Soccer was Nick’s passion in life. He liked to talk about it to his friends, read about it on the sports pages and, of course, play on weekends with his club. To keep up his fitness, he ran every day through the park near his house.

Nick moved to Australia from Greece. He soon found a job as a chef at a high-end restaurant. The position involved frequent lifting and bending, as well as standing for the eight to ten hour shifts.

At the age of twenty-seven, Nick started to develop pains in his lower back. For a few months, he worked through it, determined to earn a promotion. As time went on, the pain escalated. Nick was having trouble sleeping and completing his tasks. He finally reported his injury to his manager, who sent him to a physiotherapist.

The physiotherapist recommended weekly treatments, as well as massage and acupuncture, Nick took a week off then returned to work for four hours a day, avoiding all heavy lifting. He was told to rest his back as much as possible.

Three months later, Nick was still working modified duties. He continued to suffer significant pain. When he came home, he lay down for most of the afternoon in bed. The household tasks were done by his roommates.

Nick was becoming increasingly frustrated with the situation. He had little support in Australia and started gaining weight from lack of exercise. He tried to keep positive but it was difficult when all the cards seemed stacked against him.

The claims manager arranged for him to see a doctor with a specialty in back pain. The doctor suggested to Nick that exercise might help his condition.

With her encouragement, Nick began moving his body again. He started out walking a few kilometres each day before progressing back up to running. The exercise helped him regain energy and motivation. He went back to his everyday routine around the house. He also returned to his soccer club, helping out at the sidelines until he felt well enough to play again.

On an occupational therapist’s recommendation, Nick was provided with a sit/stand stool at work. He was also given a small platform to allow him to change his posture. These tools helped manage his condition, and he was working eight hours a day again within six weeks.

While Nick still suffers from back pain after long days, his work is no longer affected by his condition.

Lessons for Return to Work

Nick’s case demonstrates that a flexible approach to case management can kickstart a stalled situation.

A common assumption is that the severity of the injury determines the length of recovery time. Yet sometimes factors outside of the injury hold up the return to work process.

Some tactics to kickstart cases include:

• Seek a second opinion
  
  Up to date evidence based medicine takes decades to get into everyday practice. As a result, different doctors may have different, sometimes outdated, approaches to treating injury.
  
  When little progress is being made, a second opinion can provide a fresh perspective and new ideas.
  
  Successful case management means being flexible enough to change strategies when an approach is not working.
  
  In particular, a doctor with experience in back pain can provide valuable advice on self-management strategies. While there is an expectation medicine will offer solutions, self-management strategies often provide greater benefits. Yet doctors frequently fail to recommend them. 
   
• Consider appliances and aids
  
  A whole range of medical aids are available to assist workers in their return to employment. These small adjustments to the work environment can have a major impact on a worker’s comfort and pain levels.
  
  In Nick’s case, being able to use a sit/stand stool allowed him to increase his working hours to pre-injury levels.
  
  Using these aids creatively can help speed a worker’s recovery. If the Return to Work co-ordinator is unsure what tool could help, an experienced rehabilitation provider can provide advice.
   
• Address the worker’s mental state
  
  In some cases, recovery may be blocked by a worker’s poor mental state. Being aware of the client’s mental state is vital to case management.
  
  A client who is becoming de-motivated and depressed may struggle to take on the challenge of returning to work. A negative mental state may prevent a client undertaking treatment or self-care strategies and increase their pain levels.
  
  If a client seems to be losing motivation, a return to work manager can offer an understanding ear or, if necessary, arrange for counselling. Modelling positive behavior is key to improving a client’s attitude towards injury.
  
  Encouraging a client to continue pursuing normal activities, even with minor adjustments, can also help keep their motivation high. In particular, participating in everyday activities maintains the worker’s support networks, whether with family, friends or a local group.
   
• Look at the team around the worker
  
  From an outsider’s perspective, it may seem unusual to suggest an employee stand with one foot on a raised platform. Yet from a health perspective, as the person changes from one foot to the other, the spine posture also moves. As the person changes the muscles that are being used in the back, they are able to tolerate standing in the same position for a longer period.

Ensuring the employer understands the significance of any aids or appliances helps the worker get the support they need. If the employer understands the purpose of aids, they are more likely to embrace and promote their use.

Keeping in mind the many options available, as well as the advice of professionals, allows case managers to respond to cases with flexibility and creativity. When a case has stalled, looking beyond everyday medical treatment can lead to practical and successful solutions.