It’s often said the best injury is the one that never happens. Many work-related musculoskeletal disorders (WRMSDs) begin as soreness.

With a culture of early reporting and intervention, often the soreness can be managed without it turning into an injury. This can be done effectively through a few visits of care following OSHA guidelines for first aid, root cause analysis of the soreness, and appropriate behavioral and occasionally administrative or engineering ergonomic controls.

The Select Medical WorkStrategies Program defines the assessment and triage of soreness along with interventions of root cause analysis, first aid, and behavioral, administrative, and engineering ergonomic controls as Early Symptom Intervention (ESI). The goal of ESI is to have a detailed plan to intervene early, keep soreness to a minimum and prevent the need for medical care beyond first aid. These steps prevent OSHA recordables, maximizing worker productivity and minimizing the effect of soreness on the workers life.

OSHA 29 CFR 1910.151 mandates that all employers have medical personnel available for advice and consultation on plant health. In the absence of an infirmary, clinic, or hospital in near proximity to the workplace used for the treatment of all injured employees, the employer needs to have personnel adequately trained to render first aid available to its workforce.[1] In addition to having personnel trained to provide urgent onsite first aid who can support employees in emergency situations during the interval it would take for emergency medicine personnel to arrive in response to a 911 call, it also makes sense to have plans for less emergent situations where an employee may report soreness.

OSHA provides an extensive definition of first aid.[2] Many OSHA defined first aid interventions[2] and periodic interpretations of the standards on first aid[3] are effective at minimizing soreness and preventing injuries requiring medical intervention or lost work time when appropriately applied. Just as important as the use of first aid techniques to prevent injury is the need to identify when medical care beyond first aid is needed so actual injuries are treated expediently and not allowed to worsen or for the employee to lose faith in the employer’s system and medical providers. Therefore assessment of soreness and triage to the most appropriate level of intervention should be conducted by individuals with an expertise in musculoskeletal health.

Although orthopedists have the highest level of knowledge about musculoskeletal injuries, they often are not readily available for triage and not well versed in regulations in the area of occupational health. Physical Therapists (PT) and Athletic Trainers (AT) also have a high degree of knowledge about musculoskeletal injuries[4] and there is a growing trend towards PTs and ATCs who are knowledgeable of employer needs and regulations governing occupational health. These professionals are also experts in the use of modalities available under the OSHA first aid guidelines including the use of stretching,[5] exercise,[6] thermal agents,[7] taping (including kinesiology taping),[2, 8] massage, and non-prescription medications for inflammation and pain.[2]

In addition to their knowledge in the evaluation and management of acute musculoskeletal soreness, PTs and ATs have significant training in anatomy, physiology, physics, kinesiology, and body mechanics. This knowledgebase provides an extensive background for root cause analysis and the development and implementation of solutions to control hazards associated with WRMSDs consistent with the recommendations of the National Institute of Occupational Safety and Health (NIOSH).[9]

Root cause analysis should include consideration of the individual worker and possible impairments in range of motion, strength, and work habits as well as ergonomic risk factors of postures, forces, repetitions and environmental factors such as cold and vibration. In addition to getting an individual the appropriate level of first aid or medical care needed, institution of changes to the employee workstation and work habits should be instituted as part of a comprehensive ESI program. Follow up with the employee should occur for additional first aid, to assure appropriate integration of ergonomic solutions and behavioral modification.

A comprehensive ESI program using PTs or ATs is frequently provided onsite through the dedication of one or more full-time employees. However, many employers don’t have the need or resources to provide this level of support. In such cases, employers are turning to part-time onsite contracts through a company who employees full-time ATs and PTs or arranging for triage and first aid to be conducted at a local physical therapy center equipped with the knowledge and ability to accommodate an employer’s need.

PTs and ATs who have an interest and training in occupational health have a unique skill set and are readily available to assist employers in reducing OSHA recordable injuries through the use of Early Symptom Intervention including triage, first aid, root cause analysis, implementation of ergonomic controls and behavioral management techniques.

References and Further Reading:

1. United States Dept of Labor Occupational Safety and Health Administration. Standard 29 CFR 1910.151 Accessed online: https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9806
2. OSHA 1904.7 (b)(5)(ii) What is “first aide”? Accessed online: Standard Interpretations
3. United States Dept of Labor Occupational Safety and Health Administration. Standards Interpretation. Accessed online: https://www.osha.gov/pls/oshaweb/owaquery.query_docs?src_doc_type=INTERPRETATIONS&src_anchor_name=1904.7(b)(5)(ii)&src_ex_doc_type=STANDARDS&src_unique_file=1904_0007 11/11/17.
4. Childs JD, Whitman JM, Sizer PS, Pugia ML, Flynn TW, Delitto A. A description of physical therapists’ knowledge in managing musculoskeletal conditions. BMC Musculoskelet Disord. 2005 Jun 17;6:32.
5. United States Dept of Labor Occupational Safety and Health Administration. Standards Interpretation. Accessed online: https://www.osha.gov/laws-regs/standardinterpretations/2015-07-06 11/11/17.
6. United States Dept of Labor Occupational Safety and Health Administration. Standards Interpretation. Accessed online: https://www.osha.gov/laws-regs/standardinterpretations/2015-07-06 11/11/17.
7. United States Dept of Labor Occupational Safety and Health Administration. Standards Interpretation. Accessed online: https://www.osha.gov/laws-regs/standardinterpretations/2015-07-06 11/11/17.
8. United States Dept of Labor Occupational Safety and Health Administration. Standards Interpretation. Accessed online: https://www.osha.gov/laws-regs/standardinterpretations/2015-07-06 11/11/17.
9. Cohen AL, Gjessing CC, Fine LJ, Bernard BP, McGlothlin JD. Lements of ergonomics programs. A primer based on workplace evaluations of musculoskeletal disorders. Accessed Online: https://www.cdc.gov/niosh/docs/97-117/pdfs/97-117.pdf 11/11/17.