Musculoskeletal Injuries Cost Billions. Could Early Physical Therapy Help?
Musculoskeletal conditions — everything from a sprained ankle to a ligament tear — are a common and costly injury for workers’ compensation insurers.
Commonly caused by poor ergonomics, the CDC defines work-related musculoskeletal disorders as conditions in which:
- The work environment and performance of work contribute significantly to the condition; and/or
- The condition is made worse or persists longer due to work conditions.
It names carpal tunnel syndrome, back pain, back injuries and arthritis as specific examples, though by that definition, many more could be counted.
“Most of the musculoskeletal injuries that I see are not egregious safety issues,” said Dr. Douglas Lurie, orthopedic surgeon with Orthopaedic Associates of New Orleans. He also serves as National Medical Director for two URAC-certified companies, Nexus Medical Consulting and Propeer Resources.
“Most of them are not ergonomic problems; most of them are not heavy industry. The heavy industry seems to do an extremely good job of safety and prevention. Instead, most of them are what I would call flukes.”
Musculoskeletal injuries can be difficult to prevent and costly to treat, making them particularly burdensome for workers’ compensation insurers.
Luckily, a model of musculoskeletal health is emerging that could mitigate both the direct and indirect costs that stem from common musculoskeletal conditions.
Common and Costly
Musculoskeletal injuries are some of the most common injuries in the U.S.
In 2015, 124 million Americans over age 18 reported a musculoskeletal injury, making the ratio of these injuries 50.1 per 100 people, exceeding “the next two most common health conditions: circulatory conditions (such as heart disease, stroke, and hypertension) and respiratory conditions (such as emphysema and chronic asthma),” according to a National Health Interview Survey Questionnaire.
In addition to being common, they’re also costly. These types of injuries have cost an estimated $332 billion between 2012 and 2014, according to the U.S. Bone and Joint Initiative’s “The Burden of Musculoskeletal Diseases in the U.S.”
When tallied, the direct costs of musculoskeletal injuries skyrocketed 131% in 2012-2014, versus the 1996-1998 study period. The indirect costs saw an even greater jump: 220% in the same comparison.
Lifestyle Factors Blurring the Line Between Work and Home
Lurie explained that “the common denominator that is hard to prepare for is the amount of degenerative change that that 50- to 65-year-old person has, and then that becomes a work injury that the employer owns.”
To avoid falling victim to that degenerative change, lifestyle factors are a key consideration to move toward a model of musculoskeletal health.
“The best things a person can do to reduce their risk is to exercise regularly, be aware of and try to have a healthy BMI, and also not smoking,” Lurie said.
“It’s not a cause of injury itself, but the response to interventions is considerably worsened when you have a patient who is a smoker. So any kind of surgery, the probability of a successful outcome essentially goes down. Weight control, exercise and abstaining from smoking are the big three.”
Indeed, the U.S. Bone and Joint Initiative’s study echoes Lurie’s observation, reporting that “between 1996 and 2014, the costs of musculoskeletal disorders represented increasing shares of GDP, from 3.44% of GDP in 1996 to 5.76% of GDP in 2014, exceeding defense spending for that year” and “a growing and aging population guarantees that these costs will increase, unless current trends are reversed.”
Tools of the Trade
We have the ability to reverse those trends now, and one of the key tools is physical therapy.
Shelby Mendez, DPT, PT, FAAOMPT, CSCS, director of therapy operations for Concentra, has perceived a rise in certain cases in recent years.
“We’re seeing a lot more injuries in the extremities. Anything from a rotator cuff tear in the shoulder to a simple ankle sprain. It could be an overuse injury in the shoulder causing a rotator cuff tear or a traumatic injury. There’s quite a range in type and severity,” she said.
Regardless of what caused the injury, Mendez believes that physical therapy should be function-based and early to get the most benefit for both claimants and payers.
“At Concentra, we’re very hands-on and functionally-based. Each treatment is catered toward the employee’s objective and functional impairments. We are always trying to train to their specific job duties so they can get back to work,” Mendez said.
“For example, if we have a ramp agent from an airline who lifts 50-plus pounds all day, then we want to train for that, or if they’re in the belly of the plane, maybe we need to train in a kneeling position,” Mendez explained.
Beyond the treatment specifics, though, is the need for early treatment and showing the employee they are cared for in the process.
“I would say that the more that you can do to be proactive on the preventative side, the better. From an employer standpoint, it may seem like a large cost upfront, but ultimately, it’s going to save you money on the backend,” Mendez said.
Additionally, Mendez believes that approving physical therapy early can have invisible benefits as well.
“With any employee, if you feel like you’re well taken care of, whether that be with benefits or an injury prevention program, that’s only going to benefit, from a psychosocial standpoint, the employee long term.”
Lurie agreed, noting that investing in prevention and early treatment relieves friction in the event of musculoskeletal injuries, which are often variable in terms of the length of the treatment plan.
“There’s both tangible and intangible benefits to early intervention of PT, yoga, etc.,” he said.
“The tangible benefit of function-based, exercise-based physical therapy is, of course, therapeutic. It helps to restore function but it also helps with symptoms. The intangible side of it is that the employer is showing they care about their employee, as opposed to the all-too-frequent denial of everything.”
Both Lurie and Mendez spoke about the need for more physical assessment on the prevention side of the ideal model of musculoskeletal health: conducting physicals to ensure that an employee can perform all of their job duties safely and implementing appropriate ergonomic interventions to avoid repetitive motion injuries and the like.
“Being proactive saves money,” Mendez said.
“Employers see a lot of success within Concentra. We have a number of on-sites across the country, with a 60 to 85% success rate of preventing injuries in a workers’ compensation setting. That just goes to show those companies that are investing in their employees will see a return on their investment.”
It’s hard to argue with that logic. &