Real Truth Behind Sprains and Strains Fit for Duty

Date: 9-13-2021 • Runtime: 1:00:46

$42,000 – due immediately! Far-fetched or fact?

On average, medically-consulted injuries cost $42,000. Despite the expense, they keep happening. Are work environments really that dangerous or could the likeness of occurrence be related to new trends developing within our employee population?

Join us as Tom Gilliam, Ph.D., Founder and President of Industrial Physical Capability Services, Inc. discusses the Real Truth Behind Sprains/Strains. Are Employees Fit for Duty?

We’ll talk about:

  • What’s become the “new” back injury
  • Employer options to minimize injury probability
  • Best practices for effectively managing sprain/strain injuries
  • Post-injury recovery options to safely return to work
[00:00] – Holly Foxworth

Good afternoon. And thanks for joining us for the real truth behind sprains and strains are your employees actually fit for duty? So I don’t think that I’ve ever met a safety representative, an HR representative, a supervisor, an employer, etc. That can ever tell me with a straight face that some of these spring strain injuries are never a challenge for them. So I’m tickled that you’re here. We’ve got some great information that we’re going to be able to share not just about the injuries themselves, but also on ways that you can come and mitigate that risk from the very beginning. So for those of you who maybe knew, my name is Holly Foxworth. I am a registered nurse. I’m also the marketing manager for content here at Axiom Medical. I’m also joined by Dr. Tom Gilliam, which is with IPCS. And then also we have Axiom Medical Chief Marketing Officer, Dara Wheeler.

So I’ll have them both introduced themselves momentarily. But before we do pass that pond over, I did want to show you guys something that I wanted to bring your attention to. So if you look at your screen, so do it with me right now. Look at your screen, look at the top right-hand side. And so right there is where you will see the information for our next webinar. So this one actually is going to be really interesting, because this is naturally going to be the 20 year anniversary of what’s going on with the 9/11 tragedy that we all experience then. And so we’re not only going to kind of give reference to that and review the pieces that are included in that but also look at the PTSD side of that and some of the lives that have been lost, the wellness lives that were lost because of the tragedy that occurred. So we’re going to have military veterans there. We’ll have some of our public service there, and we will go through all the different components that are included, not just the diagnosis, but also the event, and really kind of give recognition there and also talk about how it is that you in the workplace can overcome some of these things and how it is that we can kind of come together, rebuild and get things back on track there.

So if you haven’t already press that button, it says register now. You don’t have to enter any additional information. Just press that, it’s going to get your registration. I’ll send it to you and it’s going to be already on your calendar. You’ll be ready to roll for the following event. One other thing we definitely always have obviously had the resources that are located there at the bottom. That’s the one that has the widget that looks like books. And there you’ll find all the different white papers. There’s everything from the how it is that you can start a vaccination program now that we officially have an FDA clearance for that vaccination that’s there. How it is that you can manage flu during the pandemic season. So there’s lots of good information there. All of it’s free. And again, you’re welcome to anything that’s there. So I think that probably covers the majority of everything that we want to talk about in the beginning and now I’m going to go ahead and kind of pass it over and let Dr. Gilliam first start. Introduce yourself, tell us your name and where you’re from and then we’ll go on there, and then we’ll get started. Dr. Gilliam, do you want to kick us off here?

[03:05] – Dr. Tom Gilliam

Sure will. Thanks, Holly. And again, hi Dara to you too. I’m Tom Gilliam, my training background, I have a doctorate or a Ph.D. degree in exercise physiology, muscle physiology, which I got many, many years ago from Michigan State University. And then I was also for many years, a tenured faculty member at the University of Michigan, got involved with industry in the late 80s, early 90s, started doing muscular strength testing with industry, then resigned from the University of Michigan and then formed my own company called IPCS, or Industrial Physical Capability Services in 1998. We are located in Hudson, Ohio, between Cleveland and Akron, and I’m the founder and owner of that company.

[03:55] – Holly Foxworth

Fantastic. Well, thanks for joining us today. We appreciate it. Dara, let me push things in your direction. Give us a quick overview.

[04:02] – Dara Wheeler

Thanks, Holly. I’m happy to be here. My name is Dara Wheeler. I’m Axiom’s Chief Marketing Officer. I have been with Axiom for a little over 15 years. I’m very, very excited to have Tom here. We’ve worked for years with him and are looking to continue this partnership. Of course, the post COVID experience has been an interesting one, but we’re getting back to thinking again about the physical capabilities of workers and employees and how we can support them and maintaining that health as they are employed throughout their life cycle. So really excited to chat with Tom about that today. Thank you, Holly.

[04:42] – Holly Foxworth

Yeah, you bet, absolutely. Well, Tom, I’ll go ahead and just kind of get started with you. So talk to us through these three little initials that we see always coming up here for the MDS. And then what does that actually mean?

[04:54] – Dr. Tom Gilliam

Well, Holly, I went back and looked at the Bureau of Labor Statistics what is their definition of musculoskeletal disorders. So I want to just give that brief definition, which we’ll talk a little bit about the ergonomic injuries, the infrequent activity, and the overexertion injury. According to the BLS, the musculoskeletal disorder, sometimes called the ergonomic injury, occurs when the body uses muscles, tendons, ligaments to perform tasks, oftentimes in awkward positions or in frequent activities, which over time can create pain and injury. Overexertion and repetitive motion are the primary causes of these injuries. The reason why I wanted to read that to the people is that, in my opinion, one very important thing is left out of what really causes a musculoskeletal disorder. And that is what is the physical capability of the worker.

My experience over the last 30, 40 years in the industry is that many injuries occur because a company will hire someone and try to place them into a job that physically they cannot do. They may have a pre-existing condition that the company doesn’t know about. And so they’re put under the ramp to unload planes or something like that. And within four or five days they’ve got themselves rotator cuff injury. So not only is it caused by the overuse of the muscle tenants and ligaments, that is a big contribution but getting that right person in the right job is critical in terms of managing or even preventing musculoskeletal disorders.

[06:41] – Holly Foxworth

Wow. You started talking about those Dara, that’s our love language, isn’t it? When we’re talking about preventing some of these that occur and what the impact there is. So talk to us then about how it is that you feel like we’re seeing a lot of consistency as you look at the different industries. This idea of graphic location, or are you seeing new trends? What are your thoughts there?

[07:04] – Dr. Tom Gilliam

Well, there were some good trends and those trends have leveled off. We see about 890, 000 non-fatal injuries that resolve in days away from work or work-related injuries. And of those 8900, about 295 000 are actual musculoskeletal injuries. And as the slide shows, about 33% of those 295 000 injuries of days away from work injuries are strains and sprains. And if you add in muscle soreness and pain, which is part of the definition, the strains/sprains, muscle pain, and soreness account for 51% of all these musculoskeletal injuries that occur each year. About 10-12 years ago, we were seeing about 340,000 of these injuries a year, and it has been lowered to about 209 and 295. But it’s leveled off for the last three or four years. And so when you see that, you have to begin to ask the question, Why is that happening? We’ve done a tremendous job with safety programs, ergonomic programs, with automation robots to help alleviate the physical demands of the job. But yet we still see a lot of these musculoskeletal injuries occurring. And when we look at the top four industries, and this is based on the frequency of injury, the healthcare worker is number one. Retail trade is number two. Manufacturing is number three, and then transportation warehousing is number four. But the number in the parentheses is the median number of days away from work. And you can see it’s almost just the opposite. Even though health care has the highest frequency of injury, they have the lowest days away from work compared to transportation warehousing, where they’re number four in terms of their frequency. But their median number of days away from work it’s 26. Well, it’s more than a month in terms of working days as far as the type of injuries. So they tend to have the more serious injury as far as a musculoskeletal injury is concerned.

[09:37] – Holly Foxworth

And I didn’t ask you about this before, but just kind of thinking through it now. Do you feel like the majority of those are from leaning forward and then trying to lift on things, or do you have any thoughts about how those are actually occurring in those industries?

[09:52] – Dr. Tom Gilliam

I have a lot of thoughts and how those are occurring. What we’ll see with my presentation, we’re going to look at what’s happening to the worker in the last 15 years in terms of their physical fitness, in terms of their muscle strength. And it’s not good news, Holly, and Dara, the selection process that you have. If you have a company that you have physically demanding jobs, it’s harder to find someone who really has the capability to safely perform those essential functions of the job. And so as we go through the presentation today, I’ll show you some hard evidence that the worker is weaker today, the worker is more obese, and all that is contributing to the increase, or at least not any further decrease in these musculoskeletal injuries. And now you throw in there what we’re just coming out off the COVID-19. And again, there’s a lot of research coming out here now that so basically says that worker is at higher risk for injury and disease because of what we just went through. And that was primarily the lockdown.

[11:01] – Holly Foxworth

Yeah, definitely. Talk to us about the frequency and the cost. I tell you that whenever I was writing some of the research that was there, my jaw dropped whenever I saw that they were saying that for anything that it’s medically consulted injury. I mean, you’re looking at something that’s over like $40,000. I mean, that’s huge. It definitely got my attention. Is that what you’re finding with some of these others as well?

[11:25] – Dr. Tom Gilliam

Yeah. It’s a big injury. It’s a big cost factor. And again, these are from the National Safety Council in terms of injuries, that in terms of frequency, looking at strains and sprains. And it’s showing that 21% of all the musculoskeletal injuries involving the lower back is the number one. I don’t necessarily agree with that. But that’s what the data says. And I’ll tell you why in just a moment, the shoulders are at 15% of all the injuries and 10% for the knees, 5% for the wrist. The type of industries that we work with are very physically demanding types of jobs. And when I talk to these people and this started about maybe 2005, our clients would say, you know, that shoulder seems to be the number one injury that we’re seeing in our workplace today. And more and more companies have said that. And certainly is what the data shows on the right-hand side. When you look at the average strange brain costs. Shoulders are the number one at $46,000, then by the back, the low back 37 and the knees at 33, and the wrists at 25. But a lot of companies today, particularly those with physically demanding jobs. Again, the number one industry, the number one injury is the shoulder. And also the most costly injury is the shoulder. Many, many years ago, I had a conversation with a person with American Airlines, and that individual stated to me that their number one injury on the ramp in terms of frequency was the shoulder, and it was more costly than the low back. So again, what we’re seeing, as I said earlier, we’re seeing a deterioration in the overall strength of the worker, and that’s contributing more to the shoulder cost than it is to the low back costs and the frequency of the claim.

[13:31] – Holly Foxworth

Okay. For this next one, I want to bring Dara here as well. And Dara, you may want to expand upon this. Whenever you start talking about days away from work, that’s one of the first conversations that come up with some of the clients that we see, that’s a big target that’s there. And everybody wants to know why it is that we need to decrease that number, how you can decrease that number. But then also the impact of that when you have employees that are out, once they go out, it’s hard to get them back in.

[14:01] – Dara Wheeler

Yeah, I can take the start. And then Tom can jump in. But I agree with what you’re saying, Holly. What we find is in the years and years of doing this that the more we can do to keep employees on the job, the better for them and their health, the better for the overall financial health of the employee and for the employer. You’re correct that the more an employee is away from work, the much harder it is to return them to work. And there’s a host of reasons around that, we see that in both work-related and non-work-related illnesses. And looking at any time an employee is out on disability or work-related injury, the more they’re out, the harder it is to really return them. And so that’s why thinking about programs that either catch or work with employers to look at this on the front end like Tom described from a pre-employment standpoint or looking at programs that minimize the impact if they do have to have days away and returning them to work even in a limited capacity is a really great way of managing injuries and thinking about these overall programs.

[15:14] – Holly Foxworth

Yeah, definitely. Tom, I was going to ask you about this whenever we were talking about those body parts. So I noticed that you put in there that the shoulder really was that 28 days then you’ve got the back, that would be at seven. So do you feel like that it’s specifically because of the interventions that have to be done to fix the injury, to kind of rehab that or where do you think that that difference comes in?

[15:42] – Dr. Tom Gilliam

Well, I think yes, the shoulder is a very complicated joint and rotator cuff injury. But people tell you, if you have surgery on your shoulder, it could take up to one year for full rehabilitation. And meanwhile, on the back, the surgical procedures or if you have to have surgery, I should say, are so much better these days, doing a microscopically and sometimes in and out in one day, and you’re back to work in seven days or less unless you’re doing a fusion or something like that. So the procedures themselves have improved as far as taking care of the back when surgery is involved. However, with the shoulder, it’s just a complicated joint that if you’re repairing a rotator cuff and if it’s a very serious rotator cuff injury, it’s weeks that you have to have your arm immobilized, and then you can begin to start slowly with your physical therapy. And then it just takes a while to get your strength back before you get your range of motion back. And before you know six months have gone by.

Then when you do come back to work, you might be able to go back in a modified assignment, but it’s going to be almost a whole year before that shoulder is going to be back to where you can perhaps do what you were doing prior to the injury. So, yeah, we do see that happening, Holly, today. And this is one of the reasons why the shoulder has become one of the worst joints as far as median days away from work. But looking over to the left there, what really astonishes me when they look at all the days away from work for musculoskeletal disorders in 2019, that’s 70 million days. That’s a lot of days. Of course, that’s a lot of injuries. There’s a lot of workers off. And I don’t have a number. But people in the HR business know when they lose a worker for a period of time, not just because of injury. There’s a ton of indirect costs, and Dara, you may have some of these numbers yourself and dealing with your clients, but when you factor that in, you’re looking at billions of dollars lost because of injuries, particularly musculoskeletal disorders, many, not all, but many of which can be prevented. And we’re going to talk about that in just a little bit.

[18:10] – Holly Foxworth

Yeah, definitely. What is it, is it the OSHA calculator is that we found that at the time, there’s actually a calculator where you could put in and what your injury was and it would calculate and come up with some of those different indirect costs. I mean, if anybody’s interested, but I think that they do have that tool that’s available on their website.

[18:31] – Dara Wheeler

Yes, the OSHA and the Department of Labor have that calculator. And it’s consistent with the numbers that Tom got up here. It’s staggering. And he’s right. The HR Departments know very well that it’s not just that direct cost. It’s all the indirect costs and turnover and replacement costs and having to train people to do the jobs. And there’s a lot of expense around injuries and people being away from work.

[19:01] – Holly Foxworth

Yeah. I guess the next question becomes if we have all these advances in medicine. We know more about the body than we’ve ever known before. We have all of these different components. So then why is it that we’re still facing some of these same risks that are occurring with these multiple injuries that take place on a daily basis?

[19:28] – Dr. Tom Gilliam

Well, I think we know of four or five very good reasons why these musculoskeletal injuries are still around. And I’m going to talk about these because in industry, they don’t pay much attention to them. I think they’re concerned, but they don’t pay much attention to them because unfortunately, what I’m going to talk about now is happening. These four factors are right here. You’ve got the aging workforce, the weakness in the muscles, obesity, and now the COVID lockdown. But when you look at the aging workforce and what Dara was talking about as well, what happens so many times in trying to get a worker back to work, it’s difficult. And the older the worker is, the more difficult it is to get that worker back to work. For example, many 60-year-olds who have a musculoskeletal injury never come back to work because it becomes permanently debilitating for that individual. So what we know when we look at the age groups of 54 to 65 and then greater than and 65, those are the only two age groups where the incidents of overexertion injury sprains/strains are increasing each year. And part of that is that we have more people 65 years old and older in the workforce than ever before. But there’s also a lot of older 50-year-olds and early 60s, and they continue to work and when they get injured, they just can’t heal or if they have the injury, an injury that might happen to a 30-year-old compared to that same injury to a 65-year-old, it’s going to take a lot longer to rehab that individual. And when that individual comes back, is going to have to come back more slowly. And there’s a really good possibility that that person will not come back.

So the aging workforce is a factor, and they seem to be more susceptible to injuries to begin with. As I mentioned, with the increase in the incidence of the frequency of soft tissue injuries and also the overexertion and strains/sprains. So that’s the first group that’s a real concern. The next is the weakness I’ve talked about. The worker is weaker today than they were 15 years ago. Our own data, we have over half a million muscular strength tests in our database now, and I like to go back and look to see, well, how is that worker changing? And we measure the absolute strength of the shoulder joint. So I’m aware more about the shoulder as far as being a very serious problem and what’s happening to the shoulder. And we also measure the knees to the leg, the knee extensors, the muscle group in the hamstring group as well. So when we looked at this data comparing what the worker looked like back in 2005, there’s about 250 workers in that group compared to what they look like in 2019. There are about 220 workers in that group and we looked at it by age group. Basically, that orange line is 2019 and that blue line is 2005. And on average, the upper body strain through shoulder strength for the worker today or in 2019 is 23% weaker than it was back in 2005.

Now I know the workforce, the workplace is changing with ergonomics and things of that sort, but many companies still have items that still weigh 30, 40, 50, 60 lbs, 80 lbs, 100 lbs, even though the job task analysis or the job description must say, you must do that with a two-man lift. My experience is that there’s a lot of workers that just want to get the work done and they don’t wait for that second person to help out. They go to make that lift and mingle, they pop a shoulder. But the critical thing is you can see that as workers age and they get weaker and weaker that they lose their strength, I should say, and there’s a reason for that too. But that doesn’t have to happen. Muscle is made to work, you stay strong, you can stay strong throughout your entire lifespan. You might lose 5% of your strength from age 30 to age 60 to 75. But you don’t have to lose 20%, 30% or 40% of your strength by just staying healthy, staying physically active and stimulating the muscles so it stays strong through weight lifting programs, things of that sort. So that’s the one thing, in industry they don’t spend a lot of time teaching their workers how to stay strong. And I understand that it’s just that they’re there to work. They were there to produce the widget, but at the same time our workers are getting weaker and weaker and by the way, with the knee strength, it’s about 19% weaker today than it was 15 years ago. And the interesting stat here, if you look at the age group of 20 to 29, the gap between that orange behind in blue line is the greatest and the difference there is more like 26% to 27%. So that younger worker that you’re trying to hire into your workforce is coming in in worse condition than ever before. And that’s another reason why they’re so susceptible to injury. And then, of course, the loss of strength as we age is another reason why we see an increase in musculoskeletal injuries with these older workers.

[25:31] – Speaker 1

Yes. And then talk to us about the role that also obesity would play in this.

[25:35] – Dr. Tom Gilliam

Well, probably the best study they ever came out with. It was in 2007 when the Duke Medical Center by author name, our research author named Dr. Ostovi, and he looked at the soft tissue injuries for nurses in their workplace. And what he saw was that the worker had a body mass index, which is a BMI of 35 or more. They had two times more soft tissue injuries. Their cost for those soft tissue injuries was seven times greater, $7,000 versus $49,000, and they had 13 times more lost workdays. But what we see with our data, again, we collect height and weight. We don’t use body mass index in determining whether a worker can work or not. But I collect the data because it’s very interesting to follow what’s happening with body mass index. And there are various ways that you can compartmentalize BMI, but for the most part, a normal BMI is 18 to 25. Now there are pluses and minuses here in terms of how effective BMI is. But when you get up to a BMI of 35 to 39 or greater, the research shows that that worker is at greater risk for injury. What does our data show? Again, the blue line is 2005 and the orange line is 2019. What we see is typically what they see nationally today, and that is about 43% of the workforce falls under that obese definition of a BMI of 30 or more. And I got to tell you that most professional basketball players have BMIs in 33, 34, 35 because they’re so tall and they’re so heavily muscled. So I don’t get too concerned when I hear someone has a BMI of 30 or 32 or 33. But we know when you hit that BMI of 35 or more, it becomes a problem. In fact, we look at data now when we look at the group with a BMI of 55 and more.

[28:20] – Holly Foxworth

I think we may have lost Tom temporarily. Let me see. I think maybe he can call back in, however, some of the same stuff that we talk about on a regular basis, especially when it comes to the lockdown, the concepts of what it is that you’re supposed to do whenever you’ve got everybody that nobody’s following by a regular diet, everybody is working from home. They’re not having to get out and perform as much exercise. I mean, what are some of the things that you’re seeing with this that obviously would play into this scenario?

[28:51] – Dara Wheeler

Yeah. And he’s got a couple of points here, and hopefully, he can join us and go through the rest of this. But I think we’ve seen a huge, interesting story of the lockdown impact, and I know anecdotally we’ve heard people either taking this approach where they’re eating more, they’re moving less. And then we’ve also heard people flip the other way and take an opportunity to be even healthier than they normally would be. But I do know that from the sedentary lifestyle standpoint if you think about just the fact that you’re at home now and you’re not physically moving into a workspace or always going to stores, you’re just moving less. I think the data everybody jokes about with everybody’s Fitbits and the Apple watches is now the steps went from 10,000 steps a day to barely 1000.

So even if you work out once a day, I like to lift weights. If I work out at lunch, I’m still not moving much throughout the day. I’m not getting up. I’m not going and walking into an office or walking around an office. And so I think there’s a big impact on health because of this lockdown. And then the other piece that I wrote down as Tom was talking, and I’m sure we could go into this a little bit more. But what we’re hearing a lot from clients is that it’s not just challenging to hire healthy employees that can do the job and that this strength is decreasing. But what I hear from a lot of employers, especially in the last year, is that they’re having a hard time hiring at all, and they’re hiring knowing that people are less healthy and are potentially at a higher risk for injury in that first year, especially. And so they’re kind of going into it with that risk approach where they’re thinking, Well, we know that we probably are going to end up with some claims or people that are not able to perform the jobs we’re asking them to perform. But the alternative is not being able to hire at all. So it’s been an interesting time, and it’s definitely going to be something that we will keep a close eye on over the next couple of years. So I know Tom’s information a little bit so I can go through it, Holly if you want me to, and then hopefully he’ll join back because he has a lot of good things to say. So Tom, his whole life as he explained, they’ve done a ton of research on the value of muscle health, and they’ve done research on the ability of the body to fight infection and disease. We do see, of course, with COVID, that underlying conditions and comorbidities is something that is a big deal because Americans have become more obese and have started to develop more and more comorbidities. Over the last 20 years, we are having a harder time fighting a new infection, a new disease like COVID-19. So one of the things that I know Dr. Cherry says a lot and a lot of the experts we have on here is that sometimes this actually, even though it’s a new infection we’re fighting, you sometimes have to go back to the basics with your overall health, sleep well, exercise and eat good food and make sure that we’re taking care of our body so that we can fight disease. And then also, Tom has on here the muscle loss that we’ve talked a little bit about over time and then also that employer impact. And we’ve talked a lot about that. It’s making sure that employees are able to physically perform the job and mitigate injury and illness and also down the line at risk to claims and injuries. And we see that it is compounded by this muscle health. And a lot of employers that are in heavy industries have work caring programs and different programs and ways to go about this. And we could talk about how to manage through that. Anything else here Holly, that you want to include?

[32:44] – Holly Foxworth

No, I think that pretty much sums it up. The next part, though, actually, is what gets my attention significantly, because this is where we can jump into the solution. What is that we could do, what kind of interventions we take, programs we put in place to actually make a difference in this. And I think if I’m not mistaken, I think, did you also go and have one of these tests done? Those screening tests? So I was extremely impressed. We did it several years ago because we partnered with additional testing for our clients. But I was extremely impressed in the actual assessment form of what it is and how it is that they’re assessing these muscles and making that determination as to whether or not that you definitely are able to perform what would be expected of that individual role. So talk to us about maybe kind of the difference in some of these tests and what that impact will look like?

[33:38] – Dara Wheeler

Absolutely. Yeah. And of course, Tom is the expert. So we’ll get him back. If not, we’ll follow up with some more information after this. And I’ve seen a few people ask if this presentation will be available after, and it will be. And of course, Tom is a phenomenal expert. So we’ll chat with Tom anytime and get him on calls if we need to. But one of the things that we see with the different approaches that are out there with what you see up here, there’s what we call PCEs or FCE. A PCE is a physical capacity exam, and an FCE is a functional capacity exam. So a lot of people in the industry know what a functional capacity exam is and there are different names for it. There are lift tests, there are different ways of explaining it. But essentially, what a physical capacity exam is is taking somebody’s job functions and making sure that if you’re hiring somebody they can perform those job functions. And so I know one of the burning questions out there is usually a lifting type thing where you’ve got an employee and Tom described, you have to partner lift maybe. And so if you’ve got in the job description that you may have to partner lift 30 lbs or you have to individually lift 30 lbs, what you want to do is put a new employee or pre-employment through those types of functions, and you do that with a physical therapist. And it’s an exam that’s built based on those job descriptions. Typically, it’s much more qualitative. You can see if somebody can move. But as a physical therapist, you’re watching for the breakdown of mechanics. You’re making sure they’re physically fit and able to perform those functions. What Tom screening does is physical capacity examination. He described that machine and it is a machine that basically measures the strength at the joint. So it’s looking at shoulder strength. It’s looking at knee strength, quad hamstring strength. And what they’re looking at is as you move and you’re doing different repetitive motions. They’re measuring the output of the strength of the joint, and they’re measuring that against all other data they’ve got. Oh, there’s Tom.

[35:55] – Holly Foxworth

You can join us again.


I was describing your PCEs right now so perfect timing. I was describing what the exam looks like with a physical capacity exam. And I already kind of went into the FCE version, but I was explaining the machines and what the output looks like from a PCE versus an FCE. If you want to jump in and take over.

[36:19] – Dr. Tom Gilliam

Sure. This high technical stuff anyway. Yeah. Both the PCE, the physical capability evaluation, and the functional capacity evaluation our means is to evaluate the strengths and capability of that new hire applicant. And both programs can demonstrate success in terms of getting the right person in the right job. And that’s the critical thing. You want to make sure that, as I said earlier, the musculoskeletal definition fails to identify that having the right physical capability to match up against the physical demands of the job is a good way to prevent or to minimize the number of musculoskeletal disorders within your company. So both the PCE and the FCE they’re different. The FCE, as Dara may have mentioned, is objective from the standpoint of assessing the amount of force you generate within a working muscle. The FCE, the functional capacity is more work simulation. Both have been around for a number of years, certainly. I’ve been doing PCEs since the late 80s and with my old company since 1998, and the FCEs have been around since early 1990. So they’re very, both functional. And did you mention anything about the legal aspect?

[37:56] – Dara Wheeler

No. I was just starting to talk about the machines and the data that you got, but I think legality is always a fascinating component for me.

[38:04] – Dr. Tom Gilliam

Right. Well, if you want to talk more about the machine, I’d be happy to do that. But the legality side, no matter who you use or what you use, if you’re going to do physical capability straight testing on the newer side, there are several things you need to look at. You have to be able to justify that. What you do actually assesses the physical demands of the job. So you have to start with the physical demands analysis. Now, a lot of companies will say, well, we have that. In reality, they don’t. They have job descriptions, and some are very good job descriptions, but they don’t have the analysis of the physical demands of the job. And so what we’re looking at. And these are usually done by certified ergonomists. They come into the workplace, they follow you around to see what you’re doing each for eight hours a day or ten hours a day. And what’s a typical day? And they’re going to look at things such as lifting, carrying, pushing, pulling, reaching, climbing, bending, stooping, all these types of physical tasks. And then how often during the course of the day do you do that? And it’s all based really off of the Department of Labor strength definitions, where you’re looking at jobs that can be rated anywhere from sedentary to light to medium-heavy and very heavy. And the demand of that job becomes a target score.

So if you do a PCE or you do an FCE, you got to test against something and you’re going to test against those physical demands, okay. So that’s the first thing you have to do from a legal point of view, you have to have a defensible job task analysis on file, and it must be relatively current. Now, no one wants to define current, but most people are saying three to five years. So I’ve been in companies that said their job task analysis was done ten years ago. Well, in that period of ten years, they’ve added robots to the plant, which has taken away from the physical demands of the job. And in some cases, they lowered the weight of a raw product. But as a result, the bags are all smaller. So they’re lifting more bags over a period of eight hours a day. That actually increases the physical demands of the job. So you gotta have that job task analysis. And then you have to demonstrate that the test you do, whether via PCE or an FCE, is job-related. So if a person is doing all upper bodywork in the plant and you’re looking at leg strength, it may not have an application to what the job is. Then you have to demonstrate consistency with business necessity. And the American Disability Act has really redefined that to say that what they’re looking at there is safety, the program that you put in place again, whether it be a PCE or an FCE. Is that going to impact the safety of the worker? Is that going to allow him or her to work more effectively with less risk for injury?

And so those are the three primary things you have to have the physical demands analysis. You have to have job-relatedness, and you have to have consistency with business necessity to have a legitimate new hire physical capability strength testing program. And the EEO sets up these guidelines. And if you do this, and if by chance, you have an EO challenge, the probability of successfully meeting that EO challenge is much greater than if you don’t do this. So those are the legal aspects of doing screening straight testing.

[42:04] – Holly Foxworth

Okay. And then talk to us about the wellness strength programs that could be implemented in the workplace.

[42:13] – Dr. Tom Gilliam

I strongly recommend this no pun intended. And the reason is going back to a couple of slides that when I went blank or you lost me or something like that. The human body, by nature, loses 30% to 35% of its muscle mass from age 30, age 30 to age 65 to 70. Then it continues right after that. That doesn’t have to happen. As I was saying, when you lost me, that doesn’t have to happen if we maintain a healthier muscle mass through weight training, that kind of thing. The American College of Sports Medicine is now doing strength testing research studies on 80 and 90-year-olds. And we’re demonstrating that even 80 years old and 90 years old can get stronger if you stimulate the muscle, that’s critical. And so you basically have to have resistance to stimulate the muscle, whether it be a weight, a stretch band, or whatever it might be doing a push-up, pull-up, whatever it might be, you have to stimulate the muscle. I know people that go to the fitness center and they pick up a one lb weight and they do that 20, 30, 40 times. And they’re not really doing much of anything. I can tell you that much. You’re not stimulating the muscle with that. It’s not going to get stronger. We don’t care if it gets bigger because that’s not the important thing. You can get stronger without increasing the curse of your muscle.

So you have to do something to stimulate that muscle to maintain that strength, to help you prevent the injuries from occurring within your workplace. You know, I’ve talked to a number of companies and they say, I don’t know how to do that. I mean, we have breaks. Yeah, but we can’t mandate things of this sort. And that’s true. So perhaps you can do that by coming up with a program for ten minutes in the morning, ten minutes in the afternoon, or during the shift. I know some companies are doing warm-up-to-work programs or some others are doing stretching programs, all very effective, all very good. But they’re not going to impact the strength of that muscle, which is what we’re trying to do. This is what we’re hoping for and the education side is this, what do we know about muscle health today in the prevention of disease? Most people think, yeah, I got to get stronger or have flexibility, so I don’t get injured. And that’s important. But the research on what healthy muscle mass does in terms of helping you to maintain or manage certain critical lifestyle diseases such as diabetes, cardiovascular disease, hypertension, and now certain cancers. They’re showing people who have a healthier muscle mass, 13 different cancers. The greater the healthier muscle mass, the greater your survivability is by as much as 43%. In fact, the cancer societies now include strength training during the treatment of some cancers so that you can at least stay strong as you go through your cancer treatments.

So muscle is not just critical to injury prevention, but it’s to our health and long-term health as well. So I encourage people to get involved with these strength training programs, particularly in the industry. And can we go to the next slide? The difference is that when you do a new higher physical capability strength test or functional capacity test, there are certain things you have to do as shown on this slide. Here to the right-hand side, you have to have the job test analysis. You have to have that, you have to have a document to establish a pass-fail. The company receives the outcomes when you do an FCE or a PCE, and it’s usually built on a per-test basis. But when you do wellness testing, you cannot mandate that. Whereas with new hires, you can mandate that as part of the screening process, becoming an employee within our company, you have to have this new hire train test. But for wellness programs, you cannot mandate it unless you have a federally regulated company or a job, such as over the road truck driver, they require a CDL license, it’s federally regulated, so they can also say you have to have a strength test every single year or every two years along with your DOT exam and the results from the wellness of valid strength evaluation goes back to the individual, not to the company. It’s like a health risk appraisal, and the company, therefore, gets a report, but the individual himself will get their results. These are usually done via health plans, employee health benefit plans, where they give them incentives. If you do a certain amount of things to enhance your health, one of them being your muscle health, you’re going to have a lower deductible for example. So that’s a critical thing. In terms of offering many restraint training programs for your workforce via a wellness program, you cannot mandate it.

[47:27] – Holly Foxworth

Okay. Tom, there have been a ton of questions that have come through. We have some that are for the town hall, but then we also have some that are brought in by the audience. Just kind of run through these quickly. Let’s see. Kevin was asking, are you aware of any new treatment trends for strain injuries, and is early intervention still the biggest driver for decreasing the recovery duration?

[47:51] – Dr. Tom Gilliam

I’ll answer the second question and the answer is yes, the earliest you can get involved. the earlier you can get involved, the quicker the recovery. Absolutely. I was talking to our athletic trainer today and to answer this question, Holly, and Dara and I said, well, what are the latest treatments, it is just a lot of gadgets, but they all do the same thing in terms of treatment. If you have a sprain/strain, you put ice on it for several days to allow that blood to anticipate the swelling down, and then the treatment can begin. And when the treatment begins, they generally start to put heat on it. He said the only thing that’s probably the latest thing that you see a lot, particularly in athletes after watching a basketball game, gymnastics, or football or whatever it is this Kinesio tape. And you’ll see a long band of tape on a certain part of the body and that helps to stabilize the body and to protect that part of the body. So other than that, it’s the same principles in terms of the treatment, it hasn’t changed. It just takes time. For some people it’s going to be done a lot more quickly. They’ll go from cold to heat much faster. Others are going to be cold for a lot longer because they have too much swelling and so forth. So that’s what’s happening there.

[49:08] – Holly Foxworth

Yeah. And I saw a question that came in. Can you talk about the impact of smoking in relation to healing, especially with bones or surgery?

[49:20] – Dr. Tom Gilliam

I know a little bit about that. Dara, you may know more about that than me, but it does impact it from a negative point of view. So smoking, what nicotine does to the muscle and things of that sort. It will slow the healing process. It doesn’t prevent it, but it does slow the healing process. Yes.

[49:42] – Holly Foxworth

Definitely. All right. Let’s see the next one that we came across was from Randy, what type of impact are employers seeing if we start a new hire strength screening program, and then are the number of work-related injuries decreasing? Also, they’re asking, would that be like a drug screen where you would be passing, that they’d be required to pass before they were able to accept the decision.

[50:06] – Dr. Tom Gilliam

The answer is yes to all those. Just kidding. Yes. I’ve been doing this for a number of years. As you know, Holly and Dara and all of our clients realize a significant reduction in musculoskeletal disorders, soft tissue injuries, particularly to the shoulders, in the knees, and ironically, to the low back. And I’ll tell you why. Because there’s a physiological anatomical connection between the shoulder and the low back. You keep your shoulders strong, you will prevent most low back strains/sprains. And I won’t get to all the research on that. But we certainly see that with our data and the research studies point that out as well. The shoulder is the most critical joint in the body. And will you see, therefore, a reduction in these injuries in the frequency and also not only just the frequency but also the length of time and days away from work as well. And it is like a drug screen from the standpoint. You can mandate it, and you can offer that as a post-job offer, and you offer them the job-based contingent on passing a physical demands evaluation or physical capability evaluation. And if not, then they withdraw that conditional offer if they don’t meet that upfront.

[51:25] – Holly Foxworth

Sorry, Holly, while you were off on your little mini-vacation, one of the things I was talking about with Holly was that we are hearing from a lot of clients that the struggle right now is these programs are really great programs, but right now we’re in a situation where often they’re not hiring fast enough. There are not enough workers to supply the demand that these employers are facing. And so often what they’re doing, at least in this last year or very recently, is they’re hiring, knowing that there’s potentially greater risk for injury. So it’s kind of even going into it eyes wide open, knowing that they’re hiring for these potential injuries or for these potential risks out there, but not being able to staff enough employees. So it’s a really challenging workplace right now for employers, especially with a lot of our health and safety professionals, and they know this stuff inside and out. And they’re going into it with eyes wide open. But they’re struggling because they just can’t hire fast enough.

[52:26] – Dr. Tom Gilliam

And Dara, absolutely, I agree with you 100%. What we see is what’s happening with some of our clients, as you may know when you set the standard when you do a job task analysis, and let’s say the job comes back as a heavy job. The company, I’m gonna say by law, but you don’t want to violate the EEL when it says that the physical demands of the job are heavy, you can’t set the standard higher than that. I have to say it was very heavy. But you have every right to say, okay, the job is heavy, but I’m going to lower it to medium-heavy or a medium or even a light-medium during this period of time where I’m having difficulty finding workers. So at least you’re doing some screening out and you might be screening out instead of 10% of the workforce. You’ll only be screening out 2% or 3% of the workforce, and it’s usually those two or three that are going to account for almost 80% of your injuries and costs. So I encourage companies if you do physical capability testing to continue, but to lower the standard because, by law, you can and at least have an impact on weeding out those that are going to have the greatest impact on your injury rates.

[53:40] – Dara Wheeler

That’s a great point. Really great point. And I think the other thing they’re doing is maybe if they’re hiring the lower job task or the lower level, that they’re making sure that they’re not that they’re maybe decreasing the requirements of some of the lists and some of the job demands or making sure they’re evaluating that on a regular basis. Maybe not official restrictions, but making sure that they’re helping employees do the right thing and they’re preventing some of those injuries.

[54:12] – Dr. Tom Gilliam


[54:16] – Holly Foxworth

Sure. Yeah. We have two more, let’s see. I see your question about the 80 lbs lift, and so we will follow up with you to get you some of the specific information afterward. Raleigh had asked the majority of our employees to continue to work from home as we all are as well, what type of muscle strengthening exercises would be most appropriate for the whole environment?

[54:38] – Dr. Tom Gilliam

Well, the good news is there are quite a few you can do. You can just use your body weight, for example, going back to your old high school days when you’re forced to do push-ups and pull-ups and sit-ups and stuff like that, that certainly stimulates the muscle. And then if you can afford it, you can go to a store and buy these stretch bands. They’re not expensive. There may be $10 or $12, and some people will buy, you can get different color bands. The color will determine the amount of resistance and they’re safe to use, and the kids can use them as well. You can do some fun things. Some people will go out and actually invest in weights, kettlebells and dumbbells, and things of that sort. If you do, I encourage you to start with lighter weights. That’s not going against what I’m saying about simulating a muscle, but you don’t want to just jump in and start lifting 30, 40, 50, 60 lbs because you might get hurt. So there are a number of things you can do at home. And the other thing is, I don’t know, depending on where your viewers live myself, I’m 77 years of age, I love working in the yard, and I use that as an opportunity to get my physical activity in and to do physically demanding jobs around my yard, which helps stimulate the muscles as well.

[55:59] – Holly Foxworth

Yeah. And I think that Matt had commented on the value of nutrition and training people to eat well, I mean, I think that plays a huge piece in the recovery impact as well. All right. One more question before we wrap up, then Leslie has asked, would a prior sprain or strain increase the likelihood of future injury. And would that history be reviewed within a new hire screening test?

[56:27] – Dr. Tom Gilliam

It’s a good question and I’ll answer the second part. The answer is yes. For example, when we do the evaluation, I’m sure other groups that do the evaluation have the right to ask that question. Is there anything I need to know that’s going to impact your safety while performing the new hire strength evaluation? So you have the right to ask that. And I will tell you that not everyone tells you the truth because we’ve seen that happen. And we look at the data that we get on that person and we can see that they had a pre-existing condition. Then when we get back to them and say, it looks like you had an old shoulder injury or knee injury. Oh, yeah, that happened two or three years ago. But you do have the right to ask that question. And then with a prior sprain or strain increase your likelihood of a future injury. If you have great rehabilitation, a good reconditioning program to get that joint and muscle strong again, the answer is it should not. But please keep in mind that whenever you injure a body part, that injury is with you for the rest of your life and you never know when it’s going to come back. So I encourage people to get injured, just don’t say I’ll ignore it, I’ll just sit at home and put some ice on it, and I’ll get better in a week or ten days. Get it appropriately assessed, get to the right physical therapy group and let them stimulate that, and let them recondition that so you can get that joint back to where it was prior to the injury, or even better than it was prior to the injury.

[57:59] – Holly Foxworth

Definitely. Yeah. I think that we can squeeze that in this one question along with that, which was Edwin was asking whether the weather could impact what that impact would be on your muscles there. So I hear you kind of hear people say that they feel with arthritis as if it’s going to start raining or something like that. Is there any truth to those types of claims?

[58:18] – Dr. Tom Gilliam

Oh, absolutely. That’s another whole area of exercise physiology. You’re talking about working in the heat or you’re working in the cold. United Airlines is one of our clients. And look at their ramp workers. You’ve got Chicago where you’re dealing with winters that are horrible. You got Houston, Texas, where you guys are during the summer, it’s hot in Texas in the hundreds, and so forth. So, yes, we have clients that their workers work in coolers or freezers all day. And so that certainly impacts the muscle, the consistency of the muscle, and the susceptibility to injury as far as soft tissue injury is concerned. Heat obviously loosens up the muscle. There’s less chance of an injury occurring than it would in a colder environment.

[59:10] – Holly Foxworth

Yeah. Awesome information, guys. Dara and Tom, both of you had great information. I appreciate you coming and joining us today. Now, we’re kind of running late here on time, so I’ll go ahead and just kind of wrap this up here. Obviously, if you have additional questions, please don’t hesitate, you can send them to us. You can put them right here on the platform. We’ll respond to you from there. Have a rep reach out to you, etc. So if there’s anything that we can answer for you, please don’t hesitate to reach out and ask those questions again. If you haven’t already, please click on that button to register for the next one. September 11 is the day that sticks in all of our heads. And so it would be nice to kind of revisit some of that. And we’ll look at the positive aspect of what it is that we could do to help in these scenarios. Get registered. We thank you for joining us, and we look forward to seeing you then on September the 9th at 1:00 P.M. Central. Thank you. Bye, bye.

[01:00:04] – Dr. Tom Gilliam

Thank you. Appreciate it.


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