Dan Reynolds, Editor-in-Chief at Risk & Insurance, recently sat down with Concentra’s Richard Amegadzie, MD, CPE, and Catharina Stander, PT, FAAOMPT, who delved into the complexities of soft tissue injuries and industries with workforces most prone to these injuries. The conversation also covered treatment options, preventive measures, and the benefits of early intervention.

What follows is a transcript of that conversation, edited for length and clarity.

Risk & Insurance: Thank you Dr. Amegadzie and Ms. Stander for your time today. If you don’t mind my starting with what might sound like a simple question: what is a soft tissue injury?

Richard Amegadzie: A soft tissue injury refers to damage to the body’s soft tissues, which include muscles, tendons, skin, fascia, nerves, and ligaments. These injuries can result from various causes, such as overuse, trauma, or sudden twisting motions.

Soft tissue injuries are distinct from injuries to harder structures like bones or joints. While they may not always be visible from the outside, they can still cause significant disability and functional deficit, and impact employees’ productivity at the workplace.

Proper diagnosis and treatment are crucial for soft tissue injuries to prevent long-term complications and ensure optimal, timely, functional recovery. Treatment often involves a combination of rest, ice, compression, elevation (RICE), and rehabilitation through physical therapy to restore strength and mobility.

R&I: Thanks for that. What industries tend to produce a higher frequency of soft tissue injuries?

Catharina Stander: Industries that involve manual labor — whether it’s repetitive or high-impact, such as lifting, pushing, and pulling — tend to have a higher frequency of soft tissue injuries. It’s challenging to group them, as they range from hard labor to sedentary jobs.

Construction, manufacturing, health care, sports, recreation, agriculture, and transportation are all industries that involve manual labor and movement. Even jobs that involve repetitive tasks like typing or using a keyboard can lead to soft tissue injuries.

So, we come across soft tissue injuries from a wide range of industries, from the extreme of hard labor to sedentary jobs.

R&I: Is the increasing use of smartphones and keyboards at work contributing to a higher frequency of soft tissue injuries, such as wrist pain from prolonged phone use?

Catharina Stander, PT, FAAOMPT, Concentra

CS: Yes, it falls into the category of repetitive strain injuries. Our generation is more sedentary, often sitting in front of televisions and not engaging in physical activities. As a result, we’re not prepared for physical exertion.

I often see patients with small hands using larger iPads that they cannot comfortably hold. Repetitively punching numbers and performing similar actions can definitely cause these types of injuries.

R&I: What are the key factors that contribute to workplace injuries, and how can they be mitigated?

RA: Workplace injuries are not necessarily caused by the movements themselves, but rather by the repetitive nature of those movements. The human body is designed to move in various ways, and a single instance of a particular movement is unlikely to cause injury.

However, the risk of injury increases when these movements are performed repetitively, especially if they are not executed with proper ergonomics. For example, watching content on a phone or TV will not cause harm if done with appropriate posture and for a reasonable duration. It’s the prolonged maintenance of inappropriate angles that leads to muscle strain or injury.

To mitigate these risks, employers must provide the right ergonomic setup, equipment, and training. For instance, if a 54-year-old worker is required to pull and lift objects above their height without a step ladder, they are more likely to sustain an injury. By offering the appropriate tools, education, and training, employers can enable their workforce to perform their duties without adverse impacts.

R&I: Simple strains can escalate into catastrophic claims in the area of soft tissue injuries; how can this be prevented?

RA: Catastrophic injuries or claims can be avoided or decreased with proper ergonomic evaluation, education, and teaching employees the correct way to approach tasks. Repetitive use injuries can lead to catastrophic outcomes if tasks are performed incorrectly, regardless of the job.

Richard Amegadzie, MD, CPE, Concentra

However, many factors beyond work, such as pregnancy, obesity, and diabetes, put individuals at higher risk for conditions like carpal tunnel syndrome. In the workplace, carpal tunnel syndrome more commonly stems from repetitive drilling rather than typing at a computer.

Athletic trainers play a key role in prevention by observing the workplace and identifying employees having difficulty or experiencing pain and discomfort. Intervening with corrective measures and first-aid measures before issues escalate. Early intervention is crucial.

CS: Untreated injuries, patient noncompliance, and delayed claim submission can lead to complications like frozen shoulder and complex regional pain syndrome (CRPS), which involves uncontrolled nerve pain. These conditions often result in higher claim costs, emphasizing the importance of prompt intervention.

R&I: How important is early intervention in workers’ compensation cases, and what role does the psychological aspect play in this context?

RA: Early intervention is indeed very important in workers’ compensation cases. We have the capability of providing telerehab, which means we can offer not only evaluation and treatment planning but also rehabilitation or telerehab through our telemedicine platform.

CS: We can combine different approaches to optimize care. For example, we might have the employee come into the clinic at least once so we can physically examine them and set up an exercise program. Then, we can follow up with telerehab sessions a couple of days a week.

This approach helps reduce the time that the employee is out of work or has to spend traveling excessively. The psychological aspect of early intervention is significant, as it provides the injured worker with a sense of being heard and cared for, which can positively impact their recovery and overall case outcome.

R&I: What overall impact does early intervention and quickly getting employees into physical therapy have on claims?

RA: Early intervention has various beneficial aspects. First, it addresses the psychological aspect by assuring the injured employee that their issue is being listened to and taken care of. This puts people in a positive mindset toward recovery.

Second, early intervention allows for the correction of incorrect movements and the prompt institution of treatments. These can include telemedicine, in-person visits, or home exercise programs. Engaging with the employee early is crucial.

More importantly, many injured employees or those experiencing symptoms don’t know what is happening to them. Early intervention provides clarity and reassurance that their condition is not severe and can be managed. This keeps them engaged while they continue working, setting them on the road to recovery.

R&I: How does early intervention in workers’ compensation cases impact the patient’s perception of their injury and recovery process?

CS: Early intervention is crucial in workers’ compensation cases. The sooner we can intervene and explain to the patient what happened to their body, why they are feeling pain, and how long it will take to recover, the less time they have to develop misconceptions about their injury and its impact on their life.

Without timely intervention, patients may turn to unreliable sources, which could lead them to believe they need surgery or that their injury is catastrophic. This can cause unnecessary anxiety and fear, such as worrying about losing their job.

By intervening early, we can put the patient at ease, help them understand their injury, and guide them through the recovery process. This approach minimizes the development of negative perceptions and facilitates a smoother recovery.

R&I: How does Concentra use benchmarking to help patients understand their recovery progress and prepare them for returning to work?

RA: At Concentra, we use a functional recovery approach. We can modify this approach as we observe a patient’s recovery progress. We compare their current range of motion to the normal range expected for their specific injury.

By their first, second, or third visit, we can determine if they have improved halfway. This allows us to provide encouraging feedback, letting them know they are 50% recovered with 50% to go. As patients reach 80% and 90% of their recovery goal, we prepare them to return to their regular duties.

Rather than suddenly informing patients they can return to work, we guide them through the entire treatment process. We provide feedback at 25%, 50%, and 75% recovery milestones. This approach not only aids in physical recovery but also mentally prepares patients to resume their regular work without fear or anxiety about reinjury.

For example, if a patient’s job requires lifting 50 to 70 pounds and they can currently lift 35 pounds, we let them know they are at the halfway point. This type of feedback is highly beneficial for patients both mentally and physically as they work toward returning to their pre-injury activities.

R&I: How do you handle a patient’s regression during the recovery process?

RA: If  a patient experiences regression during recovery, the clinician’s first step would be to conduct a thorough assessment to obtain objective findings. This would help determine if the patient was doing too much too quickly or performing activities incorrectly — both of which could be addressed through education.

It’s important to note that pain is often the last symptom to subside during recovery. If a patient experiences pain while regaining function, we assess their progress and encourage them to continue the process, reassuring them that the pain will eventually dissipate.

However, if a patient’s recovery plateaus or shows true regression after four to six weeks of therapy, it may indicate a more significant injury than initially realized. In such cases, advanced imaging like an MRI can help identify issues such as a significant tendon or ligament tear. This information guides the decision to refer the patient to a specialist for evaluation and potential surgical intervention.

Regression, while concerning, provides an opportunity to reevaluate the patient’s condition and ensure they receive the most appropriate treatment for their specific injury.

Soft tissue injuries are a serious concern in the workplace, affecting many workers across different industries. These injuries can lead to significant pain and reduced mobility, hindering productivity. Early intervention with the right treatment can improve recovery times, while effective prevention strategies such as ergonomic training can play a vital role in minimizing the risk of injury or reinjury.

Occupational health providers like Concentra offer comprehensive injury care services tailored to address work-related conditions such as soft tissue injuries. With expertise in treating occupational injuries and providing preventive health services, Concentra helps employers across various sectors create safer work environments, reduce downtime, and enhance operational efficiency. &

To learn more or partner with Concentra, please visit www.concentra.com.