Opportunities for therapists to expand their practice in the work injury management and prevention arena are growing. Musculoskeletal disorders (MSDs) continue to negatively impact the bottom-line financial performance for employers. Costs related to medical care, lost work time, restricted duty, case management, and legal issues are estimated in the billions (some estimate in the trillions) of dollars annually.

Workers are often treated by medical providers who have very limited knowledge of the specific tasks or functions that are required for the job. Job descriptions can be helpful, but are often vague and lack specific functional information to assist with injury management. This scenario often affects a physician’s decision to return employees to work and creates a dilemma for employers. But, when a therapist is willing to work on-site with an employer, a huge gap is bridged, which results in better outcomes for the worker, improved communication with medical providers, and reduced costs for the employer. This article discusses how a therapist successfully took her skills (and business) from the clinic environment on-site with employers.


Susan Moore, PT, MS, MTC, owner of Brookside Physical Therapy in Thornton, Colo, a physical therapist since 1980, offers comprehensive services for employers and workers such as post-offer functional testing, ergonomics, job site analysis, and return-to-work programs.

Susan Moore, PT, (on right) providing on-site job coaching for lifting and handling boxes of product to a Frito-Lay employee.

She established Brookside in 1984, and has completed more than 1,900 hours of continuing education courses since receiving her master’s degree.

“We originally began providing work injury management services, which focused primarily on return-to-work situations,” Moore says. “To be effective, we needed to better understand the physical demands that were required of workers. We were allowed to evaluate the jobs for the major airlines and a beer distributor we were working with at the time.” Brookside then expanded its expertise through additional training utilizing a comprehensive system developed by Susan Isernhagen, PT (DSI Work Solutions, Duluth, Minn).

Armed with additional knowledge and expertise, Moore spent more time working with employees to match their physical limitations to the demands of their jobs. “We began to see real value in observing the various job functions workers performed and could provide physicians and employers more job-specific recommendations to assist with return to work or injury prevention,” Moore says.


Eight years ago, Moore was approached about providing her expertise by the safety manager of Frito-Lay. “I was at the right place at the right time–and I had the right tools to help meet their needs,” Moore says. “It was very evident from my discussions with the safety coordinator that Frito-Lay had a strong safety culture. Their desire to be proactive in addressing musculoskeletal disorders came from the top down. Their top management actually wanted a physical or occupational therapist on-site for at least 4 hours per week.” Though this opportunity sounds ideal, Moore and her staff members also needed the right tools to meet Frito-Lay’s work injury management and prevention needs.

Once she became familiar with their processes, Moore helped identify opportunities for ergonomic improvements and issues related to improper body mechanics or work technique. Employees initially presented with concerns regarding an ache or pain. Typical encounters included an assessment of the workers’ complaints/concerns, instruction with use of heat and ice, stretching, strengthening, and body mechanics training related to the workers’ job functions. Moore also finds employees seeking her expertise for a second opinion regarding unresolved musculoskeletal issues. “Being on-site is really a huge asset,” she says. “I’m in a position to follow through on all aspects of care for the worker. I can talk directly with supervisors and the safety manager, which allows everyone to be on the same page.”

For related articles, read “Functional Capacity Testing” and “Water-Based Work Rehab” from previous issues.

Moore works closely with the safety coordinator to address injury management and prevention needs. Frito-Lay developed a process that helps workers phase into their jobs, whether they are new hires or injured and returning to work. Every work area has several trainers that implement this process. Proper body mechanics and ergonomic-related issues are addressed during this transition period. The trainers also help follow up with any employee who has seen Moore for aches and pains, to assure the workers are using proper work techniques.


The interaction on-site led to additional opportunities for Brookside in working with other employers, which has brought a steady stream of extra income for Brookside. Services are billed on an hourly rate directly to the employer–there are no insurance forms to complete or waiting for adjustors to approve services. “It’s really nice not to have the headaches associated with billing insurance companies,” says Moore. “The reimbursement is essentially 100% of what is billed to the employer based on an agreed hourly rate.”

While it may be difficult for an employer to identify one specific intervention that leads to a positive result–such as reduced injuries or costs–Moore has successfully maintained and cultivated the on-site relationship with Frito-Lay for 8 years, and quickly escalated from 4 to 10 hours of service weekly due to the success of the on-site program. This program, originally slated for production areas only, was expanded into the warehouse, sales, and delivery areas. Moore relishes on-site visits. “I feel part of the team at Frito-Lay and have enjoyed interacting with so many different workers,” she says.


Opportunities to work on-site with employers typically don’t just fall into your lap. As a therapist whose entire practice is based on-site, I find there are several factors that must come together to create a successful relationship with employers. It’s not enough to be a good therapist clinically. Success occurs when you understand the needs of each employer–and that these needs are not identical. Here are some tips to help you develop a successful on-site practice:

Develop expertise in the area of job analysis.
When performed properly, you will be able to develop functional-based job descriptions and job-related functional tests that are legally compliant with federal regulations. Moore discovered great success with DSI Work Solutions. That’s a great place to start when it comes to building expertise for work injury management and prevention services.

Get to know and understand the work injury management and prevention needs of employers.
MSDs are typically the most common and costly work-related injuries. Ask human resources, safety, and supervisory personnel what they perceive as the biggest barriers with injury management, and what factors may be contributing to MSDs. Be prepared to listen, rather than launching into a problem-solving mode.

Look for opportunities within your patient case load that may lead you toward going on-site.
You may be surprised by the positive responses you will get from employers. Observing your patient’s job tasks first hand will give you great insight in developing job-related goals for the injured worker, and an opportunity to address body mechanics or ergonomic-related issues. You will not get off the ground if you are not willing to go on-site.

A quotation from Albert Einstein applies perfectly to this scenario: “We simply cannot resolve problems today at the same level of thinking and reasoning that we created them.” Successful results occur when therapists expand their practice beyond the four walls of their clinic. Employers and their employees will only benefit from the expertise that physical and occupational therapists can offer. Seize the opportunities that await you.

Scott Ege, PT, MS, is president of Ege WorkSmart Solutions, PC, Rockton, Ill. He is a faculty member with DSI Work Solutions Inc, and author of Stretch It Out!©, a nationally recognized workplace stretching program designed for business and industry. For more information, visit www.egesolutions.com, or e-mail .