Hand Therapy and Ergonomics

Ergonomics May 20, 2019

We recently received a question from a recent CEAS grad who is also an Occupational Therapist (OT) looking to get combine those credentials with a certification in Hand Therapy (CHT). Read below and make sure to check out Jamie McGaha’s detailed response.

It seems as the need for ergonomists are a bit rare in southern California. I am currently in the beginning steps of hand therapy and was thinking the CHT paired with my CEAS/OT background may open more doors for me.

I was wondering if you would be able to share your experiences weaving your profession with Ergonomics and Hand therapy and any advice you would be willing to share with me in terms of being an ergonomist/CHT/OT?

hand therapy

Jamie McGaha, took the time to craft this incredibly in depth response. Read on…

I’m hoping I can shed some light on how the practices of OT, hand therapy and ergonomics all weave together to help you move forward in your career. 

You are probably very familiar with how the practices of OT and ergonomics compliment one another. OTs are so well versed in creating a fit between a person’s abilities and goals with a desired occupation that Ergonomics comes naturally. Creating the proper fit between a worker and their environment, whether it be about reducing injury risk, improving efficiency or maximizing the worker’s functional potential, OT has a perfect role. (see attached AOTA handout for anything further on OT and ergonomics). 

As an OT working in hands and pursuing a CHT, you are also likely familiar with the number of upper extremity injuries people can sustain through work, both traumatic and non-traumatic in nature. I think this in particular sets you up for finding a path toward ergonomics in your career. I became interested in ergonomics as I was acutely aware of the number of musculoskeletal injuries that construction workers sustain and often end up having surgery for (carpal tunnel, rotator cuff, tendonitis etc.) I mostly saw these clients post-operatively and found many had the same job risk factors that kept them from ever having a chance at avoiding surgery or difficulty returning to their previous job requirements. It was out of frustration of seeing these  clients that I wanted to help out on the front end of stopping injuries before they started. 

That said, how do you go about it? 

– One avenue may involve talking with a client about their work place risk factors. If you are seeing some improvements in their symptoms, but they continue to have flares or recurrences of symptoms, maybe discuss getting in contact with their safety manager or have them speak with their manager if ergonomic assessments are provided at their job. If they don’t have anyone they contract with, it could open the door for you to talk about your services and what you can offer.

– Another option maybe going to events in your area where safety and wellness directors could be. When I was first starting out as as graduate assistant we attended union meetings for trade workers. We would do a quick inservice, talk about safety tips, quick ergonomic solutions etc. in order to build awareness about what we could offer to keep workers safe. we would hang around for a bit to answer questions, give contact information. 

– Do you ever see a consistent pattern of overuse of injuries from one employer? Those maybe great ones to contact and ask if have any needs for ergonomics assessments or safety trainings at their place of employment. 

– Do you attend any nurse case manager rounds or CEUs? NCMs can be very valuable in helping injured workers get any and all services they need. 

– CAL/OSHA is also another fabulous place to start investigating what consulting in ergonomics looks like in CA specifically. https://www.dir.ca.gov/dosh/consultation.html

and may lead you to find some more local contacts that can assist you in finding our where ergonomic services are most needed.

Word to the wise, I do think you have to be careful about HIPPA and being pushy on offering services when you are a clinician, especially since ergonomic consulting is typically commercially paid for vs through insurance like therapy. Being familiar with what employers in your area offer ergonomic assessment services to employees, who has safety directors or safety and wellness initiatives in their company, do local government agencies have annual safety trainings or areas of ergonomic need? A needs assessment of who may need ergonomic services is a good place to start.  

3 real life examples for you on how I got a foot in the door: 

1. I treated a gentleman who worked in marketing at a tech company. It was very clear almost all of his symptoms were due to poor ergonomics at his desk. We certainly talked about proper positioning, I reviewed photos of him sitting at his desk, I made suggestions, we made an exercise break schedule and he did great. Only to come back at few months later with the same symptoms. I finally asked if anyone did ergonomic assessments at his office and could he please get one, well they didn’t have anyone who did them, but he brought my card to his manager and between myself and another OT/CHT we did their whole office in a few weeks. He never needed to come back for therapy. 

2. I treated a nurse who worked for an insurance company doing claim adjustments. She fell and broke both wrists, requiring surgery at the same time for both. Her entire job was computer and phone based. When she was cleared to return to any amount of work, the first thing I had her do was talk with her manager and her disability coordinator to make sure we could get the proper ergonomic desk set up for her. She had a remote assessment completed (by another party) and they also allowed me to write a letter of equipment recommendation based on her current function. We all worked together so she could return to work sooner.

3. After seeing 2 clients under workmen’s compensation from the same employer, I spoke with each of their claims adjusters and case managers to further investigate their safety and ergonomics practices at their place of work. They gladly agreed to have someone come in to do ergonomic assessments and make recommendations to avoid further injuries.  

I think a big piece of expanding your career into ergonomics is to being able to explain to a party why as an OT you should be hired to complete ergonomic assessment/intervention and being able to show why your skill set is valuable to them. The other side of that is understanding your skill set in ergonomics and what job areas you are best suited for. If you do not have experience and training in assembly line work, you may not want to reach out to manufacturing companies saying your can provide ergonomic assessment and training for them.

Writing an actual consulting proposal is also extremely useful if you intend to have you own practice for this. I have been very lucky and always worked with larger entities that have written the legal portions of contracts and simply provided me with a contract rate, so I do not have great experience in that realm. The Back School has an online CEU “WRITING AN ERGONOMICS CONSULTING PROPOSAL” that would likely be very helpful for you if you want to make this a personal business. 

Even though you may not know of a needs for ergonomists in southern CA, the need is likely there and veiled in a different context. You may see terms such as “safety, compliance, wellness, industrial athlete.” etc.  Wherever there are healthcare organizations, industry, agriculture, offices and humans, ergonomics is needed! 

Please let me know if can help further answer any questions you may have or any new questions this response has sparked! 


Jamie McGaha


Let us know your thoughts or questions on combining hand therapy and ergonomics in the comments below!

2 thoughts

  • Betsy

    I am a OT/CHT/CErg…Certified Ergonomist through the API. I also plan on taking some courses with The Back School.

    The article above was great! Thank you for the helpful info. I am credentialed with some insurance companies and plan to treat worker’s comp as well. I was wondering how to Bill. I would rather charge cash for all my postural assessments start to finish. If I have clients that reach out to me for postural assessments and or workspace assessments, whom have an insurance that I am in network with , can I still charge them cash? I would like to charge cash across the board for all payors for postural assessments, comprehensive report, recommendations, education, exercises .

    • thebackschool

      In reply to thebackschool.

      You certainly can charge cash for your services. However, if a client has insurance and wants that company to pay for “postural assessments and or workspace assessments “ either you or the client will have to have contact with the insurance company to get payment. Since “postural assessments and or workspace assessments” are not necessarily part of “medical management” some insurance may deny these charges. You will have to check with each provider. When you are providing these services as part of treating a worker’s comp it is medical management is the assessments are usually billed under the CPT Code of 97537. This will be a decision that you have to make. If current insurance companies are currently paying you for “postural assessments and or workspace assessments “ I would ask them to advise you on how to get other companies to do the same.

      More info on billing is also on our blog:


      Hope this information was helpful. We greatly appreciate your interest in our problems.


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