ORTHOPEDIC MUSCULOSKELETAL THERAPISTS: ARE YOU TAKING ENOUGH CARE OF YOURSELF?
While working as a manual therapist in a private practice setting, I’ve been asked by my patients “Don’t your hands hurt?” and “You must be exhausted by the end of the day!” The truth is, it does happen. I occasionally experience pain in my hands and I do get tired and overwhelmed. We’re only human, right?
In light of October’s Healthy Workplace Month coming to an end, a little thought should be put towards our own health and safety.
We love our jobs; in fact, physiotherapists are ranked within the top 100 Canadian jobs (have a look). But when is it time to prioritize our physical, mental and emotional health?
Yes, I am referring to all you hard-working musculoskeletal physiotherapists. You pull long days, treat back problems, listen to your patients’ issues, take few breaks, and work your bodies almost to the point of exhaustion.
Expectations and burnout
Expectations run high when working in a fast-paced orthopedic private clinic, and since we hold ourselves to high professional standards, we make sure these expectations are met.
- Listen attentively
- Educate our patients
- Perform some manual therapy and soft tissue work (when indicated)
- Demonstrate an exercise program, and
- Reiterate patient goals and objectives within a 30 minute session can be overwhelmingly demanding at times, often at the expense of our own health.
Truth be told, there does appear to be a conflict between clinical realities and personal ideals. Our stress levels rise as expectations aren’t met and we begin to negatively view ourselves as failures (1).
It’s been documented that higher workloads and a lack of resources (improper allocation of time, inadequate staff or equipment) were identified as significant role stressors and predictors of diminished emotional and physical well-being in physical therapists (1)(2)(3). Subsequently, these factors resulted in reduced quality of patient care (1). The long-term involvement in a state of stress can lead to physical, emotional and mental exhaustion, otherwise known as burnout (4).
Pain and the profession
On top of all of this, our bodies experience a great physical toll. Work related musculoskeletal injuries have been documented to affect 57% of physical therapists (5) [this study also included PTs working in a variety of clinical settings]. Working as movement therapists, we are constantly moving – pulling, pushing, lifting, poking, prodding, massaging, guiding and following. Having a job that requires you to move is great; however, activities that include lifting and transferring patients, and performing manual therapy are risk factors for work-related musculoskeletal disorders (5).
Specifically, patient-handling that requires transferring and repositioning increases risk of low back injury (5). Manual therapy techniques like passive range of motion techniques, soft tissue work and mobilizations are associated with an increased risk of wrist and hand injury (5). Work-related thumb pain is also a well-documented complaint amongst manual physical therapists. This pain is often due to techniques requiring force transmission through the thumbs, as seen with mobilizations (postero-anterior glides) in the cervical spine (6).
If you find yourself working to the point of exhaustion, losing interest in your job or dreading going to work, ask yourself why you are working so hard.
How to handle (and mitigate) these issues
So how can we manage with all these physical, emotional and mental issues? Here are some tips:
1. Take some time for yourself
“In dealing with those who are undergoing great suffering, if you feel ‘burnout’ setting in, if you feel demoralized and exhausted, it is best, for the sake of everyone, to withdraw and restore yourself,” says the Dalai Lama. “The point is to have long-term perspective.”
If you find yourself working to the point of exhaustion, losing interest in your job or dreading going to work, ask yourself why you are working so hard. Physical therapists tend to be compassionate, altruistic and caring individuals. Despite being admirable attributes to have, caring too much to the point your health begins to suffer is not doing yourself (or your patient) any good.
If your job is cutting into ‘you time’, decrease your workload. The number of days worked per week and an increase in workday hours has been shown to correlate with job stress (4).
Furthermore, be sure to schedule regular breaks throughout the day. Take the time you need to disconnect, re-fuel and re-energize, even if it’s for ten minutes.
2. Practice meditative techniques
Meditation has shown to have remarkable benefits for improving symptoms of many health conditions including anxiety, asthma, chronic pain, depression, fibromyalgia, heart disease, insomnia, irritable bowel syndrome, psoriasis, post-traumatic stress disorder, tension headaches (7). Meditation has also been suggested to be an effective method to improve job satisfaction, reduce work exhaustion and decrease occupational “intent to leave” (4).
For those of you who have a smartphone and 10 minutes, a good introductory app to teach you how to meditate is Headspace. This critically acclaimed, easy-to-use app has been designed to help you overcome stress, anxiety, and improve daily lifestyle.
3. Use equipment or other tools when necessary (or available to you)
Two words: Body mechanics. We all know what repetitive strain can do to our bodies, so always ensure to use equipment when necessary. The use of sliding boards, sliding sheets, lifting equipment and adjustable beds can reduce the risk of low back injury (5).
Using lip balm tubes in your hands when performing thoracic mobilizations or manipulations and/or any non-slip material (I like Dycem) which can help when performing manual techniques to the spine or peripheral joints.
Dry-needling or acupuncture can also be an alternative to using your hands for soft-tissue techniques. There is some evidence to support the use of needling in the treatment of low back pain (8).
4. Adapt manual techniques (or don’t use them at all!)
If your hands are feeling sore at the end of the day, reflect on the techniques you are using and monitor if there is one particular one that you can link to your pain. Note that soft tissue techniques have been documented to be especially hazardous for the manual therapist, as they are usually performed for longer duration of time (5).
We know we possess a healing power of touch, and treatment can be easily influenced by our patients’ response to manual techniques when they say things like “that massage really helped last week, can you do that again?” or “it felt really good when you worked on that joint.” Be sure to take the necessary time to educate your patients when manual therapy or soft tissue therapy is indicated throughout the course of treatment.
Although it may feel good, it may not be the most effective way of getting them better. Remind your patients that the effects of manual techniques are usually short-term; the combination of manual therapy with exercise has been shown to be superior in the long-term.
If your thumbs are giving you some grief, ensure to alter hand placement to avoid hyperextension through the MCP and IP joints. In the case of performing cervical postero-anterior (PA) pressures on the spinous process or articular pillar of the zygapophyseal joint, using your other fingers to support the side of the neck using a lumbrical grip can help create a stable “operational unit” with movement produced by force transmitted through elbow flexion and extension (6).
For other PA pressures of the spine, using the pisiform of one hand superimposed with the other hand with the force transmitted with your own body weight should minimize stress placed through the hand.
5. Review your skills
Some advanced manual therapy techniques require specific handling and patient positioning. If you do not feel comfortable performing certain techniques or you’re unsure about handling, ask a colleague to review it with you. Getting another opinion can often give some insight into what you may be missing with respect to finessing a skill.
Taking post graduate courses is a great way to broaden your skillset. However, we tend to pick and choose the ones that work best for us. Taking refresher courses can help revisit some useful techniques, which will add to our knowledge base. The Canadian Academy of Manipulative Physical Therapy organizes refresher courses across Canada for fellows of CAMPT.
6. Book an appointment
Seek the help you need, when you need it. As physical therapists, we often tend to neglect our own bodies and try to treat ourselves when injured. According to one study (5), physical therapists did not appear to take time off from work, or seek evaluation when they became injured.
Cultural factors may be responsible for this behavior, where dedication and good health are valued to the point where it may be “too embarrassing” for physical therapists to discuss injuries, seek help, or take time off from work (5).
Book an appointment with the appropriate healthcare professional to address any physical, mental or emotional issues you may encounter. It will do you, and your future practice, a world of good.
Sabrina Ianni is a physiotherapist working in a private orthopedic clinic in Laval, Quebec. She is a Fellow of the Canadian Academy of Manipulative Physical Therapy (FCAMPT) and is a clinical instructor at McGill university in the School of Physical and Occupational therapy.
- Campo M, Weiser S, Koenig K. Job Strain in Physical Therapists. Physical Therapy. 2009;89(9):946-956.
- Deckard G, Present R. Impact of Role-Stress on Physical Therapists’ Emotional and Physical Well-being. Physical Therapy. 1989;69(9):713-718.
- Cromie J, Robertson V, Best M. Work-Related Musculoskeletal Disorders in Physical Therapists: Prevalence, Severity, Risks, and Responses. Physical Therapy. 2000;80(4):336-351.
- Blau G, Boyer E, Davis K, Flanagan R, Konda S, Lam T et al. Exploring correlates of work exhaustion and physical exhaustion for a sample of massage therapists and body workers. Career Dev Int. 2012;17(5):414-434.
- Campo M, Weiser S, Koenig K, Nordin M. Work-Related Musculoskeletal Disorders in Physical Therapists: A Prospective Cohort Study With 1-Year Follow-up. Physical Therapy. 2008;88(5):608-619.
- Jull G. Towards preventing thumb pain from application of cervical manual therapy: A point of view. Manual Therapy. 2011;16(3):207-208.
- Sood A. The Mayo Clinic guide to stress-free living.
- Furlan A, van Tulder M, Cherkin D, Tsukayama H, Lao L, Koes B et al. Acupuncture and Dry-Needling for Low Back Pain: An Updated Systematic Review Within the Framework of the Cochrane Collaboration. Spine. 2005;30(8):944-963.