But many doctors, physicians’ assistants and nurses find that while they can help these patients with their medical problems and physical recovery, treating someone with a work injury presents a unique set of challenges – not all of them medical.

Indeed, injured workers and their families must deal with a host of issues as they try to heal and rebuild their lives after being hurt on the job. There are emotional and financial burdens, and a seemingly endless amount of bureaucratic red tape to navigate when filing a workers’ compensation claim.

Additionally, injured workers face tremendous external pressure from family members, coworkers, employers and insurance companies to return to work so they can start earning a paycheck again. It’s also not unusual for injured workers to pressure themselves to return to work before they’re physically ready because they feel obligated to do so or feel “less than” because they’re out of work and collecting unemployment benefits.

When we started the Deuterman Law Group six years ago, one of our founding principles was that we would treat clients as people, not as cases, and that we would attend to the whole person. It’s our job to ensure not only that our clients receive the maximum workers’ compensation and medical benefits available to them, but also to assist them as they adjust to a new “normal” following an injury.

I believe that most healthcare professionals who are treating injured workers want the same for these patients and realize that their obligation to them extends beyond providing basic medical care. But workers’ compensation isn’t taught in medical school, so most doctors, nurses and medical office staff don’t know how else they can help these patients. And they may also be unaware of additional services available to injured workers – at no extra cost to the patient – as a result of their workers’ compensation benefits.

I offer the following suggestions and insights into the intricacies of workers’ compensation law in North Carolina that I hope physicians and other healthcare workers will find useful as they're  treating injured and disabled workers:

• If a patient comes to you with an injury resulting from an accident at work or a chronic condition that was likely caused by their job, encourage that person to report the injury, if he or she hasn’t already done so. Ideally, work injuries should be reported immediately to the employer and the N.C. Industrial Commission and, in any event, within 30 days of the accident or diagnosis that the condition is work-related.
• Keep detailed records of the patient’s treatment and any conversations you have about the injuries. Detailed medical records, which accurately reflect the patient’s symptoms, treatment and the progression of their recovery, are crucial in workers’ compensation claims. Many cases end up in litigation simply because medical records lack details or are ambiguous.
• Encourage you patient to keep a calendar or journal to document important facts relating to the work injury and ongoing treatment. In their journals, patients should record details of how the injury occurred, who witnessed it and how and when it was reported. Additionally, injured workers should make note of any medical appointments in their journals, recording any medical procedures that were conducted and instructions they received from healthcare workers. Finally, patients should write about any symptoms or additional medical problems they’re experiencing and any harassment they encounter from employers, coworkers or the insurance company regarding the work injury. Workers’ personal journals have proven to be invaluable in presenting a workers’ comp claim to the N.C. Industrial Commission.
• Some injured workers will want to return to work before they are medically able to do so. While injured workers are justified in their fear of reprisal for missing work because of an injury, strongly discourage them from returning to a job for which they are physically unprepared. Candidly explain the risk of re-injury. And while it’s true that some people are fired for filing a workers’ compensation claim – even though the law forbids such retaliation – being fired is preferable to derailing recovery or creating a worse medical problem by returning to work too soon. Let your patients know that there is legal recourse if they are fired. Patients can file a wrongful termination claim themselves with the Industrial Commission, but many will find it helpful to have an attorney advocate on their behalf.
• Injured workers may be entitled to additional benefits beyond compensation for lost wages and traditional medical care. The standard in North Carolina is whether or not the recommended treatment is reasonably likely to effect a cure, give relief from symptoms (including pain relief) or lessen the period of disability. Under this standard, in cases of catastrophic injury, North Carolina’s workers’ compensation law allows for things like home and vehicle modifications, medical devices in the home such as hospital beds, in-home attendant care, motorized wheelchairs, etc. So long as these devices/modifications meet the standard recited above and are prescribed by a treating physician, they should be covered by the Workers’ Compensation insurance company.
• Many injured workers believe that they don’t have the right to choose their own doctor and that they must see a physician assigned by the N.C. Industrial Commission or their employer’s workers’ comp insurance company. Patients have the right to ask the Industrial Commission for permission to see a doctor of their choosing. However, if an injured person is treated by a physician without first getting permission, his or her workers’ comp benefits might be in jeopardy. If a patient comes to you under these circumstances, advise them that an attorney can help ensure that benefits are protected.
• Injured workers who must travel 20 miles or more roundtrip for medical care are entitled to collect $0.55 per mile. Special consideration also is given to employees who are totally disabled.
• Chiropractic treatment is allowed for workers’ compensation patients, if the employer or the employer’s insurance company grants permission. As many as 20 visits are allowed, if medically necessary. If additional visits are needed, the chiropractor should request this authorization from the Industrial Commission.

This time, we turn to yoga, the ancient Indian mind-body practice that has become a mainstream form of exercise, stress release and pain management.

Future articles in this series will explore massage, Pilates, Reiki and other alternative treatments and pain-management techniques. You can access all articles in the Alternative Therapies Series by clicking here.

This article is presented for informational purposes only. As always, please consult with your physician and other health care providers before undertaking an exercise regimen or alternative treatment.

The following is adapted and excerpted from the National Center for Complementary and Alternative Medicine, Yoga Today and Yoga Journal.

There are many different styles of yoga - Hatha, Vinyasa, Iyengar, Bikram (or hot yoga), Ashtanga and Kindalini, for example - but all are based on the same postures. These types of yoga differ in pacing, intensity and area of emphasis, such as breathing, body alignment or flow. It's not uncommon for people who've tried yoga and disliked it to discover that they love it after participating in another type of yoga class.

While some people practice yoga for physical fitness, others use it as a method of relaxing and reducing stress.

A good primer on the different types of yoga is available online. There's also an online tool designed to help you determine your yoga type.

The gentle Iyengar form of yoga, for instance, is good for people who have suffered from injuries or who have medical conditions that require special attention. As with any exercise regimen or alternative therapy, you should always consult with your physician before taking up yoga to avoid pushing your body beyond its limits and capabilities.

Origins of Yoga

Yoga in its full form combines physical postures, breathing exercises, meditation, and a distinct philosophy. Yoga is intended to increase relaxation and balance the mind, body, and the spirit.
Early written descriptions of yoga are in Sanskrit, the classical language of India. The word "yoga" comes from the Sanskrit word yuj, which means "yoke or union." It is believed that this describes the union between the mind and the body.

The first known text, The Yoga Sutras, was written more than 2,000 years ago, although yoga may have been practiced as early as 5,000 years ago. Yoga was originally developed as a method of discipline and attitudes to help people reach spiritual enlightenment. The Sutras outline eight limbs or foundations of yoga practice that serve as spiritual guidelines:

1. yama (moral behavior)
2. niyama (healthy habits)
3. asana (physical postures)
4. pranayama (breathing exercises)
5. pratyahara (sense withdrawal)
6. dharana (concentration)
7. dhyana (contemplation)
8. samadhi (higher consciousness)

The numerous schools of yoga incorporate these eight limbs in varying proportions. Hatha yoga, the most commonly practiced in the United States and Europe, emphasizes two of the eight limbs: postures (asanas) and breathing exercises (pranayama).

According to the 2007 National Health Interview Survey (NHIS), yoga is one of the most mainstream complementary and alternative therapies being used by Americans. More than 13 million adults had practiced yoga in the previous year, an increase of 3 million people since 2002. The 2007 survey also found that more than 1.5 million children practiced yoga in the previous year.

According to Yoga Journal's most recent "Yoga in America" survey, 15.8 million people in the United States now practice yoga, spending nearly $6 billion a year on classes, equipment, clothing, vacations and yoga-related books, magazines and DVDs.
 

Yoga & Health

People use yoga for a variety of health conditions including anxiety disorders or stress, asthma, high blood pressure, and depression. People also use yoga as part of a general health regimen-to achieve physical fitness and to relax.

Research suggests that yoga might:

• Improve mood and sense of well-being
• Counteract stress
• Reduce heart rate and blood pressure
• Increase lung capacity
• Improve muscle relaxation and body composition
• Help with conditions such as anxiety, depression, and insomnia
• Improve overall physical fitness, strength, and flexibility
• Positively affect levels of certain brain or blood chemicals.

There's strong anecdotal and increasing scientific evidence that yoga can have a healing impact on certain injuries while also offering pain relief. Recently, researchers at West Virginia University found that people with chronic low-back pain reduced their pain and improved their mobility through the practice of Iyengar yoga.

The researchers found that compared with a control group who received only standard medical care, the yoga group had significantly greater reductions in functional disability, pain, and depression.

Yoga is generally considered to be safe in healthy people when practiced appropriately.

However, people with certain medical conditions should not use some yoga practices. For example, people with disc disease of the spine, extremely high or low blood pressure, glaucoma, retinal detachment, fragile or atherosclerotic arteries, a risk of blood clots, ear problems, severe osteoporosis, or cervical spondylitis should avoid some inverted poses. It's important to consult with a physician and a skilled yoga practitioner before beginning yoga.

In addition, while yoga during pregnancy is safe if practiced under expert guidance, pregnant women should avoid certain poses that may be problematic.

Finding a Yoga Class

Because of its popularity and accessibility to people of different fitness levels and physical abilities, most private health clubs and YMCAs offer yoga classes. Most communities also have private yoga studios that offer classes for a small fee. Some physician's offices and hospitals also offer yoga classes.

In addition, you can find many yoga workouts online, many designed for people with certain injuries, illnesses or types of pain:

For lower back pain

Also for lower back pain

General yoga workouts

For shoulder pain

For knee pain
 

There are many training programs for yoga teachers throughout the country. These programs range from a few days to more than 2 years. Standards for teacher training and certification differ depending on the style of yoga.

There are organizations that register yoga teachers and training programs that have complied with minimum educational standards. For example, one nonprofit group requires at least 200 hours of training, with a specified number of hours in areas including techniques, teaching methodology, anatomy, physiology, and philosophy. However, there are currently no official licensing requirements for yoga teachers in the United States.

If You Are Thinking About Yoga

• Do not use yoga as a replacement for conventional care or to postpone seeing a doctor about a medical problem.
• If you have a medical condition, consult with your health care provider before starting yoga.
• Ask about the physical demands of the type of yoga in which you are interested, as well as the training and experience of the yoga teacher you are considering.
• Look for published research studies on yoga for the health condition you are interested in.
• Tell your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.
• If you take one yoga class and don't like it, consider trying a different style of yoga or taking a class from a different teacher. Teaching methods and yoga styles vary, and you may have to try several classes before finding the one that is right for you.
• If you experience pain while practicing yoga, stop. Don't push yourself to do any pose that causes you pain.

Many injured and disabled workers also will develop depression – creating a double whammy of physical and emotional pain that can prolong recovery and lead to additional health problems.

The stress and financial burdens of being out of work combined with physical pain and the loss of identity that many out-of-work people injured people experience quite often leads to associated depression, according to medical research and our own experience with clients at the Deuterman Law Group. Unfortunately, so-called secondary depression is often under diagnosed, according to a 2005 article in trade journal Risk & Insurance.

 It is important for anyone who is suffering from depression to seek treatment, especially those who have an injury or disability that prevents them from working. Studies have linked pain with depression, and there’s evidence that depression can slow recovery from an injury or illness.

“Depression may increase your response to pain, or at least increase the suffering associated with pain,” according to the Mayo Clinic. “Conversely, chronic pain is stressful and depressing in itself. Sometimes pain and depression create a vicious cycle,”

A 2005 British study revealed that 20 percent to 30 percent of people injured in car accidents or on the job had their recovery impacted by depression and other psychological factors.

In workers’ compensation cases, depression that is the result of a work injury may be compensable. In other instances, depressed individuals may qualify for Social Security Disability.

If a client is experiencing symptoms of depression, it’s important that they are evaluated by a qualified medical professional, who can prescribe a course of treatment that may include therapy, anti-depressants or a combination.

It’s also important that clients share this information with their attorney and paralegal, as this may be important to the case. We may be able to we may be able to offer additional help and referrals to a support groups, community resources and medical professionals who can help our clients deal with these problems and overcome their depression.

Only a qualified medical professional diagnose depression, but the following is a list of symptoms:

• Loss of interest in normal daily activities
• Feeling sad or down
• Feeling hopeless
• Crying spells for no apparent reason
• Problems sleeping
• Trouble focusing or concentrating
• Difficulty making decisions
• Unintentional weight gain or loss
• Irritability
• Restlessness
• Being easily annoyed
• Feeling fatigued or weak
• Feeling worthless
• Loss of interest in sex
• Thoughts of suicide or suicidal behavior
• Unexplained physical problems, such as back pain or headaches

The Mayo Clinic also offers a depression self-assessment tool online.

People who own BlackBerry devices can't seem to put them down. They're constantly typing and texting friends, family, the office. But handy devices such as the BlackBerry, Sidekicks, and Treos that make our hectic lives more manageable are wreaking havoc on our thumbs.

This article offers tips on preventing BlackBerry Thumb by making simple changes such as typing with your fingers instead of your thumbs. Spas at the Hyatt hotel chain are even offering a BlackBerry massage. Who knows if it works, but it's certainly great marketing! The thumb massages start at $80.