There is a sad irony in the therapeutic world: we dedicate our professional lives to healing others' pain, while many of us suffer from chronic back pain, wrist tendonitis, or thumb base degeneration. We teach patients about correct posture and ergonomics, but the moment we approach the treatment table, we often forget the basic rules of our own biomechanics.

 

Therapist burnout is not just about "fatigue"; it is the result of poor load management. At Manual IL, we view a therapist's health as an integral part of their professionalism. A therapist in pain cannot be 100% attentive to their patient. In this article, we reveal the ergonomic principles that allow us, Eyal and Giveon, to continue treating thousands of people over decades without breaking down.

 

Chapter 1: The Physics of Power – Working with Your Body, Not Your Muscles

One of the most common mistakes is trying to generate force through the muscles of the arms and shoulders. Eyal Feigin explains: "Your arms are only the conductors; they are not the generator."

Real and safe power in manual therapy comes from the ground (Ground Reaction Force) and the center (The Core).

• The Foundation Stance: A wide stance (fencing or bow stance) allows for seamless weight transfer. The power to generate a thrust in HVLA or deep pressure in STB should stem from shifting the therapist's center of gravity forward, not from pushing with the arms.
• The Locked Elbow (Sometimes): In static pressure or deep gliding techniques, keeping the elbow straight allows body weight to be transferred directly into the patient's tissue without muscular effort from the triceps. This protects the therapist's small joints from wear and tear.

 

Chapter 2: The Thumb – The Therapist's "Achilles Heel"

Statistics show that degeneration of the CMC joint (base of the thumb) is the number one reason for early retirement among massage and manual therapists. The thumb was not designed to withstand repetitive compressive loads of many kilograms for hours on end.

How to protect it?

Neutral Position: Never work with the thumb in hyperextension. Use the thumb only when supported by the other fingers or as part of a closed fist.

Using Large Joints: In the STB method, Giveon Peled teaches using the forearm (Ulna), the elbow (Olecranon), and the heel of the hand (Pisiform) instead of thumbs whenever possible. These joints are far stronger and capable of bearing significant loads without damage.

Tools (IASTM): Do not hesitate to use professional fascial release tools. They allow you to reach deep tissue while providing total protection for your fingers.

 

Chapter 3: Table Height – The Variable That Changes Everything

The height of your treatment table is a decisive factor in your lower back health.

• Table too low: Forces you to bend from the waist, creating immense pressure on your intervertebral discs.
• Table too high: Forces you to use only arm and shoulder muscles and prevents the use of body weight.

The Manual IL Rule: Table height should change according to the technique.

• For HVLA (Manipulations), the table should be relatively low so you can stand over the patient and use your mass for a rapid thrust.
• For STB and Fascial Work, the table can be slightly higher to maintain an upright back. Professional Recommendation: If you treat full-time, invest in an electric or hydraulic table. The ability to adjust height mid-session is an investment in your health that pays for itself within months.

 

Chapter 4: Rhythm and Movement – The Therapist’s "Dance"

Giveon Peled emphasizes Rhythm. A static therapist is a vulnerable therapist. When working in the STB method, we are in constant motion. We don’t just "press" on a spot; we "enter" it with the movement of the entire body. This mobility maintains proper blood flow in the therapist's muscles and prevents the accumulation of lactic acid and static tension in the shoulders.

Think of the treatment as a "Biomechanical Dance." The transition between techniques should be fluid, shifting your base stance. This not only looks more professional but also unloads the cumulative stress from your joints.

 

Chapter 5: Self-Maintenance – The Therapist is the First Patient

You cannot expect your car to drive at 200 km/h every day without going to the shop. Your body is no different.

• Warm-up: Don't start a session "cold." Five minutes of joint mobility and fascial stretching before your first patient will change your entire day.
• Strength Training: A manual therapist must be strong. Training focused on the Posterior Chain (back extensors, glutes, hamstrings) and core muscles is critical to supporting the workload.
• Get Treated: Schedule a regular treatment for yourself every 2–3 weeks. Don’t wait for your back to "seize up." Maintenance fascial release and manipulations will prevent minor issues from becoming chronic.

 

Chapter 6: The Mental Aspect and "Compassion Fatigue"

A therapist's health is not only physical. The emotional load of patients (trauma, chronic pain) can manifest as physical tension in the therapist. At Manual IL, we teach therapists to "Ground" themselves and maintain energetic and emotional boundaries. A therapist who cannot emotionally detach at the end of the day will experience muscular tension that will shorten their career just as much as a disc injury.

 

Summary: A Long-Distance Career

Our goal at Manual IL is to train therapists who not only know how to treat excellently but also know how to be excellent therapists over the long haul. Ergonomics is not a "bonus"—it is the foundation of clinical excellence.

 

When you apply the manipulative precision of Eyal Feigin along with the flow and presence of Giveon Peled, you discover that it is possible to treat with power without getting injured. You become a role model for your patients—someone living within a balanced, strong, and healthy body.

 

Want to learn how to refine your biomechanics in the treatment room? Want practical tips for protecting your joints and back during intensive work? Come to our practical workshops at Manual IL, where ergonomics is an integral part of every technique we teach.