Massage therapy is physically demanding, so practice good self-care so you can enjoy a long career.
By Michelle Vallet, May 1, 2012
Learn what this panel of massage experts has to say on the subject of keeping yourself in peak condition—both physically and emotionally.
The risks involved in underestimating the physical demands of massage therapy are many. From work related injury to burnout, massage therapists who don’t have a full understanding of the importance of self-care are likely to suffer injury at some point in their career.
Even those massage therapists who have regular self-care regimens can’t guarantee they won’t ever have to deal with injury. “The best approach for massage therapists is to be as fit as possible for this incredibly physical profession,” says Sandra K. Anderson. “The most important piece of equipment a massage therapist has is their own body.”
Here are just a few suggestions to help you meet the physical demands of the massage therapy profession:
Proper nutrition & diet. According to Anderson, a schedule of 3–4 sessions a day is the same as someone who exercises moderately. “Therefore, daily water intake should be about the same,” she explains. “A common calculation for determining how many ounces of water you need per day is to take your weight and multiply by 0.7.” To complement balanced nutrition, massage therapists should also get regular exercise.
Get enough sleep. “Good, restful sleep allows you to have a more balanced perspective,” says Anderson. “Sleep is also important on a cellular and physical level, giving the body a chance to restore and regenerate.”
Taking time out. You spend a lot of time addressing the needs of your client, and it’s just as important for you to remember your own. “The purpose of downtime is to refresh,” says Anderson. Massage therapists need to spend time pursuing hobbies they enjoy outside the massage therapy profession so they can give their bodies and minds time to rejuvenate.
“Massage therapists often injure the saddle joint of their thumb because of a combination of overuse and poor body mechanics,” explains Joseph Muscolino. “The biggest error with body mechanics is that therapists frequently torque this joint by working with it angled relative to the line of force that travels through their forearm.”
Think of it this way: When working on a client, draw an imaginary straight line down your forearm, and look to see if your thumb is in that line. If the answer is no, be aware that torque on the joint increases for every degree it’s off.
“The first solution toward preventing injury to the saddle joint of the thumb is to learn to stack the thumb in line with your forearm,” Muscolino advises. “The second solution is to brace it with your other thumb whenever possible, at least when doing deep work.”
Remember, too, that good body mechanics works to minimize physical stress to the body—not eliminate it completely—so consider using your thumb less when performing massage therapy. “I recommend that you learn to use your thumb only when really necessary,” says Muscolino. “For example, when you’re working the neck with the client prone.”
“This condition involves adhesions that develop between a tendon and its surrounding synovial sheath,” explains Whitney Lowe. “It’s most common for massage therapists near the base of the thumb, and is frequently described as DeQuervain’s tenosynovitis.”
Not unlike a wide variety of injuries that can sideline massage therapists, this condition is caused by overuse—in this case, excessive use of the tendons of the thumb. “Thumb, finger and hand movements are an essential part of almost every massage technique,” notes Lowe. “Consequently, when you have a painful condition like tenosynovitis, your ability to use your hands and fingers to the full extent dramatically decreases.”
Lowe, like Anderson, emphasizes the need for massage therapists to adequately condition their bodies for the physical demands of massage therapy. “The most effective way to prevent tenosynovitis from occurring is through adequate conditioning,” he says. “Stretching of the affected tendons after each massage session on a regular basis will be helpful.”
Additionally, suggests Lowe, practitioners can self-massage the affected tendons to help reduce any adhesions that might develop between the tendon and its sheath, effectively decreasing the incidence of this condition.
Within the carpal tunnel of the wrist, there are nine tendons of the long finger flexors, as well as the median nerve. “Carpal tunnel syndrome is a condition in which the median nerve becomes compressed, causing sensory and/or motor dysfunction,” explains Muscolino. “The most common cause of the condition is postural overuse of the wrist joint and/or the fingers.”
Two of the major concerns with carpal tunnel syndrome are the frequency with which it occurs and the time it takes to heal—things that seriously jeopardize a massage therapist’s ability to practice. “Carpal tunnel syndrome is the most frequently occurring nerve compression problem in the upper extremity,” says Whitney Lowe. “The condition is seriously painful, and because nerve compression is involved and nerve tissue is very slow to heal, it takes a great length of time to resolve.”
According to Muscolino, the most problematic posture for carpal tunnel syndrome is full wrist joint extension accompanied by finger flexion. “This posture is common when working at the computer,” he says, “but is also common when doing massage.”
Using your palm to transmit pressure into the client is another risk factor identified by Muscolino, who notes that the palm is especially good for broad, deep pressure, but shouldn’t be relied upon to the exclusion of other contacts. “One alternative is to slightly supinate the forearm so that we contact the client more on the hypothenar eminence, or even the ulnar side of the hand instead of the center of the anterior wrist or palm,” advises Muscolino. “Forearms are another good alternative contact.”
In terms of prevention, Lowe suggests stretching, self massage and conditioning. “Once it’s developed,” he adds, “finding all means possible to help decrease compressive loads on the median nerve is of crucial importance.” Muscolino also suggests massage therapists get regular bodywork to their upper extremities, including the anterior forearm and hand.
Also known as golfer’s elbow, this condition is caused by overuse of the muscles of the common flexor belly and tendon. “This condition occurs primarily because of the chronic overuse of the wrist and finger flexor muscles during massage techniques,” explains Lowe, “and can be debilitating and painful.” When the tendon begins to degenerate, Muscolino notes, the condition is called medial epicondylosis.
“Unfortunately, massage therapists use their wrists and fingers even more than the average person,” Muscolino explains. “The key is to lessen finger flexion as a means of working into the client, replacing this contact as much as possible with other contacts so that pressure can be generated from the core of the body.”
According to Muscolino, work into the flexor musculature, as well as transverse friction applied to the tendon, is recommended for massage therapists who have this condition.
Again, Lowe encourages massage therapists to be aware of the physical demand of massage therapy and prepare their bodies accordingly. “The most effective strategies for helping to prevent or address medial epicondylitis include conditioning for the demands of the activity,” he explains. “Frequent massage and stretching of the forearm flexor and extensor muscles would also be a significant benefit.”
Although neck strain is extremely common in the general population, the condition is even more prevalent among massage therapists, says Muscolino. “There is no escaping the fact that massage is a physically demanding profession,” he says. “Generating pressure into clients hour after hour is hard work for the musculoskeletal system, no matter how good the body mechanics are.”
To decrease the occurrence of many potential injuries, Muscolino encourages massage therapists to generate pressure from the core of their body instead of relying on one client contact too much. Relieving neck strain, however, is much easier. “The physical stress load on the neck extensors can be largely eliminated if we do not hold our head and neck in flexion,” suggests Muscolino.
But how do you do that? Muscolino believes massage therapists can largely relieve neck strain by doing one simple thing: not looking at their strokes. “The posture required to look at our strokes is usually an imbalanced flexion position with the head over thin air instead of balanced over the trunk,” he explains. “This requires isometric contraction of the neck extensors to hold the head and neck in partial flexion, to prevent falling all the way into flexion with the chin hitting the chest wall.”
Muscolino encourages massage therapists to either keep the head and neck in a neutral, extended position by standing fairly straight up while working or resting their chin against their chest to relieve the extensors from having to work so hard. “Closing our eyes when working reminds us that we do not need to watch the work being done so often,” he says. “We allow ourselves to better focus on what we are feeling with our hands.”
“Shoulder strain of the deltoid and rotator cuff group muscles is extremely common in massage therapists,” explains Muscolino. There are two primary reasons this condition occurs, according to Muscolino.
The first is that a massage therapist’s arms are so often isometrically held out in a position of flexion and/or abduction when practitioners are manipulating soft tissue. The second is that many massage therapists learned to generate pressure from their shoulders.
“The solution to both of these problems is to learn to generate pressure, especially deep pressure, from the core of the body,” Muscolino explains. “When the arms are placed down and in front and against the core of the body as much as possible, the pressure can transfer from the core directly into the forearm, and then the hand into the client.”
For reference, during body mechanics workshops, Muscolino likes to ask therapists to place their elbow inside the ASIS, or as close as possible. “If the strain is already present, then clinical soft tissue manipulation into the affected muscles is extremely important,” advises Muscolino. “Each of the rotator cuff muscles should be individually targeted.”
Although the causes of low back pain may be many, muscular low back pain is frequent in massage therapists, according to Lowe. “Massage practitioners spend a great deal of the day hunched over a massage treatment table and performing techniques with their upper extremity,” he explains. “As a result, there is a very high torque load on the lumbar muscles.”
Being in pain, too, seriously fatigues the individual, which can further affect their body mechanics and potentially lead to injury. “When an individual is in pain, they can no longer keep up with the extreme physical demands of their massage practice,” adds Lowe.
“Ideal body mechanics are crucial for performing techniques in the most efficient way, as well as reducing cumulative loads on the low back muscles,” says Lowe. “Stretching between sessions, and getting soft tissue treatment yourself, are very important aspects of preventing long-term low back pain.”
Other ideas for saving your low back include finding ways to alter your position, whenever possible. Also, if you can use a seated position for any part of a massage therapy session, the cumulative load on your back will be decreased.
“In the bodywork profession, therapists need to be connected to their clients on a certain level to establish a positive therapeutic relationship,” explains Anderson. “At the same time, they need to be separated enough from their clients to avoid becoming entangled in the emotional or personal aspects of the client’s life.”
According to Anderson, some situations where you might potentially run the risk of encountering boundary issues include:
Financially, if you have clients who don’t pay for massage therapy sessions in a timely manner.
Emotionally, such as when clients draw you into struggles they’re experiencing in their own lives.
Physically, like when you have clients who insist on needing to be squeezed into an already busy day, or receiving massage on your regularly scheduled day off.
Mentally, such as clients who continually reschedule at the last minute, or want extra work but don't want to pay you for it.
Not clearly defining boundaries, even if they’re slipping gradually over time, will leave massage therapists with no reserves left for their own self-care, which is critical in this profession.
“One way to develop professional boundaries is to be clear about what is appropriate and what is not,” Anderson explains. “Have procedures for making and cancelling appointments, and stick to the agreed-upon duration of your massage sessions. Require your clients pay for the sessions on time, and keep your designated days off exactly that—days off.”
Spend time developing a clear outline of your expectations—and what clients can reasonably expect from you—and then check in with yourself occasionally to make sure you’re maintaining your boundaries.
If massage therapists start feeling isolated in their work, the consequences may be wide-ranging. They might start feeling ineffective in the massage therapy they provide, feel lonely, emotionally spent and bored—all of which could end with a case of burnout and the loss of loyal clientele.
“Support can take many different forms for massage therapists,” says Anderson. “Family and friends they trust, supervision, mentoring and peer support, to name a few.”
According to Anderson, supervision would involve a periodic review of a massage therapist’s work and professional behavior in the work environment. “Ideally,” she says, “the supervisor has experience and insight into the profession and can help less experienced practitioners develop a deeper understanding of their professional work and of the importance of self-care.”
If you’re just starting out in the massage therapy profession, or are a veteran with years of experience feeling the first signs of burnout, finding a mentor may be a good source of support. You can also develop a peer support group with other massage therapists in your area who have similar levels of skill and experience. “This interaction is for encouragement and maintenance of appropriate professional and ethical practice,” Anderson says.
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