Most of us head off to work every day making for our return home at night. Many of us, however, won't get to follow that script.

The Bureau of Labor Statistics states that 1.1 million on-the-job injuries were reported in 2011. The median number of work days lost with each injury was eight. Sadder yet are the number of annual work-related fatalities: 4,609 in 2011.

A work-related shoulder injury may appear similar to a non-work-related shoulder injury, but the system the work-injured patient must now deal with is considerably more complex. The world of workers' compensation involves, at minimum: the patient, the physician, the employer and the insurance company.

What, exactly is workers' comp?

The State of Idaho describes it this way: " ... a no-fault insurance policy, which provides wage loss and medical benefits to workers with a job-related injury or disease. Nearly every working Idahoan is protected by workers' compensation insurance, as state law requires most employers to have workers' compensation insurance."

Dr. Myron Mills, a local physician board-certified in occupational medicine at Kootenai Occupational Medicine, said, "The primary thrust here is to have a neutral physician who can address the needs of the injured worker as well as the needs of the employer and the workers' comp insurance companies - a physician who can interface with the three different parties.

"We're always walking that tightrope. In occupational medicine, all we do is workers' comp. The paperwork is the most challenging part."

Apparently other physicians are in agreement, since several local family practice physicians contacted are no longer accepting workers' comp cases.

The progression of care for the injured worker usually begins with an urgent care or emergency room visit. Following that, the Idaho Industrial Commission mandates that if the injured worker's employer has a designated physician it uses for workers' comp cases, the employee must have his employer's approval or petition the Industrial Commission before being allowed to see a different physician.

Because of his specialization in occupational medicine, Mills described his practice as a kind of back-to-work fast track for injured workers.

"As physicians we will not in any way compromise when it comes to the quality of patient care we offer," he said. "But we do approach the injured worker like we would an injured athlete - to us they are 'industrial athletes.' My job is sorting things out and that means not just the initial injury.

"The majority of patients are honest and want to go back to work - only a small percentage want to game the system. The main function we serve is to keep the system going efficiently and with a balanced perspective. Statistically it has been shown that the longer an injured worker is off the job, the more difficult it is to get him back to any work at all."

Occupational Medicine is a self-limiting practice - Mills' patients see him only for the on-the-job injury for which they were initially referred.

"I look very carefully at what the patient says and in the first four to six weeks, we will have done all the major things we do - things such as diagnostic tests, treatments, physical therapy and, if possible, we will have gotten the worker back to work in some capacity, including light duty."

Physical therapy frequently plays a large role in injuries involving the musculoskeletal system. Both Paul Taylor-Halstead and Dave Walter are licensed physical therapists at Kootenai Rehabilitation Center. Taylor-Halstead is also outpatient physical therapy supervisor.

When someone is first referred to the facility with an on-the-job injury, physical therapists generally start the evaluation process by asking questions - lots of them - most of them involving how the patient uses his body in everyday activities and what kinds of movement might have caused the injury.

"We're bio-mechanical educators," Walter said. "I might say something like, 'I notice you've developed certain abnormal postures. Were you bent over or reaching to the right or to the left when the injury occurred?' And in my mind's eye, I'm trying to figure out what's going on inside them."

"People don't know how to use their bodies - even simple postures," Taylor-Halstead said. "This includes things such as, 'this is what your body likes to do and this is what it doesn't tolerate.'

'We do testing to confirm what we think might have been injured, such as muscles or joints. Then, based on the lack of normality - objective data - we try to confirm the hypothesis of what happened."

Walter said that cross-testing is another way to evaluate. "We test if one thing is weaker than another to find out what's causing a specific pain. Can the pain be turned on and off? One test does not make a diagnosis."

Pain is obviously an issue for injured patients - in many cases it is the primary issue.

"We try to find ways to manage pain," Taylor-Halstead said. "Our goal is to evaluate and treat the problem and that includes education, pain management and rehabilitation of the injured area."

Walter agrees. "We are trying to minimize pain or to decrease it, if we can. My goal is to get that patient 100 percent back to work, but she may not be totally pain free."

Getting injured workers back on the job with their "work family" is vital. The majority of injured patients, Taylor-Halstead said, feel intense pressure to go back to the job. In addition to needing a paycheck, they don't want to let down their fellow employees.

"That's so vital that we try to find some kind of limited work duty for them ASAP," Walter said. "Also, if you can get a person on light duty, they're not sitting home obsessing over their injury."

Kootenai Rehabilitation runs a work conditioning program for injured workers which serves as a bridge to their return to the job. The program recognizes the fear the recovering worker frequently has about whether or not she will be able to do all the tasks required by her employer.

"Oftentimes there is this gap," Taylor-Halstead said. "It's a big leap from doing nothing - just coming to physical therapy - to returning full time to work."

In the Kootenai program, injured workers are given tasks to perform that are similar to those they will be responsible for when they return to work. If their job involves climbing ladders, there is a ladder to climb in the rehab gym. If they carry heavy loads at work, they will practice doing that task specifically. This is all done under the watchful eyes of the physical therapy department. The goal is to discover no competency surprises the first day back at work.

Physical therapists keep in close communication with referring physicians and employers.

"We're usually seeing an injured worker with an acute injury three days a week," Walter said. "If I'm not seeing a change within four to six visits, I'll be on the phone or face to face with their doctor. And, as far as the employer goes, if there is a problem with the light duty, I'll call them up to let them know about it."

"The team's goal is to return injured workers back to their job or the closest thing to it," Taylor-Halstead said. "'Same employer, same job' is always our goal. That's a win-win for all of us."