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Senior Risk Engineer, Construction Primary Casualty, AXA XL

Musculoskeletal (MSK) injuries, such as sprains and strains, have plagued the construction industry forever. Construction activities – from heavy lifting to overexposure to tasks that put workers in awkward postures -make workers more susceptible to MSK injuries. Tendon, ligament, and muscle injuries continue to be a leading on-the-job injury among construction workers. And they are costly too. According to the National Council on Compensation Insurance, the average cost for a workers’ comp claim is $41,003.

In construction, unlike manufacturing, or other stationary occupations, designing the workspace to fit the employee is challenging due to a constantly changing work environment and changing work tasks that are found on the jobsite each day. According to AXA XL claims data, over a ten-year span, from 2011 to 2021, our collective construction book of insureds experienced 41% of total incurred WC loss expenses related to MSK injuries, the largest single accident type leading WC loss cases.

To help our Construction clients minimize MSK injuries and lost time on the jobsite, AXA XL has partnered with a mobile App platform called STAR Triage, a virtual Physical Therapy Triage platform from On-Site Solutions Physical Therapy (OSSPT), that brings injury management and MSK preventative guidance to an accessible Mobile App. STAR Triage is part of AXA XL’s Construction Ecosystem Tech Library.

Given how impactful MSK injuries are to our Construction clients, I sat down with OSSPT Owner and Doctor of Physical Therapy Melissa Gill to discuss the solutions STAR Triage brings to the construction industry and feedback on actionable measures that companies can take today to reduce workplace MSK Injuries. Here’s what Melissa has to share:

Tell us more about OSSPT. What are the core services and tech solutions?
Melissa: OSSPT is a physical therapy-based company that focuses on prevention of musculoskeletal (MSK) injuries onsite by providing services direct to employers and their employees. How do we decrease sprain/strain and overuse injuries? Our services include onsite/in person services as well as telemedicine for MSK triage. Our onsite services include work and non-work-related appointments, ergonomic evaluations, new employee body mechanic training, functional job descriptions and wellness services. OSSPT virtual services include our app, STAR Triage, which connects employees with a physical therapist for work and non-work-related aches and pains, sprains, and strains. For musculoskeletal issues, physical therapists are the “right provider at the right time.” The employee can also connect with a physical therapist on STAR Triage to get exercise and advise on how to prevent an injury or issue, such as strengthening the core muscles to decrease stress on the low back. We are woman-owned and have been providing onsite services for 13 years.

How can these other onsite or triage type Work Comp medical services work in conjunction with PT?
Melissa: An example of how we specifically work with a nurse call in line is as follows: Joe twists his ankle at work and connects with us via STAR Triage. We triage the situation and feel like he can self-manage the symptoms through OSHA first aid such as ice, compression, elevation, and light range of motion after 24-48 hours. We will follow up with the employee a few days later to assess their progress and compare to the “normal healing process.” If Joe is showing signs of a potential ankle fracture along with the sprain, we would send him to the nurse triage line which will provide all Work Comp paperwork and appropriate nurse follow up throughout the journey and medical system. If Joe is presenting as “normal” during the healing process, we will follow up 1-2 more visits to check progress and answer questions.

How is PT Triage different than Nurse Triage, something that’s more of a “household name”?
Melissa: The traditional nurse triage is a valuable service, and nurses know lots about many conditions. However, physical therapists (and athletic trainers to some extent) are musculoskeletal experts. Physical therapists and athletic trainers should be the primary provider to access acute and chronic aches and pains. Our company works within the boundaries of OSHA first aid for work related issues when possible. For work related, or non-work-related issues, physical therapists can treat autonomously, or without a referral from a doctor. Unfortunately, many people see the role of a physical therapist to rehab someone after an injury such as a rotator cuff tear or back surgery. But physical therapists and athletic trainers can be even more effective when we triage an ache or pain early and when we work to prevent MSK injuries. Nurse Triage lines are typically used for post-injury and Work Comp claim follow through. We work in conjunction with nurse call-in services as we are the first stop, but if the employee needs further medical intervention or more than OSHA first aid/self-management, we send them on to the nurse call in services such as Medcor and Work Care.



According to the National Safety Council, in 2018-2019, the average work comp claim cost (medical + indemnity) for sprains was $34,409 and fall/slip was $47,681

What are the benefits of early care for musculoskeletal injuries?
Melissa: Early intervention for MSK injuries has been shown to decrease opioid use, decrease missed days, and increase the employee ability to return to their original job.

According to the National Safety Council, in 2018-2019, the average work comp claim cost (medical + indemnity) for sprains was $34,409 and fall/slip was $47,681! If we can avoid even a few of these high-cost claims, we have a positive ROI and a better course of action for the employee.

Getting the right care at the right time, may decrease unnecessary diagnostic tests such as MRI and x-ray, and get the employee quicker answers on their MSK issue.

A constantly changing work environments, and job tasks, in construction make tackling workplace ergonomics very challenging. I am often getting the question of “where do I start?”. Knowing this is a challenge for our customers, what are some core principals and areas of focus that our construction customers can take away today to best manage MSK Injuries?
Melissa: The best construction ergonomic programs are based on understanding the neutral postures and positions and applying the concepts to a specific job task or individual performing the job task. For example, work performed at a height between hips and shoulders, will decrease strain on the back by not bending too far forward, and decrease strain on the neck and shoulders by not performing the work above shoulder height. So, an observer can assess the height of the work and give a recommendation to if the work height should be lower or raised. If the work height cannot be between hips and shoulders, then a counteracting stretch would be recommended. When a task is lower than hip height and the employee is bending forward for an amount of time, the employee should counteract the movement by bending backwards. Learning basic ergonomic principals and counteracting stretches can be beneficial to decrease risk for MSK injuries.

Construction ergonomics is a face-to-face service; however, STAR Triage supports the efforts by providing a resource for the client when questions arise. For example, if a construction ergonomic question arises, and there is not an onsite physical therapist, the client can reach the PT through STAR to get assistance and recommendations on how to decrease risk for injury through ergonomic changes.

When it comes to “Stretch and Flex” programs, can you offer any guidance what makes an effective program? Are there components of a program to stay away from?
Melissa: Absolutely! The reason why we call our program StretchRight is because there are specific and important elements in a proper stretch program. With years of experience creating construction stretch programs, and knowledge of the body and research behind proper stretching, here is an outline of a good program:

  1. Dynamic warmup – The stretching program should start with a dynamic movement to increase blood flow to the muscles, increase lubrication for the joints, and prepare the body for movement. Examples of a dynamic warm up include mini squats, marching in place, lunges, arm circles, etc.
  2. Short hold stretches – Some benefits of short hold stretches are to prepare the spine for counteracting movements and engage and activate postural muscles. One example of a short hold stretch is a backwards bend which is held for just a few seconds. These stretches can also be performed throughout the day.
  3. Holding (static) stretches – Static stretches are to be held 20-30 seconds at the end of the range of motion. The stretch should be slightly uncomfortable (so the tissue is elongating) but never painful. The most common static stretches for construction are hamstring, calf, low back and forearm/wrist.

Specific stretches should be chosen based on the most common work tasks and/or common positions. For example, if an employee uses hand tools or a hammer frequently, they will benefit from forearm stretches to decrease risk of golfers or tennis elbow, or wrist strain. Also, it is helpful to educate the worker on taking stretch breaks throughout the day as their body feels fatigued or discomfort.

StretchRight is an onsite service, however, STAR Triage can maintain a connection with the stretch leaders on a consistent basis to discuss stretching and to make changes to the program as needed. STAR can also be used if an employee is unable to perform a specific stretch, the PT can modify the stretch or provide an alternative.

How can our customers be in touch with you and learn more about Star Triage?
Melissa: We’re excited to be part of Construction Ecosystem’s Tech Library and anyone interested in learning more see us there or visit our website at www.onsitesolutionspt.com.

 

 

Global Asset Protection Services, LLC, AXA Matrix Risk Consultants S.A. and their affiliates and partners (“AXA XL Risk Consulting”) provide loss prevention and risk assessment reports and other risk consulting services, as requested. In this respect, our property loss prevention publications, services, and surveys do not address life safety or third party liability issues. This document shall not be construed as indicating the existence or availability under any policy of coverage for any particular type of loss or damage. The provision of any service does not imply that every possible hazard has been identified at a facility or that no other hazards exist.  AXA XL Risk Consulting does not assume, and shall have no liability for the control, correction, continuation or modification of any existing conditions or operations. We specifically disclaim any warranty or representation that compliance with any advice or recommendation in any document or other communication will make a facility or operation safe or healthful, or put it in compliance with any standard, code, law, rule or regulation. Save where expressly agreed in writing, AXA XL Risk Consulting and its related and affiliated companies disclaim all liability for loss or damage suffered by any party arising out of or in connection with our services, including indirect or consequential loss or damage, howsoever arising. Any party who chooses to rely in any way on the contents of this document does so at their own risk.

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Global Asset Protection Services, LLC, and its affiliates (“AXA XL Risk Consulting”) provides risk assessment reports and other loss prevention services, as requested. This document shall not be construed as indicating the existence or availability under any policy of coverage for any particular type of loss or damage. AXA XL Risk. We specifically disclaim any warranty or representation that compliance with any advice or recommendation in any publication will make a facility or operation safe or healthful, or put it in compliance with any standard, code, law, rule or regulation. Save where expressly agreed in writing, AXA XL Risk Consulting and its related and affiliated companies disclaim all liability for loss or damage suffered by any party arising out of or in connection with this publication, including indirect or consequential loss or damage, howsoever arising. Any party who chooses to rely in any way on the contents of this document does so at their own risk.

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