The Value of an Activity Prescription for Work-related Musculoskeletal Disorders

“There are many benefits associated with return to work, with or without job modifications, 
while recovering from an injury as soon as it is medically safe to do so.” 

By Peter P. Greaney, M.D., WorkCare Founder and Chief Medical Officer 

I was once asked by an employer to explain to employees why the company had engaged WorkCare to provide Injury Care, our 24/7 telehealth triage program, for immediate management of musculoskeletal disorders (MSDs) and other work-related, non-emergency medical conditions.  

In a letter introducing WorkCare as its provider partner, this is what our client told their employees: 

“As you know, our goal is always prevention, but we want to be ready to respond quickly should any of our valued employees experience a non-emergency injury, illness, or physical discomfort on the job. We chose WorkCare based on its excellent reputation in the field of occupational medicine and focus on providing the right care, at the right time, in the right setting – not less care.” 

I added this explanation to the letter: 

“In the coming weeks, you will receive instructions about using the Injury Care program in collaboration with your supervisor. WorkCare’s team of occupational nurses and physicians are just a phone call away. The sooner you report an incident, the sooner they can evaluate your symptoms and provide care guidance based on best clinical practices and your situation. They will work with you to ensure you have informed choices about your care and that your personal health information is protected. 

“If you have experienced a work-related injury or illness, you may be wondering why WorkCare and your employer emphasize the importance of return to work. You may be in pain or worried about how long it will take to get better. You may need to modify your work and leisure-time activities for a while, but with sound medical guidance that may include an “activity prescription,” you will find work is therapeutic and a critical contributor to your recovery. Research and experience show there are many benefits associated with return to work, with or without job modifications, while recovering from an injury as soon as it is medically safe to do so. 

“We know that: 

• Working and staying active contributes to overall health and well-being. 
• Work during recovery provides a sense of purpose and social stimulation; not working can cause anxiety, depression, and feelings of isolation, putting you at risk for chronic disability.  
• The longer someone is off work, the greater the chance they will never return to work. This has significant impacts on personal lives, employers, the economy, and society as a whole. 
• Being at work helps sustain productivity and reduces the pressure an absence places on the organization, co-workers, and family members.  

“In the vast majority of cases involving musculoskeletal discomfort, staying home on the couch or in bed is not recommended. In fact, it can prolong the recovery process. When a doctor who is experienced at evaluating and treating musculoskeletal disorders (MSDs) and other work-related conditions clears you for return to work, he or she may recommend a return to full duty or temporary job modifications. With appropriate job placement, the likelihood of re-injury is minimized. The WorkCare staff is here to help support your recovery. We care about your ability to safely return to work and routine activities of daily life.” 

The Story of Raymond and the Activity Prescription  

I think of return to work during recovery as an “activity prescription” for employees with work-related MSDs. Sprains and strains due to overexertion, slips and falls, awkward postures, incorrect lifting or tool-handling techniques, task workarounds, fatigue, and other factors are common complaints. Which reminds me of Raymond, a construction worker who strained muscles in his lower back while installing a pipe. His injury was not serious, but it was painful and limited his range of motion.  

At the onset of his injury, Raymond had to decide whether to: 

• Tough it out, finish the shift, and not tell anyone to avoid potential repercussions.  
• Follow company protocol, report the injury to his supervisor, and receive care guidance. 

Depending on his decision, here are some possible scenarios: 

Go home: If Raymond goes home without reporting the injury, he may feel less anxious about his job security, but he will be at risk of continued discomfort, de-conditioning, work absence, and prolonged recovery. He may attempt to self-treat symptoms or contact his primary care physician (if he has one) – not an occupational health provider – for care instructions that might include a recommendation to take a few days off. 

Clinic visit: In this scenario, we assume there is not a provider at the worksite nor an established telehealth option. Raymond’s supervisor sends him to local urgent care clinic, where a provider performs a limited physical exam and orders some diagnostic tests to rule out underlying conditions that would warrant a specialist referral. The treating provider writes a prescription for medication to relieve pain and inflammation, tells Raymond to take the rest of the day off, and recommends task restrictions upon his return to work. The treatment encounter is OSHA-recordable and results in a workers’ compensation claim. 

Telehealth Triage: In this scenario there is not a clinician available at the construction site. Raymond reports his injury, and with his supervisor, calls an occupational telehealth triage center. The supervisor gives Raymond privacy while he briefly describes his medical history and symptoms to an occupational health nurse. The nurse assesses the injury and provides care guidance based on best-practice clinical protocols. As needed, Raymond may also speak with an occupational physician. He is given the option of: 

• Self-administered first aid at the worksite with occupational clinician guidance and follow-up. 
• A telehealth transfer to consult with an industrial injury prevention specialist, who may recommend methods to help alleviate discomfort, expedite recovery, and prevent another injury in the future. 
• Referral to a local occupational health clinic for further evaluation and potential treatment.  

After Raymond is given the information he needs about the nature of his injury and expected return to full function, he opts to remain on-site and try first-aid remedies. He applies a cold pack and takes an approved nonsteroidal anti-inflammatory pain medication at non-prescription strength. He is also given an activity prescription that he can follow at work and at home while he is healing. The next day he receives a follow-up call from a telehealth nurse to re-assess his symptoms and ensure that he can continue to safely perform essential job functions, with or without restrictions. There is no case to record and no workers’ compensation claim to be filed. 

In the first two scenarios – home or clinic visit – a routine complaint of low-back discomfort may result in high medical costs, productivity loss, and legal action. In the third scenario, Raymond feels comfortable about his prospects for full recovery because he has been educated about his injury, empowered to choose the type of care he needs, and with appropriate care guidance, able to successfully manage his condition without worrying about making it worse or loss of income. 

Why Does This Matter? 

It is estimated that nine in 10 adults experience back pain at some point in their lives. When it occurs, approximately 50 percent of cases have been found to resolve on their own within one week; up to 90 percent resolve within three to 12 weeks without treatment beyond first aid, studies show. 

While practicing occupational medicine for decades in all types of industries, I have observed that most work-related injuries – including aches and pains, minor cuts and burns, bites, rashes, and contusions – can be effectively managed on-site at the first-aid level. Telehealth is especially effective when care guidance is provided by occupational health professionals who are familiar with the workplace, what a particular job involves, and optimal ways to manage the types of injuries that occur on a daily basis.  

You may ask, if that’s the case,  why do non-emergency cases that can be managed with first aid at the workplace so often end up in a clinic, or even in a hospital emergency room? The answer depends on the existence of contributing factors, which may include: 

• Lack of accurate functional job descriptions  
• Not planning ahead for reasonable work restrictions 
• Entrenched local provider referral patterns 
• Supervisors’ inexperience with injury management 
• Workers’ fears of repercussions if they report an injury 
• Employee pain (secondary-gain) behaviors, like medicalizing non-medical issues 
• Employers’ legal liability and risk management concerns 

In combination, these factors contribute to rising costs for employers and poorer health outcomes for employees. From an epidemiological standpoint, and despite best efforts, none of the parties in the workers’ system have found a way to significantly reduce costs and disability associated with work-related MSDs and certain other workplace injuries.  

In the U.S., over-treatment by providers who are not trained in occupational medicine persists as a fundamental problem. In addition, while addiction risk awareness has increased and safeguards like prescription limits are in place, narcotic medications are still being subscribed for pain management. When legal opioids are cut off, substances like highly addictive synthetic fentanyl become a potentially lethal alternative. 

A clinically sound activity prescription with specific instructions for a worker to follow throughout their recovery process puts a positive empowerment spin on restrictions. This non-recordable solution helps lower workers’ compensation claim rates, improve health outcomes, promote productivity and morale, reduce lost time, and reign in medical and legal costs. It also encourages a leadership shift from reactivity to proactive injury prevention and management as an integral part of an organization’s overall business sustainability strategy. 

Guidance from organizations such as the National Institute for Occupational Safety and Health, the Job Accommodation Network (JAN), and the American College of Occupational and Environmental Medicine supports the proactive model. This includes early intervention, functional recovery, supervisor engagement, and coordinated return-to-work practices as key elements. It’s especially important to consider the value of personal empowerment in tandem with healthcare consumer education for employees when designing workplace injury prevention and management programs.  

The Cost of Preventable Injuries 

Workplace injury rates have declined in the U.S. in recent years, but there are still millions of workers who annually experience preventable injuries. According to the U.S. Bureau of Labor Statistics: 

• There were 2.5 million workplace injuries and illnesses in 2024, the most recent reporting year.  
• The incidence rate of total recordable cases in private industry was 2.3 cases per 100 full-time equivalent (FTE) workers.  
• On average, 1.5 cases per 100 FTEs resulted in days away from work, job restriction, or transfer (DART).  
• In the two-year 2023-24 reporting period, there were 1.8 million cases involving days away from work, with a median of eight days off, and 1.1 million cases involving a median of 15 days of job transfer or restriction. 

A significant percentage of work-related injuries are MSDs, which cost employers billions of dollars annually and create substantial disability burdens. In 2023-24, the highest number of reported DART cases (946,290) were caused by overexertion, repetitive motion, and bodily conditions, followed by contact incidents (860,050 cases).  

For the past 25 years, overexertion involving outside sources and falls on the same level have been leading causes of costly disabling injuries, according to the Liberty Mutual Workplace 

Safety Index, with direct annual costs to employers estimated at about $13.7 billion for overexertion and $10.5 billion for falls that cause sprains, strains, broken bones, and other injuries.  

Early Intervention Benefits 

Liberty Mutual also reports a notable 44 percent decline in the cost of microtask-related repetitive motion injuries in recent years due to a concerted, cross-disciplinary effort by employers, safety professionals, medical providers, ergonomists, and other stakeholders to prevent them. This suggests that adjustments in work practices can be made to protect workers while maintaining productivity and that non-punitive approaches to injury reporting are effective.  

Telehealth health encounters at injury onset have been shown to shorten recovery durations, prevent emergency department and clinic visits that are not clinically warranted, and streamline safe return to work without disrupting production. 

Among related findings, a review of 10 studies published in 2023 in the Journal of Medical Internet Research found that digital health interventions were cost-effective for employees with MSDs. In a journal article published in 2024, a systematic review of 35 studies found “telemedicine for musculoskeletal conditions can provide more accessible health care with noninferior results for various clinical outcomes in comparison with conventional care.” 

In the 1990s, a panel convened by the U.S. Agency for Health Care Policy and Research – now known as the Agency for Healthcare Research and Quality – found significant evidence that over-treatment in the acute phase of low back pain had the potential to increase “sickness behavior,” a mistaken assumption by a patient that their back pain episode will become a chronic disability.  

The tendency of an injured worker to anticipate a poor outcome occurs partly through muscle deconditioning due to excessive rest. There may also be instances of injury “labeling” and “attention” effects that can cause some people to overreact to their pain. Fear avoidance, described as efforts to avoid movement because it will provoke pain, has also been shown to result in disengagement from meaningful activities, a disability mindset, and depression. In these situations, the ability to provide reassurance for full recovery based on clinical findings and experience is particularly impactful.  

What Can Employers Do to Facilitate Return to Work? 

As our client told their employees, preventing injuries is the goal, but it’s also essential to be prepared to manage them when they occur. Injuries can be anticipated. However, they are also unexpected and can cause a cascade of ill effects when not handled well from the start. An occupational health provider knows how to navigate what may appear to be competing priorities – sensitivity to an injured employee’s physical, mental, social, and financial well-being and awareness of a company’s need to maintain operations. 

Based on clinical evidence and experience, employers who achieve measurable success with injury prevention and management programs understand that medically sound interventions empower employees to take care of themselves, and when the need arises, be referred to qualified providers so they can get the right care, at the right time, in the right setting and remain in the workforce. 

Here are some suggestions for return-to-work management: 

Start with prevention: Frontline supervisors, risk managers, and safety professionals who leverage collaboration with occupational health and ergonomics experts are better equipped to detect and manage conditions that increase workers’ injury risk. Such factors include poor physical fitness, obesity, aging, depression, fatigue, substance abuse, and chronic disease. The sooner these types of conditions are detected and managed, the greater the likelihood of positive results across the board. 

Examples of preventive interventions include: 

1. On-site coaching on the use of proper body mechanics, time-of-need training, and wellness programs based on population health risk assessments. On the non-occupational side, many group health and self-insurance plans offer incentives and disincentives to encourage or discourage certain health-related behaviors. 
2. Giving the workforce a voice in the selection of preferred providers. Depending on community and workplace culture, employees may express a preference for on-site services, remote telehealth access to clinicians, or use of alternative modalities such as chiropractic care, acupuncture, or non-invasive massage techniques. When surveyed, employees often express a need for stress management instruction, mental health and substance use counseling, and physical fitness, weight control, and smoking cessation programs. 

Proactively manage incidents: No matter how minor an injury may be from a medical perspective, it is not trivial to the person who is experiencing it. Employers who respond with empathy to an injured employee’s expressed needs help diffuse potentially litigious situations. It’s a best practice to approach every occupational health encounter as a chance for employee education and empowerment. This can be done in person or via a secure telehealth/telemedicine platform. In some cases, it may become apparent that an employee needs to be seen and physically touched by a caregiver to believe that they have received optimal care and fully recover  

Recommended intervention strategies may include: 

• Encouraging reporting at injury onset – the sooner the better 
• Providing immediate access to qualified medical professionals 
• Using “simple” guidance to discourage unnecessary complexity 
• Supporting self-care at the first-aid level, as clinically appropriate 
• Managing clinical referrals and monitoring health status during recovery 
• Creating pathways and job modification options for safe return to work 

Some Final Thoughts 

At WorkCare, we have found that by using an early intervention model, an employer can expect 50 to 70 percent of employees who report musculoskeletal discomfit at onset to elect to follow first-aid guidance when presented with options, and that are they able to stay at work. Of those who request an initial clinic evaluation or are referred to a local provider by a WorkCare clinician, nearly all are cleared for return to work, usually with temporary job modifications (an activity prescription) while they heal. 

I have found that these three interventions consistently decrease the duration of time lost per work-related injury by as much as 45 percent: 

1. Temporarily modified duties that match an individual’s clinically and functionally assessed physical capacity. 
2. Empathetic communication with the injured employee and a description of their anticipated recovery path that provides reassurance in lay terms and language they can understand. 
3. Non-adversarial handling of workers’ compensation claims. 

Of course, there are certain conditions, including severe intractable pain, that preclude some employees from working, even with accommodations. However, work absence is not medically necessary in the vast majority of cases. 

My experience as an occupational health physician and years of collected injury incident data show that most employees with relatively minor injuries are willing to try guided self-care when a trusted source educates them about the nature of their injury and anticipated path of recovery – before a workers’ compensation claim is filed. An optimal strategy for protecting a patient from harm caused by overtreatment, including the use of opioid medications for pain relief, help prevent the first prescription from ever being issued. 

Simple guidance from the outset of an injury reduces the likelihood of unnecessary complexity. Regardless of the path a work-related injury case may take, the outlook is always brighter when employees feel empowered.