A client may describe shoulder pain as ‘work related’ without being able to explain which part of work is aggravating it. Job titles do not help much. Two people with the same title can spend their days doing completely different things.
For massage therapists, movement professionals and other clinicians working within their scope of practice, a short occupational history can provide useful context. The aim is to understand what the client does, how symptoms behave around those demands and when workplace assessment or medical referral may be appropriate.
Ask for a normal day, not a job description
Invite the client to talk through a typical shift. How long do they sit, stand, drive, lift or work overhead? Do they repeat one movement for long periods? Are loads carried close to the body or at arm’s length? How often do they change task?
Details matter. ‘I use a computer all day’ could mean eight hours at one desk, frequent calls while walking between rooms or short periods of screen work between manual tasks. ‘I work in construction’ could involve machine operation, finishing trades, scaffolding or site management.
Ask what happens on the days when symptoms are better or worse. A pattern linked to a particular activity can guide your clinical reasoning, but it does not prove a diagnosis or the exact workplace cause. Keep that distinction clear in your notes and communication.
Find out what the body has to do to complete the task
Ask about reach, force and repetition rather than trying to judge the workplace from a verbal label. Does the person twist while handling a load? Do they work with their arms above shoulder height? Are they gripping tools for long periods? Can they change position when discomfort starts?
Breaks and recovery time also matter. Some jobs involve brief high-force tasks with recovery between them; others keep a low-level load on the same tissues for much of the day. Travel time, overtime and second jobs can add to the total physical demand.
Footwear, temperature, vibration and the space available to move may be relevant depending on the work. Ask only what helps you understand the presentation rather than turning the consultation into a generic workplace checklist.
Be careful around safety-critical work
Some clients work at height or use fall-protection equipment. Pain, restricted movement or medication side effects may affect how they perform those tasks, but therapists should avoid making equipment or fitness-for-work decisions outside their competence.
If a client mentions a damaged harness or lanyard, encourage them to follow their employer’s reporting and inspection arrangements rather than improvising a repair. Staff assigned to inspect this equipment may use harness and lanyard training to develop relevant knowledge, alongside practical experience, supervision and employer authorisation.
Where symptoms may affect safety-critical duties, the client may need advice from occupational health, their employer or another appropriately qualified professional. The therapist can describe observed limitations or symptoms with consent, without claiming to certify the workplace or equipment as safe.
Explore screen work in enough detail
Screen-based work is another common source of vague descriptions. Ask whether the client uses a laptop, desktop computer or multiple screens, and whether they work at a fixed desk, hot-desk or from home. Find out how long they stay in one position and whether they can adjust the chair, screen and input devices.
In Great Britain, employers have duties under the Display Screen Equipment Regulations for workers who habitually use DSE as a significant part of their normal work. Assessments consider the workstation, task and individual user. They are not simply posture checks.
Where an employer needs staff to carry out these assessments, DSE assessment training can support knowledge of DSE hazards and the assessment process. A therapist treating a client does not need to become the workplace assessor; it can be more useful to suggest that the client requests a review through their employer.
Ask what has already been changed
Clients often arrive after trying several adjustments. They may have bought a new chair, moved the monitor or changed lifting technique. Ask what they changed, why they changed it and what happened next.
This helps avoid recommending something that has already failed or assuming that one item of equipment will solve a complex problem. A workplace change may also need to be tested over time and reviewed against the job demands rather than judged after a single day.
If the client has already had an occupational health or workplace assessment, ask whether they can summarise the recommendations. With consent, coordination between professionals can reduce contradictory advice.
Know when the conversation needs to move beyond work
Work may be one contributor to pain without being the whole explanation. Symptoms can also be affected by sleep, previous injury, health conditions, sport, stress and activities outside work. Keep the occupational history within a broader clinical assessment.
Red flags, neurological symptoms, significant trauma or unexplained systemic symptoms require appropriate medical assessment. Follow the referral standards of your profession and local jurisdiction rather than trying to fit every presentation into an ergonomic explanation.
Use the job history to make advice more realistic
Advice is more useful when it reflects what the client can actually change. Someone working on a production line may have little control over task order, while a home worker may be able to alter the desk setup immediately. Ask about that degree of control before suggesting changes.
You can also help the client prepare useful questions for their employer: Can the task be reviewed? Is there a manual handling assessment? Can the DSE setup be reassessed? Is occupational health available? Those questions direct the workplace issue to people who can assess and change it.
Ask about recent changes as well. A new tool, altered production target, different vehicle, home-working arrangement or temporary staff shortage may have changed the physical demand without changing the client’s job title. Timing can be useful when symptoms began soon after a change, while still avoiding the assumption that correlation proves cause.
For shift workers, the pattern across the week may be more informative than a single day. Early starts, night work and long commutes can affect recovery and activity outside work. A client who feels relatively well after two days off but deteriorates across consecutive shifts may describe the pattern more clearly when asked about the whole cycle.
A good occupational history does not require the therapist to become a safety consultant. It gives the treatment conversation enough context to distinguish what can be addressed clinically from what needs workplace assessment, equipment review or referral.
Written by aurorachina9999@gmail.com
