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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.

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Article by Todd Receveur, BSc, Lead Work Hardening Coordinator

The vestibular system plays a critical role in maintaining the sense of balance and equilibrium. The structures within the inner ear are considered part of the peripheral vestibular system and are full of motion sensors that detect motion and send that information to the brain. The brain interprets the information and determines the position of the head in space. This blog will discuss two different pathologies that can occur in the inner ear that can cause significant dizziness and how Physical Therapists can be equipped to treat them. 

Benign Paroxysmal Positional Vertigo

BPPV is the most common disorder of the peripheral vestibular system. It happens when the otoconia, that are usually in the utricle, are forcefully displaced into one of the three semicircular canals confusing the motion sensors in the ear leading to extreme and sudden vertigo. BBPV often occurs after a traumatic event, but can also happen idiopathically or with specific head movements

“Every time I roll over in bed, I feel like the room immediately begins to spin”

*Note that these patients will use the term “spinning” or “spin” to describe their dizziness.

Can Physical Therapists Treat BPPV?

Yes! A Physical Therapist might ask a few questions and conduct a few tests to establish BPPV as a diagnosis. For treatment, the therapist will guide you through a series of positions to allow the displaced otoconia to return to their correct position within the inner ear. It is usually a relatively easy and quick fix if the positional maneuver is done correctly. Only two or three additional visits may be required to ensure that all otoconia are back where they belong.

Vestibular Hypofunction

Vestibular hypofunction encompasses peripheral vestibular disorders such as neuritis, and labyrinthitis and are usually caused by infections to the inner ear or traumatic events. In this case, dizziness is usually exacerbated with head movement. The main culprit is often a malfunctioning vestibulo-ocular reflex (VOR). The VOR is crucial in stabilizing the eyes while the head is moving, and can be problematic if it is impaired. If the eyes cannot keep up with the head as it moves, it can lead to significant dizziness, and can have a detrimental effect on daily activities such as driving, reading, crossing a busy street, etc. 

“I get off balance and very dizzy every time I turn to the left, so I avoid doing so” 

*Note these patients will not use the word “spinning” or “spin” to describe their dizziness. 

Can Physical Therapists Treat Vestibular Hypofunction Too?

For the most part, yes. For treatment, the therapist will walk the patient through a series of exercises aimed at stabilizing their gaze. The goal of the exercises is to essentially re-train the brain to not get dizzy with head movements. Treatment for a vestibular hypofunction is usually longer (6-12 weeks), as it takes time for the patient to progress from simple to more complex gaze stabilization exercises. 

Final Thoughts

Dizziness can be truly debilitating and affect virtually every facet of life. It is not well known, even to fellow health care providers, that physical therapy can effectively treat vestibular disorders, yet it is well within the Physical Therapy scope of practice.  

If you’re suffering from dizziness, contact REHAB AT WORK today to see if physical therapy and rehabilitation might be a good option for you!

Article by Rebecca White, PT, DPT

References: 

• Aguilera M, Campbell D, Gallegos D. Vestibular Rehab to the Rescue. Rehab Management: The Interdisciplinary Journal of Rehabilitation. 2020; 33(2): 18-21.
• Arnold SA, Stewart AM, Moor HM, Karl RC, Reneker JC. The Effectiveness of Vestibular Rehabilitation Interventions in Treating Unilateral Peripheral Vestibular Disorders: A Systematic Review. Physiotherapy Research International. 2017; 22(3) n/a-N PAG. doi: 10.1002/pri. 1635
• Farrell L. Peripheral Versus Central Disorders: Fact sheet. Vestibular Rehabilitation Special Interest Group of the Academy of Neurologic Physical Therapy. 
• Hall CD, Herdman SJ, Whitney SL, et al. Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Evidence-Based Clinical Practice Guideline: FROM THE AMERICAN PHYSICAL THERAPY ASSOCIATION NEUROLOGY SECTION. J Neurol Phys Ther. 2016;40(2):124-155. doi:10.1097/NPT.0000000000000120

The onset of fall brings with it many weekend warrior projects for a lot of us. Cleaning out flower beds, performing other landscaping projects or preparing lawns and trees for winter these are all things looming large on the “to do” list.  Additionally, we are looking ahead to what winter has in store for us in the way of snow!  We may be checking the Farmer’s Almanac to see how many substantial snowfalls our area might be likely to receive this winter season, making sure the snowblower has enough gasoline and putting those shovels and salt upfront in an easily accessible spot in the garage. One thing that should be on our minds is how to be proactive this fall to protect against injury.

Proactivity in the New Season

As we are moving into the seasons of being physical with shoveling, weeding, bending, squatting, lifting, pushing/pulling, and digging after a summer of relaxation can lead many weekend warriors to injury.   Lower back pain is very common after shoveling, mulching, repetitive bending while working in the garden, pushing and pulling a wheelbarrow, or shoveling snow.  Shoulder pain, knee pain, elbow pain, and neck pain are also very commonly reported by folks to their primary care doctors after their physical activities outweigh their level of physical FITNESS and/or preparedness. 

This year, vow to be different, be proactive……..look out for your safety and AVOID injury! The following link has some great information about how to safely perform some common fall and winter tasks.   Moving your body properly is one of the keys to avoiding strain to your muscles and joints and allowing you to have a stress-free fall and winter season.  Check out this article that explores how!

Rehab at Work Can Help You Be Proactive This Fall

If your goal to be proactive and avoid injury is unsuccessful, consider a personal consultation with a trained Physical Therapist at REHAB AT WORK. Our therapists will provide a customized approach to address the specific muscular, postural, or ergonomic concerns associated with your pain. REHAB AT WORK has 10 offices across the DC, Maryland, and Virginia areas. Contact us today for your consultation! 

Article by Nancy David, PT

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