Chiropractors share an irony with many health care practitioners – the physical demands of their work place them at risk for the same musculoskeletal disorders (MSDs) they treat in their patients.

For some of us, the first injury occurs before our careers even begin. Students in chiropractic college can suffer upper-extremity injuries from repetitive adjusting techniques performed before they have the necessary endurance to handle the workload or the experience to use techniques that require the minimum amount of effort.¹ Students may also suffer from spinal injuries when receiving adjustments from their equally inexperienced classmates.² Unfortunately, a prior musculoskeletal injury is one of the strongest predictors of future injury.³ As a result, some chiropractors may begin their careers predisposed to the same types of injuries they have just been trained to treat.

An elevated risk for injury appears to continue through the first five years of practice, also likely due to a relative lack of experience. The most common sites of injury practitioners report are the wrist and hand, shoulder, and low back.⁴ Adjusting the thoracic and lumbosacral spine, particularly when the patient is side-lying, is associated with an increased risk of injury.⁴ It is interesting to note that occupational MSDs in health care occur not because of an isolated event like an accident, but instead as a result of activities that are a regular part of the job.

This is not to imply that work is the sole cause of these injuries. Off-work activities can expose manual practitioners to some of the same types of injury risk factors – forceful exertions, awkward postures and repetitive motions – that work can. Personal risk factors such as age, physical condition and even emotional well-being can all help determine our susceptibility to injury.³

If MSDs result from a number of different risk factors, including everyday work activities, then what can you do to prevent them? A comprehensive approach to identifying and eliminating or reducing risk factors at work and off-work, along with maintaining good physical and emotional health, is likely to be the most effective tactic. A key element in this approach is applying the principles of ergonomics to your practice.

As practitioners, you are probably already familiar with the concept of ergonomics – fitting the job to the worker – and you may even counsel your patients on ways they can use ergonomics in their work. But have you taken the time to apply these same concepts to your own work?

Proper Positioning

One straightforward example of ergonomics in a chiropractic practice is adjusting table height to reduce awkward bending postures while performing adjusting techniques on a patient's spine. A low table height, around 18 inches (465 mm), will result in greater muscle effort to support your upper-body weight as you lean forward, as well as greater stress on ligaments and higher compressive forces on intervertebral discs. Depending on your height, a medium table height closer to 26 inches (665 mm) may be appropriate for prone adjusting techniques working on the lumbar and thoracic regions, since this height still allows you to use the weight of your upper body to assist with the adjustment, but does not require excessive forward bending. A higher table, around 33 inches (845 mm) high, may be more appropriate for prone cervical work, for which less force is required.⁵

It seems intuitively obvious that table height can make a big difference in the postures practitioners must assume when working, but do you always take the time to adjust your table to the best possible position? For that matter, do you have a hylo table that you can easily adjust for working on different parts of the spine, using different techniques or even accommodating different patients?

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