Q&A: Addressing Employees’ Preexisting Conditions
By Andrew Summerlin
Injury Prevention Specialist, Fit For Work
When you hire employees in industries such as construction, warehousing, or manufacturing, they often come to you with preexisting conditions – especially musculoskeletal (MSK) issues such as past shoulder or knee injuries. In my experience, 25-50% of workers go through the onboarding process with preexisting conditions, which should be addressed as part of a proactive injury prevention program.
Early Intervention shows employees that you care while helping them avoid aggravating their condition, which could result in on-the-job injury.
Note that workers in these industries are typically physically oriented and fairly athletic. Many have played sports during high school or college and experienced the strains or sprains accompanying football, soccer, or other athletics. In fact, we often use the term “Industrial Athletes” to describe today’s workers because of the physical demands for energy, flexibility, strength, and endurance they face during long shifts.
Let’s look at some vital questions and answers around the issue of preexisting conditions.
Why is it important to address preexisting conditions?
For employers, a key objective is to keep workers healthy and decrease lost-time injuries and workers’ compensation claims. Identifying and addressing employees’ preexisting conditions is essential so they do not aggravate or reinjure these areas on the job. By tackling these issues during new employee onboarding, your injury prevention specialist can supply education and at-home exercises to decrease the likelihood of reinjury.
Providing support today pays off down the road, as many employers are seeing an aging workforce. Education and exercise programs can keep mature workers performing at peak levels while avoiding injuries. At the same time, encouraging younger employees to develop and maintain strength, flexibility, and endurance builds positive behaviors to help them avoid injury in the years to come.
What are examples of preexisting conditions?
A preexisting condition is any medical condition that an employee carries to a new job. Particularly, I see MSK disorders that can lead to aggravation of a condition and, eventually, recordable or reportable injuries. Examples include:
- Rotator cuff injury – residual shoulder weakness or limited mobility can result in reinjury moving 30-pound products in a warehouse environment
- Bicep injury or strain – repetitive motion in a manufacturing setting can aggravate a tendon tear at the shoulder or elbow
- Slipped disk – a common injury worsened by lifting, such as in an industrial freezer setting requiring repeated movement of a 50-pound product
- Ankle sprain – a chronic sports injury that can be aggravated by steel-toed composite shoes that provide limited ankle support
- Knee sprain – untreated, this issue can lead to reinjury when not utilizing three points of contact descending a semitruck, pallet jack, or other heavy equipment in construction/warehousing – increasing the slip, trip, or fall risk
How can you prevent preexisting conditions from being aggravated?
Two keys to prevention are awareness and education. By encouraging communication and offering information about preexisting conditions, we can manage the potential for aggravation and reinjury. Non-occupational services can include custom-designed home exercise programs or preemptive rehabilitation to maintain or improve the employee’s condition. For progressive companies, having a specialist onsite at the workplace makes this preventive care readily available.
Let’s consider several case studies that show how the process works.
Case Study #1 Rotator Cuff Issues
A new employee reported a history of rotator cuff issues due to a sports injury. The injury prevention specialist evaluated the employee, provided education regarding their condition, and designed a home exercise program to rehabilitate the condition. Within a few weeks, the employee reported increased rotator cuff strength and subsequent pain relief – with no reinjury.
Without this early intervention, the employee’s rotator cuff, aggravated by overcompensation, could have led to extreme pain, reinjury, and time off work. Treatment would likely have involved visiting an orthopedic specialist, injections, physical therapy, and two-three months of light duty under workers’ compensation. Instead, this employee, in his 20s, has developed healthy behaviors to protect his rotator cuff, avoid injury, and stay on the job. The employer likely avoided a lost-time injury and a workers’ compensation claim.
Case Study #2 Chronic Ankle Sprains
An employee reported a history of ankle sprains due to sports involvement. The injury prevention specialist evaluated the employee’s condition, provided education regarding chronic lateral ankle sprains, and supplied them with bracing for personal use, plus exercises to strengthen the surrounding musculature. As a result, the employee reported increased ankle strength and stability – with no injury.
A warehouse selector who routinely placed products onto a power pallet jack with fast movements, this young worker avoided a possible ankle injury that may have required treatment beyond one-time, short-term OSHA first aid. If they reinjured their ankle, treatment would have likely included an orthopedic visit, MRI, walking boot, and physical therapy. Instead, the employee and employer avoided a lost-time injury, days off work, and a possible workers’ compensation situation.
How do you encourage employees to communicate preexisting conditions?
It’s essential to foster trust in a confidential setting where employees feel free to discuss their healthcare concerns – knowing their private health information will not be shared with their employer. This is the purview of an onsite injury prevention specialist with the training, experience, and resources to advocate for the employee at an early stage – before soreness escalates or injury occurs – and act as a resource to the correct gateway service providers.
In my experience, about 75% of workers are relieved to be able to share this non-occupational information and get help for their conditions, knowing that this support will help them stay healthy on the job – and go home healthy.
There are a few guidelines for talking with employees about preexisting conditions:
- Be aware that the Americans with Disabilities Act (ADA) limits what employers can ask employees about their medical history or disabilities. Personal healthcare questions are none of the employer’s business but asking about injuries that may affect the employee at work is pertinent.
- A licensed medical professional can evaluate an employee’s preexisting conditions to determine if they can perform the job with any necessary accommodations or restrictions. During the initial evaluation, a mechanism of complaint or injury is noted, and a symptom report can detail employee comments. If an employee is injured in the same area as a preexisting condition, the insurance company will pay for treatment.
What does OSHA say about preexisting conditions?
OSHA defines a preexisting condition as an injury or illness caused by a non-work-related event or exposure outside the workplace. Preexisting conditions are not usually recorded on an OSHA log. However, if a work-related event or exposure significantly aggravates a preexisting condition, it must be recorded. A preexisting condition is considered significantly aggravated if it results in:
- Death
- Loss of consciousness
- Days away from work
- Days of restricted work or job transfer
- Medical treatment not needed before the work-related event
- A change in the course of medical treatment
For example, if an employee strains their back at home and then strains it again at work, requiring several days of bed rest, the employer must record it as a “days away” case. It becomes a recordable injury, which may affect the employer’s workers’ compensation insurance coverage. If days off work or light duty are required, this transitions to a recordable injury in the OSHA system. (Note that reportable incidents require first aid only, while recordable incidents are documented by the employer as recorded.)
Are there tangible benefits from addressing preexisting conditions?
Addressing preexisting MSK medical conditions does help prevent further injury within the workplace. For example, I recently evaluated 10 employees at a manufacturing facility for preexisting conditions, addressing any soreness or other concerns. Since then, these non-occupational cases have resolved without reinjury within the workplace.
From a non-occupational perspective, I find that about 95% of employee concerns are resolved with the help of an injury prevention specialist, and only about 5% need assistance from a medical provider. Workers appreciate that we offer personal attention, look for underlying factors in their physical problems, educate them, and help them stay on the job – stronger with less risk of injury.
Showing employees that you care yields more benefits as employees share successes by word of mouth, building your company’s positive reputation.
Another advantage is that if the time does come for a reportable injury within the workplace, employees are more likely to trust a known process and a known person. Employee buy-in from an early stage allows you to provide tangible results within OSHA first aid parameters, decreasing recordable workplace injuries. For example, 30 employees were recently evaluated at a manufacturing facility for reportable injuries – these employees were well aware of the Fit For Work Early Intervention process and program. Only two cases have been converted to recordable – a number well below the norm.
How Fit For Work Helps
Fit For Work onsite injury prevention specialists provide occupational and non-occupational services and work with employees to identify preexisting conditions and decrease the likelihood of reinjury within the workplace. Early Intervention is paramount to injury prevention, helping employees live a productive life – at work and home – while employers show that they care about workforce health and safety. Click here to learn more about Fit For Work’s Early Intervention solutions.
Andrew Summerlin graduated from the University of West Florida with a Bachelor of Science in athletic training with minors in sport management and sport and exercise psychology in May 2019. He joined Fit For Work in August 2023. Prior to starting work in the industrial setting, Andrew worked in surgical, clinical outpatient, rehabilitation, and secondary school settings. He most recently worked for Pediatric Orthopedic Surgeons, where he completed casting and bracing, developed home exercise programs, and assisted in the operating room as needed. Andrew began his Master of Health Administration in August 2023 at the University of Central Florida and anticipates graduating in July 2025.
