OSHA: Exercise for back pain recordable

Working with trainer is like physical therapy

Imagine this scenario: A nurse has soreness and back pain related to patient handling and other work duties. A certified athletic trainer recommends a regimen of stretching and exercises to reduce the pain. Does that make the injury recordable?

In a recent letter of interpretation, the U.S. Occupational Safety and Health Administration says "therapeutic exercise" is a form of physical therapy and is therefore considered a "medical treatment" and subject to reporting.

Here's what Keith Goddard, director of OSHA's Directorate of Evaluation and Analysis, said in response to a question to the agency:

"OSHA discussed the issue of therapeutic exercise in the preamble to the final rule revising OSHA's injury and illness recordkeeping regulation. See, 66 FR 5992, January 19, 2001. OSHA stated that it considers therapeutic exercise as a form of physical therapy and intentionally did not include it on the list of first aid treatments in Section 1904.7(b)(5)(ii). Section 1904.7(b)(5)(ii)(M) states that physical therapy or chiropractic treatment are considered medical treatment for OSHA recordkeeping purposes and are not considered first aid. Section 1904.7(b)(5)(iii) goes on to state that the treatments included in Section 1904.7(b)(5)(ii) is a comprehensive list of first aid treatments. Any treatment not included on this list is not considered first aid for OSHA recordkeeping purposes.

"Please be aware that if a treatment is administered as a purely precautionary measure to an employee who does not exhibit any signs or symptoms of an injury or illness, the case is not recordable. For a case to be recordable, an injury or illness must exist. For example, if, as part of an employee wellness program, [a certified athletic trainer] recommends exercise to employees that do not exhibit signs or symptoms of an abnormal condition, there is no case to record. Furthermore, if an employee has an injury or illness that is not work-related, (e.g., the employee is experiencing muscle pain from home improvement work) the administration of exercise does not make the case recordable either.

"Your letter also requested specific guidance on several questions concerning the administration of exercise. For purposes of this response, we presume that all of the questions relate to the administration of exercise as a treatment for work-related injuries."

Q: Would the providing of an employee with a written home exercise program (including sets/reps and resistance) constitute first aid or medical treatment?

A: This constitutes medical treatment.

Q: If the [certified athletic trainer] utilizes stretching to relieve their symptoms, does this service constitute medical treatment or first aid?

A: This constitutes medical treatment.

Q: Is the number of times seen for care significant in determining recordability?

A: No. The number of times seen for care is not a factor when determining OSHA recordability. The focus is on the type of treatment rather than the number of times such treatment is administered.

Q: Is the duration or intensity of the care significant in determining recordability?

A: No. The duration or intensity of the care does not determine recordability. Again, the focus is on the type of treatment.

Q: Are the numbers of follow-ups significant in the recordability of the care?

A: No. The number of follow-up visits to receive care does not determine the outcome for an OSHA recordable.

Q: Is there a general guideline that [a certified athletic trainer] can use to know if they are crossing the line from first aid to medical treatment?

A: In general, first aid can be distinguished from medical treatment per Section 1904.7(b)(5)(ii) and 1904.7(b)(5)(iii). As noted above, Section 1904.7(b)(5)(ii) states that the list of first aid treatments included in Section 1904.7(b)(5)(iii) is comprehensive. Any treatments not included on the list would not be considered "first aid" for OSHA recordkeeping purposes.