A study by Burnett et al in the Journal of Bone and Joint Surgery (2006) documented an average time from injury to accurate diagnosis for hip pain due to labral tears as 21 months. People with this type of hip pain saw an average of 3.3 providers before definitive treatment was initiaited. In 17% of their study group of 66 patients, surgery was recommended on a different anatomic site. Once the correct diagnosis was made and the hip arthroscopy was performed, 89% of the patients were clinically better off than before surgery. That is positive.
Hip pain can originate from a number of structures and as a result can be easily misdiagnosed. Low back pain can refer pain to the hip area. Sacroiliac joint dysfunction can too. Hip pain can be due to bony problems such as impingement or due to damage to the cartilage structure around the socket, that is the labrum (similar to the shoulder – see an earlier post on this blog). It can originate from strain or tearing of the lignaments around the hip joint as well as from all the many muscles which control the hip joint. In addition, pain may originate from the pubic area where the abdominal muscles and the hip adductors attach, commonly called athletic pubalgia or a sports hernia. Finally, hip pain can be a consequence of referred pain from the leg.
Hip pain is typically localized to the groin area. It may also be felt laterally over the outside of the hip or in the buttock. There may be clicking, popping and snapping in the hip joint associated with the pain. Walking, running, ascending and descending stairs, putting shoes on (figure 4 sitting) and lying on the affected side may be challenging.
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Thank you for being part of Custom Physical Therapy. Here’s to your healthy hips!
The goal of a pre-offer or post-offer pre-employment screen (PWS) is to mitigate risk in an effort to minimize workers compensation claims. In high risk jobs, those which cost your business the most in workers compensation claims due to higher injury rates, there are essential and critical job functions which can be tested prior to placing an employee in a position which may result in an injury.
Matching the right worker to the job is not a new concept, but has grown with the advent of companies concerned with providing an “Industrial Athlete” approach to the workplace – essentially ensuring that their employees are “game ready” and able to meet all challenges ahead of them. So, how should you proceed?
The first thing to do is decide if the pre-offer or post-offer screen should be used. The pre-offer pre-employment screen identifies the applicants who are physically able to safely complete the essential job functions of the position for which they are applying. It also will give you a baseline assessment of their physical abilities. If they do sustain an injury at work, this is the baseline physical ability to which they will be rehabilitated too. A post-offer pre-employment screen performs the same function but you can include a medical examination too. The advantage of a post-offer over the pre-offer screen is that you can ascertain if the applicant you have offered the job to contingent on passing the PWS has any disability (e.g. are they under physical limitations by a physician due to a prior injury). The functional test has a significant advantage over just doing a medical screen, as an employee may not choose to report a pre-existing condition. The functional test will uncover and thus document this unreported inability to perform tasks if their pre-existing condition is deemed a hindrance to performing the job demands.
Now your company must identify the high risk jobs within your business. High risk jobs are those which are simply physically difficult to perform. They are not easily modifiable to the employee nor are they easily changed to improve safety. Hence, the employee must be fitted to the demands of the job. These jobs historically may include heavy lifting, highly repetitive functions or aerobic activities. Is there a manufacturing or laborer position which results in a larger proportion of your workers compensation costs? Do you have musculoskeletal injuries occurring in a particular type of worker in a production line? Is there a high turnover rate for a particular position at your business? Are there employees who are physically taxed during the work day (sweating, out of breath, unusually fatigued) and hence avoid doing the more challenging aspects of their job by giving it to the newer, younger employees? If you have a “Yes” to the above questions, your business should be performing pre/post-offer pre-employment screens on these specific high risk employees as part of the selection process.
The next step is to develop a well-constructed, objective, accurately measured job demands analysis (JDA) for each high risk job you identified. This entails evaluating the job to ascertain the essential and nonessential tasks and objectively quantifying them. This process involves close teamwork between the employer, the physical therapist performing the JDA and worker representatives. Teamwork such as this produces a JDA that accurately reflects the high risk job functions and will comply with the American with Disabilities Act and the U.S. Equal Employment Opportunity Commission laws. Not only is the JDA used for PWS design, it is also used in rehabilitating any injured workers. The JDA should be used by the physical therapist treating your injured worker to design the rehabilitation program based on essential job functions listed in the JDA. In addition, the physical therapist will be able to clearly ascertain if the employee is ready for a safe and most importantly a sustained return to work. This same JDA becomes the foundation for any Fit for Duty testing, Job Transfer or post injury evaluation job placement.
Utilizing the JDA, the PWS is then developed by the physical therapist. It tests the essential job functions prior to placing the employee in the high risk position. The final PWS will involve combinations of lifting, pushing, pulling, carrying, ladder climbing, overhead arm use, cranking, kneeling, crawling and any other essential job functions specific to the job in which the employee will be placed on passing the test. All tasks will have a critical cadence which must also be assessed to place these tasks in a physical demands category: sedentary, light, medium, heavy or very heavy. Job specific weights will thus be lifted to job specific heights at job specific critical cadences. Job specific weights will be pulled or pushed for job specific distances. It is important that all tasks tested in the PWS are absolutely specific to the job. All tests in the protocol have to have a solid foundation of evidence supported by peer-reviewed and published papers to validate a proper extrapolation to a full eight hour workday.
Is this a cost-effective program for your business?
Consider the following savings reported by companies who utilize this approach:
Considering the average cost of industrial injuries ($13 to $15 billion annually for musculoskeletal disorders), setting up a program to limit injury rates and hence workers compensation premiums is a good idea for any company which has high risk jobs.
By matching physically suitable employees to the appropriate high risk jobs you are mitigating risk, reducing lost time and thereby improving productivity and yielding a better bottom line through a healthier workforce.
André Meintjes, M.P.T., C.F.E.,Ph.D. is a physical therapist and owner of Custom Physical Therapy in Sparks and Reno, Nevada. Contact him at 775-331-1199 or firstname.lastname@example.org.