The Appeal CommissionThe Workers Compensation Act of Manitoba

Applicable Legislation:

When a worker suffers personal injury by accident arising out of and in the course of employment, compensation is payable to the worker pursuant to subsection 4(1) of the Act. Provision of medical aid services to injured workers is payable in accordance with subsection 27(1) of the Act. The WCB makes these payments where it determines that the medical aid is necessary to cure and provide relief from an injury resulting from an accident.

WCB Policy 44.120.10 Medical Aid (the “Policy”) sets out a coordinated approach to delivery of medical aid services. As it relates to massage therapy, the Policy provides as follows:

2. Medically Prescribed Treatments, Devices and Their Related Accessories

To minimize the impact of workers’ injuries and to encourage recovery and return to work, the WCB approves the use of many prescribed and recommended treatments and devices …

…

b. Medically Recommended Treatments

i) Other medically recommended treatments include, but are not limited to, acupuncture, massage therapies, swimming, fitness therapies, obus forms, as well as new treatment modalities constantly being introduced to the market place.

ii) The WCB may approve the use of these treatments or medications subject to pre-approval by the WCB on a case-by-case basis. All such treatments must satisfy the WCB that their use will aid in the recovery of an injured worker or minimize the impact of the injury.

C. ADMINISTRATIVE GUIDELINES

1. Medically Recommended Treatments

i) The latest edition of treatment protocols developed by Healthcare Services will guide staff.

With respect to massage therapy, the latest edition of the WCB Healthcare Services treatment protocol provides as follows:

Massage therapy is only accepted on an individual case basis and should always be pre-approved. Massage therapy is not considered to be essential in restoring a worker to function and fitness for work. In some cases, it may be complementary to other treatment and may be approved on a limited basis. It is highly recommended that RACS staff consult with a Medical Advisor or Physiotherapy Advisor before approving massage therapy.

Worker’s submission:

In his submission to the Appeal Commission, the worker indicated that he is currently attending school for vocational retraining and hopes to re-enter the workforce once his training is completed. He has, however, continued to experience ongoing pain as the result of his injury which makes it difficult for him to sit for extended periods. The tightness and pain also causes him to overcompensate in other areas of his body and contributes to enhanced pain. His sleep is affected and he relies on pain medication. He indicated that he needs massage therapy, especially as it relates to the beneficial effect on his range of motion. He relied on a report from an occupational health physician dated April 9, 2009. The worker argued that massage therapy and a massage tub are pain management therapeutic aids which would allow him to carry out his retraining, and were not merely “lifestyle enhancements.”

Analysis:

The worker’s compensable diagnosis is a right foot 5^th metatarsal fracture with soft nerve injury to right foot/ankle/calf. His massage therapist’s letter of November 17, 2009 indicated that she has been his massage therapist since June 2005. Her treatment outline has been the same since the first treatment session and has six specific goals:

1. Decrease muscle hypertonicity in the right gluteal region to allow more range of motion;

2. Increase range of motion of the right hip through stretching;

3. Nerve mobilization to work with the sciatic nerve past areas of restriction;

4. Address secondary compensatory injuries due to mal-alignment, unequal weight bearing and adapted movement patterns;

5. Flushing massage over right hip and right leg;

6. Craniosacral therapy to facilitate the release of restrictions.

The WCB covered massage therapy treatment until June 13, 2006. After the WCB discontinued coverage, the worker continued to attend massage therapy which was paid for either through alternate insurance coverage or by the worker himself. The WCB does not deny that the worker obtains relief from massage therapy. Its concern, however, is that the provision of ongoing massage therapy is not curative in nature and the WCB does not normally provide unending support for programs whose goal is to provide ongoing relief. As stated in the Healthcare Services treatment protocol: “Massage therapy is not considered to be essential in restoring a worker to function and fitness for work. In some cases, it may be complementary to other treatment and may be approved on a limited basis.”

The panel does not support the provision of ongoing massage therapy treatment to the worker on an indefinite basis. Nevertheless, we do note that there are two medical reports on file which recommend the provision of a massage-based program. Following the call-in examination of May 6, 2008 by the WCB physical medicine consultant, the recommendation was made that the worker be referred for a gradual re-activation program. The report states: “the claimant noted his current massage therapist does provide instruction in aquatic-based programming and further massage therapy with respect to the right lower extremity could provide some further desensitization and assist in facilitating range of movement activities. This massage therapist could also assist the claimant in transitioning to home exercise activities.”