May 18, 2016 Andrea Wright

Losing your physical capacity to continue working as a therapist? How to reclaim your energy and gain control of your health?

Is manual therapy taking it's toll on you?

Is manual therapy taking it’s toll on you?

I’m cutting straight to the chase here; working as a physiotherapist or manual therapist can be really taxing on our bodies! Let’s face it, we are using our bodies as our main vehicle to deliver our work and for most of us have done it 8 hours a day, five days a week for years. As I’ve discovered and other colleagues I’ve spoken with this is not a sustainable pattern. It’s no wonder by the time we reach our (I say ‘our’ because I’m old!) double-figured years of service we’re completely knackered! Spent out! Looking for other options to be less ‘hands on’; consulting, management, or maybe even changing careers completely. ‘Get out whilst you can!’ might be the battle cry in your mind! And of course this might be part of a lifestyle choice. However if the driving force for those choices is one that recognises the body failing faster than you’d like because of your job, then this is a very sobering scenario. Wouldn’t it be useful to know you could continue to really enjoy what you do but not at the expense of your own health? Could this go some way to address the worry and cost of keeping well in your manual therapy work?

The ways that I’ve found to be most helpful in helping me restore energy over the years in my practice as a manual therapist has largely been due to changing my approach and awareness with my own body. This self-care approach, as I’m calling it is embedded in the principles of:

  1. Developing a more sensitive somatic awareness (Where am I spatially and how am I postured in each moment; where am I holding tension in my body?)
  2.  Allowing the movement of the tissue under your hands and in yourself to flow ‘together’ i.e. being more fluid in the body.
  3. Pushing harder doesn’t mean achieving a more favourable response from the tissues; normally to encourage a reduction in tone.
  4. Going with the flow- avoiding your own prescriptive or static body positioning in relation to the motility of the tissues that are being worked on.

So allow me to explain in more detail what these four pillars mean and how they might give you practical steps to support you in your manual work.

  1. Noticing what’s occurring in YOU, your own body/tissue is one of the most helpful things you can use as an indicator for your own health. We do it all the time; to know when we’re hungry, thirsty, need to sleep etc. We use our interoceptive sensory capacities to sense internal body states as aforementioned that help us maintain a desired physiological condition of the body. We also use our proprioceptive and ergoreceptive sense receptors to additionally support our choices in how our skeletal system is best placed for a desired functional activity. We check-in and self-regulate ourselves very well on a daily basis. But I think we miss a trick when we’re in the therapeutic space; all of our capacities to take care or recognise what our needs are in the moment are often forgotten. Our attention is fully engaged on our client’s needs, achieving an outcome, getting the job done or finding a diagnosis and solving the problem! I believe we need to develop a meta-awareness that allows us to not only engage with the client but at the same time, be ever present to ourselves as well. This embodied approach is not the norm, but I think it really needs to be and will grow traction as we realise that some of our working practices are not sustainable for our health. What is it about your position in a particular moment? How can you recognise ease or comfort in yourself whilst you work? Do you know what ‘ease’ feels like and is this even possible whilst working? Questions like these won’t get answered by ‘thinking’ them, but by feeling how this is experienced; an approach I’ve learned to apply over the years and believe that anyone can learn (if you’re not doing it already). It could be the way out of that “pain no gain” syndrome as ignorance gives way to understanding your own body’s needs with greater clarity, sensitivity and more awareness.
  2. Softening into the tissue to sense a more subtle response is one way of safeguarding against unnecessary application of force. It is a learned skill and will take some consistent practice and patience. It means that you are not ‘cognitively’ approaching the tissue by what you ‘think’ it needs. Rather your attitude is one of waiting, sensing to see what and how the tissue needs mechanical input in order to best reorganise itself. You are being ‘guided’ if you like by the tissue motility into the path of least resistance until you meet with another tensional barrier, where you’re invited to have a choice; the option to wait again, rather than push against it. You become more of an explorer of the body and become interested in how ‘it’ wishes to respond (which has more unknown possibilities and more unpredictable) rather than a dictator commanding a particular response in a linear fashion. Admittedly this takes some getting used to as the ‘will to do’ is strong in the manual therapy professions. But it’s worth exploring a different approach for the sake of your own tissues health.
  3. When we engage with the target area of tissue to work on, rather than necessarily going in ‘as hard as one can’ (noting that some argue that creating some irritation of the tissue is necessary in some cases) with a direct application, try practicing a lighter touch. When you go into the tissue harder, notice what happens your own body; do you brace, stiffen, co-contract to maintain a combination of joint/body posturing to maintain a particular force relationship? Noticing how this increased forces in you the therapist translates to the client i.e. how this affects the inter-relational system of the therapist-and-client. This ‘effort’ is energetically expensive and can accumulate over time and can become a source of pain if not checked.
  4. When you’re feeling comfortable with the above, now the fun starts!! You can combine these skills to be able to ‘go with the flow’ of what you feel in your hands in relation to what you also sense in your body! It’s as if both you and the client begin a somatic dance into areas of space and freedom. If you feel a barrier to the tissue under your hand, soften at the proximal end of your limb (most likely the shoulder) then follow that where that relaxation then places your body positioning (the body, pelvis might shift to one side or another). You might find your trunk flexing and contact arm/shoulder extending as you continue to remain connected to the client and so forth. You may need to move your feet to accommodate these changes in trunk and upper limb postures. Tracking these slower whole body movements allows you to sense ‘where is ease’ in the system’- and inter- related system of both you and the client. There is always a dynamic exchange between both biological organisms which by nature are emerging and changing at all levels of organisation. There is no ‘right’ or ‘wrong’ way to interact with living tissue. There is however a way to respect and honour what is right at a given moment for both you and the client. And that requires a sensitivity and expanded awareness to all aspects of the relating experience.

Some of these ideas might ring true to some of you reading; others it may seem vague and too chaotic. I respect this as it isn’t a comprehensive guide to all of the suggestions put forward here. If it is that you’ve read this far thank you. If there’s something resonating in you at a deeper level signalling the need to explore solutions to safeguard your health and career, then it’s worth giving it a try and persevering. After all you have nothing to lose. I’d love to hear from you if you’ve similar or different strategies to reclaim your energy as a manual therapist. I welcome you to leave a comment below. 🙂

Comments (2)

  1. Lucy McLauchlan-Self

    Hi Andrea,
    I am also a physiotherapist and can totally relate to this! I work with children so spend lots of time sitting on the floor, followed by lots of admin sat at my desk or sat in my car driving to/from work/between patients. I subsequently experience back pain from being so sedentary and can feel myself developing that typical posture of thoracic kyphosis and chin poke at my computer. I try my very best to keep on top of things by taking regular movement breaks, walking during my lunch break, yoga and as many other opportunities to be active as possible. But it is hard work and I’m not sure how it is sustainable being only 7 years into my career… I’d love to hear your thoughts on how I could use your advice into my paediatric role.
    Kind regards,

    • Dear Lucy
      Thank you for your comments. I can understand your difficulty being very active working with ‘little people’ in their ‘little world’ which is unlikely to be ergonomically suited to your needs! 🙂 It sounds like you’re already have a good pragmatic approach to address the issue by constantly changing your postures and practicing yoga. I’d be interested in whether you do any manual work with the children, if so how; on the floor, couch or otherwise?

      Consider at every level the question, “how does this feel for me right now?” Are you asymmetrically positioned, holding sustained postures, could you be positioned closer, higher, do I need equipment or do I need assistance? In each position the thing that I find helps is using the breath (maybe taking 3 breaths with a long exhalation) as a way of centring and ‘coming into your own body’. This will hopefully give you immediate sensory feedback for you to respond appropriately; shift weight, move, adjust. It also ‘grounds’ you and by that I mean you can begin to appreciate the weight of your body, noticing if your stable or grounded where you are. The long exhalation is more likely to tap into the parasympathetic NS to faciliate the relaxation response, so you’re addressing any excess tension in the system and minimising it. The key for me is practising this level of ‘checking in’ until it becomes second nature and frequent. I suggest that you experiment with just this outside of the work environment in different scenario’s to make the task easier. And when you are more attuned to that way of perceiving introduce it at work. Was that useful?

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