This is the first in a series of monthly clinical blogs from IPRS Health, written by experienced IPRS Health clinicians. The aims of the blogs are to educate, interest, debunk myths and deliver evidenced-based information for both patients and clinicians alike.
All of us at IPRS Health are really excited about this opportunity; the capacity to share information on a wider scale is something that we can, and in many cases have, benefited from. The advent of Twitter and other social media platforms has provided new ways for patients, and particularly clinicians, to both share and obtain new information. I would encourage all clinicians to embrace this new era of knowledge sharing, for the benefit of our own clinical practice and therefore our patients.
For more information about the upcoming blog series, follow @IPRSHealth on Twitter to find full details about the blogs. We have already published some great infographs over the last couple of months, summarising key messages from the latest research in Occupational Health.
In short, if you want to know about Occupational Health & Physiotherapy, the Industrial Athlete Blog Series is where you want to be.
Let's start with a fact:
‘Musculoskeletal Disorders are the leading cause of absence in the working population, accounting for approximately 40% of lost work days’.
Let’s just think about that for a second – why this might be the case, as well as why it excites me personally to work in Occupational Health.
If we think about any working environment and how our bodies are placed under stress by the physical demands of our jobs, in almost all situations we can see how injuries might arise. Take the office worker for example, someone who sits in the same position for long periods of time, using repetitive movements of the arm and hand, with minimal movement of the spine in general, and often under mental stress from a boss or manager. It’s not hard to see why or how this person would be likely to develop a musculoskeletal problem. If we consider the opposite end of the scale, the manual worker who is very active, but often lifting heavy objects poorly, alongside repetitive bending and twisting. Again in this situation, it’s not hard to see how MSK issues arise. Now think about the professional athlete, training hard day in and day out, with likely stressful demands from his or her coach and team mates; bending, twisting, lifting, repetitive motion, over and ov…. Sounds familiar, doesn’t it? Not too dissimilar from our workers, albeit obviously at different levels of intensity.
The notion is that the stresses and strains of the general worker and the professional athlete have parallels; obviously the physical demands are different, but they are still physical demands none the less. I am not suggesting that Mike from your local industrial plant trains as hard as Usain Bolt, but could Usain Bolt lift, twist, sit or stand in the same position repetitively or continuously for 9 hours, without getting aches and pains? My guess would be no, but then again he is a 9-time Olympic Gold medal winner so who knows! Maybe that was a bad example.
My point is, we are all conditioned to our environments. Usain Bolt is perfectly conditioned to run the 100m, Mike is conditioned to work 10 hours a day. Both have tasks and demands, both mental and physical. However, when the demand of the task outweighs the capacity of the individual, whether this happens in sport or in work it can, and often does, result in injury. For Mike and Usain, not only does this have physical, mental and social implications, it also has a financial one and this is the basis for the term ‘The Industrial Athlete’ – different tasks, different demands, but comparable consequences of injury.
If we look at the injury rate of musculoskeletal injuries in Occupational Health it sits at around3-7% of the workforce, depending on the type of industry. Granted, this is lower than seen in most professional sports teams (most professional sports teams function with a 20-30% injury rate), but still, it’s not only bad for the individual, it’s also really bad for business! The median cost of sickness absence to employers nationwide last year was a staggering £11 billion, which just about rivals the transfer fee for Gareth Bale!
So, it’s clear that absence from work is not only bad for the individuals who are off, it’s also bad for business. Why then is being a Physiotherapist working in professional sport sometimes held in higher regard by our peers than being a Physiotherapist in Occupational Health? This is something I hear all the time from other physios, and a recent Twitter poll I set up was quite telling. A massive 72% of respondents stated that Sport was the desired career choice for them, followed by the NHS at 16%, Private Practice at 12%, and, as you have probably worked out from those figures, Occupational Health came in at a flat 0%. Another poll conducted also showed that the majority of people also thought that the most skilled, experienced physiotherapists work in professional sport when compared against the other above sectors. Yet Occupational Health is the fastest growing, most sought after sector of employment for physios. Why? For all the reasons I have discussed. Injury is bad for the individual; physically, socially, financially and mentally. Injury is bad for business; employees being absent from their jobs (whether it’s Mike or Jamie Vardy) results in the need for the employer to pay someone to cover that job (a striker on loan from Arsenal to cover Mr Vardy!). That’s without considering the reduction in productivity and performance for those workers who remain at work carrying an on-going injury.
Why would you be the Head Physiotherapist for Manchester United with 30 players to look after when you could be the Head Physio for a huge, world-renowned motor manufacturer, or an international oil company and have hundreds of ‘players’ to look after? Challenging, engaging, rewarding.
I think I forgot to mention that here at IPRS Health we also utilise some of the latest technology in our rehab, including isokinetic dynamometry and custom app-based rehab! Anyway, enough of the IPRS Health plug, back to the point.
In my opinion, having worked as a Physiotherapist in both the professional sport and Occupational Health arenas, the patients we see in Occupational Health are often more complicated and harder to treat. Let me give you an example of 2 patients: Patient One is a 25-year-old female, non-smoker, non-drinker with an ideal BMI, who sustained a grade II hamstring tear 1 week ago. She has no previous major injuries and is highly motivated to get back to work. Patient Two is a 55-year-old male with chronic lower back pain, who is adamant he needs a scan because he believes his spine is “unstable”. He is overweight, has a history of lower back pain for the last 20 years and shows signs of mild depression. He is not motivated in any way to do any exercise or to get back to work. Which one do you think is the more challenging patient? Who needs your expertise more – Patient One or Patient Two?
I am not saying that all cases are as easy or as difficult as these examples, but this is the reason I am relishing the move to Occupational Health. Patient One, although she may be a high level athlete and great to work with, is fairly straight forward in terms of her recovery, not presenting much of a challenge to your problem-solving or clinical reasoning skills. Patient Two on the other hand is a whole different ball game. He will challenge your clinical (and non-clinical) skills in every way possible, and as a result may make you a better clinician.
There are other parallels between elite sports physio and Occupational Health physio, and these are the speed of access and how easily we can influence a patient’s prognosis. As a clinician in Occupational Health, similar to what happens daily in elite sport, I will often be the first Health Professional to see an injured patient, and this offers a lot of advantages. It provides the opportunity (to some extent) to shape that person’s prognosis. We can start to influence the patient’s beliefs, to give him or her positive, clinically correct messages and help dispel any false beliefs that he or she may have about the injury. We can get the patient off to the best possible start and on the road to recovery quickly.
Take the example of our Patient Two again, and imagine having been able to see him from day one of his lower back pain issue. Rather than seeing him 6 months down the line, after referral to several different specialists, after he’s seen all manner of different healthcare professionals privately; you see him at day one – ground zero. We can dispel his negative views of exercise; we can advise him on correct daily modifications without complete rest and we can curb his dependence on passive treatments like manual therapy. We can advise on lifestyle choices such as nutrition, smoking and drinking. We can educate the patient immediately about coping strategies around pain, stress and depression. The ability to see him at this stage could be the difference between him becoming a persistent pain patient with co-morbidities, and a patient with acute lower back pain who learns how to self-manage and take ownership of his injury. It may sounds dramatic but this is the reality. It’s why, as a clinician in Elite sport, I rarely came across a persistent pain patient - we just didn’t let them get to that stage. There is no reason for someone who has access to Occupational Health Physiotherapy to be any different!
We can also draw parallels from sport in the way that people are managed. You could have a line manager pushing for an employee to return to work early and the employee could also be keen to return as soon as they could but, just as a sports physio would hold back his players from the coach and from themselves, it’s no different in the workplace situation. The physio has to be the voice of reason and not let the employee return to normal work activities until he is safe to do so. To conclude, I hope that you can see that the sectors in which we work may be quite different in lots of ways, but the skills we need in each are very similar. In every clinical situation we need excellence in our understanding of the evidence base, clinical skills that provide the best possible care, attention to detail, first-rate man management skills, an understanding of demands and the superb application of load management. You could superimpose those skills onto either Occupational Health or Elite Sport, or onto any other sector of physiotherapy for that matter.
You may wonder what relevance Occupational Health has to you, whether you work in sport, the NHS or private practice, so I urge you to ask yourself these questions:
In my opinion, for some reason, Occupational Health Physiotherapy doesn’t seem to have the same kudos within our great profession, nor the attraction to young up and coming clinicians as a viable career aspiration. You can have an enormous positive influence over someone’s life, of which work is a huge part (it just doesn’t tend to happen in front of 80,000 at Wembley)!
Perhaps this is because we need to raise the profile of Occupational Health physio as an exciting career opportunity. I hope that, with the IPRS Health blog series, we can achieve this, both in terms of showing the value of Occupational Health Physiotherapy in itself, and of how applying the thought processes of an Occupational Health Physiotherapist can improve your clinical practice, whatever your work sector.
Over the course of the next 12 months the IPRS Health clinical team are going to provide some of their insights into the common injuries we all treat as therapists, or even may have experienced as patients. Lower Back, Shoulder, Neck, Lateral Elbow, Knee and Persistent pain are but a few! We will have a look at the anatomy, pathophysiology, assessment and rehab of the areas and look at the up to date evidence around them. There will also be a patient version to go along with each blog, so the series will be an excellent resource for both patients and clinicians alike.
Thanks for taking the time to stop by and I hope your back again for more in the near future, whether you’re a patient or a clinician.
See you in January for the first instalment!
Ashley James BSc (Hons) MCSP MACPOHE - IPRS Health Clinical Lead of Occupational Health Services (North of England & Scotland)
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International variation in absence from work attributed to musculoskeletal illness: findings from the CUPID studyDavid Coggon et al. The Journal of Occupational Environmental Medicine 2013; 70:575–584