Save Your Hands!® Injury Prevention & Ergonomics for Manual Therapists

Massage can be a rewarding career, but it is not without some risks. We know from several surveys of massage therapists, including this survey that I helped conduct, that about 3 out of every 4 massage therapists experience musculoskeletal symptoms as a result of their work.

You see other indications that the potential for injury exists in our profession. Massage trade journals frequently publish articles on self care. A number of continuing education programs promise to teach methods that are “easier on the practitioner” and can help “prolong your career.”

But it seems to me that there still is some resistance to talking openly about injuries among massage therapists. It could be that some view having symptoms or injuries as some sort of personal failure, that we’ve done something wrong, used bad technique, or failed to “work smarter.” Not wanting to admit to symptoms could delay asking for help, getting a diagnosis, or starting a treatment program. The end result might be a more serious injury than should ever have happened.

We as a profession need to create a culture where we feel safe in speaking up about symptoms and seeking the help that we need. And that culture starts with each of us as individuals, and locally in small groups of therapists. So let’s start the conversation – with our co-workers, our networks, the students that we teach, and the therapists that we go to for bodywork. Share a link to this blog with your network. And please leave a comment if you have something to say.

Just a quick post to bring up the concept of organizational well-being and the benefits it can have for employees and clients. If you work in a group setting or manage one, you might want to take a look at this article in the Gallup Business Journal.

The main point of the article is that managers can influence the wellness of employees by demonstrating their own commitment to wellness. Organizations with a wellness culture tend to have happier, more engaged employees who then go on to treat clients well, which makes the organization more successful.

And, if you’re self-employed as a massage therapist, you are both the boss and the employee. You can also benefit from creating a culture of well-being for one.

Take care, Rick

I’ve recently been reviewing workplace injury reports for a presentation I’ve been asked to give on hand injuries. The hand and fingers are the most commonly injured parts of the body in workplaces, and I would imagine at home as well.

Fortunately most hand and finger injuries are minor and don’t result in missed work. But as massage therapists, we need to be especially protective of our hands. Even a minor injury could result in some difficulty using certain techniques. And of course any time we compromise the skin’s integrity we can allow infection in.

One fact really leaps out from the injury statistics: Knives cut fingers! I know this isn’t exactly shocking, but it’s an extremely common injury. Again, most cuts are minor, but every once in a while someone manages to cut into a tendon or even cut off the tip of a finger.

With that in mind, here’s a video on knife safety in the kitchen.

This will be a short post, since I’m on vacation. One of the things I’m focusing on while on vacation is getting enough sleep. I’ve always known that sleep is important for my overall health, but now there’s new research from Harvard that shows that getting enough sleep is important for avoiding pain.

The study found that sleep deficiency “is significantly associated with pain, functional limitations of daily living tasks due to that pain, and difficulty performing work tasks due to that pain, among hospital care workers.” The study has some relevance to massage therapists, since it was done with healthcare workers, and with a population that resembles the massage profession as a whole (predominately female, average age in the early 40′s).

So sleep, heal, and feel better. And I can highly recommend vacations. Take care, Rick

There’s been a lot of discussion in the ergonomics community about the use of mobile devices lately. Most people look at devices like smart phones and tablet computers and think: “This is great. I can take this with me and really stay connected.” Ergonomists look at these new technologies with a different perspective: “I wonder what types of injuries might result if someone overuses these things?”

It’s not that ergonomists are overly pessimistic, we just understand human nature. Every technology has a potential misuse, and so the odds are that a popular device will lead to some sort of problems. A lot of ergonomists worried about the potential for thumb injuries with too much texting, and we’re starting to get an indication that our concerns are well founded. There are people who send thousands of text messages a month, and a number of them are developing osteoarthritis at an early age because of it.

What’s a safe number of text messages to type in a month, or week, or day? We don’t have an answer to that question yet. The best approach to the unknown may be a conservative one. With all of the potential for thumb injury in massage work, why add to it with a lot of unnecessary texting?

There are enough challenges in life right now, so I thought I’d share some self-care tips that don’t require a lot of effort. Some of these I’m sure you’ve heard before, but I’m throwing in a little scientific explanation of why they’re good for you so there’ll be some value added.

1. Get enough sleep. We’re talking the full 8 hours here. There’s a small percentage of the population that can get by on less sleep. There’s probably a slightly larger percentage that think they can by on less, but really can’t. Adequate sleep is more than just feeling rested and alert. Sleep is also the time when your body repairs any damage done to it during the day.

2. Avoid deep forward spinal flexion in the morning. As you sleep, fluid returns to your intervertebral disks, part of that nighttime repair process. This “plumps up” the disks and makes your spine a little stiffer for the first couple of hours in the day. While the extra fluid helps keep the disks healthy, the resulting stiffness actually makes your back temporarily more vulnerable to injury. So, it’s best to avoid bending forward at the waist or doing any heavy lifting when you first get out of bed. After a couple of hours of being upright, gravity pushes a lot of the fluid back out of your disks and your spine regains its flexibility.

3. Take an Epsom salt soak. Yes, it’s old school, but Epsom salts are making a comeback. I saw scented Epsom salts prominently displayed in the grocery store the other day. A soak in warm to hot water (keep in mind that heat is contraindicated for acute inflammation) helps to relax the muscles, and the Epsom salts can help reduce inflammation.
4. Drink water. Hopefully the tap water is good where you are. If not, there are a lot of filter options. Even being a little bit dehydrated can reduce muscle performance and cause fatigue. If you’re thirsty, that likely means you’re already somewhat dehydrated. Drink regularly, especially as the weather warms up.

5. Go for a walk. A brisk, 10-minute walk before a massage session is one of the best ways to warm up your muscles and get your blood flowing. Even better if you can get outside for a little sun, for the Vitamin D production and mood enhancement.

What simple things do you do to keep yourself well? Please share with others by leaving a comment.

In my last post I wrote about how much I missed the warmth of the sun during the winter and spring. The sun also provides light, which is more important to us than simply allowing us to see. In addition to stimulating the retina and optic nerve, light also affects the endocrine system. Bright light increases the levels of cortisol in our bodies, which increases our arousal level during the day. Decreasing light levels trigger an increase in melatonin, which helps us to feel sleepy at bedtime.

Sleep problems can occur when we don’t get enough bright light during the day, or when we get too much bright light in the evening. Many massage therapists work in low light levels, since this creates a relaxing environment for the client. Massage rooms are most likely lit with a “warm” light, such as an incandescent bulb or artificial candle. “Cool” lights, such as daylight fluorescents or LEDs may seem harsh, but the blue end of the spectrum that they provide is important for increasing wakefulness during the day. Of course all artificial light is just that – artificial. Natural daylight, as long as we avoid over-exposure, seems to be the best thing for our well-being, both physical and psychological.

So, if you’re not having any issues with sleep or mood, you probably don’t need to make any changes to your light exposure. But if you are having sleep problems, you might try getting more natural light during the day, and using low level, warm lighting in the evenings.

I live in the Pacific Northwest, where we have a lot of things that make for a great quality of life. Abundant sunshine, especially in the winter and spring, is not one of them. The cold and damp can result in a lot of sore and achy muscles, which keeps the local massage therapists busy. The downside is that the massage therapists themselves can also develop the same sore and achy muscles. I speak from personal experience.

I’ve noticed that I can often go an entire summer without really needing a massage, even though I’m even more active than usual during the warmer months. In talking to other massage therapists, they’ve also noticed that their business decreases during the summer. It seems that the warm, sunny days help to keep muscles loose and relaxed.

I’ve found something that helps to replace the therapeutic effects of the sun during the cold, dark winter months. There are now infrared heating pads that are commercially available. These heating pads produce heat that penetrates deeply into the muscles, relaxing muscles and lubricating fascial tissues. Infrared heat may even reduce inflammation and draw moisture into the tissues to help speed healing.

I’ve been using infrared heating for a couple of winters now, and I have found it very beneficial. The heat has a very relaxing quality to it, unlike traditional heating pads that just seem to make my skin hot and itchy. Infrared heating pads use a lower level of electric current, which also means that they generate lower levels of electro-magnetic fields (EMFs). I use infrared heating pads both for self care, and to warm a client’s muscles before working on trigger points.

In the interest of full disclosure, I have no ties to any manufacturers or vendors of infrared heating pads. I’m just happy to have a way to replicate the warmth of the sun when I seem to need it the most.

Instability can lead to unnatural positioning, one of the main factors that contributes to work-related injury. For this reason, avoid using any technique that puts the arms and/or hands in positions that are hard to control, or causes them to wobble.  Using broad, flat areas, like the forearm or front of the fist or knuckles, will give you the most stability.  The thumb and fingers are the most unstable parts to use, since they tend to buckle and wobble when pressure is applied to them.

Enhance stability by reinforcing your hands, wrists and fingers. The more stable the wrist or finger joints are, the less the muscles have to work to keep the joints in alignment. The added stability distributes stress more evenly, and allows the muscles to relax, since they no longer have to work so hard to maintain stable positioning.

Try using your free hand to enhance stability at the wrist. When using your fingers, create stability by using at least two fingers at a time: never use just one finger to apply pressure. When using a flat palm, place the other palm on top of it. Keep the bottom hand soft and relaxed, so it can palpate properly and retain its sensitivity.  Think of the bottom hand as the “palpating hand”, and the upper one as the “power hand,” the one that propels and creates the pressure of the stroke. You can use this same technique when you apply pressure with your fingertips.

I should probably clarify – I don’t actually have a problem with Daylight Savings Time itself. I like the extra daylight in the evening, since I have time to come home from work, eat dinner, and still do something outside.

It’s the time change in the spring that I don’t like. I don’t do well losing an hour’s sleep. And I’m not alone in this. The “spring forward” time change has been associated with negative outcomes such as mood changes, higher rates of serious workplace injuries, an increase in heart attacks, and a spike in fatal car crashes.

It doesn’t seem likely that all of these effects could be from the loss of just one hour’s sleep. It seems more likely that the time change is the tipping point for people who are already a little short on sleep, something that’s all too common these days.

My strategy for dealing with the time change? I’m taking a vacation day on Monday. And getting a good night’s sleep.