Resistance training, some of it job-specific, was successful in getting 90 percent of workers with severe rotator cuff injuries back to work, the majority (75 percent) at their previous job, after traditional physical therapy had failed to do so. Furthermore, all but one of the 42 employees in the study (98 percent) reported satisfaction with the resistance-training program and its outcome.
Dr. Jamie Stark described this and five related studies of workers suffering work-related rotator cuff and lumbar fusion injuries at Experimental Biology 2007, meeting in Washington, DC. His presentations, on April 29, are part of the scientific program of The American Physiological Society.
Participants in the rotator cuff study represent a class of "worse-case-scenarios" of work-related injuries. Rotator cuff injuries involve those muscles and tendons that stabilize the shoulder and can be caused by pulling the arm out of place, by falls and other accidents. All 42 of the employees had been through surgery to repair their torn muscles or ligaments. All had already gone through weeks of traditional rehabilitation and physical therapy. Even so, none had been judged capable of going back to work and thus were eligible for disability and workmen's compensation settlements.
This was just the patient population Dr. Stark, director of Research and Development at the Athletic and Therapeutic Institute in Chicago and his colleagues at the research division of the Institute wanted. Nothing had worked for these patients, and the researchers figured that what would work for them also would work for employees with less severe injuries.
The injured employees attended the Institute program four hours a day, five days a week, on average for six weeks. Their daily training began with warm up, stretching, and core exercises for balance and proper biomechanics, then moved to free weight resistance training of the upper and lower body. Unlike traditional physical therapy programs after injuries, this program was a modified version of what professional and collegiate athletes do using free weights. On the third day of the week, the exercises involved less weight than the previous two days but were much more dynamic, addressing specific injury and biomechanical patterns related to the workers' previous jobs. A drywaller, for example, would work muscles used in lifting large sheets of drywall overhead and in place. During the last two days of each week, the amount of weight used durinig free weight lifting was heavier than that of the first two days of the week.
At the end of the six weeks training, the workers were tested on physical function (a four hour protocol based on U.S. Department of Labor classifications of different types of work, re specific amounts of weight lifted for specific percentages of time). Ninety-six percent of patients met or exceeded the physical function levels of their previous job, and 90 percent went back to work, most at their previous job. Almost all employees were satisfied with the program, and so were employers.
Dr. Stark says "We are at a new era in which we can develop standardized exercise prescriptions that produce desired, achievable functional goals." He believes doing that will meet the goals of all key stakeholders. Patients want to regain full function as soon as possible and be satisfied with their physical and work outcomes. Employers want workers to come back to work as soon as possible, as fully as possible, at a cost that prevents escalation in insurance premiums.
And payors, whether insurance companies or self-insured employers, are interested in the cost benefit between getting a worker back to the job at a functioning level (costs of medical, physical therapy, and other rehabilitation programs such as those these workers went through) and a worker's not being able to go back to work at all or at his or her previous level (costs of long-term disability settlement, workman's compensation). "To date," says Dr. Stark, "this model of rehabilitation using intense free weight training has proved objective, measurable, and successful in patient satisfaction, return to work, and cost benefit."
The researchers now hope to test the model in a larger prospective trial of workers at varying levels of injury in order to demonstrate increased outcome efficacy with a standardized prescription and concurrently measure cost-benefit to the worker's compensation system.