Passive Therapy Addictions in Workers Comp…

Let’s face it we all need a little TLC sometimes. I mean it’s great to be ‘looked after’ and have some passive therapies and a “therapy session” about life and our daily woes at the same time. “That will be $60 thanks, oh, but you get a rebate through your private health….BARGAIN!” You feel better for the session….rinse and repeat!

That is until your money runs out and at that stage, if you need it you will pay out of pocket, if not you will likely begin the self-management process and move on with life. The therapist-client situation is vastly different in the workers compensation system.

In workers compensation passive therapies can become highly addictive and cause or continue an entrenchment process that is bad for the patient and very costly.

What do I mean by this? Recently Absolute Balance Exercise Physiology Group held a panel presentation whereby one panel member brought up this exact topic. The presenter was Mr David Colvin; Orthopaedic Surgeon at Western Orthopaedic Clinic. David explained that:

Frequent visits to the physiotherapist serve as a never-ending reminder of your medical condition and limits your ability to live a normal life while your treatment is progressing. This arrangement can lead to a dependency upon the therapist

Mr Colvin went on to say passive therapies are more addictive than crack cocaine. So it begs the question, why is there seemingly a dependency on the therapist with injuries in worker’s compensation compared with private clients who pay for it themselves?

The answer is multifaceted, the first issue is the industry. Most Physiotherapists are on a commission basis, they get paid per client so frequent visits serve them well financially regardless of whether the client needs the sessions in their clinical opinion. Now there are really great physios out there and like any industry some not so good ones. It becomes a tricky balancing act between earning a living and what’s best for the clients.

Another issue is the treatment itself. Often we ask clients what exactly the physio is doing treatment wise and we get answers like “manipulation, massage, tens machine etc”. In workers compensation, all providers must be following the clinical framework. Critical to this is empowering the injured worker to self-manage their injury. A never-ending procession of sessions will not assist in this both physically and psychologically.

Another element is to implement goals focused on optimising function, participation and return to work. In our experience, we have seen that the best therapists know when to positively influence the client to begin other modalities….enter exercise rehabilitation with Accredited Exercise Physiologists. When a client is engaged in exercise rehabilitation offsite they OWN their rehab rather than driving to said practice, getting therapy and driving away, only to do it all again next session with no end in sight. They are in control of their own destiny and often achieve a self-fulfilling prophecy that “I am getting better!” Exercise rehabilitation has so many positives and in my opinion, is underutilised or utilised too far down the track within workplace injuries. There is a natural crossover with exercise rehabilitation that (if done correctly) leads to better outcomes particularly when used early.

When clients are self-managing their injuries through exercise rehabilitation it then becomes behavioural which leads to another element of the clinical framework; adopt a biopsychosocial approach. It’s clear that exercise rehabilitation is good for them physically, socially and mentally.

Ryan O’Connor

Director – Accredited Exercise Physiologist (AEP) (ESSAM)