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It is a well-known fact that some injuries are associated with certain professions and sports. Thus we have tennis elbow, golfer elbow, miner's knee or washerwoman's thumb. The mention of repetitive strain injury (RSI) usually evokes the office worker who has to hit the keyboard all day long. But RSI is not the preserve of the computer user. The very people who treat RSI and other carpal tunnel syndromes in overworked computer users are also very much at risk of developing these conditions. Massage therapists, physiotherapists, nurses, osteopaths and chiropractors... all manual therapists run the risk of seeing their career terminated or compromised by work-related musculoskeletal disorders.

Save Your Hands! The Complete Guide to Injury Prevention and Ergonomics for Manual Therapists, now in its second edition, is a book specifically "dedicated to understanding, preventing and treating work-related musculoskeletal disorders" in manual therapists.  For the second edition of this very useful book, Lauriann Greene has enlisted the help of Rick Goggins, a Certified Professional Ergonomist and a massage therapist. The authors know what they are talking about as they both experienced, at some stage of their training and career, the debilitating effect of musculoskeletal disorders. Now they are keen to share with manual therapists the extensive knowledge and understanding of the subject they have acquired over the years, so that they can prevent work-related injuries or to remedy them when they happen.

Lauriann and Rick published the first reliable statistics on injury among massage practitioners in 2006. Since then, more statistics have been produced and they reveal the considerable extent of the problem. Did you know for example that 41% of massage practitioners were injured over a 2 years period and that 84% of chiropractors were injured during careers averaging only 11 years? I didn't either, before I read this book. A survey on injury among American massage therapists found that an astounding 77% of practitioners complained of work-related pain and discomfort during the previous two years. From the same survey we learn that 64% of practitioners had symptoms that were serious enough to cause them to seek medical treatment, and 41% were diagnosed with a musculoskeletal disorder. The American Massage Therapy Association reveals that the average massage career does not last more than eight years. Some can't even finish their training due to injury. All manual therapy schools should issue a health warning: a career in bodywork can damage your musculoskeletal system!  

Thankfully, help is at hand with this hefty manual. Save Your Hands!  is a 332- page, well-written, comprehensive and authoritative book.  It is well-designed with clear photos and illustrations, sidebars, tables, tips and hints. It is both a reference and practical guide which, no doubt, will end up being well-thumbed due to its wealth of practical advice, tackling both the physical and emotional aspects of the manual therapist's work. When reading this book, you'd better heed the advice given in it – 'use a hands-free book holder or place books in your lap or on a table.'

The book is divided into three parts. Part one deals with the why and how manual therapists get injured. To avoid being injured it is essential to understand what causes these injuries to happen. Part one addresses this subject in a thorough manner, guiding the reader into a form of risk assessment process. You will learn about the 'weak links' in the manual therapist body – the five parts of the body which get injured most frequently: thumbs, hands/wrists, shoulders, neck/upper back, and lower back, in that order. Once you have developed an awareness of the risk of injury and understood how these risk factors cause injury, you'll have reached part two which deals with prevention proper.

There is plenty of useful information in this part two, from Body Mechanics to Ergonomics, from Physical Conditioning to Modifying Your Techniques. Most useful to me was the chapter about Modifying Your Techniques. After reading it, you'll never dare to bend or deviate your wrists while massaging. Many of the habitual hand techniques used in massage are discouraged and one feels that it could be at the expense of the client, unless the therapist has a lot of experience and practice in the alternatives to using them. The topic about Body mechanics is really about the Use of the Self. In my opinion, the best available method of learning how to use yourself correctly is the Alexander technique (mentioned a few times in the book), often imitated but never equalled. As it is impossible to teach good use of the body/mind unit by words and pictures alone, don't expect to be proficient at it without hands-on teaching from a qualified practitioner.

My favourite chapter in Part Two is Modifying Your Techniques. By contrast, I am disappointed, but not surprised by the content of the chapter entitled Physical Conditioning which was developed by Janet M Peterson. In this chapter, the usual myths and, in my view as a Mézières therapist, misguided advice are served up. Thus, we read that ..."for most practitioners, the focus should really be on strengthening postural stability muscles..." whereas, in reality, those muscles always suffer from hypertonicity. We go on to read that "...the diaphragm can become weak from underuse", whereas it also always ends up hypertonic. Later in this chapter, we have the now ubiquitous mention of the so-called core muscles. The author repeats the common misconception that strengthening them will help the practitioner "...to counteract the forward shoulder and head posture..." The true position is that this faulty posture is caused by hypertonic muscles (c.f 'the muscular chains' of F. Mézières), so they do not need any strengthening, but loosening instead. Of course, this chapter had to offer exercises. Exercises! Everybody wants them, but people hardly ever carry them out. It is as well, since the exercises under the heading Core Strengthening may be harmful, and may, in my opinion as a Mézières therapist, compound and aggravate the conditions they purport to remedy.

Part three deals with injuries and their treatment; it could have been called Physician Heals Thyself. You'll find here an exhaustive list of injuries common to manual therapists and a chapter on how to diagnose and treat them. Most therapists would or should already be well cognizant of these injuries and how to deal with them, since it is their bread and butter. It is nevertheless a very useful reference work that will be welcomed by both students and practitioners – the former can use it as a learning aid; the latter, to refresh their memory.

All in all, Save Your Hands is a book that I will recommend heartily to any aspiring or experienced manual therapist. Hands are your primary tool and, as such, deserve some respect, care and attention.

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