Lessons from Sports Medicine on how to better prevent and manage workplace injuries.

Sports Medicine has made massive advancements in the past 15 years. Looking after an elite team requires the service of a multidisciplinary team to keep the athlete healthy, prevent injury, and identify problems early. Whilst elite team management is probably beyond the resources of most workplaces; many lessons can be gained from how teams are managed, with the potential to transfer strategies to the workplace.

Athletes and Industry Workers can be much alike:
While most workers would not consider themselves ‘athletes’ they can be put through arduous and repetitive load through their bodies.

• Physically demanding vocations (even office-based workers can put large amounts of repetitive load to the bodies).
• Prone to acute and overuse injuries
• Typically motivated to return early
• Removal from ‘on-field or on-tools’ role can be associated with psychological recriminations
• Receive ‘rewards’ from staying in the ‘on-field’ role- financial, wellbeing etc.

Sports Medicine ‘Team Model’

When an athlete becomes part of an elite team, a number of strategies are performed before their training even commences. Likewise, screening and regular assessments of a newly employed worker could help identify problems, and intervene before they develop injuries, or even better prevent injuries from occurring. Elite teams will use all of the following strategies which could be transferred to the workplace.

• Comprehensive baseline screening (musculoskeletal, medical, concussion etc.) on entry to elite programme- this identifies potential risk factors for illness or injury that can be modified.
• Regular (weekly) athlete assessment
• Screening helps identify issues early before they limit participation
• Modify training as appropriate to keep athletes on the field- ‘rehab group’ with clear guidelines to return to sport.
• In acute injury prompt assessment, investigation, and establish a diagnosis.

Sports Medicine Tools to Monitor Injury Risk

Some or all of the following tools used in elite team management could be used in the workplace, to identify signs of overload, or ‘burn-out’, and allow prompt management of workers at risk.

• Ratings or Perceived Exertion (RPE)
• Global Positioning System (GPS): an accurate measure of distance, change of direction load
• Wellbeing Monitoring: Self-reported data encompassing mood
• Injury Prevention System: Multiple data entry performed online and using a mathematical formula to give a risk score

Sports Medicine Industry Model

• Attempt to emulate elite sporting team approach
• Prevent injury and promote ‘wellness’ if possible
• Promotion of general fitness
• Specific preventative programmes in areas of high risk
• Diagnose injury as soon as possible
• Regular reporting of ‘pre-injuries
• Arrange assessment of any confirmed injuries ASAP
• Institute correct initial management (conservative versus surgical)
• Coordinate ongoing rehabilitation- ‘rehab group’
• Prescribe suitable duties and graded return to work plan
• Higher worker numbers, and diverse fitness group, many pre-existing injuries.

How can we prevent injury?

Prevention is better than cure.
Some ideas to keep your workers healthy and injury-free follow:

• Establish a healthy base and prescribe exercise:
• Regular exercise is known to independently be of benefit in the management of all chronic medical and musculoskeletal conditions
• Monitor worker health and wellbeing

Use of Sports Medicine tools such as RPE.

• Identify risk factors for injury and minimize their potential
• Intrinsic issues to identify and optimise treatment for:
  • General Health issues- obesity, smoking, sedentary lifestyle
  • Specific targets- core stability, rotator cuff tendinopathy
• Extrinsic issues
• Workplace Health and Safety
• Fatigue
• Ergonomics of office set-up

Difficulties of Preventative Programmes

Compliance- getting your workers to participate in ongoing preventative strategies can be difficult:

• Military overcome this by making PT compulsory and necessary for Promotion to higher positions
• In lieu of this some ‘reward’ system likely to be necessary
• Use of ‘aids’ (e.g. Pedometer, or group exercise) shown to increase compliance
• Need to individualize programmes to individual needs- costly and difficult to coordinate

Possible Preventative Programmes

Following are a number of simple strategies that be incorporated into the workplace to encourage injury prevention:

• General fitness and wellbeing programmes
• Aerobic fitness, Resistance training
• Target specific programmes
• Identify the five most common workplace injuries for specific roles
• Initiate specific interventions, e.g. core stability rehab for chronic back pain; proprioceptive drills to prevent ankle injuries; rotator cuff strengthening for overhead workers.

How do we optimize injury management?

• Once injury has occurred early reporting and triage is essential
• Establish a diagnosis- specialist referral when this in in doubt, or investigation needed.
• Establish appropriate treatment immediately, with regular checks of the progress of recovery
• Institute suitable duties appropriate for the injury.
• Check ‘minimum’, ‘optimum’ and ‘maximum’ times for return to full duties for each specific injury.
• Any worker falling outside expected timeframes have specialist review.

Multidisciplinary Team

Elite teams are privileged to have access to a number of medical and allied health specialists to coordinate management of injured athletes. This model could readily be applied to many workplaces.

• Sport and Exercise Medicine Physician
• A physiotherapist (hands-on treatment and regular review- develop regional providers as well as central specialists)
• Exercise Physiologist/Occupational Therapist/Registered Nurse
• Dietitian/Sports Psychologist /Podiatrist
• Appropriate Surgical Specialist when needed

Grief and Loss Resulting from Chronic InjuryIt is naïve to focus purely on the musculoskeletal side of injury in treatment and return to work. Incorporating psychological counselling can be of great benefit.

• Any chronic medical condition or injury typically has coinciding psychological manifestations
• Removal from an enjoyable and supportive ‘team’ role
• Possibly viewed as ‘malingerer’ by peers with subsequent isolation
• Severe injury can have far-reaching and life-changing consequences
• Essential to identify psychological issues early and institute coping strategies such a Cognitive Behavioural Therapy and/or Mindfulness treatment

In conclusion, there are many similarities between the elite athlete and the worker. Lessons can be gained from the Sports Medicine approach to athlete care, with the aim of identifying risk factors, monitoring for signs of ‘pre-injury’, preventing workplace injury, and managing issues early and appropriately so that the worker can return to work at the optimal time.