Effective Injury Prevention-Think Holistically

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By Lauriann Greene, CEAS and Richard W. Goggins, CPE, LMP September 10, 2014 Leave a comment Go to comments

by Lauriann Greene, CEAS and Richard W. Goggins, CPE, LMP

Anyone who has worked as a manual therapist for any amount of time knows how physically demanding this kind of work can be. Manual therapists often use repetitive movements combined with hand force in their work; they may hold pressure or stay in one position for a long time, causing static loading to their tissues; fatigue may cause them to end up working in awkward postures that stress vulnerable parts of their bodies. Repetitive movements, hand force, static loading and awkward postures are all recognized risk factors for developing musculoskeletal disorders (MSDs). The therapist’s age, general health, previous injuries and other personal physical and emotional factors are additional risk factors that can increase their injury risk. Given all of these risk factors, it is not surprising to learn that recent studies have shown a high rate of symptoms and MSDs among manual therapists as a result of their work. A 2006 study of massage therapists and bodyworkers showed that 77 percent had experienced pain or other musculoskeletal symptoms related to their work, and 41 percent were diagnosed with an MSD.1 High rates of symptoms and injury were also reported in other studies among PTs, PTAs, hand therapists and chiropractors.2, 3, 4, 5

Before you start thinking about putting your treatment table up for sale, it’s important to understand that injury is NOT inevitable. Many professions have inherent risks, and many people in these professions have successful, long-term, healthy careers. There is a great deal you can do to prevent injuries from occurring in the first place, and to minimize their effects if they do occur. The key to managing your risk of injury is to reduce your exposure to risk factors as much as possible. You can do this by modifying the risk factors you can change (like repetitive movement or awkward postures), and maintaining awareness of and developing coping strategies for those you can’t change (like your age or previous injuries).

Proven methods exist to lower the incidence of work-related injury. Many of them involve making simple but important changes to your activities, both at work and elsewhere; others will take more thought and practice to apply. But taking the necessary steps to prevent injury is much easier and less disruptive to your career than dealing with an injury once it has occurred.

Developing Your Multifaceted, Holistic Injury Prevention Strategy

It would be wonderful to find a single solution to preventing injury. But decades of research have shown that reliance on just one tactic, like improving your body mechanics or doing strengthening exercises, is rarely effective in preventing MSDs. Since multiple factors are involved in causing work-related injuries, a successful prevention strategy must be holistic and multifaceted, combining many of these tactics to address all of the potential causes.

There are five primary steps to injury prevention:

  1. Maintaining awareness of the risk of injury in your work
  2. Understanding how risk factors cause injury
  3. Reducing risk factors through ergonomics
  4. Developing good body mechanics and work practices
  5. Taking care of your general physical and emotional health, including physical conditioning.

Because a manual therapist’s work is so physically demanding, workplace risk factors play a primary role in causing MSDs among these practitioners. The science of ergonomics provides proven and remarkably effective ways of addressing these risk factors to help you prevent injury.

The main goal of ergonomics is to find ways to make the work environment better fit the worker. Designing your treatment space to fit your body characteristics and the type of work you do makes it possible for you to use good body mechanics. You need enough space to move freely around your table to avoid static positioning and awkward postures. Your table needs to be adjustable so you can work comfortably and efficiently as you change techniques and move from one client to another (a power-adjustable table is ideal for this purpose). Equipment like hydroculators or massage stone heaters can be raised to waist level so you can avoid bending to reach them or having to lift their heavy contents in awkward postures. Each change adds up to make your treatment space a safer place to work.

Your work schedule can also benefit from some ergonomics help. To avoid injury, you need to balance periods of exertion with periods of rest and recovery. You’ll need to schedule breaks that are long enough for you to do some stretches, breathe and relax your mind and muscles. To not overload your body, you will also need to limit the number of treatment sessions you do in a day and in a week. The goal is to have a consistent, manageable workload from day to day and week to week, to avoid any sudden increases in workload, a situation that can increase your injury risk.

Developing good body mechanics is an important part of any injury prevention strategy. Your goal, however, is to have “good” body mechanics, not “perfect” body mechanics. In the real work world, no one uses perfect form at every moment. The idea is to continue to use your body in a natural and efficient way, while doing your best to maintain an approach that maximizes your strength and avoids overloading the most vulnerable parts of your body. You will need to modify or eliminate any technique that causes you pain or discomfort; plainly speaking, if it hurts, don’t do it.

Your general health plays a major role in your ability to prevent injury. Maintaining good physical conditioning, getting enough sleep, eating well and avoiding unhealthy habits like smoking can have a direct effect on your ability to withstand the rigors of your work and heal tissue damage before it progresses to the point of injury.

Sometimes, despite your best efforts to avoid injury, you may find yourself developing symptoms. In real life, it is difficult to always avoid every risk factor and perfectly control your work environment to stay 100 percent symptom-free. If symptoms occur, recognizing them and getting appropriate treatment as early as possible is the best way to minimize interruption to your work and get you back on the road to health as quickly as possible.

Injury prevention is a concern you share with all manual therapists. Meet with your colleagues regularly, talk openly about your injury concerns, watch each other work and support each other’s efforts to reduce injury risk. Give your own physical and emotional needs the same care and consideration that you give to your clients. Learn to be good to yourself, and a long, healthy career will be within your grasp.

1.Lauriann Greene and Richard W. Goggins, “Musculoskeletal Symptoms and Injuries among Experienced Massage and Bodywork Professionals,” Massage & Bodywork, 2006; Dec-Jan: 48-58. 2.Nicole L. Holder, et al, “Cause, Prevalence and Response to Occupational Musculoskeletal Injuries Reported by Physical Therapists and Physical Therapist Assistants,” Physical Therapy, 1999; 79(7): 642–652. 3.Suzanne Caragianis, “The Prevalence of Occupational Injuries among Hand Therapists in Australia and New Zealand,” Journal of Hand Therapy, 2002 Jul–Sep; 15(3): 234–241. 4.Dennis M. J. Homack, “Occupational Injuries to Chiropractors in New York State,” (Masters’ Thesis, Graduate School of Cornell University, 2004). 5.Wayne J. Albert, et al., “A Survey of Musculoskeletal Injuries Amongst Canadian Massage Therapists,” Journal of Bodywork and Movement Therapy, 2007: 1–8 6.Jean E. Cromie, et al, “Work-Related Musculoskeletal Disorders in Physical Therapists: Prevalence, Severity, Risks, and Responses,” Physical Therapy, 2000; 80(4): 336–351.

Portions of this article reprinted from Save Your Hands! The Complete Guide to Injury Prevention and Ergonomics for Manual Therapists, 2nd Edition, Copyright © 2008 Gilded Age Press, Inc. All rights reserved.

About The Author
Lauriann Greene, CEAS and Richard W. Goggins, CPE, LMP are co-authors of the all-new 2nd Edition of Save Your Hands! The Complete Guide to Injury Prevention and Ergonomics for Manual Therapists, the leading self-care textbook used by schools throughout the U.S. and Canada, and worldwide. Lauriann and Richard have published numerous articles in national magazines on this subject, co-authored the first comprehensive statistical study on injury among massage therapists, and offer consulting and training services to clinics, spas and schools to help manual therapists prevent workplace injury.

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