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

Looking at the equipment a massage therapist uses daily in their work and making sure it fits their body well is an important part of ergonomics, one of the key elements in any injury prevention strategy.

One piece of equipment you probably use quite a bit is a computer. It may not be the piece of equipment you most associate with massage work, but it’s important to look at your computer workstation and make sure it’s set up in a way that minimizes your exposure to risk factors for injury.

Typing on the computer exposes your upper extremity to several risk factors, including repetitive motion (from typing and mousing) and possibly awkward postures. It’s easy to get into a forward-head posture and to “slump” while you work at the computer, and both of these postures create stress for the neck and shoulders. Your neck, back, shoulders and upper extremities may already be overused in your massage work, so you want to make sure you’re not adding to the stress on your body with a computer workstation that is poorly set up.

Ergonomics always seeks to fit the work to the worker, rather than fitting the worker to the work. In the case of working at the computer, you could try to sit up straighter, not crane your neck or keep your wrists as straight as possible; however, if your workstation is set up in such a way that it’s very difficult for you to change your body mechanics, you’re going to be fighting a losing battle. It’s much better to adjust the workstation to better fit your body, making it easier for you to sit in a more neutral posture and keep your wrists straight.

There are a number of good web pages that discuss the ergonomics of one’s computer workstation. Here are some suggestions (links below). You can also find a discussion of this topic and a detailed workstation diagram in the Appendices of Save Your Hands! 2nd Edition:
OSHA e-tool
HealthyComputing.com
UCLA’s 4-Step Guidelines
Laptop tips

I spent this past weekend exhibiting at the Florida State Massage Therapy Association conference. I spent each day on my feet, greeting massage students and professionals and chatting about their self-care and injury prevention efforts and concerns. I rarely got a chance to sit down, and when I wasn’t standing in place, I was taking small steps in and around the booth. At the end of each day I was very tired. After two and half days, I felt stiff all over, my back hurt, my legs hurt, and I was physically exhausted.

You might be wondering why someone who is relatively young and in good shape would find just standing around so tiring. It’s actually quite fatiguing to stand in one place or take only small steps for long periods. My muscles were being asked to maintain a fairly constant level of contraction to hold me up and in place, and that was keeping them in a state of static loading with not enough oxygen getting into my tissues. The result was stiffness and pain when I finally did start moving again, and an overall level of fatigue. With my muscles so stiff and fatigued, I could easily have injured myself if I attempted to do more strenuous work, like lifting boxes of books and carrying them to my car.

Now think about doing massage work. Many therapists stand for most if not all of their massage. They may take very short breaks, if any, between massages, and may not sit at all for hours on end. While they’re massaging, they may plant their feet in one place for a good portion of the massage. They may spend a good portion of the massage with their back bent over the client. The result? Fatigued, stiff, contracted muscles that could tear if an additional demand were placed on them, for example, reaching out farther than usual or lifting the client’s limb.

To avoid fatigue, be sure to sit down for at least a portion of your massage. A good rule of thumb would spending 15 minutes of every hour seated. Be sure to move around as you work – don’t let yourself stand in one place for too long. Every few minutes, try to move to a different position at the table. In the 17 years that I’ve observed massage therapists working, I’ve found that the massage therapists who have the fewest issues with symptoms or injury are those that are in nearly constant, fluid movement as they work. Try to incorporate movement into your massages, and be sure to take enough of a break between massages to sit down, relax, breath and prepare for the next client. Your feet, legs and back will thank you!

I crashed my bicycle the other day. Wait. Let me back up and introduce myself. I’m Rick Goggins and I’ve worked with Lauriann Greene spreading the word about injury prevention for massage therapists for several years now. But even when your job is injury prevention, you can still get hurt.

Getting back to my crash, it was a pretty embarrassing event for an experienced cyclist. A moment’s inattention, a mailbox that stuck out into the bike lane, and I found myself laying on the pavement. I wasn’t going very fast, but asphalt is just as hard at 10 mph as it is at 20.

Fortunately I was wearing padded cycling gloves. They literally saved my hands. Instead of scraped up palms or a broken wrist, I just had a bad bruise across the thenar muscles at the base of my thumb.

My crash makes for a good reminder to protect your hands outside of work. Gloves are a good idea when gardening, doing home improvement projects, and cleaning around the house, as well as for recreational activities.

My injury also reminded me just how much we use our thumbs over the course of the day. Turning a doorknob, grabbing the handle of my computer case, even hitting the space bar on my keyboard were all quite painful until that bruise healed. So take care of your thumbs, and they’ll take care of you.

Be safe, be well. Rick

I’ve been struck recently by the increasingly frequent practice in the massage profession of doing longer and longer massage sessions. While 50 minute (spa setting) or 1 hour massage are still the norm, more and more therapists are now regularly doing 1 1/2 hour, 2 hour or even 3 hour massages. Sometimes they are asked by an employer to do this, but many times they are willing to do these long sessions in their own private practice.

I find this practice troubling from an injury prevention point of view. To prevent injury, the body needs periods of rest and recovery, so that microtrauma caused by repetitive motion and other risk factor exposures can heal. Repeated trauma without adequate healing time can lead to injury. Fatigue is also a risk factor for injury, and who would not be fatigued by doing a 2-3 hour massage, particularly during a day when you’re also doing other massages?

I also find it troubling because I don’t think it’s beneficial to the client. I just had a great 1-hour massage today, and I felt very relaxed afterward and in less pain. Frankly, I don’t think I would have felt much more relaxed or in that much less pain if it had lasted longer – maybe 10-20% more, if that. So I think that therapists (and clients) overestimate how much better they would feel with a longer massage, and end up tiring themselves and increasing their injury risk for very little additional gain, if any. Since some of the massage involved working on painful areas, and I already felt sore 6 hours later due to the work that had been done there, if more work had been done, it would have been too much and I would have felt too sore. I have had 1 1/2 hour massages, and I remember feeling nauseous and really groggy afterward. That’s not how I want to feel after a massage.

Clients need time to integrate the work you do, to gauge how their bodies feel different, to see if the work was helpful, etc. That comes from having a series of massages to work on their various issues. Therapists need to educate their clients and explain that you get better results from a series of massage than from one long massage. Chiropractors, physical therapists and other manual therapists work in this way – they create a treatment plan involving a number of sessions. It’s just not possible to work on everything in one massage, and the result is over treatment and an exhausted therapist. It’s part of setting healthy boundaries to say “no” to really long sessions. It’s also better for your business, as you will encourage the client to think of you as her ongoing therapist that she sees regularly, rather than someone she sees once and maybe never again. OK, maybe you could do a 1 1/2 hour massage under some circumstances, but not on a regular basis. And I just don’t see any justification at all for 2 hours or longer, not from a therapeutic point of view and certainly not from the point of view of maintaining your own health and career longevity.

In addition to blogging about injury prevention and self-care topics for students and therapists, we also want to talk about teaching these topics in massage school. So we’d like to invite massage instructors, education directors, school administrators, etc. to participate in this blog, too. Ideally, massage therapists and bodyworkers would develop good work practices, awareness of risk factors, good body mechanics and excellent self-care practices from the very start. That means from day one of their massage training. So talking about how these things are taught in school is really important.

There are lots of schools out there that are already incorporating effective injury prevention and self-care into their curriculum. But we do hear from lots of students and recent grads that their school did not give them enough information on this subject, and they feel quite disappointed by that. I think it’s important for schools to realize that prospective students are looking for schools that teach them not only how to do massage, but how to be successful as a massage therapist and have a career that lasts as long as they want it to. Students are investing a lot of money in their training, and they want the school to help them protect that investment. And a big part of being successful is being able to avoid symptoms and injury that can interfere with their career and their ability to make a living. Years ago, the fact that there is a high rate of injury among massage therapists wasn’t well-known – now, every magazine has articles about the importance of self-care and preventing injury (Rick and I write lots of them ourselves). So even people who are thinking about going to massage school know that this is important. So whether the school includes comprehensive information on injury prevention (going far beyond just using good body mechanics), or not, can make the difference between a student choosing that school, or not.

Given that fact, I would like to encourage schools not only to include comprehensive injury prevention information in their curriculum (and we’ll be talking more about how to do that in other posts – it’s easier than you may think), but to let prospective students know that they do. Put it in your promotional materials, on your web site – it’s a great value-add for your school, a wonderful benefit for your students – it really does give your school a competitive advantage! So advertise it proudly. If you let prospective students know that you care enough about their health and long-term success in their new career to provide this vital information, they WILL appreciate it, choose your school, and then recommend your school to others when they graduate. More to come!

Rick and I are very happy to collaborate with our friends at Massage Magazine on our new blog.  Back in 1999, Massage Magazine was the first to publish a regular column on self-care and injury prevention, written by myself, called “Helping the Healers”.  So I was really pleased when Massage Magazine once again asked me to provide regular content on this important subject, this time in blog format. Rick Goggins will be blogging with me, contributing his wisdom and knowledge as both a Licensed Massage Practitioner and a Board-Certified Professional Ergonomist with nearly 20 years of workplace injury prevention and ergonomics experience.

In this blog, we’ll be looking at all aspects of self-care, injury prevention, body mechanics and ergonomics for massage therapists. Preventing injury on the job was a major concern for massage therapists back in 1999, and it still is.  In 2006, Rick and I did a study that produced the first reliable statistics on symptoms and injury among American massage therapists, and the results showed that there is definitely reason for all massage therapists to seriously address this issue.  We found that 77% of massage therapists experience symptoms or injury as a result of their work. While that’s a worrisome number, Rick and I also want you to know that there is a great deal you can do to prevent injury.  Injury is common among massage therapists, but it’s definitely not inevitable.

So what do you have to do to prevent injury due to your massage work?  I wish I could tell you “just use good body mechanics”, or “never do more than X number of massages per week.”  But it takes a bit more effort than that.  We tend to want to find one strategy, one simple technique adjustment or new approach to body mechanics that will keep us injury-free throughout our careers.  But there really is no single approach that has been shown to be effective. To maintain your general health, you have to use a number of tactics (eat right, exercise, etc.) – the same is true to avoid work-related injury.  Since there are many reasons that therapists become injured, you need to use a number of different tactics to address the different reasons (referred to as “risk factors”).  For this reason, research has shown that the most effective approach to injury prevention is multifaceted and holistic.  This is the approach we’ll be talking about extensively in this blog.

In this blog, Rick and I also hope to relate some of the science that exists to help you protect and prolong your career.  There are decades worth of research on this subject that has produced proven methods that we know are effective.  You can use these methods not only to prevent injury in your own career, but also to better understand and treat your clients’ work-related symptoms and injuries.  After all, most of your clients work, and they’re also exposed to risk factors, both physical and emotional, on the job.  So you’ll not only learn to save your own hands, neck, shoulders and back; you’ll also enhance your skill as a therapist by learning more about preventing injury!

We look forward to reading and responding to your comments and questions, so please let us hear from you!