Research · Hands and work strain
Work-related musculoskeletal disorders in physical therapists: the research
Manual therapy asks a lot of the practitioner's hands, back and neck, often for decades. These studies measure how often physical therapists, physiotherapists and massage therapists develop work-related musculoskeletal disorders (WRMSDs), where they feel them, and what they change because of them.
In short
- 38.5% of 361 US orthopaedic physical therapists who use manual therapy had had at least one injury they put down to it; the wrist or hand was involved in 80.6% of those cases (Cornwell et al., 2021).
- Over one year, 20.7% of 882 randomly selected US physical therapists developed a new work-related disorder. Joint mobilisation and soft tissue work were among the risk factors (Campo et al., 2008).
- Thumb pain is common: 49.3% of 219 Italian manual therapists had it in the past year (Rossettini et al., 2016), and 65% of 961 Australian physiotherapists had had a thumb problem during their career (McMahon et al., 2006).
- In an Australian state survey, 1 in 6 physical therapists changed setting or left the profession because of a work-related disorder (Cromie et al., 2000).
These figures use different definitions (career-long, one year, the past 12 months) in different countries and groups. Read each one on its own terms rather than side by side.
How common it is
Surveys from the US, Australia and Korea, plus one study that followed therapists forward for a year.
Work-related musculoskeletal disorders in physical therapists attributable to manual therapy
Cornwell L, Doyle H, Stohner M, et al. · Journal of Manual & Manipulative Therapy 2021;29(2):92–98 (online 2020)
What they did. An online survey of members of the APTA Academy of Orthopaedic Physical Therapy (2018) asked who had been injured by their own manual therapy work, where, and with what effect.
What they found. 38.5% reported at least one work-related injury they attributed to manual therapy. The wrist or hand was involved in 80.6% of those cases. Women reported more such injuries, and injuries started early in careers as well as late.
Limits. Respondents chose to take part and reported from memory, so the figures may not represent all physical therapists.
Read or download free PubMed DOI 10.1080/10669817.2020.1793470
Work-related musculoskeletal disorders in physical therapists: a prospective cohort study with 1-year follow-up
Campo M, Weiser S, Koenig KL, et al. · Physical Therapy 2008;88(5):608–619
What they did. Randomly selected APTA members filled in a questionnaire on their work tasks and were asked again a year later about new musculoskeletal disorders (at least 4/10 severity, monthly or lasting over a week).
What they found. 20.7% developed a new work-related disorder within the year. Risk factors included patient transfers and repositioning, bent or twisted postures, joint mobilisation, soft tissue work and job strain.
Limits. Some therapists changed jobs during the year, which complicates the exposure picture. Symptoms were self-reported.
Work-related musculoskeletal disorders in physical therapists: prevalence, severity, risks, and responses
Cromie JE, Robertson VJ, Best MO · Physical Therapy 2000;80(4):336–351
What they did. A mailed questionnaire to one in four physical therapists on a state register asked about symptoms, tasks, risk factors and what therapists did after an injury.
What they found. Lifetime prevalence of work-related disorders was 91%, and 1 in 6 moved within or left the profession because of them. Mobilisation and manipulation techniques were linked with more thumb symptoms.
Limits. One Australian state, data from the late 1990s, recalled over a whole career.
Work-related musculoskeletal disorders among physical therapists
Bork BE, Cook TM, Rosecrance JC, et al. · Physical Therapy 1996;76(8):827–835
What they did. A four-page questionnaire went to physical therapists who had trained at the University of Iowa (80% replied), covering symptoms over the past 12 months and job factors.
What they found. Over 12 months, the most affected areas were the low back (45%), wrist and hand (29.6%), upper back (28.7%) and neck (24.7%). Lifting or transferring dependent patients was rated the main contributing job factor.
Limits. Graduates of one school, self-reported, and an early study of the field.
Work-related musculoskeletal disorders among Korean physical therapists
Chung SH, Her JG, Ko T, et al. · Journal of Physical Therapy Science 2013;25(1):55–59
What they did. A self-administered questionnaire was given to 234 physical therapists in Korean hospitals; 157 complete replies were analysed.
What they found. 92.4% reported a work-related disorder in the past 12 months, most often in the low back (53.5%) and shoulders (45.2%). 51.6% coped by using a different part of their body to apply manual techniques.
Limits. A 12-month, all-causes figure from self-report, so it measures something different from career-long or manual-therapy-only figures.
The thumb
The thumb comes up again and again, especially with sustained pressure techniques. For practical ways of taking load off a massage therapist's thumb at the table, see Protecting Your Hands.
Prevalence and risk factors of thumb pain in Italian manual therapists: an observational cross-sectional study
Rossettini G, Rondoni A, Schiavetti I, et al. · Work 2016;54(1):159–169
What they did. An email survey of physiotherapists trained in manual therapy (219 of 523 completed it) asked about thumb pain, the techniques they use and what they changed.
What they found. 70.8% had had thumb pain at some point and 49.3% in the past 12 months. Trigger point ischaemic compression was linked with higher odds of thumb pain, and therapists with more than five years' experience reported less of it. Of the 108 with thumb pain in the past year, 69.4% changed their technique.
Limits. Fewer than half of those invited replied, and pain was self-reported.
The prevalence of thumb problems in Australian physiotherapists is high: an observational study
McMahon M, Stiller K, Trott P · Australian Journal of Physiotherapy 2006;52(4):287–292
What they did. A random 10% of registered Australian physiotherapists were surveyed about thumb problems, their work and joint mobility.
What they found. 65% had had a thumb problem in their career and 41% had one at the time. Manual therapy, trigger point therapy and massage were all associated with thumb problems, as was being unable to stabilise the thumb joints during techniques. Of those affected, 19% changed area of practice and 4% left the profession.
Limits. Self-reported, and associations do not show cause.
Read free at publisher PubMed DOI 10.1016/s0004-9514(06)70009-5
Factors related to thumb pain in physiotherapists
Snodgrass SJ, Rivett DA, Chiarelli P, et al. · Australian Journal of Physiotherapy 2003;49(4):243–250
What they did. Physiotherapists with and without work-related thumb pain were compared on joint laxity, strength, hand position and force during mobilisation, and other factors.
What they found. Everyone in the pain group linked their thumb pain to manual techniques, and 88% had changed how they worked because of it. Hand position and applied force varied widely between therapists. The pain group had looser thumb base joints and weaker tip pinch.
Limits. A small sample, so it shows associations worth testing rather than firm causes.
Read free at publisher PubMed DOI 10.1016/s0004-9514(14)60140-9
Massage therapists
Most of the research covers physical therapists. The picture from massage therapists looks similar, with the wrist and thumb at the top of the list.
A survey of musculoskeletal injuries amongst Canadian massage therapists
Albert WJ, Currie-Jackson N, Duncan CA · Journal of Bodywork and Movement Therapies 2008;12(1):86–93
What they did. Registered massage therapists across Canada reported pain and discomfort in the low back, shoulders, neck, wrists and thumbs linked to giving treatments.
What they found. Pain and discomfort were most often reported in the wrist and thumb, then the low back, neck and shoulders, even though most respondents said they had been trained in posture and self-care.
Limits. Self-reported, with no comparison group.
Reviews and opinion
Work-related musculoskeletal disorders among physical therapists: a comprehensive narrative review
Milhem M, Kalichman L, Ezra D, et al. · International Journal of Occupational Medicine and Environmental Health 2016;29(5):735–747
What they did. The authors reviewed published research on how common work-related disorders are in physical therapists, what drives them and what helps.
What they found. Reported lifetime prevalence ranged from 55% to 91% across studies, with the low back most often affected. Knowing correct body mechanics did not by itself prevent work-related injuries, and the authors call for new strategies that don't compromise the quality of treatment.
Limits. A narrative review, so studies were not selected or weighed by a formal protocol.
Strategies to overcome size and mechanical disadvantages in manual therapy
Hazle CR Jr, Lee M · Journal of Manual & Manipulative Therapy 2016;24(3):120–127
What they did. Two physical therapists described common manual therapy techniques and showed how to set them up so they take less effort, especially for smaller practitioners or larger patients.
What they found. They argue that body position, leverage and preparation can cut the exertion many techniques demand without changing what the technique does, and recommend teaching these adaptations in training programmes.
Limits. A practical commentary, not a trial. The adaptations were described, not measured.
Read or download free PubMed DOI 10.1080/10669817.2015.1119371
The use of instrument-assisted soft-tissue mobilization for manual medicine: aiding hand health in clinical practice
Pianese L, Bordoni B · Cureus 2022;14(8):e28623
What they did. Two physical medicine clinicians reviewed the literature on hand strain in manual work and on soft tissue tools.
What they found. They argue that tools may spare the clinician's hands and could become a way to protect them, and they call for studies comparing practitioners who use tools with those who don't.
Limits. An argument, not a trial. It points to a gap in the research rather than filling it.
What the research doesn't show yet
None of the studies on this page tested Trigger PRO, and we haven't found a trial showing that any tool, Trigger PRO included, lowers injury rates in practitioners. Most studies on this page are surveys, which depend on memory and on who chooses to reply. A useful next step is to measure the load directly: how much force the hands carry with and without help, and how tired they get over a working day. That is the kind of study we support.
Where next
Last reviewed October 2026. Summaries are ours; read the original paper before citing it. Know a study we should add? Tell us.
