Work	Quick Index 1. Returning to work 2. Your symptons 3. Return to work plan 4. While at work 5. Conclusion

Returning to work

"In the first few months I had physiotherapy twice a week and remedial deep massage at the chiropractor once a week. After two weeks off work, I was on a gradual work return program. My main pain came from my neck while working at the computer. I solved this by listening to music on my earphones and moving my shoulders, neck and head in time with the tune. Plus installing WorkPace, an ergonomic minder that I had read about in your magazine that helped me keep regular breaks and exercise time. The unanticipated usefulness of the Minder is that it reinforces to your work colleagues the need for you to take regular breaks."     Aneke

If you have been given some time off work in order to recover, thinking about a return to work can be daunting. It is a time when many people with RSI are unsure about themselves and their job and feel they have little control over their situation. In theory, the return to work process is designed to help you back into work without aggravating your injury. Returning to work will involve some or all of the following people:

• Your rehabilitation provider.
• Your employer and/or case manager.
• Your doctor, and You.

Discussions between these people will determine your position, tasks and hours when you return to work. A timetable may be put forward outlining a return to work program and the steps involved. It is then expected that all parties will abide by this plan.
However, the return to work process does not always run smoothly. Many people feel they are pushed into going back to work before they have a chance to fully or even partially recover. They feel fearful about perhaps losing their job or about how others perceive their time off.

"You just feel so compelled. I kept thinking that I would lose my job if I didn’t go back… You don’t want people to think that you are taking off too much time or not making a contribution. You feel forced to maintain the same standard as you would if you were not injured."

Many people with RSI feel they have little control throughout this process. They agree to return-to-work plans that are not ideal for them because of the pressure they are under.  They are unsure of what is happening to them and don’t feel they can speak up.

"You are in a confused state of mind, you don’t really know what is happening to you: if you are going to get better or continue to get worse. The focus of your energy is on the pain that you are in and particularly if you haven’t got support structures around you and people being assertive on your behalf, you just feel like you are caught in a strong current that you can’t get out of."

It can be difficult to stand up for yourself during this time. You may feel you don’t have a grasp on the situation or aren’t able to make clear decisions. It is common to feel that you are being swept along without any control.

The most important thing for you to remember during this time is that you have a right to speak up. You can feel very vulnerable and distressed at this stage but the following suggestions should help you to stay in control by being aware of what to expect.

Know when you are ready

How do you know when you are ready to return to work? With so many people pushing you in all directions it can be difficult to work out what to do.
At this stage there will be a number of people involved with your RSI - your doctor, your rehabilitation provider, your employer/case manager. It is likely some of them will be pushing for you to return to work even if you don’t feel ready.

You may not have a clear understanding of your situation and this can cause you to go along with their suggestions. You may even find that you completely give up control. But you need to be aware of your situation and how you feel physically and emotionally in order to manage the process and get a good outcome. You have to live in your body for the rest of your life: they don’t. So it’s vital that you have a chance to recover. The decisions made at this point can be a turning point either to a return to health or, in the worse case, a long period of chronic pain.

Your doctor will give you a certain amount of time off work. This may be a week, a month, or any length of time depending on how he/she perceives your situation. After this time, unless extended by your doctor, you will be expected to return to work, possibly at reduced hours.

If you don’t feel this is enough time you can, and should, ask for more time off. However, you need to understand that your doctor may be under pressure from the insurer or case manager to return you to work as soon as possible.
So you need to have a clear understanding of your injury and pain in order to know if you are ready to return to work. Look at the following questions and answer them honestly. They will help you to understand what stage you are at.

Your symptoms

• Is there considerable pain even when resting?
• Is the pain stronger after certain tasks?
• Are there some tasks you can now do that you couldn’t do when you were first injured?

How would these symptoms affect your working capacity?

• Could you return to your previous position?
• If not, could you take on some parts of the position?
• How many hours a day would you be able to work without hurting yourself?

How do these symptoms affect your day to day life

• Can you undertake household chores such as washing, cooking, cleaning?
• Can you still undertake hobbies or other interests?

Are you pressuring yourself into returning because you are afraid of losing your job?

• Are you pressuring yourself into returning because you are afraid of what others think of you?
• Do you think that more time off work would be beneficial to you?
• Do you feel ready to return to work?

Try jotting down notes or speaking into a tape recorder to answer to these questions. It is often easier to understand your thoughts if they are out in the open. You might even want to try answering these questions at different times.

It is vital that your doctor understands the level of your pain and your limitations. If you don’t feel ready to return to work - tell your doctor and explain why. They need to know what you can and can’t do. It is difficult for anyone without RSI including your doctor to understand the kinds of limitations it places on your activities.

I wrote down everything that I thought was important in dot points - what I couldn’t do; if I did this, that happened etc. I wish that I had done that at the beginning because when I handed that to my doctor, I realised that he had no idea that I was at work trying to do a physically demanding job without the capacity to do it.

The more clearly your doctor understands the situation, the more chance you have of recovering properly. Discuss with your doctor the options you have, be open to their suggestions and offer your own. Don’t be afraid to speak up to others as well -your employer, your rehabilitation provider and even your family and friends.

We know that speaking about your condition can be difficult. Talking about your condition will help you get a clearer picture of your situation. Try it out on someone your trust first; this way you won’t feel overwhelmed when you have to speak to doctors, case managers or rehabilitation providers.

Stay ahead by:

• Helping your doctor to understand your injury - write a list of things that are difficult or you can’t do at all and why.
• Helping yourself gaining an understanding of your limitations and progress.
• Discussing your options and thoughts with your doctor and someone you trust. Aim to work at a level where your injury does not flare up.

Your rehabilitation provider

The insurer will appoint a rehabilitation provider. Their responsibilities include working out a suitable return to work plan and helping you to find new employment or training.
The rehabilitation provider will:

• Conduct an ‘Initial Needs Assessment’ for home and work - this is to determine
• What help is required for you and start arranging it.
• Speak with your doctor to determine what you can and can’t do - this will give .
• Them a clearer understanding of your position.
• Arrange a meeting with your employer or case manager, yourself and possibly .
• Your doctor to discuss a return to work plan - this is the first step in getting back to work.
• Help you to find other work options if you can’t return to your pre-injury employment.
  

Rehabilitation providers are generally in the difficult position of trying to keep all parties happy. This can be almost impossible due to the often conflicting needs of the different parties. The rehab provider is a ‘middle man’ between you and your employer. They are there to help you AND to get you back to work, which means keeping your employer and the insurance company happy too.
To get the most out of your rehabilitation provider, keep these points in mind:

• Be clear about what you can and can’t do.
• Don’t let them force you into a decision you aren’t ready for.
• Speak  to them about other job options and possible tasks you could do.
• Use your rehab provider as a ‘middle man’ if your employer or case manager is not acting appropriately.

Return to work plan

Once the return to work process has started, a meeting will be organised with yourself, your rehabilitation provider, your employer, and possibly your doctor. At this meeting a program or return to work plan will be put forward outlining your hours and duties.

This plan is designed to graduate your return to work and limit the amount of pressure placed on your injury.  All parties mentioned above must agree to and sign the plan before it is put into action. This means that all parties are have been made fully aware of the plan and what you can and can’t do.

When discussing your return to work plan, you need to take an active part. You may know of jobs or tasks at your workplace that you can do, for example, you could move into a training position or work on the telephone if you’re provided with a headset. You may be able to do your old work if you have secretarial help for a few hours a day. With voice-operated software and some training you may be able to work at a computer. A check-out operator found that she was able to work at the returns desk for four hours a day, even though she couldn’t do her former work.

It’s a good idea to brainstorm where you might be able to fit into your organisation, or whether you could do something useful with some extra equipment or some modifications. One woman we know moved to new work within her organisation as a trainer for several months after she returned to work and recovered completely.
Your boss and your rehabilitation provider may also have some ideas – be as flexible as you can while respecting your limitations. It will help you during this process if you have a clear idea about what you feel you can do. The questions above will help you with this. It may be useful to go through the above process again during this planning stage.

The plan must be achievable; there is no point agreeing to a plan you know you can’t do. So you should be prepared to argue your case if you need to. Although you may not feel like it, everyone in the meeting is there because of you and hopefully to help you. But only you know exactly what is right for you. So speak up for yourself.
You can feel a little out numbered at these meetings, so go prepared to stick up for yourself. You may be able to take a supporter – a union rep or a friend. Be open to others’ suggestions but keep in mind that you are the person who has to work through the plan so it must suit you. Don’t be afraid to offer your own suggestions if theirs aren’t suitable.

Your return to work plan will set out your work, hours, days, as well as things such as work restrictions and breaks during the day. This plan will generally be approved and signed by all parties present at the meeting. This way, no one can deny that they didn't know what was required of them.

The finer details such as days and hours of work may be put down separately in as a sub-section of the plan. Keep in mind that if you are to work, for example, four hours per day but need to take a break for 15 minutes every hour, you will actually be there for five hours.

The recommendations made in these reports should be adhered to by your insurer, employer, case manager and yourself.

Initial needs assessment

This report is conducted by your rehabilitation officer to determine the type of issues that need to be addressed and set a goal for your return to work program. It will address the following issues:

• History
• Daily living difficulties
• Emotional difficulties
• Vocational activities and issues
• Current situation and work restrictions
• Recommendations – for example:
• Case conference
• Workstation assessment
• Home assessment; and
• Guidelines for the work place

Home assessment

A home assessment will look at your home and family situation to determine if extra home help is needed. Recommendations will be about the amount and type of help required, eg housework, gardening.

Workstation assessment

This assessment will look at your job and the difficulties you are having. It will set out the problems identified with your physical workstation and the adjustments that should be made. These could include different equipment, eg, a telephone headset or voice-operated software.

Task and work pratice recommendations

This document sets out the limitations and recommendations for work. It will state the number of hours to be worked; the restrictions that apply, such as limitations to typing, pulling, lifting; as well as exercises, task rotation and any other restrictions on your work situation.

Progress report

A progress report will restate the goal of the program and set out progress to date. It is produced after your rehabilitation officer has met with you and discussed your current situation. It will discuss any improvement or difficulties you are still having. It does not provide any recommendations.

Case closure report

This report will state the outcome of the program, the services provided by the rehabilitation officer and the current situation. This report indicates that the rehabilitation officer cannot provide any more assistance at this stage.

While at work

Once you are back at work, you will need to follow through with the timetable and plans that have been set out. Be aware of how you are coping with the workload and tasks. If you are having problems, let your case manager or rehabilitation provider know.

Don’t feel forced to work at the same pace you had prior to your injury. You can’t do it and will only aggravate your injury. When you first return, productivity is not the issue, the purpose is only to reintegrate you into the work force. So, keep to the plan set out, or, if you find that it is too difficult to manage, ask for it to be revised.
In an ideal situation, any employee returning to work will have support from their manager, their colleagues and feel that the job is worthwhile. Successful return to work programs are those where the worker feels valued and has positive support from management and other employees. Unfortunately this is not always the case. As on member said, ‘They said that I could collect money for the Christmas party and I was just so distraught. It was so humiliating. I felt that people thought that I was stupid’.

There is a general lack of understanding around RSI and overuse injuries. It is important to note that not all employers are unsupportive because they don’t care. In many cases, people simply do not know how to handle the situation. Your employer probably won’t have an understanding of RSI because they have not been affected by it. It is unlikely, therefore, that they will know how it affects you and the kinds of limitations it places on your ability to work.

There is no easy way to explain RSI to anyone else. But it will help if you tell your employer how it affects you in the workplace and at home. You should aim to be clear and straightforward in your approach. Remain calm and talk about how RSI affects your ability to work and do household tasks. If you don’t feel comfortable with this, ask your doctor to ring your employer and explain what you can and can’t do.

It can also be difficult for your employer. Even if they are trying to help you, what they see as helping, you may see as hindering. So be clear with your employer about what you need, how they can help you and the best ways for you to help yourself.

This can be very difficult. You may not be capable of doing your old job and your employer may struggle to find suitable work for you. It is sometimes the case that they won’t, or don’t, take time to look carefully and deeply into the situation. ‘When I went back to work I was basically useless, so it was as difficult for my employer as it was for me.’

It is very easy to blame your employer for not finding a challenging job or blame yourself for not being able to work. However, blame won’t help you to achieve what you really want. Instead, try taking responsibility for your happiness at work. If you are not satisfied with your job, try these:

• Ask around others in the workplace and find out if there are any jobs that need to be done – this could be helping them with a task, finishing off work they haven’t been able to, perhaps someone who has too much work and needs help.
• Approach your employer with a list of suggestions of jobs you feel capable of doing. Point out that will be doing something productive and worthwhile.
• Point out to your boss that you want to and are still capable of working. Say to your employer ‘I would like to do…’, and ‘I am capable of doing…’. Be direct and clear in what you want to do and how you will go about it.
• If you boss does not listen or brushes off your suggestions, don’t give up. Put your ideas in writing; talk to your rehab provider. You deserve to be treated with the same respect as any other employee.
• You might be able to suggest that they give you two weeks to prove that you can do a job or help in a certain area. At the end of that time, if either of you is unhappy you can reassess the situation.

The process will run much more smoothly if both parties are willing to make it a team effort. Try not to be too aggressive or passive with your employer.
If you employer is unresponsive, hostile or aggressive, contact your rehabilitation officer and let them know. It is part of their job to make the return to work process as smooth as possible. It is not acceptable for anyone to treat you badly and your rehabilitation officer can contact your employer and speak to them.
Dealing with hostile employers and workmates is challenging. Because RSI cannot physically be seen in many cases, people are not understanding of the limitations it places on you.

I had taken on a new job part-time but a lot of my workmates didn’t understand and there was a lot of impatience.  You know – “why can’t you do that job?”, “the other girl used to do it”.         Sue

Your aim is to feel valued in the workplace. If you just accept boring jobs that are below your capacity, your employer will not know that you are capable of more. You need to point this out to them. By approaching your employer you are proving to yourself and them that you are taking control. You are putting out an assertive image of yourself that people will respond to.

This can apply at home too, for example, asking a family member to do part of a job or explaining to them you need help and suggesting ways that you can work together rather than feeling bitter that they are not helping you.

If a workmate is becoming hostile, try speaking to them. It is unfortunate that some people feel they can put others down when they think that person won’t stand up for themselves. Point out to them, without being hostile yourself, exactly what your limitations are.

Stay ahead by:

• Communicating with others involved in the process.
• Having a clear idea of what you can and cannot do.
• Standing up for yourself .

Your right and responsibilities

Knowing your rights and responsibilities is part of staying in control of your RSI. Here are a few points to help:

• You can request a new rehabilitation provider if you feel that the one appointed is not helping you.
• You can seek out new employment if you don't feel you can or want to return to your previous employment.
• You can speak up for yourself and request changes to working conditions, return to work plans or anything else you are unhappy about.
• You always have a choice either to sit back and take it, or to stand up and ask for change.
• You can acknowledge to yourself and those around you if you are happy with the situation and how you are being treated.
• Be prepared for situations by knowing your rights and being clear about your physical and emotional condition.
• Be knowledgeable and prepared to correct people, especially insurers and employers.
• Speak up for yourself - no one else will do it for you.

In conclusion

All of the above is not meant to imply that you are at fault in any way if you feel powerless and outgunned or if people treat your badly. Having a poorly-understood work injury like RSI is very disempowering and you are operating in a legal framework that does not give you the support you need.

So what can you do? When you feel you have little power, allies can be a tremendous practical and emotional support. They can include:

• Your doctor
• A psychologist
• Professional counsellors
• Your friends
• Union representative
• OH&S representative
• Your lawyer
• An advocate
• The RSI Association
• You can even pay someone, such as a professional advocate, to be your ally.
  

An ally can:

• Go to doctor’s appointments with you.
• Accompany you to AAT hearings, your lawyer, or a medico – legal examination.
• Listen to you while you talk about what’s happening to you (professional counsellors may be best for this – don’t overdo it with friends).
• Let you know about new strategies to try or give you helpful advice.
  
• Find other allies for you!

What if you can’t return to your previous job?

Sometimes, going back to your pre-injury job isn’t an option. Particularly in the private sector, some small workplaces simply do not have positions for an injured worker. Other times the worker decides to move on to something else.

During this time many people with RSI begin to question their careers and whether they really want to continue down that path. Other options may emerge because the one they were following is no longer valid.

"I was put off work by my employer and after some time sitting around feeling depressed and unsure of my own abilities, I came across an advertisement for a course that sounded really interesting. After completing the course I realised that I had all these options in front of me that I hadn’t seen before."           Kate

Try to spend some time thinking about your current career:

• Do you actually like your job?
• Are there other careers that you have thought about?
• Do you think you are more suited to a different field?
• Are you in a position where you can take some time off and recover, then worry about retraining yourself?
• What does it really mean to you to have a career that is hurting you?

Thinking about altrnative work

If you can’t, or even don’t want to, return to your previous employment you need to think about what you would like to do. Where do your talents lie? What sources of enjoyment are there for you? Finding answers to these questions isn’t as hard as you might think!

Try these steps

• Write a list of all the jobs that appeal to you regardless of whether or not you have the qualifications or are capable of it at the present time. This can be things you are good at or simply think you might enjoy.
• Go through the list slowly and cross out the jobs that are not at all possible. For example you might want to be a professional ballerina but are too old to start training! Remember that retraining for most careers is an option. But also think about the constraints of your own life, for example young children or mortgage repayments.
• Once you have it down to a couple of reasonable options, set about discovering how you might get into that industry. Do you need to retrain or could you get into it by going door to door with your resume? You might contact people within the industry and find out about recruitment processes or find out about courses.

For more information on this sort of process read What Colour is Your Parachute? by Richard N Bolles. It is updated every year and provides some tips for discovering what you might like to do and how you can go about finding a new career.

As you can see, the situation isn’t as hopeless as it might first appear. Many people with RSI realise around this time that there are many other options for them. Some change careers, some go back to study, some resign and look after themselves for a while.

Think about what you really want in your life. This is an unexpected opportunity to change direction.

"It got really hard to stay in control at the time. And in the end I just gave it all up to my partner. I didn’t think at that time that I had a voice or thoughts on my own situation because I allowed someone else to speak for me. I realise now that I always had the knowledge, I just didn’t know how to tap into it." Judy.

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