I use this euphemism in occ health, parenting, and in managing the CompChoice clinics. It makes sense and it holds true-everytime.

On a daily basis those involved in workers compensation issues must determine if one and one are adding up to two when it comes to :

*Determining cause and effect-Does the mechanism of injury make sense?

*Employability-Can the injured employee still do the job?

*Diagnostic tests- When are they needed?

*Specialty consultation- When is it time to ask for help?

I would like to use this column to outline those cases where one and one were not adding up to two. The goal is to help all of us by sharing the process of resolving difficult cases. Help me out by sharing some of your difficult cases when things weren’t adding up. No names will ever be used, just the circumstances of the case. I want to hear about those cases when you knew you didn’t have the whole story- you know the ones I mean.

• The next CompChoice Breakfast Seminar will be on May 26th in our Council Bluffs Clinic. Watch for your invitation!

•The first meeting of Occupational Health Nurses held March 23rd was a great success. Our next meeting will be Wednesday, May 25th at 11:30. The location will again be the Omaha CompChoice located at 8630 F Street. We look forward to seeing everyone again and remember lunch is on us!

During a recent conversation with one of our customers, they expressed concerns about the frequency of injuries experienced by new employees. They had experienced several incidents during the preceding months that suggested new employees were not well suited to the physical demands of the positions they were being placed into. Further discussion identified that they currently did not have a process for matching new hires with the positions they were hiring into. Individuals were being placed into positions as they became available without assessment of their physical capabilities.

We discussed several possible solutions to this problem. In the end, the employer identified several areas that appeared to be higher risk for new employees developing complaints. They implemented a pre-placement screening process for each of these positions, to be performed in conjunction with their established process for substance abuse screening. The physical demands of each position were assessed. All applicants that were being considered for these positions were evaluated in comparison to the outlined physical demands. The screening process includes a history questionnaire, physical exam and job specific functional testing.

The outcome thus far has been very positive. The employer is still able to hire the individuals they need. Some of the applicants have been turned away based on inability to safely perform the essential functions of the job. Some applicants have been placed into positions that require lower physical demands depending on their qualifications. The employer has expressed greater confidence that they are placing new hires appropriately and the injury rates are down in these areas where they have implemented screening.

Post-offer pre-placement physical exams are an excellent tool for preventing injuries, reducing turnover and increasing productivity by matching the capabilities of workers to the physical demands of the job. Recent changes in Iowa Workers Compensation laws make these examinations even more important in Iowa now that employers are able to “start over” with a new employee even if they have a history of prior workers compensation injury and impairment.

If you have questions related to pre-placement screening or are in need of other solutions related to injuries at work, please contact Dan Atha, Marketing Director for CompChoice.

CompChoice physicians help each injured worker understand that physical rehabilitation is necessary for their recovery. Sometimes the patient believes they must rest and should not work until they are “100%”. We explain that rest is usually counterproductive to recovery. An analogy to how injured professional athletes quickly rehabilitate and recover is often helpful.

If an employee sustains a cumulative trauma disorder such as tendonitis, muscle strain, or carpal tunnel syndrome; the ultimate treatment for overuse injury is to reduce or eliminate the suspected offending task. If an employee’s tendonitis has been present just for a few weeks or a couple of months, they should respond very quickly to modified work. Subsequent reconditioning of the affected muscles and tendons will prevent relapse. While some doctors simply state “no repetitive work”, the doctors of CompChoice will explain how limited the repetition must be (e.g. less than twice per minute) and for how much of the shift (e.g. less than 30%).

Acute trauma such as slip and fall is initially treated by rest, elevation and ice for 24 hours. After swelling resolves, cautious and progressive rehabilitation is still the best way to recover. I try to explain to the patient that working the injured part is necessary, but it must also be protected from overuse or overstrain. Modification of normal work duties is an ideal form of rehabilitation.

It is often necessary to limit the amount of weight lifted by an employee with low back strain. It also important for the employer to understand that, while 20 lb may not seem very heavy, injured muscles will tire very quickly if the light weight is lifted several times per minute. Patients with true lumbar disk injury often have trouble tolerating long periods of either standing or sitting, and require frequent changes in position and work tasks.

Shoulder injury is a common complaint by patients seen at CompChoice. Because most shoulder tendonitis is caused by shoulder elevation and rotation, our typical restriction is to keep the patient’s work below chest high and within arm’s length.

Lastly, if you ever receive restrictions from a treating physician that are vague or seem inconsistent with the patient’s injury, the doctors at CompChoice are available to perform an independent review of the employee’s injury, treatment plan and identify appropriate work restrictions.