OSHA's May 2, 2024 enforcement guidance memo to Regional Administrators explains how to determine recordability when musculoskeletal injuries are treated exclusively with first aid, Active Release Techniques (ART), or exercise and stretching. Under 29 CFR 1904.4(a), a case is recordable if it is an injury or illness, is work-related, is a new case, and meets at least one criterion in 1904.7 or 1904.8-1904.11 — death, days away, restricted work or job transfer, medical treatment beyond first aid, loss of consciousness, or a significant diagnosed injury. Critically, 'each criterion operates independently': an injury treated only with first aid is still recordable if it results in work restrictions.
First aid is defined by the comprehensive list at 1904.7(b)(5)(ii) — nonprescription medications at nonprescription strength, hot or cold therapy, wound coverings, massage, and other listed items. Anything not on the list is medical treatment beyond first aid. Multiple applications of first aid remain non-recordable, and OSHA considers listed treatments first aid 'regardless of the professional status of the person providing the treatment.' But OSHA warns that repeated first aid applications to the same worker for identical complaints may indicate inadequate medical assessment, possible avoidance of recording obligations, and even a violation of 29 CFR 1910.151(a), which requires medical personnel to be available for consultation.
ART is a movement-based soft tissue treatment performed by certified licensed practitioners. OSHA determined in 2006 that 'ART is massage for purposes of OSHA recordkeeping,' so if ART is the only treatment, the case is not recordable — regardless of the provider's credentials. It becomes recordable if it results in job transfer, restricted work, or days away. OSHA also notes ART-certified practitioners should not recommend work restrictions; doing so indicates practice beyond ART's scope.
Exercise and stretching are different: therapeutic exercise/stretching is not on the first aid list, so when it is designed and administered to treat a specific work-related injury as part of a treatment plan — including home programs with written instructions — it is medical treatment beyond first aid and the case is recordable, 'regardless of the professional status of the person making the recommendation.' Duration and frequency are irrelevant. By contrast, generic pre-shift stretching programs offered to all employees as a safe work practice, unconnected to a diagnosed condition, are not medical treatment and do not trigger recording.