as teaching the injured worker a counterbalance stretch, which consists of having the worker move into the opposite direction every 30 minutes.

Second, it is important to work directly with the employer to modify a job to fit the worker’s needs. For example, a deli stocker who injured their back while lifting milk crates is limited with lifting only from floor to waist. What type of ergonomic opportunities can we look for? One solution may be to place a pallet under the milk crates. This raises the surface, allowing the stocker to work within their available lumbar range of motion.

In the clinic, a lifting progression program would be ideal for this scenario as the employee has the opportunity to condition up to his job level demand while still producing and working.

It does not take an enormous amount of time or finances to construct a few adjustments to an employee’s workstation. Identify the risk factors and learn to be creative about how you can decrease their exposure to those risk factors. Once these modifications are implemented and the adjustments have been made, they help to prevent future risk exposure and potential injuries for other workers.

Identifying the risk factors and addressing accommodations are an essential part of a rehab program for an injured worker. Addressing these concerns on day one of the rehab process will accelerate the transition from modified duty to full duty.

Injury prevention protocols used in the clinic and a progressive treatment plan that carries over to the workplace are just the beginning. Once a company understands how easy the solution can be to make accommodations, injured workers on modified duty will return to full duty sooner. Then, a company can begin to eliminate high-risk tasks with assistance from a PT one step at a time and transitional work becomes second nature to allow their workers to produce and to work safely.

Gina Sandoval, PT, DPT, CEAS, is a physical therapist and worksite strategies specialist at Spine Solutions Inc, Santa Fe, NM. She can be reached at .