A lot has been said and debated when it comes to the effectiveness of manual therapy (MT). Rightly the clinical effectivness of MT is usually at the forefront of debate however there is a side of the story you probably haven’t given much thought – the impact on the clinician performing MT. Work-related musculoskeletal disorders (WRMDs) are common for physiotherapists with many studies directly linking this to our clinical practice and treatment choices. Interestingly there is some association with novice clinicians sustaining higher frequency of injury suggesting technique and treatment choice may play a part but many injuries are sustained by experienced clinicians too.
The treatment choice isn’t only down to MTs of course as manual handling, treatment time, plinth positioning, increased patient contact time and strength and size of clinician all being associated with higher rates of WRMDs as demonstrated by this systematic review. At the time of publication there was little evidence investigating the specific relationship between MTs and WRMDs. The aim of this study was to begin to explore the type, association association, prevalence and impact of work related musculoskeletal disorders amongst clinicians which use manual techniques.
Participants of the survey were members of the Academy of Orthopaedic Physical Therapy Association and actively use or have used MTs in clinical practice during their career. 361 clinicians responded to the survey with a wide range of clinical experience and expertise. 38.5% of clinicians who responded reported that they had experienced an injury as a direct concequence of MT. Effects of the injury were wide ranging and impacted quality of like and ability to work in many cases. The most common sites of injury are shown on the image below taken from the article.
Clearly this is a small survey and only members of the AOPTA were contacted limitimg generalizability.
Education is required to try and reduce the risk of injury as a concequence of MT. Participants reported that MT made up some 60% (average) of their caseload which does appear high and perhaps some alternative treatments which are as or more effective should be used. Protective strategies should be explored and managers / team leaders should be aware of the risk of injury and mitigation strategies should be put in place.
This is a really interesting topic area and awareness and access to occupational health is important for physiotherapy clinicians too. If you are interested in this field why not take a look at the Physioplus programme we have available which explores this specialist field of interest.