Understanding a Functional Capacity Evaluation: A Look into the Rationale

The Functional Capacity Evaluation (FCE) is an integral part of the return-to-work process. It forms a medical basis for return-to-work decisions by identifying the patient’s productivity level and suggesting modifications for physically acceptable or contraindicated activities. The FCE does not stand alone but interfaces with the information from the treating physician and therapist, as well as work information provided by the employer. It is the foundation for an effective work injury management system.

When a comprehensive and objective FCE is put to optimum use, it will assist all parties who need functional return-to-work information. FCEs are performed by trained physical or occupational therapists or chiropractors. These professionals have a strong background in the study of physical movement patterns. They also are trained in evaluating the biomechanics, or the delivery of movement patterns and posture during walking, bending, carrying, and lifting tasks.

During any physical activity, sets of muscles are used in a normal specific sequence. When the activity is performed at a low or safe level, only the primary muscles are needed to make the movement. When a movement becomes heavy or as an individual becomes fatigued, accessory or “extra muscles” automatically contract to assist the primary movers. This accessory movement is involuntary and can be dangerous, thus setting up a chance for repeated trauma or re-injury.

Proper FCE testing stresses a “safety first” philosophy. A professional who adheres to this philosophy will not allow the individual to be injured while in their care. The advantage of this kinesio-physical approach becomes clear when the patient’s musculoskeletal findings are correlated with functional findings and observations.  For example, it is not enough to identify that the patient can only lift 25 pounds from the floor; additional questions must be answered. “Could she lift more if she was properly trained or rehabbed?” “Could she lift 10 pounds repeatedly?” “If not, why not?” “What is the limiting factor?” It may be due to quadriceps weakness or a preexisting arthritic hip or some low back instability. Also, overall chronic pain behaviors, motivation, or sensation of pain are the main factors that can influence FCE results. Therapists and physicians must consider these important factors when planning future studies, testing, rehab, or vocational planning to interpret the patient’s Functional Capacity.

Finally, the FCE is not a guarantee against re-injury or a way to determine if someone is “faking an injury.”  It is instead a piece of a puzzle when determining one’s physical performance, safe capacity, and motivation for return to their work. It is currently the only legally defensible and reliable tool that the medical, legal, and employment community has to support a fair and safe opinion for one’s return to gainful employment.

Exceptional Physical Therapy in Central Maryland

At MMI, we have a staff of skilled physical therapists dedicated to getting you back to work as quickly as possible. Contact us for more information or to schedule an appointment.