The Industrial Athlete

Phillip c. Zinni III

Industrial or occupational injuries are a staggering economic cost to employees and employers alike. In 2000 (the last year of complete data), there were 5.7 million Americans injured on the job according to the Occupational Safety and Health Administration (OSHA), resulting in 1.7 million lost-time injuries (1). This cost employers in the United States $56 billion dollars in direct medical costs and $45.9 billion dollars in indemnity costs (includes cash wage replacement payments) for a total of nearly $102 billion dollars. These figures come from the National Institute of Occupational Safety and Health (NIOSH) (2) and the National Academy of Social Insurance (NASI) (3). On average it costs employers $805 dollars for each injury. These injuries and illnesses cost the employees and employers slightly less to treat than the direct and indirect costs of all cancers ($107 billion dollars) or a little over one third of the costs attributable to heart disease and strokes (4) ($286 billion dollars). The average cost of health care per person in the United States is about $3,925 dollars per year.

However, about 70% of illnesses are preventable, and it stands to reason that a majority of occupational injuries are also preventable (5). Of these lost-time injuries, according to the Bureau of Labor and Statistics (BLS), 25% were back/lumbar sprains/strains; 10% were arm, wrist, and hand sprains/strains; 8% were knee sprains/strains; 6% were shoulder sprains/strains; 4% were ankle sprains/strains; 2% were cervical sprains/strains; and 2% were carpal tunnel syndrome.

A newer approach to industrial injuries is the sports medicine paradigm. In this concept, the industrial athlete is cared for using a team concept similar to the organization of collegiate and professional sports medicine establishments. Because industrial workers perform physical labor and skills for their income, their careers are not too dissimilar from the professional athlete, who performs physical labor and skills for money as well. This paradigm has been successful, and organizations such as The Industrial Athlete have developed on-site fitness programs and facilities at industrial settings to allow industrial athletes to train in-season. There are training rooms, on-site doctors and nurses, and even general manager types whose primary responsibility is to oversee the medical management of these industrial athletes.

JOB REQUIREMENTS

The tasks that industrial athletes perform include lifting, pushing, pulling, carrying, gripping, grasping, reaching, bending, stooping, and squatting in a time frame labeled as continuous, frequent, occasional, or seldom. The job task analysis, akin to a position description in sports, describes the essential functions required. The essential functions or tasks are those which the industrial athlete must perform in order to successfully complete the job, similar to the sports athlete who fulfills the designated position on the field of play in a sports arena.

An ergonomist, who may or may not have a physical therapy background or degree, usually performs the job task analysis. The ergonomist, akin to the football team equipment manager, is responsible for matching the player to the equipment. Similarly, the physical therapist, akin to the defensive coordinator and strength and conditioning coach, is
responsible for preventing injuries by showing players how to lift and how to maintain their strength, dexterity, and stamina.

With the job task analysis in mind, the staff physician can perform an examination on the industrial athlete tailored to the task that the individual must perform. In this perspective, the staff physician is a position coach. He or she can effectively place the industrial athlete in the correct and appropriate job task to maximize the individual’s natural talent and capabilities, and also match him or her to the essential job functions. One would not expect a wide receiver like Jerry Rice to be able to lift or push 300 pounds and play an interior lineman; the same rule applies to industrial athletes.

PREVENTION

The first moment of intervention is usually during the initial pre-employment physical examination. This is performed similar to an athletic pre-participation examination. Screening for functional axial spinal and appendicular range of motion, adequate ligamentous stability, and baseline grip strength is performed. The emphasis is on the cervical and lumbar spine, shoulder, wrist, hip, and knee range of motion. The industrial athlete screening is a quick examination.

As with most competitive athletes, the industrial athlete wants the best care so he or she can get back on the playing field. However, the workplace does not always foster a trusting relationship; the environment is often adversarial or even hostile. It falls to the physician to deftly handle these situations and act in the best interest of all parties involved.

This basic philosophy is anchored by an accurate diagnosis and grounded in appropriate treatment. The P-R-I-C-E-M-M-M-Well protocol is used to ensure that no matter who treats the industrial athlete’s injury in the clinic, the same thought process is used. The protocol ensures that each industrial athlete is evaluated for his or her need of appropriate Protection, Rest, Ice, Compression, Elevation, Manipulation, Medicine, Modalities (physical therapy), and Wellness. The protocol is discussed in detail throughout this chapter.

PROTECTION AND REST

If the industrial athlete is injured but capable of protecting himself or herself from further injury, then the person is asked to perform only those functions allowed by his or her capabilities. Work capacity is determined primarily by the person’s progress with progressive resistive exercises comfortably performed in physical therapy. The first evaluation bases the assessment of capabilities on the activities of daily living that the industrial athlete comfortably performs.

Additionally, conventional braces, gloves, splints, and wraps seen in the athletic training room or on the sidelines are also implemented in the industrial setting. These protective devices not only protect the industrial athlete from further injury but also allow the affected part to be supported and rested. Usually the industrial athlete can still use the body part to some degree. An example is the postoperative industrial athlete recovering from an ulnar nerve transposition procedure who can adequately protect himself or herself but is restricted to one-hand duty with the unaffected arm.

WELLNESS

The wellness component of the protocol is the summary of each industrial athlete’s visit to remind the clinician to engage the athlete and/or plan for the next visit. At this point in the visit, the clinician should review any contributory effects of body mechanics or workstation setup and inspect the workstation personally or have the company ergonomist do it. Additionally, the clinician or company physical therapist should review the industrial athlete’s biomechanics. Exacerbating factors such as deconditioning, poor fitness, obesity, and smoking should be addressed and treated. If the initial
visit is the pre-employment physical examination, then the clinician should plan a Prehab program, which is somewhat of a preseason conditioning program, jointly determined and administered by the physical therapist and physician. Additionally, the physical therapist can implement a back program to teach and promote proper lifting techniques.

The clinician should always teach and promote self-care as the greatest preventive tool. This reinforces the fundamentals of warm-up, stretching adequately and at appropriate times, icing if needed, aerobic and strength conditioning, and lifestyle with behavioral modifications when applicable.

TREATMENT PHASES

Most athletic injuries are treated through a series of phases to get the athlete back to preinjury status. This is a broad generalization that can apply to any musculoskeletal injury. For more precise prognostication, the Occupational Disability Guidelines (ODG) (5) or the Medical Disability Advisor (MDA) (6) can give the clinician an estimated time of return to work for any injury (International Classification of Diseases [ICD]-9/10 code) relative to Department of Labor classifications (7) of the type of work (sedentary/clerical to heavy manual) the industrial athlete is going back to perform. For example, an industrial athlete with a herniated disc, ICD-9 code 722.1, treated conservatively at first, would be expected to return to work within 3 days if the person had a clerical position or within 28 days if he or she performed manual labor.

Phase 1: Pain Control. This period lasts about 1 week for large muscle group injuries or injuries that involve weight bearing. These injuries commonly entail all aspects of the P-R-I-C-E-M-M-M-Well protocol with the most emphasis on the initial P-R-M-M-M portion. In shift workers, somnolent medications can be used to induce sleep, because the industrial athlete with a disrupted sleep-wake cycle is handicapped by difficulties in recovery. In addition, this aids in developing a positive attitude toward recovery, as it applies a multimodel holistic approach toward an injury. For small muscle group and non-weight-bearing injuries, phase I may run concurrently with phase II, again with emphasis on the initial P-R-I-C-E-M-M-M portion.

Phase 2: Stabilization. This period lasts about 2 to 4 weeks for large muscle group injuries or injuries that involve weight bearing. The industrial athlete at this stage of rehabilitation generally has full passive range of motion of the injured body part or limb, needs less medication, and can control symptoms more with self-care taught by the physical therapist or physician.

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