Occupational Therapists and Chronic Pain

I first started having pain several years ago. The hand therapist at my facility had moved out of state and, having California advanced practice certifications in physical agent modalities and hand therapy, I seemed a good candidate to cover her outpatient caseload until another therapist could be hired.

A couple of months soon turned into a year, and after using manual mobilization techniques on a daily basis, I started experiencing a great deal of thumb pain. What began as an achy feeling at the end of a busy work day slowly became a daily occurrence.

But I’m young, I thought. I exercise regularly, and am careful to take good care of my body. What was going on?

I was completing a post-professional OTD from Creighton University at the time, and decided to do a little research on the topic. Clearly, I couldn’t be the only occupational therapy practitioner experiencing such issues. It turns out I was correct.

Burke et al.1 noted that therapists who routinely performed manual therapy were 3.5 times more likely to report musculoskeletal symptoms in the wrists and hands than those who did not, and in a survey of members of Musculoskeletal Physiotherapy Australia, 83% of 155 respondents complained of pain in the thumbs directly related to their work.2

In fact, the prevalence of thumb pain has been reported to be about 60% among all therapists who regularly administer manual techniques.3 It became clear to me that if I did not make some adjustments in my treatment techniques, in my efforts to heal the injuries of my patients I could be at risk of permanent injury to myself.

Furthermore, I found that data has shown the prevalence of musculoskeletal symptoms is quite high in younger therapists, with a recent study indicating 50% of therapists experience their first episode as a student or during their first five years of practice.4

As I was a clinician and an adjunct faculty member in an OTA program at the time, this was particularly alarming to me. Not only had I never received any formal education in college or during my early professional years on preventive techniques, it was an area I had never approached with my own students.Hand therapy

As I began to study further in the area, research showed that to prevent work-related musculoskeletal disorders among manual therapy practitioners, particular emphasis should be placed on the hand and thumb, as these are the commonly reported sites of injury. Furthermore, education on self-protective techniques must be taught to occupational and physical therapists at all levels, regardless of specialty area.3

To date, there has been little research on preventive strategies and the utilization of tools to minimize injuries sustained by manual therapists. However, preventive strategies and activity modification via mobilization tools and ergonomics must be explored further in physical and occupational therapy to reduce work-related musculoskeletal disorders.

Programs that provide activity modification education and preventive strategies for new and current OT practitioners are crucial. By exerting less physical force on a clinician’s hands, the risk of injury can be reduced on therapists performing repetitive manual therapy.

SEE ALSO: Repetitive Stress Injuries Unraveled

It’s important to minimize use of the thumb as a pseudo-weight-bearing joint and limit stress while it is abducted from the body. Taking miniature rest breaks every 15 minutes or so to stretch, using the palm of the hand, and teaching clients to perform their own scar management and joint mobilization techniques is a necessity.

Some studies have indicated that clients report the use of manual mobilization tools as less comfortable than a therapist’s hands;5 however, I think a combination approach utilizing both tools and hands needs to be explored further if it could reduce the percentage of thumb and hand pain.

It was ironic that many injuries I was treating were caused by prolonged repetitive jobs and resultant cumulative stress injuries. One of the main components of my therapeutic intervention focused on activity modification, yet I wasn’t incorporating it into my daily occupation.

One reason I love to teach students and aspiring therapists is that I can share the knowledge I’ve gained through the years. I hope that I, from my own errors and lessons learned, can facilitate them to be practitioners who are as aware of their own body’s limitations as they are of their clients’ and will incorporate the OT principles of activity modification into their own practice.


1. Burke J, Buchberger DJ, Carey-Loghmani MT, et al. A pilot study comparing two manual therapy interventions for carpal tunnel syndrome. J Manipulative Physiol Ther. 2007;30(1),50-61.

2. Atkinson BW, Maher T. Thumb pain in physiotherapists: Biomechanics, causes of pain and alternate methods of preventing distress in treatment. J Man Manip Ther. 2004;12(4),187-191.

3. Snodgrass SJ, Rivett DA. Thumb pain in physiotherapists: Potential risk factors and proposed prevention strategies. J Man Manip Ther. 2002;10,205-216.

4. Cromie JE, Robertson VO, Best MO. Work-related musculoskeletal disorders in physical therapists: Prevalence, severity, risks, and responses. Phys Ther. 2000;80(4),336-351.

5. Waddington G. Manual application of controlled forces to thoracic and lumbar spine with a device: Rated comfort for the receiver’s back and the applier’s hands. J Manipulative Physiol Ther. 2007;30(5),365-373.

Erin Murray is an assistant professor in the MSOT program at West Coast University in Los Angeles.

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