Physical Therapy Can Lead Innovation in Workers’ Compensation Medical Care 

The landscape of workers’ compensation has shifted significantly in recent years, impacted by technology, advances in medical treatments, and a better understanding of how different types of injuries affect employees. Many workers’ compensation cases now involve comorbid conditions, repetitive motion injuries, or musculoskeletal conditions, which may require long-term care and rehabilitation. As a result, the focus has changed from treating injuries to a more proactive, preventive, and holistic approach. Physical therapy has emerged as a key driver in innovation in workers’ compensation care, offering new approaches that can improve recovery outcomes, reduce costs, and enhance the overall health of employees. Think Triple Aim, everyone! Opportunities for innovation from physical therapy include: 

Injury prevention and wellness – Physical therapy has been a core component of treatment after an injury, but mounting evidence demands a shift in focus from injury treatment to prevention. A recent report indicates that a third of all workplace injuries occurred during the first year of employment.¹ A pre-employment evaluation by a physical therapist can identify potential red flags, reducing the likelihood that a new employee becomes your company’s next workers’ compensation claim. Physical therapists in the workplace can assess ergonomics, identify risks and hazards before they develop or progress, and provide training on lifting and movement mechanics. As movement experts, they can offer advice on-site before soreness or small strains/sprains become repetitive motion injuries. Musculoskeletal conditions are the leading driver of US healthcare spending and studies have shown that over half of US adults suffer from musculoskeletal conditions that can cause pain, impair function, and substantially decrease productivity at work.² As Desmond Tutu said, ‘We need to stop just pulling people out of the river. We need to go upstream and find out why they’re falling in.’ Investing in prevention, wellness, and education has the potential to decrease downstream costs. 

Early intervention – One of the keys to successful rehabilitation is early intervention. A recent study on work-related musculoskeletal disorders (WMSDs) found that initiating physical therapy (PT) early, particularly within the first two days post-injury, was associated with shorter case durations and fewer PT sessions in people with acute WMSDs.³  The longer an acute injury goes without treatment, the more likely it will result in lost work time, increased pain and stiffness, and delayed recovery. I recall a patient I saw who was admitted to the hospital through the emergency department (ED) with acute low back pain following a work site injury. The order set included physical therapy, a lumbar spine MRI scan, opioids, and other pain medications. After evaluating him, treatment included muscle energy techniques to address malalignment, patient education on lifting and movement, instruction in a home program, followed by a walk through the hallway with cues for postural mechanics. To his surprise, pain dramatically decreased, imaging studies were subsequently cancelled, and he discharged shortly after the PT session without opioids or pain medications. A costly and unnecessary hospital admission could have been avoided with physical therapy directly in the ED. 

Expanding primary care – The current shortage of primary care physicians in the US is projected to worsen, particularly in rural areas and for underserved populations. Physical therapists possess a high level of knowledge in managing musculoskeletal conditions, ranking second only to orthopedists,⁴ and as part of an integrated team approach, are well suited to serve in primary care settings. Physical therapists in primary care can allow for more timely patient access to care, reduced costs, and improved outcomes, especially for musculoskeletal injuries. Physical therapists can also address wellness, fitness, exercise prescription and healthy lifestyle, stress management, nutrition, and other risk factors for comorbid conditions. 

Telehealth and Remote Therapeutic Monitoring – Telehealth has exploded since the COVID-19 pandemic and physical therapy has benefitted from this technology offering. With telehealth, injured workers who may not have access to in-person PT services – whether due to geographical location, time constraints, or transportation issues – can receive treatment and guidance remotely. Remote therapeutic monitoring (RTM) is a technology which allows physical therapists to track and remotely monitor a patient’s health status, treatment progress, and adherence to a plan of care. With a home exercise program set up at the initial evaluation, patients can reach out between visits with questions, report progress, and receive support. Recovery can be accelerated using RTM, shortening modified duty or, in other cases, allow injured workers to remain on the job, avoiding temporary total disability costs.  

Cost effectiveness and reduced long-term expenses – Medical services represent over 60% of the total cost of all workers’ compensation costs⁵ and the average medical cost per claim has had a threefold increase in the past 20 years.⁶ Recent studies have shown that physical therapy as a first-line treatment can reduce the overall cost of care, reducing long-term opioid use and lower likelihood for advanced imaging.⁷ With physical therapy as first management, the expense of extended medical treatment, including surgeries, medications, and long-term disability benefits can be reduced. Improving recovery times and returning workers to their roles faster can decrease the likelihood for developing or exacerbating existing mental health conditions like depression and anxiety.   

Outcomes – Physical therapy assesses several functional metrics to advance outcomes-based care including patient goals of care, treatment goals emphasizing function which can directly correlate with physical readiness for return to work, and patient-reported functional outcome measures used throughout the episode of care. Tracking and sharing these and other outcomes with patients, providers, and payers offers transparency, an opportunity for shared decision-making, and process improvement. For a line of business that has traditionally paid for treatments and not results, enhanced data analytics is a welcome nudge in the right direction. 

Through injury prevention and wellness, early intervention, integration into the primary care team, and enhanced outcomes-based care, physical therapy can offer innovative approaches to improve recovery, reduce costs, and enhance the overall worker experience.  

Anne Stanco, PhD, PT, CHC is an experienced Physical Therapist and PhD-trained former academician and researcher with a comprehensive background across the healthcare ecosystem. With over 25 years of expertise in clinical practice, utilization management, Medicare fraud investigation, evidence-based medicine, and payment policy and regulations, Anne has a proven track record of driving innovation in healthcare.

Most recently, Anne led the development of a unique company claims management resource for a workers’ compensation insurance company. She is now seeking new opportunities to apply her diverse skill set and drive impactful change within the healthcare and workers’ compensation industries.

If you're interested in discussing potential collaborations or innovative approaches for physical therapy in workers' compensation, Anne can be reached at: annestanco@icloud.com or (402) 290-4014.

References

(1) Workers’ Compensation Research Institute. (2024, August). FlashReport.

(2) Kaiser Permanente. (n.d.). From conference calls to construction sites: How musculoskeletal conditions impact workforce health. Retrieved from https://business.kaiserpermanente.org/healthy-employees/care-conditions/musculoskeletal-conditions

(3) Morgan, M., Shinost, C., Mendez, S., Klose, J., Lee, G., Forte, R., Lane, T., & Klinker, M. (2025). The effect of early physical therapy intervention on case duration and physical therapy visits in acute work-related musculoskeletal injuries across body regions: A retrospective cohort study. JOSPT Open, Advance online publication. https://www.jospt.org/doi/pdf/10.2519/josptopen.2025.0135

(4) Childs, J. D., Whitman, J. M., Sizer, P. S., Pugia, M. L., Flynn, T. W., & Delitto, A. (2005). A description of physical therapists' knowledge in managing musculoskeletal conditions. BMC Musculoskeletal Disorders, 6(32). https://doi.org/10.1186/1471-2474-6-32

(5) NCCI Holdings. (2017, November 6). Medical cost trends: Then and now. WorkersCompensation.com.

(6) NCCI Holdings. (2018). 2019 state of the line guide. NCCI.com.

(7) Childs, J. D., Fritz, J. M., Wu, S. S., et al. (2015). Implications of early and guideline-adherent physical therapy for low back pain on utilization and costs. BMC Health Services Research, 15, 150. https://doi.org/10.1186/s12913-015-0830-3

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