How much do you value your hands?

By Dominic Smith, Clinical Applications Specialist

 

Hand injury is the second most common work-related musculoskeletal injury among physical therapists (PTs) and other manual therapy professionals such as osteopaths, physiotherapists, chiropractors, acupuncturists and massage therapists1.
As manual therapists, one of the aspects you don’t necessarily appreciate is how much of a toll your job can have on your own body. I am only 5 years into my career and my hands (particularly thumbs) have already taken a battering!
As part of my job with Physiquipe, I am lucky to work with such amazing tools and technologies, which have not only improved my clinical outcomes but also, I believe, have saved my career as a Sports Therapist.
I am not the only one who feels this. Speaking to many other individuals where manual therapy is part of their day to day practice, whether it be in private healthcare or the NHS, this is a common occurrence. However, investment in new equipment to support the therapist is limited, often by funding.
All this has prompted me to look into the research of the prevalence of thumb, hand and wrist pain in those associated with manual therapy, but also as the question of;
As the therapist – How much do you value your hands?
As a manager – How much do you value your staff and your staff’s hands?

 

On my searches, I found some interesting papers. I have briefly reviewed and listed a couple of them and their key findings.
1. Occupational hand injuries: a current review of the prevalence and proposed prevention strategies for physical therapists and similar healthcare professionals. (2018) Gyer G1Michael J2Inklebarger J2.

 

– The lifetime prevalence of hand injuries was about 15%–46%
– Annual prevalence was reported as 5%–30%
– Thumb injuries were found to be the most prevalent of all injuries, accounting more than 50% of all hand-related problems
– The most significant risk factors for job-related hand injuries were;
           – Performing manual therapy techniques
           – Repetitive workloads
           – Treating many patients per day
           – Continued work while injured or hurt
           – Weakness of the thumb muscles
           – Thumb hyper mobility, and instability at the thumb joints
– PTs reported these major consequences of their injury;
            – Modifying treatment technique
            – Taking time off on sick leave
            – Seeking intervention
            – Shifting the speciality area
– The authors recommend that PTs should develop specific preventive strategies and put more emphasis on the use of aids and equipment to reduce the risk of an unnecessary injury.

 

2. Wrist and hand pain in orthopaedic physical therapists: A mixed-methods study. (2019) Campo, Hyland, Suek, Pappas.

 

– 962 PTs and the focus groups included 10
– The one-year prevalence of wrist and hand pain was 75%
– Factors associated with an increased risk of moderate to severe wrist and hand pain include;
                – Increasing age
                – Decreasing experience
                – Female gender
                – Performing more manual therapy
                – Working more than 40 hours per week
– Soft-tissue mobilisation was the most frequently cited causative factor
– The most commonly mentioned strategy for prevention was altering body mechanics and technique
 

 

3. The prevalence of thumb problems in Australian physiotherapists is high: an observational study (2006). Margaret McMahon, Kathy Stiller and Pat Trott.

 

– 1562 (approximately 10% of the total) registered Australian physiotherapists;
                  – 1102 (71%) questionnaires were returned
                  – 961 (68%) completed
                  – Lifetime prevalence of thumb problems was 65%
– Current prevalence was 41%
– Factors that were significantly associated with thumb problems included;
                 – Working in orthopaedic outpatients
                 – Using manual therapy
                 – Trigger point therapy and massage
                 – Having thumb joint hypermobility; or an inability to stabilise the joints of the thumb whilst performing physiotherapy techniques
– Of those respondents who reported thumb problems;
                  – 19% had changed their area of practice
                  – 4% had left the profession as a result of their thumb problems

 

Now, as a Medtech ‘Sales rep,’ understandably, you may think of me as bias towards equipment, however, first I am a clinician, and my first port of call is for hands on therapy. There is no better tool than that of our hands. No piece of equipment can ever beat clinical experience with hands or the building of that relationship with a patient through touch.
However, we must recognise that as good as our hands are, they are limited, like any treatment modality available to us. Often this limitation with hands is our own pain threshold, but when looking at new treatment solutions, I am looking at;
– What does this equipment do that my hands simply can’t?
                       – And, does it work (obviously!)
– Will it unload the day to day pressures on my hands?
– Does this treatment/technology compliment what I do with my hands?

 

 

Reference list;

  1. Prevalence, risk factors and preventive strategies in work-related musculoskeletal disorders among Israeli physical therapists. (2010) Rozenfeld V1Ribak JDanziger JTsamir JCarmeli E.
  2. Occupational hand injuries: a current review of the prevalence and proposed prevention strategies for physical therapists and similar healthcare professionals. (2018). Gyer G1Michael J2Inklebarger J2.
  3. Factors related to thumb pain in physiotherapists (2003). Snodgrass et. Al.
  4. Prevalence of work-related MSK disorders among Physiotherapists in Sabah: A cross sectional study (2016). Balakrishnan et. Al.
  5. Wrist and hand pain in orthopaedic physical therapists: A mixed-methods study. (2019) Campo, Hyland, Suek, Pappas.