DEPARTMENTS
VIEWPOINT
LORRAINE SEDLAK, CIH, CSP, FAIHA, is a senior EHS consultant at Bright Talent located in Tustin, California.
The opinions in this article are the author’s and do not necessarily reflect those of AIHA® or The Synergist®. When confronted with the issues discussed in this article, readers should consult legal counsel. Send feedback to The Synergist.
First Aid, ART, Stretching, and Recordability
BY LORRAINE SEDLAK
Many employers offer Active Release Techniques to manage workers’ pain and prevent injuries. Developed in the mid-1980s, ART is a patented treatment for soft-tissue and nerve issues, including strains, sprains, and musculoskeletal disorders. In letters of interpretation issued in 2006 and 2019, OSHA emphasized applications of ART that do not trigger recordkeeping obligations. But last year, the agency distributed a memorandum to regional administrators that identifies the potential for not only ART but first aid, exercise, and stretching to constitute an OSHA-recordable injury or illness.
BACKGROUND
OSHA’s July 2006 letter of interpretation is a response to Michael Leahy, the founder of ART. Leahy had asked OSHA to reconsider its classification of ART as a “medical treatment,” a designation that meant the application of ART to an injured employee triggered recordkeeping requirements. OSHA’s response explained that it found ART to be essentially a form of massage and that ART should therefore be considered first aid, not medical treatment. The administration of ART, OSHA explained, did not confer recordkeeping requirements if it was “a purely precautionary measure” or was “part of an employee wellness program” and if the recipient was “an employee who does not exhibit any signs or symptoms of an injury or illness.”
In some instances, ART, first aid, exercise, and stretching may trigger recordkeeping requirements.
OSHA returned to the issue in May 2019. This letter of interpretation explained that it considers other techniques of soft tissue massage similar to ART to be first aid for recordkeeping purposes.
Then came the memo dated May 2, 2024, which reaffirms the agency’s determination that ART is first aid but also discusses instances where ART, first aid, exercise, and stretching may trigger recordkeeping requirements for employers. According to the memo, these include:
The repeated or improper application of first aid. OSHA’s concern is that employers could attempt to avoid recordkeeping requirements by improperly administering first aid to an employee.
Additional treatments with ART. OSHA notes that “it is not always easy to determine whether the only treatment an injured worker received was ART.” Compliance Safety and Health Officers (CSHOs) may need to interview injured workers “to learn more about the type and extent of treatment they received” and, if necessary, “request access to review” the employee’s medical records.
ART that results in work restrictions. OSHA states that a case is recordable if ART is used to treat a work-related injury or illness and results in job transfer, restricted work activity, or days away from work.
Exercise and stretching as part of a treatment plan. Recordkeeping requirements apply to cases where exercise and stretching “are used to treat a work-related injury or illness as part of a treatment plan and ends once the objectives of the treatment [have] been met.” While exercise or stretching performed only as precautionary measures do not trigger recordkeeping requirements, OSHA notes that “if stretching exercises were modified or changed to specifically address an employee’s injury or illness, the case is likely […] OSHA recordable.”
The memo concludes with a list of questions for CSHOs to consider when evaluating whether a case that involves ART, first aid, exercise, or stretching is recordable.
RECOMMENDATIONS FOR OEHS PROFESSIONALS
In light of OSHA’s memo, I encourage you to communicate this new guidance to company leaders and review its potential impact to your organization. Use the recommended questions for CSHOs in the memo to review all incidents for potential gaps in your recordkeeping program that could lead to noncompliance with the standard. Understand the memo’s implications to the determination of OSHA recordability for first aid, ART, exercise, and stretching. Verify that ART practitioners are certified or licensed to practice ART therapy, and ensure that they understand they cannot make recommendations on work restrictions. Confirm that treatment and medical records are readily available for review; if your organization houses all treatment records with their providers, ensure that these records are available upon OSHA’s request. Finally, review your first aid logs to identify treatment that may be considered recordable.
RESOURCES
Active Release Techniques.
OSHA: Standard Interpretation: Clarification of Soft Tissue Massage (May 2019).
OSHA: Standard Interpretation: Determining Whether Active Release Techniques (ART) Constitutes First-Aid or Medical Treatment (July 2006).
OSHA: Standard Interpretation: Enforcement Guidance Under OSHA’s Recordkeeping Regulation When First Aid, Active Release Techniques (ART), and Exercise/Stretching Are Used to Treat Musculoskeletal Injuries and Illnesses (May 2024).