Work hardening is a type of physical therapy program developed for those patients who need to prepare themselves to return to full-duty work. The physical therapist will develop a treatment plan based on the requirements of the job that they are trying to return to performing. All exercises and activities that are performed in the clinic are time based versus based on repetitions as usually done with a standard physical therapy program due to the nature of work activities. When scheduling a work hardening program, the initial program is a minimum of 2 hours in the clinic that will be progressed by 2 hour increments up to a total of 8 hours which is a typical work day. You are entitled to a lunch break when you achieve an 8 hour work hardening program. Depending on the doctor’s prescription, work hardening can take place anywhere from 3 days per week to 5 days per week. Typically a work description should be supplied to the physical therapist so that he or she could develop a work hardening program that would accomplish the goal of returning to full-duty work.
Here is an example of a patient who was receiving physical therapy for the lumbar spine and has reached a point in his rehabilitation process where he is ready to prepare for a return to work. This patient works in a warehouse where their job requirements are lifting up to 80 lbs from floor level to an overhead position, lifting and carrying up to 50 lbs a distance of 50 feet, placing up to 80 lb pallets on a push cart and pushing the cart to the opposite side of the warehouse. All exercises and activities to be performed in physical therapy are to mimic those above activities in preparation for a full recovery and a return to work.
Based on the above job description, the following program would be implemented.
- Walking on the treadmill for 10 minutes at a comfortable walking pace.
- Box lift from floor to chest height progressing to overhead. Initially starting with a light weight of 15 lbs and increasing in 5 lb increments.
- Box lift from floor to chest height and carrying a distance of 50 feet, placing the box on a table and then picking the box up and walking to the original spot for the time frame of 10 minutes. Weight inside would gradually increase until achieving 50 lbs.
- Using a push cart with weighted objects placed on the base, patient will walk around the clinic pushing the cart during a time frame of 10 minutes.
- Repetitively squatting without weight working on body mechanics such as lifting with the legs and not with the back for a time frame of 10 minutes and gradually increasing the time.
- Walking backwards on a treadmill for 10 minutes at a comfortable pace in case patient has to pull the cart backwards such as moving through doorways.
- Using an upper extremity bike ergo meter (arm bike) for upper extremity conditioning to prepare patient for a return to work gradually increasing resistance and time frame.
The patient would cycle through the above work hardening program repetitively until achieving the minimum of 2 hours and up to the maximum of 8 hours. The physical therapist may also stretch any of the involved structures out after the exercise routine, as well as ice to eliminate any muscle soreness that may develop after the work hardening program.
