For many the only relief of musculoskeletal pain comes from manual therapy, which is akin to a spa like massage but with more focused and purposeful techniques to address muscle spasm and connective tissue adhesions and scarring. Manual therapy also encompasses joint mobilization techniques aimed at improving joint alignment and decreasing pain. These techniques require close direct contact between clinician and the patient and require some extraordinary practices to prevent the transmission of disease.
A facility providing manual therapy must standardize preventative measures to protect client health from the moment they enter the facility for check in, throughout the treatment, and continue for check out. Preventive measures must be taken to address contact transmission and aerosol related cross contamination for clients and clinicians. In addition to providing sanitized surfaces that the client may come in contact, all facilities where staff members come into direct contact with one another must be sanitizing. Preventative Strategies to Include:
* Requiring all visitors and staff to sanitize their hands upon entering the building
- Measuring the body temperature of of all guests to pre-screen for illness
- Disinfecting all treatment surfaces, exercise equipment, cuff weights and dumbbells after each use due
- Offering disposable gloves for contact with exercise equipment
- Disposable sanitary pillow cases used in patient positioning
- Maintaining constant ventilation and using air filters to remove viral droplets from the air
- Screening patients for those who themselves, or household members, have travelled to level 2 and 3 designations: Japan, China, Italy, South Korea or Iran in the last 14 days, and requiring them to not schedule PT appointments for 14 days upon. Likewise for anyone who knowingly have been in close contact to anyone diagnosed with the corona virus.
Cleaning and disinfecting frequently touched surfaces, including:
- Doorknobs
- Countertops
- Faucets and sinks
- Keypads, computer terminals and iPads
- POS terminals
Cleaning workspaces frequently, including the:
- Breakroom
- Restrooms
- Treatment environment:
- Requiring employees to clean hands often by:
- Washing with soap and water for at least 20 seconds before entering patient care areas and upon leaving patient care area.
- Using hand sanitizer that contains at least 60% alcohol after all patient contact, face touching, nose blowing, coughing, or sneezing
- Covering all surfaces of hands and rubbing them together until they feel dry
- Making hand sanitizer available to customers
- Avoiding touch to nose, eyes, and mouth with unwashed hands
- Covering coughs and sneezes
- Covering mouth and nose with a tissue or the inside of elbow
- Throwing used tissues in the trash
- Sick employees are not to report to work
- We require all employees to notify supervisors in advance of unanticipated absence
- If an employee is out for three (3) consecutive shifts a doctor’s note is required to return to work
Treatment Area Precautions
- Therapist to don mask before entering the room for disease prevention cleaning
- All hard surfaces are sanitized before patient enters the room
- Air circulation: windows open , door open when appropriate, circulation fan on (preferably from ceiling)
- All sheets are sanitized before and after each client
- Disposable paper pillow cases on all pillows including face pillow for prone positioning
- Massage lotion bottle sanitized
Manual Therapy Technique Modifications for the prevention of COVID-19 infection must focus on preventing therapists breath from falling on the patient’s face
- Therapist to don mask before entering the room for prevention of infection
- Gloves are optional per patient request
Patient Prone for Most Techniques
- cervical, thoracic, lumbar, gluts, pelvis, hamstrings, anterior tibialis, peroneals, calf and foot
- Upper extremities, shoulder and hands
Sidelying Techniques
- Anterior Shoulder
- Quadratus Lumborum
Supine Techniques:
- Must be Minimized and therapist must keep their face covered
- pecs, abdominals, illio-psoas, quads
Patient is instructed to wash their hands and don a mask before entering the room and upon completion of treatment and they are encouraged to shower when they get home and change into fresh clothes.
