A GOOGLE SEARCH STARTED HIS CAREER IN PHYSICAL THERAPY:  Josh was originally a scrawny kid who started lifting weights to bulk up. He competed in Power Lifting and wanted to make it a career. He had ambitions to be a Strength and Conditioning Coach, working with football players to make them bigger, faster, and stronger. While pursuing a degree in Exercise and Sport Science, he took a class that helped out kids with disabilities and assisted with their rehabilitation. One of the main goals of this class was to work with the kids and show them the joy of physical activities. He felt that he had found his true calling after that class, obtained his Masters in Exercise Therapy, and got accepted into the beginning Ph.D. program for Special Education. While he loved the idea of obtaining his PhD in Special Education, the joy of it was fizzled by the possibility of going broke. One night, he did a Google Search for “How do I get into helping kids with disabilities and make money?” The answer provided by the search was Physical Therapy, and he applied that night for his Doctorate in Physical Therapy. He was accepted into the program, and a career path came to life. He became a Physical Therapist fourteen years ago and is now the Director of National Worker’s Compensation Sales and Account Management with Brooks Rehabilitation.

WHAT IS THE ROLE OF PHYSICAL THERAPY IN RECOVERY? Physical therapy is usually a main component of recovery, regardless of whether an injury requires surgery. It is very appropriate for a multitude of injuries. When someone has suffered a neurologic or orthopedic injury, the injured worker needs rehabilitation to get their balance and weight-bearing right. There are injuries where people are bedridden for weeks or months, and they are not going to get up and be able to get out the door. It is a step-by-step process, and the goal is to get them back to their lives safely.

 IT IS IMPORTANT TO COMMUNICATE AND MANAGE EXPECTATIONS:  Josh is very upfront and honest with injured workers about the process. He will tell them things they may not want to hear, such as there is going to be pain. He is not here to reinjure them, but to progress, they will have to push themselves, which will not be pleasant. If they do not move the injured body part, the pain will get worse over time. He is also very honest about the timeline for recovery. There isn’t a quick fix. The recovery could take months, depending on the injury and the current condition of the injured worker. Sometimes injured workers will expect to be done with therapy in two weeks, but that is unrealistic. For example, if a professional athlete takes a whole season to recover from an injury, a person who never exercises will take longer. He makes sure that he communicates this to the employers as well. Sometimes employers are frustrated because their employee is undergoing physical therapy for a couple of weeks and isn’t back at full capacity. He explains that it is a process, and if it isn’t done correctly, there is a risk of reinjury and other issues. He feels it is better to be upfront right away about the process. While injured workers and employers may initially be disappointed at the initial consult, it would be worse to inflate their expectations and then have them upset later on when they are not recovering quickly and without pain.

IF YOU WANT A GREAT RECOVERY, YOU MUST ALSO BE AN ACTIVE PARTICIPANT IN YOUR HOME EXERCISE PROGRAM:  In the early stages of physical therapy, the patient should do range of motion exercises with a skilled therapist to ensure safety. Once they are past that stage and they are independent, the injured worker needs to do their home exercises. Sometimes, injured workers will note they are not getting better, but the physical therapist notes they are not completing their home exercises, so they will not progress. Even if you spend one hour a day at the physical therapy clinic and then spend twenty-three hours doing everything you are not supposed to, the bad hours will trump the good hour.

WHAT IS A FUNCTIONAL CAPACITY EVALUATION (FCE), AND WHEN SHOULD IT BE USED? There are times when an injured worker has had months of therapy and is not making progress. A Functional Capacity Evaluation is a detailed, objective physical test, to determine an injured worker’s maximum safe physical abilities. The test takes about four to five hours. Writing the report can take about three to four hours. Sometimes the test can take longer, depending on the injured worker and the complexity of the injury. The exam starts the second he first sees the injured worker, whether they are in the parking lot or the waiting room. The exam ends the second the injured worker gets in their vehicle after the exam. A Functional Capacity Exam (FCE) will be referred to determine where the injured worker is as far as functioning. This test can also determine any inconsistencies in their pain complaints. For example, if someone only has 28 degrees of flexion during the test but can pick up a bag at ninety degrees of flexion in the waiting room, he will note the inconsistency. He is not a psychologist; he cannot diagnose malingering and only report the inconsistency. He cannot diagnose a SLAP tear that hasn’t healed properly. He can only note the physical abilities. The provider and the adjuster need to review the report and determine if further studies or specialties should be referred to uncover why progress hasn’t been made.

WHEN SHOULD AN INJURED WORKER HAVE BALANCE TESTING? If an injured worker has been referred for an FCE, but the reports indicate issues with balance, the FCE should not be performed until balance testing has been completed. It is crucial to uncover the underlying cause of the balance issues to ensure the safety of the injured worker. A machine that can measure consistency is called the Neuro Combine Balance Master. This machine has moving platforms (force plates) that are harnessed in so they will not fall during the test. The force plates move underneath the patient as it gets tougher, and the whole platform moves around as the test progresses. Balance is measured in three ways: eyes, inner ears, and feet. The test should be done within thirty minutes. The FCE can be scheduled and completed if a balance issue has been ruled out.

NOT ALL FCE EVALUATORS ARE THE SAME: It is important to know how long the evaluator has been conducting FCEs. He recommends an evaluator that is very experienced and has had a lot of training. He said it is crucial to have a “thinking evaluator” who doesn’t solely rely on the data but also thinks everything through. There are several things to consider when conducting an FCE, so the experience is key when it comes to complicated, nuanced claims.

THE GREATEST PART OF HIS JOB:  There are injured workers that were admitted to Brooks Rehabilitation Hospital that had a bleak prognosis. It was unknown if they were going to live. It is the greatest feeling when an injured worker has a catastrophic injury and several months later is thriving and needs an FCE. Seeing people make an epic comeback is why he gets up in the morning. For more information on Brooks Rehabilitation, go to www.brooksrehab.org.