General Guideline Principles for Rehabilitation
for workers compensation patients

The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Rehabilitation.

These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders.

The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.

Rehabilitation of Therapeutic Procedures

Rehab (supervised formal therapy) needed after a work-related injury should be concentrated on regaining the functional ability needed to meet the patient’s daily and work obligations and enable them to return to work, with the goal of returning the injured worker to their pre-injury status to the extent that is practical.

Active therapy calls for the patient to put in an internal effort to finish a particular activity or assignment. The procedures known as passive therapy rely on modalities that are administered by a therapist rather than the patient exerting any effort on their side.

Passive therapies are typically seen as a way to speed up an active therapy programme and achieve concurrently objective functional gains. Over passive interventions, active initiatives should be prioritised.

To sustain improvement levels, the patient should be advised to continue both active and passive therapies at home as an extension of the therapeutic process.

To facilitate functional gains, assistive devices may be used as an adjuvant measure in the rehabilitation strategy.

1. Physical / Occupational TherapyPhysical / Occupational Therapy is recommended to enhance strength and range of motion while functioning.

   Frequency/Dose/Duration: The severity of the constraint often determines the frequency of visits. For the first two weeks of a fitness programme, two to three visits per week are typical. For mild individuals, the total number of visits could be as low as two to three, or as high as 12 to 15 if objective functional improvement was documented.

   Patients should be advised to continue both active and passive therapy at home as part of the rehabilitation plan in order to extend the healing process and sustain progress.

   Indications: all postoperative patients with low and middle back pain who were treated conservatively.

   Indications for Discontinuation: Pain, intolerance, lack of effectiveness, or noncompliance are all resolved.

    

2. Therapeutic ExerciseTherapeutic Exercise is recommended Exercises that fall under the category of therapeutic exercise include inertial, isotonic, isometric, and isokinetic forms of exercise.

   Indications: Enhanced cardiovascular fitness, decreased edema, higher bone density, improved muscle resilience, improved fascial strength and integrity, improved muscle recruitment, expanded range of motion, and encouragement of regular movement patterns are just a few. the use of movement therapy as a supplemental or alternative treatment.

   Frequency/Dose/Duration: Frequency: Typically, 3 to 5 times each week, with a maximum of 8 weeks as clinically necessary. Two to six treatments are required to generate an impact.

    

3. Aerobic Exercises

   Aerobic Exercises are recommended Despite the majority of the existing evidence comes from studies treating patients with chronic back pain, for the treatment of all patients with acute or non-acute back pain.

   However, it should be taken into account if an examination is necessary for those with major heart disease or high potential for cardiovascular illness before beginning intense activity. A organised, progressive walking regimen on level ground or a treadmill without an elevation is advised for the majority of patients.

   From a biomechanical perspective (lordosis), there has been some debate over whether cycling is beneficial or harmful. Since cycling involves less use of the back muscles, it may not be as suitable.

   However, if cycling is the patient’s preferred form of exercise, it is seen to be considerably preferable to doing no aerobic activity. There is no specific data for patients who want to do other aerobic activities, but there are signs that suggest a direct relationship between benefit and the quantity of aerobic activity that causes a greater MET expenditure.

   Given that compliance is a known issue, the activity that the patient will stick to is therefore thought to be the one that is most likely to be effective.

   Frequency/Duration: Walking at least four times per week at 60% of the anticipated maximum heart rate (220-age = maximum heart rate) is advised for people with non-acute back pain.

   One effective study used benchmarks of 20 minutes during the first week, 30 minutes during the second week, and 45 minutes after that. A graded walking programme is typically used for people with acute back pain, frequently using distance or time as minimal criteria.

   For instance, a patient could begin by exercising for 10 to 15 minutes twice day for a week, then gradually increase that amount by 10 to 15 minutes each week until they are exercising for at least 30 minutes each day.

   Discontinuation: When intolerance (a rare occurrence) or the emergence of other illnesses occurs, aerobic activity should be stopped. To prevent back discomfort (see below) and to maintain good health, almost all patients should be urged to continue aerobic exercise over the long term

   Aerobic Exercises are Recommended for the management of back pain in postoperative patients.

   Strengthening and Stabilization

   Strengthening and Stabilization Exercises are recommended Strengthening exercises are advised for the treatment of back pain in patients with acute or quasi-back pain, as well as post-operative back pain sufferers.

   Back discomfort can be prevented and treated, especially postoperatively, with specific strengthening activities, such as stability exercises. These exercises must be added when either aerobic activities have already been implemented and more treatment is required or in circumstances where both are thought to be necessary, as the evidence for the benefit of aerobic exercises is larger. In an exercise program, the patient should first be taught the exercises before performing them.

   Follow-up appointments to check technique and compliance (using exercise logbooks) are advised for individuals who do not improve.Frequency/Duration: For non-acute back pain, the frequency of the home programme is two to three times per day compared to one to two times per day for acute back pain.

   Discontinuation: Indications to stop strengthening activities include the occurrence of a strain during therapy or a lack of progress.

    

4. Strengthening and Stabilization Exercises

   Strengthening and Stabilization Exercises are not recommended- Back pain therapy or prevention does not include abdominal strengthening exercises in particular as either the sole or focal point of a strengthening programme.

   Strengthening of abdominal muscles (e.g., rectus abdominus and obliques Programs for treating or preventing back pain frequently aim to reduce discomfort (sometimes with sit-up exercises).

   These exercises have not been confirmed to be useful, there is evidence to suggest they are ineffective, and there are other treatment modalities with demonstrated or at the very least suggested higher efficacy.

    

5. Aquatic Therapy (Including Swimming)

   Aquatic Therapy (Including Swimming) is recommended For the non-acute treatment of back problems in a person who meets the requirements for a referral for a monitored exercise program and has co-morbidities (such as extreme obesity, important joint instability, etc.) that make effective engagement in a load physical activity impossible, a trial of hydrotherapy is advised.

   A walking program is not contraindicated in the case of knee osteoarthritis; in fact, high-quality research suggests that walking may be healthcare.

   Frequency/Duration: Typically, a program should start with three or four weekly visits. To warrant subsequent visits, the individual must have shown signs of rehabilitation within the initial two weeks. Aquatic treatment for a maximum of four weeks should be a part of the program.

   Discontinuation: Lack of tolerance, stagnation, or completion within a four- to six-week period.

    

6. Manipulation of Rehabilitation

   The therapeutic application of manually controlled forces by an operator to restore physiologic function and/or promote homeostasis that has been disrupted by the accident or occupational disease and has affiliated clinical importance is referred to as manipulative treatment (not therapy). joint instability, fractures, severe osteoarthritis, infection, metastatic malignancy, active inflammatory arthritis, and indicators of increasing neurologic impairments or myelopathy are all possible contraindications to manipulation.

   Stenosis, degenerative discs, and disc herniation are examples of relative contraindications.

    

7. Manipulation

   Manipulation is recommended to be connected to measurable improvements in the treatment of acute back pain and when there is no sign of a fracture or severe instability. Patients with established spinal stenosis require special attention.

   Frequency: Up to two treatments per week over the following four weeks with a reevaluation for signs of rehabilitation or the necessity for additional workup, depending on the severity of activation and the intended effect during the first four weeks.

   For all manipulative treatment modalities, the time to effect is one to six treatments.

   Treatment continuation will depend on functional progress. The ideal duration is eight to twelve weeks.

   Maximum Duration: thirty days. In situations of re-injury, disrupted continuity of care, worsening of symptoms, and in patients with comorbidities, extended care periods beyond what is deemed “maximum” may be required.

   Manipulation is recommended In some circumstances, following the assessment of MMI, a maintenance program of conventional medicine (by a doctor (MD/DO), chiropractor, or physiotherapist) may be appropriate when related to maintenance of clinical capacity. (See Therapy: Ongoing Maintenance Care, Section D.9.)

   Manipulation is not recommended, prophylactic treatment is effective, either for primary prevention (before the first episode of pain) or for secondary prevention (after recovery from an episode of back pain) and prophylactic treatment is not recommended.

    

8. Manipulation under Anesthesia (MUA) and Medication-Assisted Spinal Manipulation (MASM)

   Manipulation under Anesthesia (MUA) and Medication-Assisted Spinal Manipulation (MASM) are not recommended.

    

9. Massage (Manual or Mechanical)

   Soft tissue is moved during a massage (manual or mechanical), which has numerous benefits for circulation and relaxation. Acupressure, the use of suction cups, and techniques including pressing, lifting, rubbing, and pinching of fatty tissue by or with the practitioner’s hands are a few examples of what might be done.

   There are several indicators, such as edema (peripheral or hard and non-pliable edema, muscle need to boost the circulation of blood and range of motion or to relax and stretch muscles more before exercising.

   Massage must be combined with exercise and patient education, as is the case with all passive therapies. In order to continue treatment, an objective benefit (functional improvement along with symptom reduction) must be shown.

    

   1. Massage (Manual or Mechanical)

      Massage (Manual or Mechanical) is recommended as an addition to less effective treatments, typically a graded aerobic and strengthening exercise regimen, for specific use in non-acute back pain.

      Frequency: One to two times each week, starting immediately, for a maximum of six weeks.

      Discontinuation: Starting immediately, for a maximum of six weeks, one to two times per week.

       

   2. Massage (Manual or Mechanical)

      Massage (Manual or Mechanical) are recommended for both non-acute radicular syndromes and acute back pain, both of which have a significant back pain symptom component.

      Frequency: One to two times each week, starting immediately, for a maximum of six weeks.

      Discontinuation: Resolution, intolerance, lack of benefit.

      Massage (Manual or Mechanical) is recommended for people who do not have an underlying significant pathology, such as a fracture, tumour, or infection, and who only have non-acute back pain.

      Frequency: One to two times each week, starting immediately, for a maximum of six weeks.

      Discontinuation: Efficacy, tolerance, and lack of benefit.

      Massage (Manual or Mechanical) is not recommended the practise of giving massages using machinery.

      Mobilization (Joint) of Rehabilitation

      The process of mobilization involves oscillatory vibrations applied to the vertebral segment passively (s). The passive mobility maneuver is carried out in a graded way (I, II, III, IV, or V), indicating the speed and range of joint motion. It might involve expert manual stretching of joint tissues.

       

10. Mobilization (Joint)Mobilization (Joint) is recommended clinically appropriate in a subset of patients.

    Indications: Need to enhance joint play, align segments, enhance intracapsular kinematics, or lessen pain brought on by tissue impingement. Active therapy should be used in conjunction with mobilization. Joint instability, fractures, severe fracture, infection, colon cancers, active inflammatory arthritis, and symptoms of increasing neurologic deficits, myelopathy, vertebrobasilar inadequacy, or carotid artery disease are all contraindications to Level V mobilization.

    Stenosis, spinal arthritis, and disc herniation are examples of relative contraindications.

    Frequency: Typically, at least three times each week. It takes up to nine treatments to see results. The best time frame is four to six weeks.

     

11. Mobilization (Soft Tissue) of Rehabilitation

    The expert use of muscular energy, strain/counter strain, palm trigger point release, and some other manual therapy techniques is known as the mobilization of soft tissue. These techniques are intended to improve or restore patterns of movement by reducing pain and constraints in the soft tissues.

    These might be interactive in which the patient participates or passive in which the patient unwinds and allows the practitioner to manipulate the tissues of the body.

     

12. Mobilization (Soft Tissue) of Rehabilitation

    Mobilization (Soft Tissue) is recommended clinically appropriate in a subset of patients.

    Indications: Include neurological compression, trigger points, adhesions, and muscular spasm surrounding a joint. Active therapy should be used in conjunction with mobilisation.

    Frequency: Typically, it takes four to nine sessions and up to three each week to see results. optimum duration four to six weeks.

13. Superficial Heat and Cold of Rehabilitation

    Thermal agents, often referred to as superficial warmth and cold, are delivered in a variety of methods to lower or raise the body’s temperature in order to relieve pain, inflammation, and/or effusion brought on by an injury or brought on by activity. Heat is given to certain acupuncture points just above the skin’s surface.

     

14. Superficial Heat and Cold

    Superficial Heat and Cold is recommended To treat acute pain, edema, and hemorrhage, one must lower muscle spasms, encourage stretching, and raise the pain threshold. As an extension of therapy provided in a clinic setting, cold and hot packs can be applied at home.

    Frequency: Two to five times a week, effective immediately.

    Optimum Duration: 3 weeks as the main treatment period, or up to two months occasionally as an add-on to other therapy techniques.

     

15. Diathermy

    Diathermy is not recommended in the treatment of any diseases connected to back pain.

     

16. Low-Level Laser Therapy

    Low-Level Laser Therapy is not recommended for the treatment of any disorders linked to back pain.

     

17. Infrared Therapy

    Infrared Therapy is recommended clinically appropriate in a subset of patients.

    Note: It is advised to only utilise this intervention as a provider-based treatment and to pair it with an active exercise programme in situations where it is used to treat acute back pain.

     

18. Ultrasound

    Ultrasound is recommended in select patients

    Indication: A brief trial of ultrasound for the management of backaches is feasible in circumstances where deeper warming is desired, but only when done in conjunction with exercise.

    Frequency: Usually three times per week, it takes six to fifteen treatments to see results, and the best time frame is four to eight weeks. No more than eight weeks.

     

19. Reflexology

    Reflexology is not recommended for the treatment of acute or non-acute back pain, radicular back pain, or other spinal conditions.

     

20. Neuroflex Therapy

    Neuroflex Therapy is not recommended for the treatment of acute or non-acute back pain, radicular back pain or other spinal conditions.

     

21. Traction

    Traction is not recommended for treatment of acute or non-acute back pain or radicular pain syndromes.

     

22. Vertebral Axial Compression (VAX-D) and Other Decompressive Devices

    Vertebral Axial Compression (VAX-D) and Other Decompressive Devices is not recommended VAX-D or other spinal decompressive devices is not recommended for acute or non-acute back pain or radicular pain syndromes.

     

What our office can do if you have workers compensation Rehabilitation

We have the experience to help you with their workers compensation injuries. We understand what you are going through and will meet your medical needs and follow the guidelines set by the New York State Workers Compensation Board.

We understand the importance of your workers compensation cases. Let us help you navigate through the maze of dealing with the workers compensation insurance company and your employer.

We understand that this is a stressful time for you and your family. If you would like to schedule an appointment, please contact us so we will do everything we can to make it as easy on you as possible.