I've been in industry for 40 years now. It used to be if you got hurt, you stayed on the job no matter what. Then for a long time, people just retired early on disability. Now I see workers are coming back to work again after an injury. What controls these swings back and forth?

Many factors play a role in return-to-work decisions. The policies of Workers’ Compensation are one important factor. The availability of disability benefits is another major contributor. The business and legal climate of our country also makes a difference.

Social expectations about return-to-work change with changes in each of these policies. And published research on the subject of injury, chronic pain, and disability can also sway treatment programs.

For a long time, we operated under the belief that bedrest was the best treatment for low back pain (LBP). Then about 20 years ago, a group of researchers published a landmark study that changed everything.

They showed that activity and exercise was the best way to manage low back pain. Specific exercises, training in work-related tasks, and work simulation became the new focus. Patients spent up to 57 hours a week in a work hardening program. This was designed to get them back on the job.

The results of this new approach have stood the test of time. Many other independent studies have backed up the conclusions of the original research. Preventing deconditioning with activity has been shown to reduce the number of days off work.

The focus is no longer just on reducing pain. Managing the pain while improving function is the new direction. Patient education focuses on overcoming patients' beliefs about their limits. This may be what you are seeing in your own particular area of industry.