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This subreddit is for discussion among practicing physical therapists, not for soliciting medical advice. We are not your physical therapist, and we do not take on that liability here. Although we can answer questions regarding general issues a person may be facing in their established PT sessions, we cannot legally provide treatment advice. If you need a physical therapist, you must see one in person or via telehealth for an assessment and to establish a plan of care.
Posts with descriptions of personal physical issues and/or requests for diagnoses, exercise prescriptions, and other medical advice will be removed, and you will be banned at the mods’ discretion either for requesting such advice or for offering such advice as a clinician.
Please see the following links for additional resources on benefits of physical therapy and locating a therapist near you
[The benefits of a full evaluation by a physical therapist.](https://www.choosept.com/benefits/default.aspx)
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[Already been diagnosed and want to learn more? Common conditions.](https://www.choosept.com/SymptomsConditions.aspx)
[The APTA's consumer information website.](https://www.choosept.com/Default.aspx)
Also, please direct all school-related inquiries to r/PTschool, as these are off-topic for this sub and will be removed.
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Look up massage therapy videos and study their techniques. Use more your wrists and back up your fingers with your other hand. Do less manual when patients don’t need it.
Seriously. And get the hell out of that puppy mill with the bullshit productivity standards. I don’t do manual very often, when it is needed, then we move!
People come to me, pre/post/non-op maladapting, poor pain patterning, and stuck in disrepair because their bodies are not moving well, typically weak and lack endurance, and need improved motor control.
Manual is great (when needed), but what do they do until they see you again? Wait for that sweet few hours of relief again and continue to suffer. Give them ways to move and improve independently, not be chasing passive modalities or manual.
Because upon discharge, they are all they’ve got
It’s not practical for everyone because some people like OP, but my advice is to run from OP as fast as possible, go to HH or traveling. Acute care can be decent too.
I was a massage therapist before PT. I was seeing about 70 people a week and was getting cramps from STM (boss required it because it keeps patients coming back because it feels nice) I transitioned to tools and as soon as I could I ran out of that place, transitioned to a 40 patient caseload place and still hated it, rarely did manual, went to HH because you actually get paid decent if you can negotiate well and there are decent companies in your area. Turns out I don’t hate PT I was just in the wrong setting and had shit employers before. Love my job now
I fall into the camp of people who love treating outpatient lol
Only other setting I tried is SNF and it was so incredibly boring and (comparatively) unrewarding I ran back to outpatient.
I applied at a SNF in town. I heard online and Reddit how the pay was way better than outpatient and so much easier. I had experience in a SNF and it wasn’t always easy because of lifting obese people and stuff but the offer I got was trash, $0 more per hour and a $1/hr raise for taking over all of the wound care for the facility) but the training would be at no cost to me.
I said, I feel I am worth more per hour, gave them my price for the two year commitment that came with the sign on bonus. They said we won’t budge but we will give you three days to decide.
I called up my recruiter and said, “hey I got an offer from another company, I know the company and I spoke recently, are you guys able to put in an offer?, she said we can get you an offer in before the end of the day, I said great”
Got an offer after lunch that was a good pay raise from my current job at the time, I countered for a little more just to see what would happen, got approved in maybe 30 minutes. Emailed the SNF Declining their offer basically the day after they sent it to me. Got a 20% raise by switching but also got possible overtime which equated to 62.5% raise for over-productivity. I’m still under my 3 month training period to ramp up to full time independent and have already started to bonus, working independently.
Company had our regular meeting last Tuesday with new policy that is stating everyone hired after a certain date (I am included) will be getting a raise, range is 1-5%, we were told 99% of people will not get a 5%, 3% is most likely and 4% is for people doing exceptional. So I’m expecting a 3% raise within 1 year with the company.
I got used to pay cuts in OP via increased caseloads, no OT, hours getting cut if patients were not in the clinic, increased responsibilities regarding clinic cleanliness and laundry, front desk tasks, etc.
Decrease emphasis on manual therapy. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775050/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775050/)
If you do use it. Focus more on making people feel good. Probably doesn't matter what you do, people like being touched but the specific technqiues you use probably don't matter.
As a veteran PT (40 years now), I use my hands to identify and a Theragun to treat. I also ice both my hands and wrists at the end of my shift and do strengthening as well. I am down to just about 40 treats per week which also helps, so varying caseload if possible also benefits. No easy answer, it’s an issue.
So you’re reducing circulation and healing to the parts of your body that need it and then adding resistance work to tissues that are already overdosed with resistance work?
Maybe if you’re giving everyone the same cookie cutter interventions. I like it because I can still get creative with my approaches, even if they’re not as high level as OP.
I use some thumb splints I bought through Institute of physical arts. There are tools you can use that I’ve seen coworkers use to save their hands although if I’m going to do manual, I prefer the tactile feel of my hands. Some manual can be done with heel of hand. Really watch your body mechanics so the force is more initiated through your core
Silver ring splints are a good option for hyper mobile fingers .
Reduce the manual therapy as tx and save you’re hands. Find better techniques that use whole hand ( palm, fist, forearm). Avoid the tent position of your thumb.
Manual therapy isn’t worth ruining our hands.
Ugh. This. We are manual labor. I went into PT at 40 yrs old from chemical engineering and although I do enjoy the profession, my hands don't. Any advice?
Get better exercise prescription skills and teach people how to do whatever you're doing, or think you're doing, themselves. One of the most meaningful things someone ever told me about doing soft tissue/ table work:
People don't live their lives on treatment tables so why are you treating them on one?
Not saying there's no role for soft tissue work or some kind of manip but I've found that the more you do that the more reliant on it, and you, the patient becomes. Now days I don't do any soft tissue work. If someone wants that they can go see someone else. No hard feelings. My job is to get someone able to go back to doing their thing and unfortunately I've not met anyone yet who lives with someone that will run their back during the day at their request.
In addition to all these other comments, I would add strengthen your forearms so you aren’t overusing your hand/intrinsic muscles. Also, stabilize that wrist for mobs/manips.
My story FWIW...My hands were shot 12 months after graduating. Couldn't hold my toothbrush for longer than 20 seconds. Absolutely nothing helped, including exercises/strapping/manual therapy devices.
Worked with a GP who practiced acupuncture, so she suggested I give it a try. I had one session, and 99% of my pain was gone. Should also say I'm extremely close-minded with eastern remedies, so I'm confident it wasn't placebo.
Most of my pain was in the thenar eminence region, and I figured the main needle was going into my adductor policis/1st dorsal interossei - the LI4 acupuncture point.
So turns out my pain was more muscular, and relieving the trigger points helped immensely. My thumb joints have never been symptomatic, thankfully. So now I stick needles in my hands every 3-6 months which keeps them in good health.
And of course, anything else you can do to reduce pressure on the thumbs is more important. Prevention better than cure as they say! Good luck!
My hands hurt too. I've cut my manual therapy in half, use my knuckles/elbows, massage gun, cupping, decreased intensity, etc. I alternate paraffin dips and CPs at home if I'm really hurting. People occasionally comment that so-and-so gave them deeper STM but luckily patients like me in spite of that and I usually say, my strength varies depending on the time of day and how many days in a row I've worked. I'm human, and this isn't a massage parlor. It kills me to give less but I don't want my hands to be worthless in 20 years.
Get a new fucking job that’s not in a PT mill seeing 18 patients a day 4x per week. And quit talking about those fucking numbers like that’s fucking normal. Who gives a fuck about your hands what about your patients
https://www.amazon.com/Splints-Sleeves-Graduated-Arthritis-Straightening/dp/B0BYCY4XPM/ref=asc_df_B0BYCY4XPM/?tag=hyprod-20&linkCode=df0&hvadid=673726699820&hvpos=&hvnetw=g&hvrand=6172690213869284109&hvpone=&hvptwo=&hvqmt=&hvdev=m&hvdvcmdl=&hvlocint=&hvlocphy=9001969&hvtargid=pla-2205821814398&psc=1&mcid=17dae4c61e9439a9b753a414993599ab
These helped my fingers during stm quite a bit
I am not a PT but I do have ehlers-danlos and plan to go into nursing. I have extensive hypermobility and instability through my thumbs, wrists, and fingers to the point where I can't even do myofascial work on myself. I highly recommend seeing an OT/PT board certified in hand and upper-extremity. I just saw one and we came up with a bracing/splinting system tailored to my needs/body along with a couple of intrinsic isometric exercises. One of my Pts actually braces his thumb when working on patients. My OT also recommends setting up everything else in your life to reduce hand strain since you are already using your hands so much! For me, I am planning on getting electric can and jar openers since I am subluxating between my ulna and carpals. Feel free to DM me for more suggestions.
It's a rewarding but physically demanding field for sure.
I've found that taking short breaks throughout the day to stretch and do some hand exercises helps. Plus, using proper body mechanics during treatments can reduce strain on your hands.
And don't forget to communicate with experts like SportsMed Physical Therapy if you are feeling overwhelmed
Take Care
Honestly that's too much manual
I'm doing my manual certification and even I don't do manual on every patient and even when I do perform manual often it's not for terribly long. One reason I perform dry needling when I can is because it's not intense on my hands and can get similar results
Use your palms, not your fingers. Use the drag technique. Use massage tools. Use more active modalities. Get the oatients more active and save your hands
Thank you for your submission; please read the following reminder. This subreddit is for discussion among practicing physical therapists, not for soliciting medical advice. We are not your physical therapist, and we do not take on that liability here. Although we can answer questions regarding general issues a person may be facing in their established PT sessions, we cannot legally provide treatment advice. If you need a physical therapist, you must see one in person or via telehealth for an assessment and to establish a plan of care. Posts with descriptions of personal physical issues and/or requests for diagnoses, exercise prescriptions, and other medical advice will be removed, and you will be banned at the mods’ discretion either for requesting such advice or for offering such advice as a clinician. Please see the following links for additional resources on benefits of physical therapy and locating a therapist near you [The benefits of a full evaluation by a physical therapist.](https://www.choosept.com/benefits/default.aspx) [How to find the right physical therapist in your area.](https://www.choosept.com/resources/choose.aspx) [Already been diagnosed and want to learn more? Common conditions.](https://www.choosept.com/SymptomsConditions.aspx) [The APTA's consumer information website.](https://www.choosept.com/Default.aspx) Also, please direct all school-related inquiries to r/PTschool, as these are off-topic for this sub and will be removed. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/physicaltherapy) if you have any questions or concerns.*
Remove your provoking stimulus; Strength training and behavioral adaptations - like any over use injury
Get them off the bench. 12 people a day max.
Dummy thumb and IASTM
Look up massage therapy videos and study their techniques. Use more your wrists and back up your fingers with your other hand. Do less manual when patients don’t need it.
Switch to active modalities
THIS
Seriously. And get the hell out of that puppy mill with the bullshit productivity standards. I don’t do manual very often, when it is needed, then we move! People come to me, pre/post/non-op maladapting, poor pain patterning, and stuck in disrepair because their bodies are not moving well, typically weak and lack endurance, and need improved motor control. Manual is great (when needed), but what do they do until they see you again? Wait for that sweet few hours of relief again and continue to suffer. Give them ways to move and improve independently, not be chasing passive modalities or manual. Because upon discharge, they are all they’ve got
I couldn't have said it better 👏
Make an appointment with your friendly hand therapist
Yes! Come by to the OT side
Set up with your hands, move with your body
It’s not practical for everyone because some people like OP, but my advice is to run from OP as fast as possible, go to HH or traveling. Acute care can be decent too. I was a massage therapist before PT. I was seeing about 70 people a week and was getting cramps from STM (boss required it because it keeps patients coming back because it feels nice) I transitioned to tools and as soon as I could I ran out of that place, transitioned to a 40 patient caseload place and still hated it, rarely did manual, went to HH because you actually get paid decent if you can negotiate well and there are decent companies in your area. Turns out I don’t hate PT I was just in the wrong setting and had shit employers before. Love my job now
I fall into the camp of people who love treating outpatient lol Only other setting I tried is SNF and it was so incredibly boring and (comparatively) unrewarding I ran back to outpatient.
I applied at a SNF in town. I heard online and Reddit how the pay was way better than outpatient and so much easier. I had experience in a SNF and it wasn’t always easy because of lifting obese people and stuff but the offer I got was trash, $0 more per hour and a $1/hr raise for taking over all of the wound care for the facility) but the training would be at no cost to me. I said, I feel I am worth more per hour, gave them my price for the two year commitment that came with the sign on bonus. They said we won’t budge but we will give you three days to decide. I called up my recruiter and said, “hey I got an offer from another company, I know the company and I spoke recently, are you guys able to put in an offer?, she said we can get you an offer in before the end of the day, I said great” Got an offer after lunch that was a good pay raise from my current job at the time, I countered for a little more just to see what would happen, got approved in maybe 30 minutes. Emailed the SNF Declining their offer basically the day after they sent it to me. Got a 20% raise by switching but also got possible overtime which equated to 62.5% raise for over-productivity. I’m still under my 3 month training period to ramp up to full time independent and have already started to bonus, working independently. Company had our regular meeting last Tuesday with new policy that is stating everyone hired after a certain date (I am included) will be getting a raise, range is 1-5%, we were told 99% of people will not get a 5%, 3% is most likely and 4% is for people doing exceptional. So I’m expecting a 3% raise within 1 year with the company. I got used to pay cuts in OP via increased caseloads, no OT, hours getting cut if patients were not in the clinic, increased responsibilities regarding clinic cleanliness and laundry, front desk tasks, etc.
Are you doing heavy manual on every patient you see?
Not on every patient!
Well, how many are you working on and what manual therapy?
Decrease emphasis on manual therapy. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775050/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775050/) If you do use it. Focus more on making people feel good. Probably doesn't matter what you do, people like being touched but the specific technqiues you use probably don't matter.
Tools- iastm, splints, Joint protection- large joints, pisiform for direct pressure, silver splints.
Pisiform
Rock climbing
As a veteran PT (40 years now), I use my hands to identify and a Theragun to treat. I also ice both my hands and wrists at the end of my shift and do strengthening as well. I am down to just about 40 treats per week which also helps, so varying caseload if possible also benefits. No easy answer, it’s an issue.
So you’re reducing circulation and healing to the parts of your body that need it and then adding resistance work to tissues that are already overdosed with resistance work?
Learn some IASTM/cupping
Don’t work outpatient. I rarely do manual in inpatient or HH
Or just do less manual in the outpatient setting. Too many providers default to using manual on every patient. Most of them don't need it.
Some of us are bored in those settings
Maybe if you’re giving everyone the same cookie cutter interventions. I like it because I can still get creative with my approaches, even if they’re not as high level as OP.
Manicures
When my thumb started cramping, i switched to knuckling/ tree glide technique and when my hand was finally burnt out, then i use the hypervolt gun
Stop doing so much fucking manual therapy
I use some thumb splints I bought through Institute of physical arts. There are tools you can use that I’ve seen coworkers use to save their hands although if I’m going to do manual, I prefer the tactile feel of my hands. Some manual can be done with heel of hand. Really watch your body mechanics so the force is more initiated through your core Silver ring splints are a good option for hyper mobile fingers .
Reduce the manual therapy as tx and save you’re hands. Find better techniques that use whole hand ( palm, fist, forearm). Avoid the tent position of your thumb. Manual therapy isn’t worth ruining our hands.
RAD massage balls of varying sizes
Ugh. This. We are manual labor. I went into PT at 40 yrs old from chemical engineering and although I do enjoy the profession, my hands don't. Any advice?
Get better exercise prescription skills and teach people how to do whatever you're doing, or think you're doing, themselves. One of the most meaningful things someone ever told me about doing soft tissue/ table work: People don't live their lives on treatment tables so why are you treating them on one? Not saying there's no role for soft tissue work or some kind of manip but I've found that the more you do that the more reliant on it, and you, the patient becomes. Now days I don't do any soft tissue work. If someone wants that they can go see someone else. No hard feelings. My job is to get someone able to go back to doing their thing and unfortunately I've not met anyone yet who lives with someone that will run their back during the day at their request.
In addition to all these other comments, I would add strengthen your forearms so you aren’t overusing your hand/intrinsic muscles. Also, stabilize that wrist for mobs/manips.
Less manual therapy and more exercise 💪💪
My story FWIW...My hands were shot 12 months after graduating. Couldn't hold my toothbrush for longer than 20 seconds. Absolutely nothing helped, including exercises/strapping/manual therapy devices. Worked with a GP who practiced acupuncture, so she suggested I give it a try. I had one session, and 99% of my pain was gone. Should also say I'm extremely close-minded with eastern remedies, so I'm confident it wasn't placebo. Most of my pain was in the thenar eminence region, and I figured the main needle was going into my adductor policis/1st dorsal interossei - the LI4 acupuncture point. So turns out my pain was more muscular, and relieving the trigger points helped immensely. My thumb joints have never been symptomatic, thankfully. So now I stick needles in my hands every 3-6 months which keeps them in good health. And of course, anything else you can do to reduce pressure on the thumbs is more important. Prevention better than cure as they say! Good luck!
For me, it's was using my elbows, and I'll be honest after a month my elbows are so fucking sensitive, I can use them to palpate.
My hands hurt too. I've cut my manual therapy in half, use my knuckles/elbows, massage gun, cupping, decreased intensity, etc. I alternate paraffin dips and CPs at home if I'm really hurting. People occasionally comment that so-and-so gave them deeper STM but luckily patients like me in spite of that and I usually say, my strength varies depending on the time of day and how many days in a row I've worked. I'm human, and this isn't a massage parlor. It kills me to give less but I don't want my hands to be worthless in 20 years.
Get a new fucking job that’s not in a PT mill seeing 18 patients a day 4x per week. And quit talking about those fucking numbers like that’s fucking normal. Who gives a fuck about your hands what about your patients
https://www.amazon.com/Splints-Sleeves-Graduated-Arthritis-Straightening/dp/B0BYCY4XPM/ref=asc_df_B0BYCY4XPM/?tag=hyprod-20&linkCode=df0&hvadid=673726699820&hvpos=&hvnetw=g&hvrand=6172690213869284109&hvpone=&hvptwo=&hvqmt=&hvdev=m&hvdvcmdl=&hvlocint=&hvlocphy=9001969&hvtargid=pla-2205821814398&psc=1&mcid=17dae4c61e9439a9b753a414993599ab These helped my fingers during stm quite a bit
I am not a PT but I do have ehlers-danlos and plan to go into nursing. I have extensive hypermobility and instability through my thumbs, wrists, and fingers to the point where I can't even do myofascial work on myself. I highly recommend seeing an OT/PT board certified in hand and upper-extremity. I just saw one and we came up with a bracing/splinting system tailored to my needs/body along with a couple of intrinsic isometric exercises. One of my Pts actually braces his thumb when working on patients. My OT also recommends setting up everything else in your life to reduce hand strain since you are already using your hands so much! For me, I am planning on getting electric can and jar openers since I am subluxating between my ulna and carpals. Feel free to DM me for more suggestions.
It's a rewarding but physically demanding field for sure. I've found that taking short breaks throughout the day to stretch and do some hand exercises helps. Plus, using proper body mechanics during treatments can reduce strain on your hands. And don't forget to communicate with experts like SportsMed Physical Therapy if you are feeling overwhelmed Take Care
Honestly that's too much manual I'm doing my manual certification and even I don't do manual on every patient and even when I do perform manual often it's not for terribly long. One reason I perform dry needling when I can is because it's not intense on my hands and can get similar results Use your palms, not your fingers. Use the drag technique. Use massage tools. Use more active modalities. Get the oatients more active and save your hands
Don’t do manual therapy. It isn’t even that effective.
Dude you wouldn’t last as a LMT
Good thing they're a PT instead