Injury Prevention for Manual Therapists


The work that manual therapists do is physically demanding. Practitioners often use repetitive movements, hand force, static loading and awkward postures in their work, all recognized risk factors for developing musculoskeletal disorders (MSDs). The therapist’s age, general health, previous injuries and other personal physical and emotional factors are additional risk factors. It is not surprising to learn that, as a result of these factors, manual therapists experience high rates of MSDs (see table, below).


Before you start thinking about putting your treatment table up for sale, it’s important to understand that injury is NOT inevitable. Many professions have inherent risks, and most people in these professions have successful, long-term careers. There is a great deal you can do to prevent injuries from occurring in the first place, and to minimize their effects if they do occur.

The keys to managing your risk of injury are to:
• Reduce your exposure to risk factors as much as possible. You can do this by modifying the risk factors you can change (like repetitive movement or awkward postures), and maintaining awareness of and developing coping strategies for those you can’t change (like your age or previous injuries);
• Treat symptoms early and effectively, to keep them from leading to injury.


Proven methods exist to lower the incidence of work-related injury. Many of them involve making simple but important changes to your activities, both at work and elsewhere; others will take more thought and practice to apply. But taking the necessary steps to prevent injury is much easier and less disruptive to your career than dealing with an injury once it has occurred. Ideally, all students should learn effective injury prevention and ergonomics techniques during their training, to prepare them for the challenges of their future careers.


A Multi-Faceted, Holistic Approach to Injury Prevention

Decades of research have shown that reliance on just one tactic, like improving your body mechanics or doing strengthening exercises, is rarely effective in preventing MSDs. Since multiple factors are involved in causing work-related injuries, a successful prevention strategy must be holistic and multifaceted, combining many of these tactics to address all of the potential causes.

There are five primary steps to injury prevention:
1. Maintaining awareness of the risk of injury in your work
2. Understanding how risk factors cause injury
3. Reducing risk factors through ergonomics
4. Developing good body mechanics and work practices
5. Taking care of your general physical and emotional health, including physical

This comprehensive approach to injury prevention is detailed in Save Your Hands! The Complete Guide to Injury Prevention and Ergonomics for Manual Therapists, 2nd Edition (read more about the book here). Our continuing education courses give therapists the foundations of injury prevention and ergonomics in convenient online and in-person formats with CE credits. Consulting and training are available to businesses and schools, to provide cost-effective and cost-reducing methods to support the health and safety of their manual therapists. See Resources for more information on injury prevention and ergonomics.


Profession Injury Rate Symptoms Rate
Massage Therapists1 41% over a 2-year period 77% over a 2-year period
Physical Therapists2 32% over a 2-year period  
Physical Therapist Assistants2 35% over a 2-year period  
Hand Therapists3 66% over course of career (~7 year avg.)  
Chiropractors4 84% over course of career (~11 year avg.)  


1. Lauriann Greene and Richard W. Goggins, “Musculoskeletal Symptoms and Injuries among Experienced Massage and Bodywork Professionals,” Massage & Bodywork, 2006; Dec–Jan: 48–58.

2. Nicole L. Holder, et al, “Cause, Prevalence and Response to Occupational Musculoskeletal Injuries Reported by Physical Therapists and Physical Therapist Assistants,” Physical Therapy, 1999; 79(7): 642–652.

3. Suzanne Caragianis, “The Prevalence of Occupational Injuries among Hand Therapists in Australia and New Zealand,” Journal of Hand Therapy, 2002 Jul–Sep; 15(3): 234–241.

4. Dennis M. J. Homack, “Occupational Injuries to Chiropractors in New York State,” (Masters’ Thesis, Graduate School of Cornell University, 2004).