In an enforcement memorandum dated May 2, 2024, OSHA provided guidance on whether musculoskeletal injuries are recordable under three treatment scenarios: first aid, Active Release Technique (ART) (massage that targets soft tissues), and exercises and stretching.

In doing so, OSHA reminded employers that the definition of “first aid” set forth in 29 CFR 1904.7(b)(5)(ii) is a comprehensive list of first aid treatments. Any treatment not included on the list is considered medical treatment beyond first aid and, thus, generally meets recording criteria.

OSHA clarified that it considers all enumerated treatments as first aid regardless of the professional status of the person providing the treatment. Thus, even if a physician provides such treatments, they are still considered first aid and do not need to be recorded, assuming the absence of other recording requirements. Accordingly, ART is first aid regardless of the professional status of the person providing the treatment. However, as mentioned above, an injury is recordable even if it meets the definition of first aid but satisfies other recording requirements, such as resulting in days away from work or restricted work activity.

First aid specifically includes hot or cold therapy and massages. Thus, the use of either treatment, even over a long period of time or requiring multiple applications, is generally not recordable. However, OSHA stated that repeated applications of first aid to the same employee presenting the same concerns may reveal an improper application of first aid and potentially reflect intentional avoidance of recording a work-related case. In such an event, the CSHO should investigate further.

OSHA acknowledged that it may not be easy to determine whether an injured worker received only ART treatment. If so, the CSHO should interview the injured worker to learn more about the type and extent of treatment received and request access to review treatment records.

OSHA also opined that exercise or stretching is not included on the list of first aid treatments. Accordingly, such therapeutic exercise is considered medical treatment when it is designed and administered to treat a particular work-related injury as part of a treatment plan and thus should be recorded.