Thank you for taking on this often difficult subject. 1)Would you be able to help us by giving a rough estimate for how long patients should be off work for common injuries? I think it would help us set goals for patients, and help us with moving pts along in their rehab, and finally when it is reasonable to be starting to think something else is going on beside the actual injury. So many times I wish I had more confidence to be able to tell my patients that they should be much further along the functional improvement pathway, yet hesitate since not sure how reasonable, (or LoL, unreasonable), I am being. So for examples- Acute back strain- a) with no radiculopathy b)with radiculopathy - Acute neck strain- a) with no radiculopathy b) with radiculopathy c) in the context of whiplash especially post MVA - Shoulder tendinitis- - Wrist tendinitis a) de Quervains. b) not de Q… more generalized 2) When is enough Physio? I use it for 2 reasons- teaching exercise and monitoring progress - to help patients with developing a routine of staying busy and active, while off work. But after a while,I find that the patient plateaus. Partly I think the visits are often short, not that supervised and functional goal setting isn’t being established and encouraged/ priorized. Then I find it becomes a waste of money or even just a crutch With thanks

Hi, I have a few questions: 1) New diagnosis as a result of the injury, for example patient unable to complete physio sessions for lumbar strain because of a first MDE related to a long consolidation period. Patient was assessed by the BEM and her file was closed because they said her lumbar strain had resolved, however there was not a single mention of depression throughout the entire assessment despite the fact that the physio had written that depressive symptoms were getting in the way of her being able to complete physio on numerous evaluations. How would you manage this situation or can you even? Once the BEM closed her file it seemed it could not be re-opened and they seemed unhappy that I added adjustment disorder and eventually depression to the list of diagnoses related to the injury itself. 2) New injury that investigations lead to new but chronic diagnoses. I have a patient that had a tree fall on their head while helping people escape a building during a tornado. Chronic and atypical evaluation of concussion symptoms so an MRI was done. MRI shows severe degenerative disc changes much more in keeping with his 30 year work history in construction which was previously undiagnosed. Is able to work but with ++ difficulty - residual dizziness etc, has been stable for over a year now. How do I know when to consolidate? How do I document when I don't know how much of the MRI findings are related to injury vs a significant underlying issue from work that has now surfaced because of the injury? I tried to keep it up objective and just describe symptoms and MRI findings. 3) I have patients that were acts of criminal violence over 10 years ago that have permanent sequellae from the event and cannot work. They say they still need to see me every 4-6 weeks or else IVAC will cut their pay. Do I have to see them indefinitely? Will their pay be cut if I consolidate? If I have to keep seeing them and they are stable can I still extend the time to see them?