Clinical Services » Physical Therapy

Physical therapy services within the hospital assist patients with the achievement, maintenance, and restoration of maximal physical functioning and health. Physical therapists participate within the healthcare team as professional autonomous practitioners with expertise in movement science. [See OSHA’s statement regarding its choice of focus points for this hospital area]

Select a common safety and health topic or hazard from the list below to view information related to the topic/hazard.


Physical therapists perform frequent lifting and repositioning of patients during treatment procedures and transfers. Physical therapists are at an increased risk of developing work-related musculoskeletal disorders (MSDs) (i.e., strain and sprain injuries to back and shoulders areas), while performing tasks that are:

  • Repetitive (i.e., performed frequently without adequate time to recover);
  • Performed in awkward postures (e.g., twisting, bending to the side, back hyperextension of the flexion, reaching across the patient beds);
  • Performed with awkward postures fixed over a period of time (e.g., holding the arm out straight for several minutes, which contributes to muscle and tendon fatigue and joint soreness);
  • Performed with a great deal of force (e.g., repositioning a physically dependent patient, or pushing chairs or gurneys across elevation changes or up ramps while transferring a patient to or from physical therapy sessions);
  • A combination these factors.

Other risk factors include:

  • Overexertion (e.g., trying to stop a patient from falling or picking a patient up from the floor or bed).
  • Lifting uncooperative and/or confused patients.
  • Lifting patients who cannot support their own weight.
  • Lifting and/or repositioning very heavy patients (bariatric patients).
  • Distance the patient is being moved, and the distance the patient is from the employee, (e.g., it is more stressful to reach away from the body to lift or pull a patient).
  • Focusing on body mechanics and lifting techniques instead of providing mechanical lifting devices.

Recognized Controls and Work Practices

Safe Patient Handling Programs and policies that limit or prohibit manual lifting have been shown to be effective in reducing MSDs in hospital and nursing staff. Research has shown that the use of mechanical lifting equipment and a Safe Patient Handling Program can significantly reduce injuries to hospital staff.

Minimize manual lifting of patients in all cases and eliminate manual lifting when possible. Focusing solely on “proper body mechanics" during lifting is not sufficient to prevent MSDs.

Additional Information

Patient lifts, transfers and repositioning

Provide employees with proper assistive devices and equipment to reduce lifting hazards.

  • Proper equipment selection depends on the specific needs of the patient and constraints of the facility

Examples of Patient Mobility Assistive Devices

  • Mechanical lifting equipment: Helps lift patients who cannot support their own weight or are able to bear only some body weight. Choose a lift that does not require manual pumping to avoid possible repetitive motion disorders to workers' arms or shoulders. Portable lift equipment falls into two main categories:
    • Sit -stand assist device: Used for lifting patients from bed to chair, chair to bed, or bathing and toileting.
    • Sling-type full lift: Used for lifting totally or partially dependent patients from bed to chair, bathing and toileting, or after a patient falls.
  • Overhead lift track system: This lift system consists of a track that is mounted overhead, usually directly into a ceiling, and an electric motor that is attached to a wheeled trolley that travels along the track. The electric motor can raise and lower a patient in a patient lift sling and also can move a patient in the horizontal direction, allowing transfers from room to room without manual lifting.
  • Lateral transfer devices: Devices used to laterally transfer patients/residents for example from bed to gurney. They usually involve multiple staff members to assist with the lifting. This is often done with the help of a draw sheet, or similar device. Some lateral transfer systems do not require any lifting by staff (such as an air transfer system). This type of device helps prevent staff back injuries.
  • Sliding transfer boards and benches: A slick board used under patients/residents to help reduce the friction during transfer of patients/residents from bed to wheelchair, or chair to car. Patients/residents are slid rather than lifted.
  • Slip sheets/Roller sheets: Help to reduce friction while laterally transferring patients/residents or repositioning patients/residents in bed and reduce the force workers need to exert to move the patient/resident.
  • Repositioning devices: Mechanically assist patients/residents up in bed, thus eliminating manual maneuvering by staff.
  • Height adjustable electric beds: Have height controls to allow for easy transfers from bed height to wheelchair height. These beds can be kept low to the ground for the safety of patients/residents and then raised up for interaction with staff. Avoid hand cranked beds, which can lead to wrist/shoulder musculoskeletal disorders, such as strain or repetitive motion injuries.
  • Trapeze lifts: A bar device suspended above the bed which allows patients/residents with upper muscle strength to help reposition themselves. This device is particularly useful with adjustable beds and armless wheelchairs.
  • Walking belts or gait belts (with handles): Provide stabilization for ambulatory patients/residents by allowing workers to hold onto the belt and support patients/residents when walking. Not designed for lifting patients/residents.
    • Note: Develop programs to eliminate or minimize the use of gait belts for patients with medical conditions that prevent their safe usage: Use gait belts only in situations where patients are able to bear some of their own weight. Gait belts are not appropriate for patients who are at high risk for falls, who are combative, unpredictable, or have cognitive deficits, or who have medical conditions that would prevent their safe usage (e.g., colostomy/ileostomy surgery, severe respiratory problem, severe cardiac condition, recent abdominal, chest, or back surgery).
  • Wheelchairs with removable arms: Allow for easier lateral transfers. Especially useful with height adjustable beds.
  • Sitting-standing wheelchairs: Wheelchairs that provide sitting to standing options for patients/residents and healthcare workers.

Additional Information

Physical therapists may be exposed to a variety of common and emerging infectious disease hazards, particularly if proper infection prevention and control measures are not implemented in the workplace. Examples of infectious disease hazards include seasonal and pandemic influenza; norovirus; Ebola; Middle East Respiratory Syndrome (MERS), tuberculosis, methicillin-resistant Staphylococcus aureus (MRSA), and other potentially drug-resistant organisms.

Infectious diseases are caused by agents that are transmissible through one or more different routes, including the contact, droplet, airborne, and bloodborne routes. The transmission of infectious agents through the bloodborne route—a specific subset of contact transmission—is defined in the Bloodborne Pathogens (BBP) standard, 29 CFR 1910.1030 (See the Bloodborne Pathogens section below).

An effective infection control program normally relies upon a multi-layered and overlapping strategy of engineering, administrative and work practice controls, and PPE. It is OSHA’s intent in this eTool to highlight some – not all – of the controls that would be necessary to the development and implementation of an effective program. Implementing the controls highlighted here alone will not typically protect workers from infection hazards.

Follow standard and transmission-based precautions to prevent worker infections (see also the OSHA page: Worker protections against occupational exposure to infectious diseases). Early identification and isolation of sources of infectious agents (including sick patients), proper hand hygiene, worker training, effective engineering and administrative controls, safer work practices, and appropriate personal protective equipment (PPE), among other controls, help reduce the risk of transmission of infectious agents to workers.

Employers must comply with the BBP standard to the extent that standard applies (i.e., to the extent workers have reasonably anticipated contact with blood or other potentially infectious materials (OPIM) that may result from the performance of duties). Employers must also comply with the PPE Standard 29 CFR 1910 Subpart I, and the OSH Act’s General Duty Clause, 29 U.S.C. 654(a)(1), to protect their workers from infectious disease hazards. The General Duty Clause requires each employer to "furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees."

OSHA provides agent-specific guidance for a variety of pathogens that workers in hospital settings may encounter. See OSHA's Safety and Health Topics Pages for Biological Agents and Bloodborne Pathogens and Needlestick Prevention for additional information.

In this module, OSHA provides additional guidance specifically for:

Bloodborne pathogens (BBP)

Bloodborne pathogens are pathogenic microorganisms present in human blood that can cause disease in humans. These pathogens include, but are not limited to, Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), Human Immunodeficiency Virus (HIV) and Viral Hemorrhagic Fevers (e.g. Ebola). [29 CFR 1910.1030(b)]


Exposure to infectious diseases during physical therapy treatment of patients through exposure to blood or other potentially infectious body fluids (OPIM).

Requirements under OSHA's Bloodborne Pathogens Standard, 29 CFR 1910.1030

The Bloodborne Pathogens Standard requires precautions when there is occupational exposure to blood or OPIM (as defined by the standard). Under the standard, OPIM means (1) the following human body fluids: semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids; (2) any unfixed tissue or organ (other than intact skin) from a human (living or dead); and (3) HIV-containing cell or tissue cultures, organ cultures, and HIV- or HBV-containing culture medium or other solutions; and blood, organs, or other tissues from experimental animals infected with HIV or HBV.

OSHA requires employers to ensure that the biosafety officer or other responsible person conducts an exposure determination to determine the exposure of workers to blood or OPIM throughout the hospital setting. [29 CFR 1910.1030(c)(2)(i)].

For more information, see Hospital-wide Hazards - Bloodborne Pathogens.

Legionnaires' Disease


Inhalation of the Legionella bacteria in contaminated aerosolized water may cause a form of pneumonia called Legionnaires’ Disease, or a less serious disease known as Pontiac Fever. In the physical therapy area, Legionella bacteria may be present in the shower or whirlpool area, or areas with a spray nozzle. These water sources may provide optimal conditions for growth of Legionella bacteria if the hospital water system is not being maintained and managed properly (e.g., too warm or not hot-enough water storage and delivery temperatures, sediment as a food source for the organisms, etc.).

For more information, see Hospital-wide Hazards – Legionnaires’ Disease.

Additional Information


Employee exposure to hazardous chemicals found and used in the physical therapy area:

  • Cleaning chemicals used to disinfect whirlpools or tubs.
  • Gel used for ultrasound procedures.
  • Prescription medications, creams, or ointments rubbed into skin of patient by therapist during physical therapy treatment.

Requirements under OSHA's Hazard Communication Standard, 29 CFR 1910.1200

One purpose of OSHA's Hazard Communication Standard (HCS) is to provide information to employees on the hazards of the chemicals they use at work. Employers are required to ensure that employees are aware of the hazards associated with the chemicals to which they are exposed in the workplace and on the precautions to properly protect themselves. The standard requires employers to:

Some Other OSHA Requirements Associated with Exposure to Hazardous Chemicals:

  • Control chemical hazards with the use of engineering controls (e.g., ventilation) or administrative controls when feasible (see, e.g., 29 CFR Part 1910.1000(e)).
  • Provide and ensure employees use PPE (e.g., goggles, gloves, splash aprons, as appropriate) under 29 CFR Part 1910 Subpart I.
    • Examples of when PPE is required:
      • When employees remove heated items or change out detergent from cleaning equipment, such as washer/decontaminators, or ultrasonic, tunnel or cart washers that automate the dispensing of washing chemicals.
      • When employees handle hazardous detergents and chemicals to clean equipment and surfaces.
    • Ensure workers use caution during the use, donning, and doffing of appropriate PPE (e.g., goggles, gloves, etc.) to avoid injury, illness, and infection.
    • For more information see OSHA Safety and Health Topics page - Personal Protective Equipment.
  • Medical services and first aid: Where the eyes or body of any person may be exposed to injurious corrosive materials, suitable facilities for quick drenching or flushing of the eyes and body must be provided within the work area for immediate emergency use. [29 CFR 1910.151(c)].
  • In addition to the Hazard Communication Standard, employee exposure to specific hazardous chemicals might be regulated by OSHA standards specific to those chemicals.

Recognized Controls and Work Practices

  • Substitute less-toxic products if feasible and available, or use other processes for sterilization. Use extreme care when selecting possible substitutes. It is necessary to fully evaluate possible health effects and exposure potentials of substitutes before making a selection.
  • Ensure adequate ventilation in whirlpool rooms.
  • Follow recommended procedures included with product for safe administration of medications and creams. Ensure therapists wear gloves while applying certain medications to patients (e.g., if skin contact with the medication is indicated only for the patient).
  • Also see Hospital-wide Hazards - Hazardous Chemicals.

Additional Information


Physical therapists use different types of electrical treatment equipment, such as hydroculators and ultrasound devices, that could be hazardous to the therapist if:

  • Water and electrical energies mix, resulting in a possible shock hazard.
  • Equipment is used improperly.
  • Electrical cords are frayed or damaged, resulting in potential electrical exposure.

Recognized Controls and Work Practices

  • Maintain machines in good working order
    • Routinely monitor the condition of equipment.
    • Train employees to correctly and safely use and clean equipment.
    • Maintain adequate working space and access to equipment.
    • Visually inspect equipment before using.
      • Visually inspect cords. Do not use if frayed or damaged.
      • If something does not look right, do not use the machine. Call for assistance.
    • Ensure that all electrical service equipment near sources of water is properly grounded. [29 CFR 1910.304]
  • Adhere to all manufacturer and operator instructions to ensure safe use of equipment.

Additional Information


Physical therapists use different modalities of treatment in caring for patients. Some of these treatments involve:

  • Ice (e.g., ice machine and ice bags) or moist hot packs (e.g., packs stored in hot water in a machine called a hydroculator);
  • Whirlpools; and
  • Exercise equipment (e.g., treadmills).

There is a potential for slips and falls if water from the whirlpool, ice machine or hydroculator leaks or is spilled onto the floor, and there is a potential for tripping if electrical or other cords run across pathways.

Requirements under OSHA's Walking-Working Surfaces Standard, 29 CFR 1910.22

  • Keep floors clean and dry. [29 CFR 1910.22(a)(2)]
  • Keep aisles and passageways clear and in good repair, with no obstruction across or in aisles that could create a hazard. [29 CFR 1910.22(a)]

Other OSHA Requirements

Follow Bloodborne Pathogens Standard spill clean-up requirements for spills containing blood or other potentially infectious materials (OPIM) [29 CFR 1910.1030].

Recognized Controls and Work Practices

  • Place a table along the side of the hydroculator and provide towels under hot packs to absorb any dripping water.

Additional Information