A lot has been said and discussed when it comes to the effectiveness of manual therapy (MT). Rightly, the clinical efficacy of MT is rightly at the forefront of the debate, but there is one side to the story that you probably didn't think about much about – the impact on the clinician who does MT. Work-related diseases of the musculoskeletal system (WRMD) are common among physiotherapists. Many studies link this directly to our clinical practice and treatment options. Interestingly, there is some association with inexperienced clinicians who are more likely to be injured, suggesting that technique and choice of treatment may play a role, but many injuries are also experienced by experienced clinicians.
The choice of treatment naturally does not only depend on MTs, since manual handling, treatment time, pedestal positioning, increased patient contact time and the strength and size of the clinician are associated with higher WRMD rates, as this systematic review shows. At the time of publication, there was little evidence to investigate the specific relationship between MTs and WRMDs. The aim of this study was to investigate the type, association association, prevalence and impact of work-related diseases of the musculoskeletal system in clinicians who use manual techniques.
Survey participants were members of the Academy of Orthopedic Physical Therapy Association, and have actively used or used MTs in clinical practice throughout their careers. 361 clinicians responded to the survey with a wide range of clinical experience and expertise. 38.5% of responding clinicians said they had suffered an injury as a direct result of MT. The impact of the injury was far-reaching, and in many cases affected the quality of equality and the ability to work. The most common injuries are shown in the picture below from the article.
This is clearly a small survey, and only AOPTA members were contacted to limit generalizability.
Clinical Implications
Education is required to reduce the risk of injury as a result of MT. Participants reported that MT was about 60% (average) of their fall load, which appears high, and that some alternative treatments that are just as or more effective may need to be used. Protection strategies should be explored, managers / team leaders should be aware of the risk of injury, and damage mitigation strategies should be introduced.
This is a really interesting topic, and awareness and access to health at work are also important for physiotherapists. If you are interested in this area, take a look at the available Physioplus program that has examined this particular area of interest.
