By Brian Peers, DPT, MBA, Vice President Clinical Services and Provider Management, MedRisk
The third most expensive lost-time claims in workers’ compensation, averaging just over $60,000 each, are those involving the neck, according to the National Council on Compensation Insurance (NCCI)
The causes are many and varied. Because the neck supports the weight of the head, it is particularly vulnerable to injury.
Whiplash from rear-end auto collisions that jerk the head back and forth, straining the soft tissues of the neck and falls are common reasons. Hours hunched over a computer or smartphone can lead to muscle strain and neck pain.
Even something as seemingly unrelated as gritting teeth can cause neck pain and restrict motion. In fact, other body parts are often involved when a claim includes a diagnostic code for a neck injury. All these triggers can have a more significant impact as people age since neck joints wear down over time.
A physical exam is used to assess neck function, that is, a patient’s ability to move their head forward, backward, and side-to-side, as well as symptoms of tenderness, numbness, and muscle weakness. In some cases, imaging tests such as CT scans, x-rays or MRIs may be ordered to determine the root cause of the pain.
Once a diagnosis is made, treatment is often put in the hands of a physical therapist (PT) or a chiropractor. Conservative therapy reduces the chance of opioid prescriptions. One study found that an initial consult with a non-pharmacological provider like these can decrease opioid exposure in the year following diagnosis.
In the early phase of treatment, heat, ice, and electrical stimulation may be applied along with traction, using weights and pulleys to stretch the neck and address nerve root irritation. Then PTs and chiropractors help injured workers manage neck pain and regain neck function by normalizing alignment, teaching exercises to correct muscle flexibility and strengthen deficits. Therapists also educate patients on proper posture and self-care. In some cases, treatment may go beyond conservative care measures to include injections of corticosteroids or numbing medications such as lidocaine to relieve neck pain.
Treatment challenges can occur above the neck. While some practitioners are locked into the biomechanical model, many are incorporating a biopsychosocial model. In addition to identifying psychosocial factors and noting these for adjusters to consider addressing, therapists should also educate patients about their injuries and encourage them to talk about concerns. Patients need to feel heard and assured their concerns will be taken into consideration in the treatment plan.
Fear of pain and re-injury is quite common. People tend to be more afraid of spine and neck injuries than, say, injuries of the wrist or knee. They can see their wrist, after all. There’s a perception that neck pain must be serious because the neck is part of the spine, and the spine is delicate.
Actually, the spine is one of the most protected parts of the entire body, shielded by thick ligaments and muscles. Educating the patient about this part of the body and the nature of their injury is the first step in deescalating the urge to catastrophize. Understanding how exercises work to improve the condition makes them seem more reasonable and less frightening. When patients can connect the biomechanical reasons to hold their posture a certain way, make ergonomic changes, and perform exercises correctly, they become more engaged in their own recovery.
The rise of telerehabilitation during the pandemic helped promote self-management strategies among injured workers. While in-person therapy is sometimes necessary and often preferred, delivering therapy virtually forced patients to help themselves. A PT could demonstrate an exercise, watch the patient perform it, correct, if necessary, but in the end, the patient had to do it on their own with the help of videos to remind them how.
Another phase of patient empowerment is working. Staying at work and returning to work are underappreciated and misunderstood by many clinicians. Returning to work is part of therapy. Avoiding activity can slow recovery. It sounds counterintuitive, but it’s true. Engaging with other people on the job, solving problems and moving around can facilitate healing.
It’s important to talk to injured workers about returning to work right from the beginning and tailor rehabilitation around the job’s physical demands. The likelihood of chronic pain following a neck injury depends on the nature of the injury, of course, but also on the expectations set around the long-term pain experience. Some employees fear returning to the place where they are injured. They may think they’ll hurt themselves again or the injury will become worse. It’s good for the therapist or someone else working the claim to talk with them about this. They might feel some pain when returning to the job and should be prepared with stretches, exercises, and ergonomic solutions to manage it.
The employer may need to provide light or modified duty or ergonomic changes to assist. Headphones, adjusting keyboards, computer screens and a yoga mat so they can lay down and stretch can make a huge difference in the return-to-work experience.
Early intervention, conservative care, patient education and a return-to-work mindset are the keys to neck injury recovery.
About Brian Peers
Brian Peers is a licensed physical therapist serving as MedRisk’s Vice President of Clinical Services and Provider Management. He is responsible for overseeing and ensuring the quality of MedRisk’s centralized telerehabilitation services, as well as MedRisk’s platinum grade clinical review and peer-to peer provider coaching program. He is board certified as an orthopedic clinical specialist and is recognized as an expert in rehabilitation of the injured worker. Prior to joining MedRisk, Dr. Peers was the owner and operator of an interdisciplinary rehab practice and has held faculty appointments at multiple physical therapy education programs. He has also served as an injury prevention consultant for multiple large corporations and the United States Department of Defense. He holds Bachelor of Science and Master of Physical Therapy degrees from St. Francis University in Loretto, Pennsylvania, an MBA from Louisiana State University in Baton Rouge, Louisiana and a Doctorate in Physical Therapy from the University of St. Augustine, in St. Augustine, Florida.
Based in King of Prussia, Pennsylvania, MedRisk is the largest managed care organization dedicated to the physical rehabilitation of injured workers. Its national network of more than 191,000 physical therapists, occupational therapists, chiropractors, and other specialists deliver in-clinic and on-site therapy along with telerehabilitation and functional capacity examinations. Clinically driven since its inception, the company has an International Scientific Advisory Board that developed and maintains physical medicine-specific, evidence-based guidelines for workers’ compensation. MedRisk, which has successfully completed SSAE 18 SOC Type 1 and 2 examinations, ensures high quality care and outstanding customer service. For more information, visit www.medrisknet.com or call 800-225-9675.
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This is NOT a paid placement.