Keep Moving Forward at Your Own Pace

“I fell and landed on my shoulder,” a patient once told me. He expressed himself with a concerned look on his face. He was worried about his daughter’s birthday party. In two days, all of her friends would be over and he felt as though he was not contributing as much as he should have been in order to prepare for the event. He told me that for some reason his arm was not moving as it normally would. 

What Is Frozen Shoulder?

As this story is told, one may begin ask what could possibly be causing the gentleman’s problem. One answer is Adhesive Capsulitis, also known as Frozen Shoulder. Do you know someone who has received this diagnosis? If so, what you may not have known is that this diagnosis does not have a standard definition or classification. What it is does have are similar characteristics between the varying diagnosing parties. 

What are the Characteristics of Frozen Shoulder?

What is known for certain is that there is a progressive loss of range of motion and that the pathology progresses through different stages. Let’s begin with identifying the commonly accepted three phases of Frozen Shoulder: freezing, frozen, and thawing phase. Each of these has different pain levels associated with them. Each phase is also associated with a varying range of motion that may improve or worsen, depending on what phase the person is in. 

Photo via Mayo Clinic

In general, Frozen Shoulder can take around two years to resolve naturally. So, can you imagine presenting that news to the gentleman we were discussing before? 

Not being able to complete his normal life activities for two years would be hard to hear. The good news is that there are various interventions one can use to help manage the symptoms of Frozen Shoulder throughout the various phases. Two potential options are a passive range of motion of the glenohumeral joint (avoiding the painful range) and scapular mobilization, which are both examples of physical therapy interventions. Some physicians may choose to do a manipulation under anesthesia. 

Get Assistance with Frozen Shoulder

If you want to learn more about skilled interventions to treat Frozen Shoulder, we are here to serve you. We aim to provide evidence-based interventions and help you along your rehabilitative care. The team at Rehab At Work provides expert knowledge and patient-first care. If you’d like to schedule a consultation, contact us today.

Article by Dr. De La Cruz, DPT, PT, Lanham Clinic


What is Work Hardening and How is it Different from Physical Therapy?

What is Work Hardening?

Work Hardening is a specific therapy program for worker’s compensation clients who are injured and cannot work at full capacity. The program is designed to help injured workers get back to work by restoring their work-related function and tolerances. Those who qualify for a Work Hardening Program have an initial evaluation of tests to determine what needs to improve, and a specific treatment plan is created for the individual based on their current limitations. The Work Hardening client is supported by a therapy team that works together to plan weekly goals which help clients meet their job requirements and safely return to work. The ultimate goal is a return to their previous job or a similar occupation while decreasing time out of work.

Who Qualifies for Work Hardening?

If you’ve had an injury at work, you may be a candidate for a Work Hardening Program. Most clients have already shown improvement from Physical Therapy but need a more intensive or work-related program to get back on the job. A doctor may refer someone for Work Hardening when they are close to their return-to-work job requirements and have the potential to get better. The client also needs to be medically stable and willing to participate in the program. There are other services under the category of Industrial Rehabilitation that may be appropriate to help injured workers at other stages of recovery, such as: Occupational Therapy, Work Conditioning, and/or Worksite services.

Does Worker’s Compensation Cover Physical Therapy?

In most cases, yes, although there are reasons why Work Hardening may be more appropriate. Early treatment after an injury is very important for a full recovery. Physical Therapy is best following a recent injury or surgery when restoring function is not the main goal. In Physical Therapy, the primary objective is gradually improving strength and range of motion while managing the potential for complications that may affect recovery. Treatment in Physical Therapy is therapist-directed and injury-specific. Once a client has improved with a Physical Therapy program, a transition to Work Hardening with job-specific functional goals may be beneficial to progress into functional activities that are more similar to work. For those who need a combination of injury management and improving their work tolerance, a Work Conditioning Program may be indicated. If you are unsure which service is best, feel free to reach out to your health care provider for advice.

What Do You Do in a Work Hardening Program?

Every program is different, but it usually starts with 4-hour sessions 5 days per week Monday to Friday, and gradually increases to 8 hours per day. Clients are assigned an individual program of cardio and gym workouts, real or simulated work activities, and specific job tasks based on their job, injury, and work restrictions. Each Work Hardening participant initially receives extensive training and one on one instruction, but will eventually become more independent while practicing improved self-management. The main focus of each day is to educate the client on health, safety, and injury prevention while trying to improve the restrictions that are keeping them out of work, especially specific work tasks that are limited or restricted. The goal at the end of the program is to return to safe and productive work. A return to their pre-injury job position is the most desirable result, although some may need to find a different job or occupation if they are unable to meet their previous job requirements.

What Happens at the End of the Program?

When injured workers finish the program and are discharged, they return to their doctor for a final evaluation. If they were able to consistently perform their full duty job with no restrictions in the Work Hardening Program, the doctor can recommend a return to work. This may be the same job with the same employer, or a different job if their last job is no longer available. Clients will also receive a home exercise program with instructions on how to maintain their fitness and work readiness independently. For those who are still unable to return to work, their physician may provide other treatment options to help with recovery.

Where Can I Find More Information?

Your primary care physician knows you best and is always the first place to start for questions about your personal health, including return-to-work programs. Most clients that start a Work Hardening Program were referred by their doctor or surgeon. If you or your doctor have any questions regarding Work Hardening or other therapy services, please contact any one of our 10 REHAB AT WORK locations around the Washington DC area and ask to speak with a Work Hardening Program Coordinator.

Article by Todd Receveur, BSc, Lead Work Hardening Coordinator


12 At-Home Exercises to Improve Balance and Reduce the Risk of Falls

With the onset of middle age, many of us may start reducing the frequency of the activities that kept us challenged physically in our younger years. We no longer get onto or off of the floor or ground to play with our children, to play with our dogs, or to the garden.  As we downsize our living situations we are no longer carrying laundry baskets up and downstairs and we begin to pay to have someone else paint, hang drapes and wash our windows. As a result of this progression into a simpler and more leisurely middle age, we will rarely have the need or opportunity to get on/off of the floor, reach or work overhead, carry moderate weights up and down stairs or walk on challenging unlevel terrain. Unfortunately, we lose what we don’t use!

Without regular challenges to our balance, over time we run the risk of losing the ability to maintain our balance when it matters most.   Falls increase as we age for that exact reason and falls can result in hip fractures, concussions, or worse. Falls are the number one cause of injuries and death from injuries among older Americans. In fact, according to a report from the Centers for Disease Control and Prevention, an older adult falls every single second of each day in the United States. Nearly any activity that keeps you on your feet and moving, such as walking, can help you to maintain a good balance. But specific exercises designed to enhance your balance are beneficial to include in your daily routine as they can help improve your stability.   Below is a list of 12 exercises that you can do at home to improve your balance and reduce the risk of injury due to falls. Also included are several exercises that will help improve your leg strength so that if you do find yourself on the ground you will be able to get yourself back up again!  If you have severe balance problems or symptoms of dizziness or vertigo, you should be evaluated by a physician or physical therapist before attempting to engage in balance exercises. Dizziness is not the same as balance. Dizziness is a sense of spinning or disequilibrium that can cause balance deficits but it needs to be fully evaluated as to its cause prior to engaging in any type of balance retraining.  

1). SINGLE LEG STANDING ON LEVEL SURFACE (Goal is 30 continuous seconds)


To challenge yourself when performing your single-leg standing reach out with one leg either forward or out to the side. Repeat 10 times. As an alternative, swing your leg back and forth quickly either front to back or side to side


To challenge yourself when performing your single-leg standing reach up over the head with either arm. Repeat 10 times. Move slowly or quickly to vary the challenge.

Once you can safely manage 30 continuous seconds on a level surface, challenge yourself by attempting an unlevel surface such as a pillow. Work up to 30 continuous seconds of single-leg standing.

Stand with one foot in front of the other as above. Maintain your balance for 30 seconds then switch, placing the other foot in front, and repeat.

To challenge yourself, toss a ball with a family member or friend (or against the wall to yourself!) while attempting to maintain your balance for 30 seconds. Switch and place the other foot in front and repeat

Perform this activity in a safe location (the corner of a room, next to the kitchen counter). Begin with feet comfortably apart and close your eyes. Maintain your balance. When you can safely manage 30 continuous seconds progress yourself by moving your feet closer together and then, eventually, to standing on a pillow/uneven surface.


Perform this activity in the kitchen with your hand lightly touching or hovering above the counter in case you lose your balance. Walk heel to toe forward. Walking the length of the counter and then walk heel to toe backward. Repeat several times.

To increase your leg strength for getting up off of the floor, practice standing up from a chair without using your arms to assist you. If this proves too difficult at first, place a pillow or two in the chair when you first get started and then remove the pillows as you get stronger.

Perform this activity against a sturdy wall. With your feet away from the wall, slide your back down the wall to end up in what appears to be a sitting position. Hold this position for 3-5 seconds and then push with your legs to slide yourself back up the wall to a standing position.


Wall Sits Start Position
Wall Sits End Position
    (start position)                        (end position)

Article by Nancy David, PT, Frederick Clinic Manager