Occupational therapy’s historical roots are firmly steeped in work or occupation. In the past one hundred years, the concept of work has been the corner stone of our profession. While occupational therapy encompasses wide and varied employment opportunities and specialty areas, occupation is the constant component of this profession. By understanding where we come from as a profession, and embracing occupation, we will enhance our future professional growth. Though the method of using occupation and work has evolved in or profession, “the therapeutic use of work has remained a central tenet and is derived from two basic assumptions-the human need for mastery and self-actualization, and the occupational need of the individual”. This paper will attempt to correlate occupational therapy’s historical connection and the value of work to the specialty of industrial rehabilitation. It is my belief that because of this perspective the profession of occupational therapy is a perfect fit for not only treating the injured worker but for addressing the critical components of the worker’s jobs. The evolution of work hardening, work conditioning and job simulation in occupational therapy treatment will be described. Evidence for post operative occupational therapy, work conditioning and job simulation when treating patients who have undergone a rotator cudd repair following a work related shoulder injury will also be presented.