By Dave Sherman
via O2X
Key Points
- No gold standard exists for evaluating return-to-work readiness of firefighters after injury.
- Traditional criteria are mainly focused on time, wheras the ideal process incorporates injury impairments, functional capacity, mental health (i.e., psychological readiness), and gradual reintegration into the physical demands of the job.
- You are the key decision-maker when it comes to returning to work. Being an advocate for yourself with respect to physical and mental health can reduce frustration and prevent reinjury.
Fighting Back to Work after Injury
Orthopedic injuries can be a common occurrence for firefighters, as the physically demanding nature of their job can put a lot of strain on the body. These injuries can range from sprains and strains to more serious conditions like burns, broken bones, and torn ligaments. Furthermore, reinjury rates are reported between seven and 34%, suggesting that current processes for return to work are suboptimal. The consensus in the field is that determination of return-to-work readiness should incorporate physical assessments of muscular strength and aerobic fitness, as well as social support, psychological factors, and stress. If you’ve ever experienced injury, you understand the physical limitations and mental impact the pain and limitations can have. If not managed appropriately, even nagging, non-serious aches and pains can cascade into fear of movement, prolonged disability, and loss of work.
- Firefighter Injury Prevention: Adapting Your Fitness Program to Fit Their Needs
- Sprains, Strains, and Muscle Injuries
- So, Now You’re Injured
Effective return-to-work decision making can help optimize health and wellness, restore job performance, and reduce reinjury. Unfortunately, nearly half of firefighters report knowing a colleague who felt they had returned to work too soon after injury—suggesting that the return-to-work process after an orthopedic injury is often suboptimal.
The Many Factors Influencing Return to Work
After an injury that affects your ability to work in full capacity, you, your medical team, and your fire department are faced with a decision of when to return to work. This is a challenging process, as you must be able to perform physically demanding tasks in high-stakes environments while protecting your injury from further damage. In addition to physical demands, your recovery process is influenced by external pressures and obligations that may drive or hinder recovery. Regarding drivers of recovery, many firefighters cite a love of the job and a culture of pride and camaraderie that motivates them to return to work faster. This decision is equally driven by personal finances, dislike of light-duty work, and external pressures and obligations from the department.
On the other hand, factors that burden or slow return to work include anxiety and fear of reinjury, depression, stress related to finances, physical disabilities, or feeling detached from the watch. Difficulty overcoming physical deconditioning and injury-related impairments also commonly occur.
It is in this context that the determination of your return-to-work readiness is made. So how can we manage this complex system to improve your success?
Identifying and Partnering with Stakeholders
Remember that when a firefighter suffers an injury, the impact on a fire department can be significant. The effects on sick time, worker’s compensation costs, department overtime, and staffing levels can create significant hardship for a department. Some people view injuries as collateral damage and part of the profession, but this view contributes to psychological stress and undue pressure on individual firefighters to return to work. Medical providers such as physical therapists, athletic trainers, and physicians are also important decision makers in the return-to-work decision-making process.
Identifying these stakeholders and where injury fits into the broader system is helpful. However, the most important piece of the return work puzzle is you, the patient. The key is encouraging transparency through communication between all parties.
Barriers and How to Manage Them
In a recent study, firefighters identified four main barriers to recovery and return to work and strategies to manage them.
- Poor communication between different departments and caregivers contributing to uncertainty and inconsistency in the return-to-work process.
- Explain your work requirements to occupational health, physical therapists, and human resources. Advocate for your right to rebuild your fitness and job readiness and get them connected. This may require signing a waiver to allow them to communicate directly with one another.
- Physical therapy expectations falling short of work demands.
- Ensure a clear understanding of work duties and your goals. Talk to physical therapists about concerns, fears, and other mental barriers to return-to-work as well. Graded/gradual exposure and a fitness plan to work on outside of formal physical therapy visits.
- An inability to access facilities while off work (i.e. unable to use station gyms and loss of camaraderie)
- Assignment to light duties can seem boring compared to your typical responsibilities. Still, administrative work or equipment maintenance gets you back in the facilities and in the rhythm of working again. These duties are also more flexible and can accommodate setbacks in recovery or the need to take breaks.
- Lack of appropriately modified work, transition to full duty, and follow-up after return to work.
- Many departments still lack appropriately graded duties when progressing from light duty to full. This raises the stakes when it comes to the return-to-work readiness decision. Honest and open communication with all the stakeholders about the criteria below will reduce uncertainty here.
Return to Work Criteria
Understanding how medical providers determine your readiness for work can demystify the process. Here are the main criteria to prepare for:
Time: Many injuries or surgeries are associated with a normal “time frame” for recovery. If you’ve been injured, find out this information, but keep in mind that every recovery is different. It is never recommended to return to work based on the time from injury or surgery alone.
Patient-reported outcome measures: Your physical therapist and physician should ask you to complete health-related quality of life or impairment-based surveys. This gives them a standardized view of how the injury influences your life and function. Any return-to-work assessment should incorporate progress in your scores over time.
Clinical examination and functional assessments: An advanced clinical examination should incorporate muscle strength, range of motion, tests of function, assessment of movement quality, and endurance. Normal values exist for all these criteria. For example, tests of function and assessments of movement quality should reflect your work-related duties—e.g., hose running, hose carrying, ladder lifting, ladder climbing, and casualty evacuation. Aerobic fitness and muscular endurance should also be screened through running or biking standards or formal VO2 max assessments.
Psychological Factors: Most of the time, screening for psychological factors in recovery is done through standardized surveys about fear of reinjury, fear of movement, and health-related quality of life. If you are struggling with anxiety, depression, or other mental stressors surrounding the injury or return-to-work process, discuss this with your physician and physical therapist.
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Firefighters will face a unique set of factors when faced with returning to work after an injury. There is poor consistency of return-to-work procedures across departments, which contributes to uncertainty, stress, and unnecessary complexity. Advocate for yourself with open and transparent communication with all stakeholders from the days and weeks following injury through the months after return to work. Build a solid relationship with your physical therapists – they can provide a rehabilitation plan that fits your goals. This plan can be optimized if you share your recovery goals and describe the physical objectives and mental hurdles between you and your unrestricted return to work. Access to the fire station should also be prioritized to encourage social contact and allow physical training as part of your rehabilitation. Lastly, identify the tasks on your functional assessment early and incorporate them into your recovery—do not return to work without passing this test.
References
- Nosanov LB, Romanowski KS (2022). “Firefighter Postinjury Return to Work: A Balance of Dedication and Obligation.” Journal of Burn Care & Research. 41(5):935–944.
- Noll L, Mallows A, Moran J (2022). “Psychosocial barriers and facilitators for a successful return to work following injury within firefighters.” Int Arch Occup Environ Health. 95, 331–339.
- Schmitt B, Tim T, McHugh M (2012). “Hamstring injury rehabilitation and prevention of reinjury using lengthened state eccentric training: a new concept.” Int J Sports Phys Ther 7(3):333.
- Noll L, Mallows A, Moran J (2021). “Consensus on tasks to be included in a return to work assessment for a UK firefighter following an injury: an online Delphi study.” Int Arch Occup Environ Health. 21:1–1.
Dave Sherman is a licensed physical therapist and certified athletic trainer with a background in clinical science and research. He is a postdoctoral researcher in the Department of Physical Therapy at Boston University and the Harvard John A. Paulson School of Engineering and Applied Sciences, where his research focuses on investigating the root causes of chronic pain and motor impairments in orthopedic populations. His work develops and tests the efficacy of physical therapy treatments and rehabilitation technologies that restore neuromotor control and reduce the burden of disease through neuromodulation. Dave is also an expert in return to sport assessment and has piloted the application of interpersonal coordination as a marker for athlete readiness. His work has been funded by the National Athletic Trainers Association and the American College of Sports Medicine, and he has national speaking experience on topics such as motor control, motor learning, electroencephalography, and neuromodulation.
O2X Human Performance provides comprehensive, science-backed programs to hundreds of public safety departments, federal agencies, and the military. O2X works with clients to elevate culture, improve mental and physical wellbeing, support healthy lifestyles, and reduce healthcare costs associated with injuries and illnesses. Driven by results and cutting edge research, O2X programs are designed and delivered by a team of Special Operations veterans, high level athletes, and hundreds of leading experts in their respective fields of human performance.
