Central West Health & Rehabilitation
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Managing Stress Apr 23rd, 2014


10 proactive hazard identification methods Apr 23rd, 2014
Here are 10 methods you could adopt to identify health and safety hazards before an incident occurs:

  1. conducting pre-start discussions on the work to be carried out;

  2. encouraging workers to recognise and highlight hazards while performing work;

  3. carrying out safety inspections and audits of the workplace and work procedures;

  4. conducting job safety analyses (or similar task evaluation processes);

  5. monitoring, measuring and testing the working environment such as noise monitoring, electrical testing and atmospheric testing;

  6. analysing proposed new or modified plant, material, process or structure;

  7. conducting hazard (or risk) surveys;

  8. reviewing product information, e.g. safety data sheets, operating manuals; and

  9. researching publicly available data on hazards, e.g. newspaper articles, industry or safety regulator alerts; and

  10. looking at past incident and near-miss reports. 


Health & Safety Bulletin

7 Things We Can Learn About Aging Gracefully Apr 23rd, 2014

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The world's largest population of older healthy adults is on the Japanese island of Okinawa. And the last two people who held the title of world's oldest person (116 in both cases) were from Japan.

So what does Japan know that the Western world doesn't about longevity and aging? We'd broaden that to what does the East know that the West doesn't? Here are seven things we can learn from the East about aging:

  1. Healthy arteries don't just happen; you need to work at them.

  2. Yes, genes matter.

  3. It isn't just that they live longer; they live better.

  4. They not only exercise, but they do it as a community.

  5. The need to get things in balance is understood.

  6. A diet is what you eat for life; dieting is what occurs when you don't have a diet

  7. Naps are your friend.

How to manage an ageing workforce Apr 17th, 2014

In his Autumn statement last year, the chancellor of the exchequer set in motion plans to raise the state pension age to 70 for today's young people, on course to be the highest in the world. The question of whether people will need to work longer in the future is pretty much settled but there is still a lack of clarity about what work will be like for older workers of the future and how managers will oversee increasingly ageing workforces.

Answering the question of how to extend working life made a significant advance when the NHS Working Longer Review group reported the preliminary findings of its investigation into the impact of higher pension ages on the delivery of health services. This is the largest review of working practices in relation to age undertaken in the UK.

The outcome of their work is likely to prove seminal to the construction of a 21st century workplace bespoke to an ageing workforce for four reasons.

  1. Listen to the concerns of the staff

  2. Career progression

  3. A precious resource

  4. The need for dialogue with unions


Fight back against insurance premium increases Apr 15th, 2014

These recommendations together will give your control in the battle to minimize the cost of workers’ compensation.

Safety Program:

The lowest cost workers’ compensation claim is the one that never occurs. When an insurer is calculating your annual premium they review the frequency of accidents and the severity of the accidents that do occur, as well as the costs. A strong safety program will incorporate safety training for all employees, manual handling training, a job hazard analysis to identify and eliminate causes of accidents, work-site evaluations and inspections to prevent accidents, and a safety specialist or safety committee to keep safe practices at the fore-front of your work process.

Return to Work Program:

It is mandatory for your company to have an injury managment system and a company-wide return to work policy should be implemented. The return to work policy should be a part of every new employee’s orientation. It should be posted on the employee’s bulletin board and be discussed in staff meetings. All employees should know a job will be available to them as soon as they medically approved for light duties.

The company’s Injury Management Co-ordinator (IMC) should place a call to the medical provider the day of the initial medical treatment to learn the work restrictions provided by the doctor. The IMC should advise the doctor of the employer’s willingness to modify the employee’s job duties to comply with the work restrictions and be able to provide details of avaliable suitable duties.

Wellness Program:

An integrated health and wellness program will reduce the cost of workers’ compensation by reducing the impact of comorbidities on the injured employee’s recovery. The combination of unhealthy employee's and an aging population, with moves to increase the retirement age mean you will be increasingly hiring people with with one or a number of chronic conditions. By reducing obesity, diabetes, hypertension and physical deconditioning, an injured employee recovers faster from an injury, reducing both the amount paid for medical care and the time lost from work.

Get started with our free online LifeRISK Program.

Medical Cost Control Program:

In Western Australia, medical expenses make up ~16.0% of the total cost of worker comp. By directing the injured employee to a doctor with vocational medicine experience who understands the need to get the employee back to work as soon as feasible, you will eliminate unnecessary medical treatment and unnecessary delay in the employee returning to work. 

From the moment of injury and Post-Injury Investigation, until the injured employee has reached maximum medical improvement,  the course of the medical care should be managed. Initially, an IMC or occupational nurse can arrange the immediate first aid and any subsequent medical appointments. If the injury is severe, and the employee is going to be off work, the IMC or a preferred voc rehab provider can monitor and assist with coordination of medical care.

Line Supervisors - An Important role in RTW Apr 15th, 2014
Although there are many stakeholders in the RTW process, and employees supervisor has a pivotal role. A review of workers’ compensation systems in Australia revealed that injured workers nominated someone from the workplace as providing the most help with their RTW (16 %), third after their general practitioner (20 %) and their physiotherapist (19 %). Of that 16 %, nearly one-third (30 %) of injured workers nominated their immediate supervisor as the most helpful person at the workplace compared with occupational health and safety (OHS) officers (8 %), human resource (HR) staff (3 %) or RTW coordinators (3 %). However, 16 % of injured workers said their supervisor made RTW harder and these workers were less likely to sustain RTW

Employee supervisors provide:

  • modified work,

  • interpret policies,

  • assist with access to resources,

  • monitor workers’ health and functioning,

  • facilitate communication among stakeholders, and

  • communicate positive messages of concern and support, while having intimate knowledge of the jobs available.

  • The interface among upper management, rehabilitation and health care providers, coworkers, and the injured worker. 

However supervisors frequently experience role conflict between their production responsibilities and the demands of the modified work program. Some do not have a good understanding of musculoskeletal disorders (MSDs) or the ergonomic principles underlying the selection of appropriate duties or how to modify duties to meet the medical restrictions. These problems may result in the supervisor either not adhering to restrictions set by the medical certificate or preferring the worker to be fully recovered before RTW, neither of which is desirable. 


Johnston et al, 2014 put forward a model of the 10 competencies that should receive priority in any training delivered to supervisors. Supervisors need and seek support from experts in managing staff returning to work. This support can assist with complex cases, provide clarity to the supervisor’s role, and connect the returning worker to the services available within the organization. In large organizations this support may be available from in-house rehabilitation and RTW specialists but small to medium sized organizations may be disadvantaged by its absence.

  1. Managing and respecting privacy issues and medical and other confidential information received

  2. Knowing the tasks and workload of the worker’s job 

  3. Knowing what and how much the injured worker can and can’t do and how the injury impacts on the demands of the job 

  4. (MHC) Managing privacy issues in terms of disclosure, e.g. with co-workers

  5. Being honest

  6. Being able to manage conflict 

  7. Being able to deliver sensitive information, including information the injured worker doesn’t want to hear

  8. Being fair and just 

  9. Communicating in a respectful and appropriate way

  10. Knowing their legal obligations as supervisors

Sports Performance Testing Apr 14th, 2014

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Independent Medical Examinations and Specialist Assessment Apr 13th, 2014
Independent medical and Specialist examinations (IME's) can be an effective way to determine an injured worker’s medical status. But too often, they turn out to be a waste of money.

Here are a few tips for understanding getting the most from an IME:

  1. Before scheduling an IME, the claims manager and treating GP must know its purpose. Be specific about the details. Whether the issue is misdiagnosis, causation or degree of disability, provide medical reports, witness and injured worker statements, and other supporting materials.

  2. Find out the state’s laws and applicable treatment guidelines. Make a checklist of what needs to be done, how and when. Some states dictate timing and conditions of the IME. More often than not, IMEs occur too late in the process. Therefore, start considering an IME when the medical pieces of a claim are not fitting together and/or “red/yellow  flags” are showing up.

  3. To ensure credibility, hire well qualified and highly respected doctors. Those with a relevant specialty tend to get more weight than generalists. Doctors with successful private practices, are affiliated with teaching hospitals or are involved in research are generally given more credence.

  4. IMEs related to returning an injured worker to the job should include specific job requirements (i.e duties registry/suitable duties registry) according to the employer, physician input and the employer’s efforts to assure return to work.

  5. Communicate clearly to appropriate parties throughout the claims process. No matter how much you follow the other steps, miscommunication can cause something to go wrong.

Return to Work Tips Apr 13th, 2014

Returning injured workers to work is simply the right thing to do. Return to work is as humane as providing immediate appropriate medical care because workers who do not return to the job face lower salary potential in the future. There are several reasons for this. Working is good for us both physically and mentally, and the longer workers are away from the job and feel disconnected from their employer, the harder returning to work becomes. At a basic level, successful employers maintain contact with injured employees and believe that finding work for them during recovery is important. They prepare for return to work before an injury occurs, set clear expectations, consistently monitor employees on modified duty and more.

Here’s more ideas from the experts:

Consider taking the long view. Since workers who spend years loading and unloading heavy objects are more likely to sustain an injury, consider developing career paths for blue-collar workers. Potential career progression jobs include fork life operator or inspector.

Create a Suitable Duties Registry before an injury occurs. Approach each department of your organization to find out what work can be done by someone on limited duty. Constantly update the job list. Each job should include the position’s physical demands to appropriately match the injured employee to the job.

Have a formal written early return-to-work policy. A 'written' injury management sytem is legislatively required in WA. Consider including language limiting the time frames for the light duty as well as cautioning how transitional duty must meet relevant medical restrictions.

Clearly communicate to employees about workers’ compensation. This is most clearly and transperantly done by a formal Injury Managment Policy.

After injury, contact the injured worker as soon as possible. When the immediate supervisor and Injury Management Co-ordinator learn of the incident or the claim, he or she should contact the injured worker within 24 hours. Assistthe employee with filing a workers’ compensation claim forms and tell workers they are missed and that accommodations will be made for a transitional job as soon as possible.

Involve the injured worker’s doctor when developing a modified duty job with multiple restrictions. Rather than merely telling the worker about the modified job, put together a team that includes human resources, the supervisor, engineer and employee to work together to anticipate potential glitches. 

Informally gather the crew, supervisor, and the employee before putting him or her on transitional duty. This will make it easier to follow the doctor’s orders when everyone is aware of the worker’s restrictions as the employee works up to their MMI.

Ensure supervisors are accommodating rehabilitation plans by granting injured workers permission to elevate their feet, stretch and walk as recommended by the doctor.

To discourage re-injury, require managers to record workers’ activities when they return to the job. Include not only workers’ accomplishments but also tasks that they refuse. A detailed record of abilities and accomplishments could deter non-compliance and discrimination claims.

Encourage workers on modified duty jobs to spend their free time practicing safety exercises instead of sending workers home when they finish their work early. Injured workers can also get more safety training by watching videos or taking safety quizzes.  Perhaps they can share what they learned at a safety meeting.

Arthritic knee solutions Apr 11th, 2014

CONSIDER the alternative to total knee replacement in young, active patients with arthritis.

Medial compartment arthritis of the knee causes pain and interferes with the activities of many physiologically young and active patients.

Treatment options for these patients are limited if they wish to stay physically active. Total knee replacement (TKR) is reliable at providing pain relief for these patients but it restricts their work and sporting capabilities considerably.

The main goal of a high tibial osteotomy (HTO) is to realign the leg to decrease the pain associated with arthritis.

In younger patients who wish to remain active, this improves function and slows arthritis progression. Older or less active patients may be satisfied with a TKR.


Art of War - Lessons for Sport Apr 11th, 2014

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The Physical Genius Apr 10th, 2014


Cochrane Review - Childhood Obesity Apr 10th, 2014

Prevention of childhood obesity is an international public health priority given the significant impact of obesity on acute and chronic diseases, general health, development and well-being. The international evidence base for strategies that governments, communities and families can implement to prevent obesity, and promote health, has been accumulating but remains unclear. This review primarily aims to update the previous Cochrane review of childhood obesity prevention research and determine the effectiveness of evaluated interventions intended to prevent obesity in children, assessed by change in Body Mass Index (BMI). Secondary aims were to examine the characteristics of the programs and strategies to answer the questions "What works for whom, why and for what cost?"



We found strong evidence to support beneficial effects of child obesity prevention programmes on BMI, particularly for programmes targeted to children aged six to 12 years. However, given the unexplained heterogeneity and the likelihood of small study bias, these findings must be interpreted cautiously. A broad range of programme components were used in these studies and whilst it is not possible to distinguish which of these components contributed most to the beneficial effects observed, our synthesis indicates the following to be promising policies and strategies:

  • school curriculum that includes healthy eating, physical activity and body image;

  • increased sessions for physical activity and the development of fundamental movement skills throughout the school week;

  • improvements in nutritional quality of the food supply in schools;

  • environments and cultural practices that support children eating healthier foods and being active throughout each day;

  • support for teachers and other staff to implement health promotion strategies and activities (e.g. professional development, capacity building activities);

  • parent support and home activities that encourage children to be more active, eat more nutritious foods and spend less time in screen based activities.

Habits Predict Physical Activity on Days When Intentions Are Weak Apr 8th, 2014

Physical activity is regulated by controlled processes, such as intentions, and automatic processes, such as habits. Intentions relate to physical activity more strongly for people with weak habits than for people with strong habits, but people’s intentions vary day by day. Physical activity may be regulated by habits unless daily physical activity intentions are strong. This study suggested that on days when people had intentions that were weaker than typical for them, habit strength was positively related to physical activity, but on days when people had typical or stronger intentions than was typical for them, habit strength was unrelated to daily physical activity. Efforts to promote physical activity may need to account for habits and the dynamics of intentions.

Mothers improve their daughters’ vegetable intake Apr 5th, 2014

An intervention was designed for mothers to provide more vegetables to their daughters’ diet. The self-regulation intervention in mothers led to an increase in vegetable intake among their daughters. Engaging mothers in self-regulatory health promotion programmes may be a feasiblestrategy to facilitate more vegetable intake among their daughters.


A management accounting perspective on safety Apr 5th, 2014


Management accounting supports decision making in organisations by providing managers with relevant information and analysis on the performance, costs, and benefits of a certain operation. For safety-related issues, cost-based calculations dominate practice, and typical measures include cost per injury or the total cost of accidents. Monetary information is needed to guide safety-related decision-making. Besides focusing on financial information, management accounting should also focus on non-financial information, such as safety improvement, strategic safety objectives and employee relations. 

In safety-related investments, the monetary costs of an investment are usually well known, but the monetary value of the benefits is hard to calculate. Thus, there is a need for cost–benefit evaluation methods, including the non-financial benefits and value created though preventing accidents. In addition to calculating the safety investment costs, the efficiency of the improvements, such as productivity improvements, quality and the value of safety goodwill, should be evaluated as well.

The objective of this paper is to chart current management accounting practices related to safety issues on the basis of findings from relevant literature. Moreover, we discuss the applicability of certain management accounting methods for safety-related decision-making and how these can be used to improve current practices further. The relevant methods include the Balanced Scorecard approach, the payback period, the simple rate of return, and the benefit-to-cost ratio. They all offer means of calculating the cost and benefits of safety if the basic problems of uncertainty, valuation, perimeter of analysis, and quantification of costs and benefits are perceived. Valuing human life in cost–benefit analyses is also discussed.



Exercise is medicine - For the body and the brain Mar 27th, 2014


Cognitive decline is one of the most pressing healthcare issues of the 21st century. Worldwide, one new case of major cognitive decline (ie, dementia) is detected every 4 seconds. Given that no effective pharmacological treatment to alter the progress of cognitive decline exists, there is much interest in lifestyle approaches for preventing or treating dementia. One attractive solution that aligns with the above criteria is exercise. However,despite a large and consistent pool of evidence generated over the past five decades linking exercise to improved cognitive functions in older adults, there is a reluctance among academics, healthcare practitioners and the public alike to embrace exercise as a prevention and treatment strategy for cognitive decline. 

Since 2010, we have additional evidence from Random Controled Trials (RCT) that exercise, both moderate-to-vigorous intensity aerobic and resistance training, promotes cognitive and brain plasticity and have gained further insight into underlying mechanisms. In 2011, Erickson et al demonstrated that aerobic exercise resulted in increased hippocampal volume in healthy communitydwelling older adults. Furthermore,changes in hippocampal volume in the aerobic exercise group were significantly associated with increased spatial memory performance. Voss et al8 demonstrated that aerobic exercise improved the functional connectivity or temporal coherence of brain regions that are functionally related in a network known to deteriorate with ageing.For resistance training, Liu-Ambrose et al demonstrated increased functional plasticity after 12 months of training with corresponding improvement in selective attention and conflict resolution in healthy older women. Among older women with Mild Cognitive Impairment, Nagamatsu et al demonstrated that 6 months of resistance training led to improved executive functions, spatial memory and associative memory with concurring functional plasticity. In the same study, the authors also found that aerobic training improved verbal memory and learning.

Conclusion: Exercise should be promoted as an essential component of healthy ageing given that reducing physical inactivity by 25% could prevent as many as one million cases of dementia worldwide.



  1. Erickson KI, Voss MW, Prakash RS, et al. Exercise training increases size of hippocampus and improves memory. Proc Natl Acad Sci USA 2011;108:3017–22.

  2. Voss MW, Prakash RS, Erickson KI, et al. Plasticity of brain networks in a randomized intervention trial of exercise training in older adults. Front Aging Neurosci 2010;2,pii:32.

  3. Liu-Ambrose T, Nagamatsu LS, Graf P, et al. Resistance training and executive functions: a 12-month randomized controlled trial. Arch Intern Med 2010;170:170–8.

  4. Nagamatsu LS, Handy TC, Hsu CL, et al. Resistance training promotes cognitive and functional brain plasticity in seniors with probable mild cognitive impairment. Arch Intern Med 2012;172:666–8.

  5. Nagamatsu LS, Chan A, Davis JC, et al. Physical activity improves verbal and spatial memory in older adults with probable mild cognitive impairment: a 6-month randomized controlled trial. J Aging Res 2013,2013:861893.


Older Workers - How are the Japanese looking after their aging workforce Mar 26th, 2014

Unique efforts of the Japanese industries in meeting the needs of the super-aged society are introduced through their association with International Association for Universal Design (IAUD). Considerations are made on how successes were brought about, what can be learned as well as what issues should be addressed in the future.

What’s the best diet for weight loss? Mar 25th, 2014


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When it comes to weight loss, there are no magic tricks that guarantee success. What works for you is likely to be different to what works for your partner, neighbour or workmate. The best advice is to find a healthy eating regime – let’s call it a diet – that you can stick to. You may choose a specific diet book or commercial program to kick start your weight loss, but in the longer term, switch to an eating pattern you can live with for good.

The diet that works best will depend on many factors: your current weight, dieting history, how much weight you need to lose, reasons for wanting to lose weight, your knowledge and skills around food preparation and nutrition, personal supports and the time you have to focus on weight loss.

But first, a warning about fad diets.

Fad diets can work in the short-term because they lead to a reduction in total kilojoules but are usually nutritionally inadequate. They often ban specific foods or food groups, such as carbohydrates, and promise miraculous results. Or they may promote unproven fat burning or other supplements. Fad diets generally contradict advice from credible health professionals. Research shows the more radical the diet approach, the more likely you are to give up because of boredom or unpleasant side-effects including bad breath, constipation, and even gall bladder disease.




Seasonal Fruit Chart - Click for Printout Mar 25th, 2014

Chart Graphic

Seasonal Vegetable Chart - Click for Printout Mar 25th, 2014


Breaking up prolonged sitting with walking improves blood sugar levels Mar 24th, 2014

This study suggests that interrupting sitting time with frequent brief bouts of light-intensity activity, but not standing, imparts beneficial postprandial responses that may enhance cardiometabolic health. These findings may have importance in the design of effective interventions to reduce cardiometabolic disease risk.

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Steps to progress difficult Workers Compensation Claims Mar 23rd, 2014
Circumstances like the injured worker regularly getting no work capacity certificates without reporting any difficulties to their supervisor; maintaining they cannot do certain tasks despite apparently being within their certified work capacity; making requests of the Doctor to certify them to not work in certain areas/ locations; wanting to come in early and leave early on their reduced hours; requesting to work Monday to Wednesday for the 3 days they are certified for despite the Tuesday and Thursday being proposed as ‘rest days’ given their injury.

What to do?

1.  Engage with the Nominated Treating Doctor (NTD)

If you haven’t already you need to do whatever it takes to get the NTD to see you are not the ‘enemy’. Letting the NTD know you are committed to the early, safe and sustained return to work of their patient by sending the NTD details of the injured worker’s Return to Work Plan or arranging a Case Conference.

2.  Get a Second Opinion

It is important to have objective information on the injured worker’s current work capacity e.g. is there an issue that has not been addressed, does treatment need to change, is there fear of re-injury.  You could use your Preferred Medical Advisor or ask your insurer to arrange an Vocational Rehabilitation Referral.  It is important you do this ASAP as the longer a RTW Plan is not closely managed the harder it is to get it back on track and the more impact on the workplace culture.

3.  Know the Nominated Treating Doctor does not Run Your Business.

It is the domain of the NTD to diagnose and advise on work capacity, treatment and prognosis.  The NTD does not have the mandate to dictate which section someone works in or where they are located except maybe if there is a psych issue or genuine travel restriction but even then those can probably be managed in collaboration with the NTD like a co-worker collects the person.

4.  Develop a Detailed Return to Work Plan

The RTW Plan should detail all the information that is relevant to the injured worker such as their work capacity, suitable duties, hours and days of work and what they should do if they can’t adhere to it.  Points such as when the person starts and finishes, how they get to work (if travel is an issue), who they report to, what they do on the designated breaks (are they supposed to be resting, can they smoke?), when they attend physio and what time they leave and return for the appointment.  You get the drift I am sure.

5.  Monitor the RTW Plan Closely

As the RTW Co-ordinator it is your job to ensure the RTW Plan is relevant, progressing and adhered to.  Contact the injured worker every time they advise they have no work capacity to ensure the RTW Plan is still suitable, collaborate with the treatment providers and Insurer as well as engage with the NTD to keep the RTW Plan progressing.

6. Remember the Injuried Employee also has Responsibilities!


Optimal handle position for boxes Mar 22nd, 2014
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Previous studies indicate that Manual Material Handling (MMH) is not only the most frequent but also the most costly category of compensable loss in the workplace. Handles on objects are very important for enhancing the safety and efficiency of manual handling for people who use them. In this study, four different prototype boxes with auxiliary handles were designed to determine the optimal handle position of a box based on the evaluated user preferences and body part discomfort. The results show that the subjects preferred the upper part of the handle on a small box regardless of handling position; while the mid to upper parts of the handle on a big box were preferred for handling above the waist height. BPD also indicated that an upper handle was less stressful for a relatively smaller box than a big one; and mid to upper handles were less comfortable for a big box.Box

Conclusions: this study found that upper handles on boxes were the most appropriate in many MMH cases, but for bulky boxes or stacking heights above the waist level, there was a need to design a box with both upper and middle handles. It also should be considered that a different handling position may require a middle or lower handle.


10 Reasons Why Injured Workers become Chronic Claims Mar 20th, 2014
Some injuries take longer to heal due to the nature of the injury and management. However following are 10 psychosocial factors that lead to poor workers compensation outcomes. 

1. They Choose the Wrong Doctor

Just because the Family Doctor got them through the coughs and colds it does not mean their Dr is equipped to best treat their work-related back injury. Best practice in the management of workers with soft tissue injuries includes early return to work and advice to stay active and yet many Nominated Treating Doctors persist in certifying these patients with no work capacity. This results in deconditioning, detachment from the workplace and distress for both the worker and employer. It is important to realise the Health Benefits of Work.

A Doctor skilled in Occupational Health is Vital

2.Their Employer Does Not Take Control of Injury Management and RTW

In the absence of a well trained and supported RTW Co-ordinator and effective injury management and return to work procedures an injured worker chooses their Family Doctor as the Nominated Treating Doctor that is the first mistake.  The second one is to for the Employer to totally rely on the Agent to drive the process.

3. Referral to Rehabilitation is Delayed

It’s a fact the earlier an injured worker gets assistance to return to work the better the outcome.  Clearly this makes good business sense as someone sitting at home with an injury is not thinking good thoughts not to mention the impact on the NSW employer’s premium.  However the it does appear to improve outcomes for patients also.

4. The System Makes Them Sicker

Liability is obviously a big issue in the workers compensation system meaning injured workers might have to attend a raft of assessments that can overmedicalise their condition.  So what might have started out as a simple injury starts to feel like something very serious.  In any case if you are not back at work then you need to prove that you actually cannot work that entrenches the sick role.  Sadly too there is often no-one on the team telling them otherwise.

5. They Lack the Health Literacy to Make Themselves Better

Injured workers can tend to not ask questions of their Doctors as they are used to doing as they are told and after all it is a common assumption Doctors do leap tall buildings and catch speeding bullets in their teeth.  Some Doctors might even speak with God.  Low health literacy reduces the success of treatment and increases the risk of medical error.

6. Pain must mean there is Something Seriously Wrong with Me

The evidence that tissue pathology does not explain chronic pain is overwhelming and yet injured workers who have been badly managed and managed themselves badly end up in this hopeless cycle of inactivity and inaction for fear they will make themselves worse.  Some even have needless surgery because that’s what their Doctors suggested – refer to the assumption of speaking with God.

7. They Want to be 100% Better

We all age and our bodies endure wear and tear so when an injury happens there might be underlying features that made the worker prone to such an injury and in fact it easily could have happened at home where there would be no liabiity.  The issue is aches and pains go with wearing out and 100% better is not achievable.

8. They Think the Employer Should Pay

Anger can be a big factor in Chronic Pain.  My employer did this to me and I am going to make them pay.  It’s a pity the injured worker can trash their own life in the process.

9. They Persist with Unhelpful Treatment because the Employer is Paying.

It’s like the company car that goes from reverse to first at 50 kph if someone else is paying the bill then you won’t be judicious about what are the benefits and the value of what you are getting.  Poor health literacy also does not help.  Persisting with passive physiotherapy for example even makes you worse as you decondition and it entrenches the sick role.

10. Some People Don’t want to Go Back to Work

Sadly a workers’ compensation lifestyle can very quickly and easily prevail.  You don’t have to perform and you get to pick up the kids from school so the by the time your pay drops it is not such an issue and anyway you have sort of painted yourself into a corner.