Rehab processes, especially in the world of Occupational Rehabilitation, almost always involve a multidisciplinary team. Physios, EPs, RCs, Chiro, Osteos, Rehab Providers and Psychologists, just to name a few.
Most of these disciplines are very clear in their delineation and their specialisation but possibly the most confusing part of a rehab process and one of the most common questions I’ve had from Claims Managers, be it in Worker’s Comp, Motor Accidents or Life Insurance, is “when should a claimant move from Physiotherapy into Exercise Physiology?”
Physios do an amazing job, they’re essential to the recovery process but they’re not the only part of the process.
Because there are some similarities and close crossover at the time of progression, it’s not uncommon to be confused.
So, let’s go through the ideal timeline and where both providers fit in.
What Would The Ideal Treatment Timeline Look Like?
In the world of occ rehab, acute lower back pain is one of the most common diagnoses that’s encountered so let’s start there. A research review, by Costa et al, 2012 found that most acute lower back pain is recovered by 12 weeks.
It’s a similar timeline for whiplash too, according to the WAD Guidelines issued by SIRA in 2014.
In fact, that’s the expected prognosis for most injuries and surgeries.
So, from this, by 12 weeks at the latest, patients should have at least started some reconditioning and functional training, preferably with the experts i.e. an Exercise Physiologist.
By 12 weeks, functional conditioning should have commenced. And by 24 weeks, the claimant would ideally be, self-managing.
So, Let’s Put The Timeline Into A Treatment Perspective
Physio: Weeks 0-12
Generally speaking, physiotherapists will diagnose and manage acute conditions through manual therapy (massage, manipulation, needling etc). The earlier they’re involved, the better.
As soon as possible, they should be providing injury specific exercises to improve mobility and minimise strength and function loss, increasing when appropriate.
Again, using the Whiplash guidelines as an example, they state that at the 6-week mark there should be evidence of improvement, at which stage passive treatment should decrease, with an increase in active treatment (exercise).
At the 6 week mark, if there is not 10% improvement in pain and function, it may be appropriate to consider a psychological review.
Throughout the process treatment should be monitored closely to ensure that benefit is being achieved and to assess the appropriateness of progression to an Exercise Physiologist.
Exercise Physiologists: 8-12+ weeks
Exercises Physiologists specialise in the management of chronic conditions (chronic refers to post 12 weeks), as well as injury and illness prevention.
In the return to work and life setting, their expertise is in increasing Functional Capacity.
A claimant should start with an Exercise Physiologist, approximately 12 weeks into rehab because, as previously mentioned, most of the healing and recovery has been achieved by now and they should be ready.
They may start earlier than 3 months depending on the severity of the injury and outcomes of treatment to date. Starting later than 3 months is fine, but results are always better the earlier the intervention starts. Even if the actual injured area isn’t ready for functional training, the client will experience great benefit having an active and empowering approach regarding ability.
When To Refer to EP
There are a few things you can consider other than just weeks. Weeks after all, aren’t that individualised. I’ll list the stages at which there are clear markers that your claimant should already be seeing an EP:
- It is 12, or more, weeks post injury
- They have reached 90% of functional range of motion – This basically means they can reach 90% of what they need to be able to do to function. For example, imagine you’re hanging the washing on the line, your hands aren’t directly above your head. To reach the line is functional motion, to go past is full range.
- Their strength on the affected side is 80% of the unaffected side
- To be able to return to their previous function, they need cardiovascular training or whole-body conditioning
- They are exhibiting mood symptoms (exercise is an essential part of mental health)(also consider psychology!)
Why Use An Exercise Physiologist For Exercise And Not A Physio?
Yes, physios do prescribe exercise. However, for most of them, their expertise is early rehab exercises, and specific to the joint affected.
Exercise Physiologists, on the other hand, have extensive training covering physiology, biomechanics, force production, exercise prescription, end-stage rehab and functional capacity.
Yes, some Physios can have great exercise prescribing skills, however, it’s not their main job. Whereas Exercise Physiologists, because their scope and role is in late-stage rehab, close to 100% of their on-the-job experience, for the last few or more years, is exercise prescription to optimise for whole-body functional improvements.
Exercise Physiologists have often had to have a bigger focus on goal setting, identifying and overcoming yellow flags and supporting behaviour change, as well as empowering the client and placing focus on ability as opposed to inability.
And to go a tad further and give our own guys a plug… Specialised Health’s Exercise Physiologists prioritise communication with detailed reports and regular email updates. Not to mention teleconferencing, is old school for us. Our nationwide company has been using it for weekly team meetings and in-services as well as telehealth for the last 8 years.
So yes, of course both disciplines have their rightful place. Are we biased and always want you to refer to an EP, of course, but we want you to do it at the right time, when it’s right for the claimant and right for their rehab process meaning the best outcome will be achieved 💪