Workplace Ergonomics: A Practical Guide

posted by Pivotal Health Solutions on Friday, October 10, 2014

For chiropractors, massage therapists, physical therapists and other health care practitioners, their hands are often considered their best tools. As such, it’s important to maintain the function and sensitivity of the hands in delivering care to patients. Workplace ergonomics suggest that hand tools can play an important role in reducing stress and pressure in the hands. Lauriann Greene, CEAS, and Richard W. Goggins, CPE, LMP, explain in this excerpt from Save Your Hands! The Complete Guide to Injury Prevention and Ergonomics for Manual Therapists, 2nd Edition, Copyright © 2008 Gilded Age Press, Inc.

Workplace risk factors play a primary role in causing musculoskeletal disorders among manual practitioners. While some factors, like your age or previous injuries, are realities that you cannot change, risk factors in your practice are modifiable to a great extent. Ergonomics is a proven and remarkably effective way of reducing injury risk.

The main goal of ergonomics is to find ways to make the work environment better fit the worker. Finding ways to adapt your work or workplace to better fit your body can reduce your exposure to work-related risk factors and help you stay healthy in your career. An effective way to reduce risk factors in the workplace is to use tools that increase your comfort and safety as you work.

Hand-Held Tools

For example, consider adding hand tools to your practice. A number of tools are available for performing hands-on modalities, particularly for applying sustained or deep pressure.

You may believe that all soft tissue work should be done with your hands alone, so you can palpate and feel what is happening in your clients’ bodies. Your hands, and particularly your fingertips, are indeed very sensitive, because the nerves run very close to the surface. For this same reason, they are easily affected by pressure. Applying sustained pressure with your fingertips can result in localized compression of the nerves and the small blood vessels that nourish them. In the short term, this can lead to inflammation, reduced circulation and a loss of sensitivity that can take some time to resolve. Over time, repeated damage to nerves and blood vessels in the fingertips without adequate time for healing can result in a long-lasting reduction in sensitivity. Pressure applied with the fingertips has also been shown to increase pressure in the carpal tunnel, increasing the likelihood of damage to the median nerve, which supplies sensation to most of the fingers.

Rather than lose the ability to use one of your most important tools—your hands—consider using them only to locate trigger points, adhesions or other conditions needing treatment, and then using a small hand tool to apply pressure. If you use a good tool carefully and sensitively, your clients often will not even realize that you are using a tool instead of your hand. You can always rest a couple of fingers of your other hand on either side of the tool, so you can regulate the pressure you are applying and feel for changes in the tissues.

When evaluating hand tools, look for ones that:

•  Allow you to keep your wrist straight as you apply pressure.

•  Do not place pressure at the base of the palm where the median nerve exits the carpal tunnel.

•  Allow you to grip comfortably using all of your fingers and your thumb; avoid tools that you would have to hold primarily with your fingertips, since the idea of using a tool is to take pressure off the fingertips. Gripping with just a few fingers is more risky than gripping using the entire hand.

Tools are useful for more than just compression and trigger-point work. Cupping tools can be used to lift tissues in place of repetitive techniques such as petrissage and skin rolling. Percussive tools and power massagers can be used in place of your hands for percussion techniques (tapotement), or to provide general relaxation to groups of muscles.

Using tools does not avoid all problems. While tools may help take some of the stress off your hands and wrists, using them improperly can place your upper arm in awkward positions, increasing your risk for shoulder injury. Repetitive gripping is also a risk factor for MSDs, and gripping a tool can become a problem for some manual therapists. For others, gripping causes fewer adverse effects than using their thumbs or fingertips. Most of the hand tools out there are fairly inexpensive, so it is easy to experiment with different tools to find out whether they work for you.

Using tools is not a good practice for every practitioner, every client, or every technique. In fact, tools should be used in a fairly limited way in your practice. They can help you reduce the effort required for a number of situations, allowing your hands to rest and be more available for those techniques where tools are not appropriate.

Even if you choose not to use tools with your clients, you should consider using them to massage your own tissues. They can give you more leverage for self-massage, and allow you to apply pressure to trigger points without having to assume awkward postures.

Using Hand-Held Tools Safely

Following some basic safety guidelines can help make your use of tools a positive experience for you and your clients.

• Since tools can allow you to use larger muscles, you can apply more force with less effort,  sometimes a good deal more force. Keeping this fact in mind, be careful to not exert more force than you intend to when using tools.

• Practice with tools on yourself to get a sense of how much pressure you are applying. Compare a tool in one hand with using your fingers on your other hand to apply equal force on your quadriceps. Compare the effort with the tool hand to the finger hand.

• Check in frequently with your client to make sure they do not experience any discomfort as you use tools. Be sure to get their feedback on the level of pressure you are using.

• Go easy with tools until both you and your clients are used to them.

• Keep a few fingers around the tip of the tool to help gauge your pressure.

• Check tools before each use for cracks or nicks that could cause them to break or could tear the client’s skin.

• Do not use tools on the elderly or anyone else with fragile skin that could tear easily.

• Do not use percussive tools directly over the kidneys or other delicate organs.

• Use tools primarily in areas that are less sensitive, such as the larger muscles of the back and hips. Use them carefully on sensitive areas, such as the IT band, the pectorals, the rotator cuff muscles, etc. Do not use them at all over delicate structures such as floating ribs, the xyphoid process, or around any sites of potential endangerment.

• Put tools down when you are not actively using them. Holding on to them while performing other techniques can place your hands in awkward positions or cause static loading from continuous gripping.

• Sanitize tools after use with each client.

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