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  • PTs in Pain: Study Finds Relationships Between PTs Who Experience MSK Pain and Hours Worked, Patient Volume, and Years of Experience

    In this review: Professional experience, work setting, work posture, and workload influence the risk for musculoskeletal pain among physical therapists: a cross-sectional study
    (International Archives of Occupational and Environmental Health, August, 2019)

    The message
    A survey of physical therapists (PTs) in Spain revealed that about half of all respondents had experienced moderate-to-high levels of low back pain in the last 30 days, and nearly 3 in 5 had experienced neck pain in the same time frame. Researchers analyzed those and other areas of pain in relation to work conditions and demographic variables, and found several elements that they believe increase—and sometimes decrease—the odds of experiencing musculoskeletal pain (MP). Among the connections: larger patient loads, more hours worked per week, and more frequent use of machines and manual therapy raised the odds of some types of MSK pain, while more years of experience in the field tended to have the opposite effect.

    The study
    Members of Spain's physical therapy professional association were invited to participate in an online survey that asked them about any MP they may have experienced in the past 30 days, including the pain site as well as the severity of the pain on a 0-10 scale. For purposes of the study, researchers focused on pain episodes with ratings of 3 and above, and limited pain sites to neck, shoulders, upper back, low back, elbow/forearm, and hand/wrist.

    The pain episodes were then compared with self-reported work-related factors including years of experience, work in the public vs private sector, hours worked per week, number of patients per week, prevalence of treating multiple patients at a time, primary patient type, and primary type of treatment used. A total of 981 questionnaires were analyzed. The study population had an average age of 34.3 years, with females making up 70.6% of respondents.


    • Overall, 57% of respondents reported experiencing moderate-to-significant neck pain within the past 30 days, and 49.4% reported low back pain (LBP). Upper back pain was the third most reported site at 36.1%, followed by shoulders (33.8%), hand/wrist (32.7%), and elbow/forearm (16.7%)
    • Higher odds of experiencing LBP were associated with treating more than 1 patient at the same time (2.14 times as likely than treating individual patients), working more than 45 hours per week (1.73 times as likely compared with working fewer than 35 hours per week), and working in a seated position (2.04 times as likely compared with standing work).
    • PTs who reported using exercise interventions as their primary type of treatment tended to have lower rates of neck pain compared with PTs whose primary approach was manual therapy. PTs who primarily used machines "consistently reported higher rates of upper back pain," compared with the use of manual or exercise therapy, according to the study's authors.
    • In addition to its correlation to LBP, working more than 45 hours per week was also associated with higher prevalence of upper back pain compared with PTs who worked fewer than 35 hours per week.
    • Patient load was found to have a weak-to-moderate effect on increased rates of shoulder pain, with PTs who treated 30 or more patients per week reporting a higher prevalence than those who treated fewer than 30 patients per week.
    • PTs with 6 to 15 years of experience were found to have lower odds of experiencing shoulder, low back, and elbow/forearm pain compared with PTs reporting 5 or fewer years of experience. PTs with more than 15 years' experience were found to have lower odds of experiencing pain in those same areas, as well as lower odds of neck pain, compared with the 0-5 year group.

    Why it matters
    While MP is common among health care providers, PTs tend to be at higher risk, with a recent systematic review predicting that as many as 91% of PTs will experience MP in their lifetimes. Authors of this study hope that their findings could help in the development of clinical guidelines and interventions "to prevent work-related MP and better working conditions among PTs."

    More from the study
    Authors were particularly interested in the reasons why more experienced PTs reported a lower prevalence of MP. They suggested 4 possible explanations:

    • Better patient management skills and "the dearth of practice about how to reduce the risk of MP"
    • Better injury prevention strategies among more experienced PTs such as "modification of treatment techniques or increasing the use of support staff"
    • Attrition as PTs who experience MP early in their careers leave those careers sooner (the "healthy workforce effect")
    • The possibility that "more experienced PTs developed a higher pain threshold due to higher work volume"

    Related APTA resources
    APTA's Safe Patient Handling webpage offers resources for avoiding injury, including links to online courses, US Food and Drug Administration guidelines on proper use of patient lifts, and a bibliography of journal articles from multiple disciplines.

    Keep in mind...
    The study, based on survey results, looked at exposure and outcomes simultaneously, which can influence the ways associations are established. Additionally, researchers didn't know how many PTs received the initial survey, so they couldn't determine a response rate—data that could also color the findings.

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.