Work-Related Musculoskeletal Exposures and Injury

By Jerrilyn Cambron, DC, PhD
[Somatic Research]

According to the US Occupational Safety and Health Administration, more workers are injured in the health-care and social assistance industry sector than any other division of labor, including the industrial manufacturing sector. These data do not specifically include data on massage therapists, nor are there any scientific articles assessing the overall work-related repetitive strain injuries in the massage profession. These injury data are needed; otherwise, our profession cannot develop appropriate prevention programs.
The physical therapy profession is related to massage therapy and has been studied extensively regarding workplace injury. Some of the work that physical therapists do is similar to that of massage therapists, and therefore we can presume the effects of this work are also similar on massage therapists. Both professions can include physically demanding tasks, such as repetitive motions, high-force manual techniques for treating patients, techniques that exert direct pressure on certain joints during the treatment, awkward positioning of joints during certain maneuvers, and prolonged constrained postures.     

Research on Physical Therapists
A recent article reviewed several research studies that assessed the work-related musculoskeletal disorders among physical therapists.1 Thirteen previously published articles were found that defined the prevalence of musculoskeletal disorders along with risk factors. A surprising 55–91 percent of physical therapists develop a work-related musculoskeletal disorder in their lifetime, and 40–91.3 percent develop a disorder within 12 months. Low-back pain is the most common location for work-related pain in physical therapists, most often followed by the neck, upper back, and shoulder.
In this review, several risk factors for low-back pain in physical therapists were identified, including high physical load on the body, an age of less than 30 years old, practice experience of five years or less, and female gender. The only modifiable factor in this list is the high physical load. Therefore, prevention strategies that decrease the amount of exertion may be beneficial, such as height-adjustable beds or tables and stools with wheels. Other self-care suggestions to reduce the risk of injury included regular breaks during the workday, warming up before performing work-related physical activity, and alternating the body parts through which the force is exerted, such as fingers, thumbs, palms of hands, and forearms.
A related article used qualitative analysis to better understand work-related exposures and physical complaints of physical therapists.2 In this study, two qualitative methods were used. First, a focus group was assembled with five representatives of professional physiotherapy associations and health and safety stakeholders, along with two moderators. Participants were asked about individual perceptions concerning typical work-related exposures and characteristics of work-related complaints and diseases, as well as their perceptions of work-related resources. In the second portion of this study, 40 physical therapists completed semi-structured telephone interviews that included questions about work-related exposures and main complaints experienced by this working group.
The results of both the focus group and the telephone interviews indicated that the work-related exposures fell into three categories: musculoskeletal, dermal/infectious, and psychosocial. Some of these exposures included awkward body posture during treatment, physical overexertion, patient skin infections, and time pressures during care. The work-related disorders and diseases that were discussed by both groups mirrored the exposures and included musculoskeletal, dermal/infectious, and mental categories. Examples of the discussed disorders and diseases common in physical therapists included spinal disorders, finger and wrist complaints, physical exhaustion, joint pains, skin infections, colds, mental exhaustion, and burnout.
Both the focus group and telephone interviews explored possible resources for prevention and treatment of work-related disorders. All resources surrounded both organizational and personal criteria. Some examples of resources that might improve the workplace included: creativity and practicality in treatment, diversity in occupational tasks, teamwork, and positive feedback by patients. All these factors may benefit individuals working in a massage therapy practice as well.

Limited Research for MTs
Only one article was found that focused on a massage therapy work-related disorder.3 In this case report, a 32-year-old female massage therapist presented with a six-month history of pain and numbness in bilateral thumbs, with the right worse than the left. Even though there was normal range-of-thumb motion, imaging revealed hypertrophied muscles, soft-tissue edema, and thickening of the ulnar nerve. Surgical debulking of the hypertrophied right first dorsal interosseous and adductor pollicis longus muscles immediately decreased the compression neuropathy and thereby improved her pain and numbness.
The therapist did not want surgical intervention on the left thumb, and so it was treated with an injection of botulinum toxin. After the surgery and injection, the massage therapist was taught how to use proximal large muscles while practicing massage instead of relying on small intrinsic muscles in order to prevent recurrence. She returned to work three weeks after surgery and remained pain-free during the 36 months of follow-up.

Moving Forward
More research studies are needed on work-related exposures and disorders among massage therapists, along with prevention strategies for such disorders. It is important to note that since 1995, there has been some significant work done by Lauriann Greene and Richard W. Goggins on injuries and ergonomics for massage therapists. For more information, visit
 Based on the above findings involving the physical therapy profession, manual therapists most likely need to be mindful of hand and finger overuse, back pain, and mental burnout. Personal and workplace strategies to diminish these work-related disorders would be beneficial.

1. M. Milhem et al., “Work-Related Musculoskeletal Disorders Among Physical Therapists: A Comprehensive Narrative Review,” International Journal of Occupational Medicine and Environmental Health 29, no. 5 (2016): 735–47. doi: 10.13075/ijomeh.1896.00620.
2. M. Girbig et al., “Work-Related Exposures and Disorders Among Physical Therapists: Experiences and Beliefs of Professional Representatives Assessed Using a Qualitative Approach,” Journal of Occupational Medicine and Toxicology 12 (January 7, 2017): 2. doi: 10.1186/s12995-016-0147-0.
3. C. C. Chen et al., “Compression Neuropathy of the Ulnar Digital Nerves in the Thumbs of a Massage Therapist,” Annals of Plastic Surgery 72, no. 6 (2014): 649–51. doi: 10.1097/SAP.0b013e31826a1607.

Jerrilyn Cambron, DC, PhD, MPH, LMT, is an educator at the National University of Health Sciences and president of the Massage Therapy Foundation. Contact her at