Workers’ Compensation System Dilemmas: The Two Silos of Understanding Injury Recovery and Human Performance
In the workers’ compensation system, treatment decisions are made by medical specialists and a person’s capacity to return to work is guided by a performance test called the Functional Capacity Evaluation. A worker experiencing intolerance for work, determined to be compensable within the workers’ compensation system, can often be tripped up by an assessment gap between medical care and functional performance.
In contrast, professional athletes and human performance enthusiasts focus their injury recovery on the quality of movement AND the foundation of performance. This assessment gap, between medical care and human performance, is addressed by movement specialists for sport and human performance enthusiasts. Once the elite athlete is cleared of any serious medical problems, it is the movement specialist who bridges this assessment gap and guides the restoration of the foundation for peak performance. Surgery and strong pain medications are a last resort for individuals focused on sustained recovery and peak performance.
We believe there is a need to go beyond medical care and take a critical look at function performance within the body. The absence of pain is not an indication of movement system competency and preparedness to jump back into work or training. Movement experts have seen that re-injury is common when rebalancing of the movement system is overlooked. Furthermore, successful athletes do not train when pain exists because motor control is disturbed in unpredictable ways by pain.
Because the principles used by the best movement specialists are grounded in human development, they are applicable to world-class athletes and active grandmothers alike. The specifics are much different based on the performers needs, but basic tissue mobility and basic motor control stability requirements still apply.
In the workers’ compensation system this assessment gap is camouflaged and therefore more hazardous. When an injured worker with persistent pain is determined by a medical specialist to have reached their maximal benefit from physical therapy and medical care, they are referred for a Functional Capacity Evaluation (FCE). The FCE is thought to be the best tool to use to resolve a complex case and get the worker back on the job. The shortcoming of a traditional FCE is that it usually does not bridge the assessment gap between medical care and human performance. The certification program, for training those who perform FCEs, is typically a two-day course with no requirements for a basic knowledge of modern pain science or a modern understanding of the movement system functional patterns used by movement experts.
The Caruso Method FCE is a comprehensive FCE that includes a movement system analysis that bridges the assessment gap and identifies the deficits in an individual’s foundation of performance. Corrective exercises are designed and described both for the benefit of the worker and communicated for the case manager with clear movement quality goals. This approach often benefits the worker by providing new, safe options for recovery and long-term self-care not previously available to them. This approach can benefit the payer with foresight to appreciate the benefits of a sustainable recovery and less dependency on the healthcare system over the long-term.