Workers' Compensation

Work Hardening Bridges Gap Between Unable & Able To Work

Injured employees who are off work for a significant amount of time are often out of physical shape and are not physically ready to return to work when they have reached their maximum medical improvement. Work hardening, which is performed by physical therapists, is designed to assist the injured employee to regain the capability of performing the tasks of his/her prior job. A work hardening program, when needed, will be requested by the medical provider who has been providing the employee’s medical care.

Work Hardening Program Provides Physical, Functional, Behavior, & Vocational Assistance

A properly designed work hardening program will provide the injured employee with physical, functional, behavioral and vocational assistance. Work hardening is an intensive program with defined goals designed to assist the injured employee to return to work performing the tasks of his/her regular job. Work hardening will also teach an employee proper ergonomics and train the employee to work safely and to prevent re-injury.

The physical therapist administering the work hardening program will provide both actual work and simulated work activities to improve the employee’s ability to perform the work tasks of the employer. While not absolutely essential, it is very beneficial for the therapist to have a detailed job description from the employer that outlines the physical movement requirements, especially the amount of lifting the employee does on the job, along with the weight of objects that will be lifted, carried, moved, etc.

When the medical provider requests work hardening, the physical therapist office will arrange an initial evaluation meeting with the employee. The initial evaluation will include both an in-depth interview with the employee and a review of the treatment records from the medical provider. Often, the employee who needs work hardening has been through prior physical therapy sessions. The previous physical therapy records are included in the work hardening evaluation.

Comprehensive Evaluation Includes Testing & Work Simulation

The comprehensive evaluation will include a physical examination, cardiovascular testing, posture and dexterity testing, and work simulation. During the initial evaluation the therapist will have the employee go through an extensive set of movements including standing, sitting, squatting, kneeling, bending and twisting to measure the employee’s biomechanical and neuromuscular capability. This creates a baseline for measurement of improvement over the work hardening course.

Skilled therapists often include physical movement tests that appear to be different to the employee, but in actuality are repetitive. By measuring the employee’s physical capabilities with duplicate testing, the therapist is able to determine if the employee is being honest in his efforts to complete the work hardening program. When the employee provides less than an honest effort on the physical evaluation testing, the therapist obtains “false positives” and “false negatives” which reveals self-limiting actions of the employee. The therapist is able to identify when the employee is exaggerating an inability to perform a task or exaggerates a complaint of pain from doing a work task.

Based on the results of the initial evaluation and testing, and the employer’s detailed job description, a customized and detailed work hardening program / rehabilitation plan is developed for the employee. The work hardening program will have performance objectives for the employee including the ability to lift, carry, stand, sit, squat, kneel, twist and bend to meet the requirements of the employee’s job description. The work hardening program / rehabilitation plan will include a time frame for completion of the program, along with an estimated date the employee will be able to return to work. Properly administered, a work hardening program bridges the gap between the inability to return to work and the successful return to work.

Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact:

Editor Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. Contact:

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