In workers’ compensation, much of the focus during rehabilitation centers on the physical injury: healing tissues, restoring range of motion, improving strength, and eventually returning to functional tasks. These are all essential. But when physical therapy hits a plateau or a case drags on far beyond the expected timeline—it’s often not just the body holding the worker back.
It’s the mind.
The invisible barriers to recovery
Psychosocial factors such as kinesiophobia (fear of movement), fear-avoidance behaviors, and catastrophizing can quietly derail even the most appropriate and evidence-based treatment plans. These mental and emotional responses to injury can prevent an individual from engaging fully in rehab or returning to work, even when physically capable.
- Kinesiophobia can lead to excessive guarding or refusal to perform certain tasks
- Fear-avoidance behaviors often manifest as missed appointments or refusal to progress in therapy
- Catastrophizing can drive a narrative of helplessness, where pain is interpreted as damage and recovery feels impossible
All of these contribute to delayed recovery, prolonged disability, and increased medical costs. In fact, psychosocial factors are often stronger predictors of delayed recovery than the severity of the physical injury itself (Main & George, 2011; Vlaeyen & Linton, 2000).
Real impacts on claims
We’ve seen cases where the physical impairments were manageable, but the patient’s beliefs about pain and injury created a far greater obstacle. These beliefs often go unrecognized unless a provider is trained to identify and address them.
When fear of movement and pain catastrophizing take hold:
- Physical therapy sessions become less effective
- Functional improvement stalls
- Return-to-work readiness becomes unclear or delayed
- Additional imaging, injections, or referrals are often pursued unnecessarily
Systematic reviews have shown that fear-avoidance beliefs are associated with longer durations of disability and increased healthcare utilization in patients with musculoskeletal pain (Wertli et al., 2014).
What we do differently at Comp Rx
At Comp Rx Physical Therapy, we incorporate psychosocial screening and education into our treatment process. We use pain neuroscience education (PNE) and graded exposure techniques to help patients understand that pain does not always equal harm. We teach them how pain works, why movement matters, and how to regain control over their recovery.
Pain neuroscience education has been shown to reduce fear-avoidance behaviors and improve outcomes in musculoskeletal conditions (Louw et al., 2016).
At Comp Rx, we are committed to identifying when psychosocial factors in work injuries are impeding progress in recovery. If we observe that a patient is not responding to physical therapy as expected, we communicate this promptly with the case team and recommend appropriate next steps. This may include referring back to the physician or transitioning to a work conditioning or work hardening program when indicated. Early transitions to these programs can often speed up recovery, helping workers return to full duty more quickly and with greater success.
In some cases, return to work isn’t the immediate goal. If recovery reaches an endpoint where full recovery isn’t feasible, we work collaboratively with all involved to determine case closure, ensuring the patient and employer both have clarity on the next steps.
At Comp Rx, we understand the importance of a coordinated, transparent approach. By recognizing when treatment isn’t moving the case forward, we prevent unnecessary delays and help the entire team stay aligned toward a successful resolution.
Let’s work together
Physical therapists often spend more one-on-one time with injured workers than anyone else on the case. That gives us insight—into both the physical and behavioral sides of recovery. If your provider isn’t addressing psychosocial factors in work injuries, it could be costing more than just time.
Feel free to contact us and let us help get your injured workers moving forward!
References
- Vlaeyen, J. W. S., & Linton, S. J. (2000). Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art. Pain, 85(3), 317–332. https://doi.org/10.1016/S0304-3959(99)00242-0
- Wertli, M. M., Rasmussen-Barr, E., Weiser, S., Bachmann, L. M., & Brunner, F. (2014). The role of fear avoidance beliefs as a prognostic factor for outcome in patients with nonspecific low back pain: A systematic review. Spine Journal, 14(5), 816–836. https://doi.org/10.1016/j.spinee.2013.09.036
- Louw, A., Zimney, K., Puentedura, E. J., & Diener, I. (2016). The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature. Physiotherapy Theory and Practice, 32(5), 332–355. https://doi.org/10.1080/09593985.2016.1194646
- Main, C. J., & George, S. Z. (2011). Psychologically informed practice for management of low back pain: Future directions in practice and research. Physical Therapy, 91(5), 820–824. https://doi.org/10.2522/ptj.20100326