Exploring Physiotherapist Movement During Patient and Therapeutic Handling in a Laboratory Setting

Conflicts of Interest: No conflicts of interest Source of Funding: No funding obtained Background Back pain is the highest reported work-related musculoskeletal disorder among physiotherapists, frequently linked to patient handling. Neurological rehabilitation often requires sustained forward-flexed and asymmetrical postures, yet objective biomechanical evidence describing whole body and inter-segmental spinal movement during therapeutic handling is limited. This study aimed to evaluate the feasibility of capturing neurological patient handling tasks in a motion-capture laboratory and explore how physiotherapist positioning (standing, sitting front/side, half-kneeling) influences postural injury risk during two handling tasks. Methods A two-phase observational laboratory study using Vicon motion capture was conducted. A feasibility phase with physiotherapy students assessed data quality and participant-acceptability. Two tasks were then examined in a pilot study with qualified neurological physiotherapists and volunteers with neurological conditions. Inter-segmental spinal (lumbar, thoracic, cervical), shoulder, hip and knee kinematics were quantified during sit-to-stand and supine lower-limb gait facilitation tasks performed from varied positions. Time-normalised kinematic data were analysed using Rapid Upper Limb Assessment and Postural Load Index frameworks to determine risk. Results Sustained thoracic flexion was consistently observed, exceeding ergonomic thresholds for increased injury risk. Physiotherapist positioning significantly influenced movement patterns; no single position reduced exposure across all body regions, instead redistributing postural demands between the spinal segments and shoulders. Inter-segmental analysis revealed regional differences in spinal injury risk that may be underestimated by tools treating the trunk as a single segment. Conclusion Varying physiotherapist position redistributed biomechanical demand, offering options to modify handling techniques. Integrating inter-segmental biomechanical analysis with ergonomic assessment could offer clinically relevant insights to inform physiotherapy-specific training and back pain prevention strategies.