Self-Care for Massage Therapists: Neck and Shoulders

August 22, 2017

There’s no getting around the fact that one of the biggest factors in massage therapy career longevity—being able to stay in the profession you love for as long as you want—is developing and maintaining a sound self-care regimen. Overuse injuries, burnout and chronic pain, for example, can lead to serious setbacks in your career or, in some cases, be career-ending.

Here, we’ll break down some of the most common neck and shoulder injuries massage therapists face, as well as self-care strategies that can help you protect against them.

The Role of the Neck and Shoulders in Massage

Although ideally much of your strength when performing massage is going to be coming from your legs and core rather than your upper extremities, massage therapists are still going to be using their neck and shoulders during every session. “Proper massage mechanics should include more use of the legs and core,” says Portia Resnick, a massage therapist. “But, it’s not possible to avoid using the muscles that control the shoulders, upper back and neck.”

Robin Anderson, massage therapy program director for CCBC School of Health Professions, agrees. “They should be in a fairly neutral position, since most effective massage stroke movement originates from the core using the therapist’s own body weight as a means of force or pressure,” she says. “While the shoulders are involved in movement, the mobility occurring should come from a place of relative stabilization, and massage therapists should strive to keep strokes at a less than 90-degree angle whenever possible.”

Potential for Injury

“When performing massage, it’s common to have the scapula become elevated and protracted, which can lead to soreness in the trapezius and rhomboid muscles, as well as tightness in the pectoralis major and minor,” Resnick says. “The head, too, may become forward flexed, rotated or laterally flexed, putting increased strain on the neck musculature.”

Overuse injuries are probably going to be the most common neck and shoulder complaints, including muscle soreness and tendonitis, Resnick adds. “The genohumeral joint can be subject to rotator cuff tendonitis or subacromial bursitis from the scapular malpositioning,” she says. “Additionally, the cervical spine could be at risk for disc pathology based on increased stresses from improper head positioning.”

Repetitive motion will also be problematic for the neck, according to Anderson. “Thinking in terms of ergonomic assessment, repetitive motion in the neck area, such as lateral head tilting, hyperflexion or regularly rotating from side to side when performing massage are considered contributors to increasing risk for potential strain or injury,” she says.

Much of the research being done on injuries in the massage therapy profession back up what Resnick and Anderson are saying. “According to data from the Bureau of Labor Statistics, overexertion and repetitive motion injuries are the leading cause of injury to massage therapists who are considered to be working full-time,” explains Anderson, who is currently doing research herself on effective teaching methods for proper body mechanics. “In other recent research from the Proceedings of the Human Factors and Ergonomics Society Annual Meeting, massage therapists indicated that they frequently experienced wrist or thumb, shoulder, lower back and neck work-related pain.”

Common Causes of Neck and Shoulder Injuries in Massage Therapists

Many of the common risk factors for injury are things massage therapists can control. “Improper body mechanics, having the massage table positioned too high and/or working in a space that limits the massage therapist’s ability to use proper mechanics can lead to some of these overuse injuries,” Resnick explains.

The type of massage therapy you practice can also increase risk for injury, particularly if you don’t regularly vary the techniques you use. “Overusing deeper massage techniques seem to be a driving force behind more frequent work-related injury,” Anderson explains.

For many of these injuries, Anderson sees a common link between risk and a massage therapist’s understanding of ergonomics. Ergonomics is concerned with both designing specific tools to make a job task easier, as well as adapting a work task to better suit a worker. “Bodies come in all shapes and sizes. What works for one person may not be the most ideal for another,” Anderson says. “So I think a contributing factor to injury is our lack of kinesthetic awareness about the way we move when we do our work. We are great at doing this for assessing clients, but what about ourselves?”

How Injury Hurts You—And Your Massage Practice

Two of the biggest concerns surrounding injury are physical complications and the time you may have to spend away from your practice recovering. In the most serious circumstances, massage therapists may also have to worry about the possibility that they won’t be able to practice at all. “An injury such as tendonitis or bursitis requires rest and may lead to a massage therapist having to take time off work or reduce their client load for a few weeks,” Resnick says. “Also, injuries such as a disc pathology could
be career-threatening, especially if there is any associated muscle weakness.”

Injuries that keep you practicing but limit your mobility can also have significant impact on your career, Anderson says. For example, injury or pain that limits mobility in your neck and shoulders can affect your ability to perform massage therapy and reduce the number of techniques you’re able to use in a session.

Injury can also affect dynamics in your massage practice that you might not initially consider. “If you typically do outcalls, a neck or shoulder injury could mean it would be difficult or impossible to travel to your clients’ location and set up your equipment,” Anderson says. “So, you might have to choose a different work setting or decrease your workload.” If recurring pain is involved, Anderson adds, massage therapists might have to limit the number of sessions they do or think about working with a different client demographic. “What if you work with athletes that require deeper and more intensive massage?” she asks. “You may not be able to do that anymore with a sustainable injury.”

Whether you need to take time away from your practice or work a limited schedule during recovery, the bottom line is that injury will almost always affect your income. So it’s important to act early if you sense signs of pain.”

How to Practice Good Self-care

Proper body mechanics are foundational to good self-care. Anderson encourages massage therapists to take a quick peek at their body positioning if they have mirrors in their treatment room, especially if they’re experiencing any discomfort.

“Try to use it as a self-observational and awareness tool,” she explains, though she is quick to add that you need to stay focused on the client. “Some questions to think about as you do your self-analysis include: Do you tilt your head a lot when you perform massage? What does your body position look like when you are feeling strained? Are you overreaching or twisting out of alignment from your upper and lower torso or extremities? Do you stay in one place for a significant amount of time when massaging? What do you do when you cannot reach your endpoint to complete a stroke? Do you vary your techniques enough so that you are still achieving client outcomes while exerting the least amount of energy to get there?”

If you find you’re answering “yes” to many of these questions, or noticed that any discomfort you experience is related to a particular position or technique, Anderson suggests considering any adjustments you can make that would help preserve your body. You might also want to learn some additional techniques and explore what’s the most efficient movement pattern for you, as well as what table height works best with different types and sizes of clients. “What about sitting while performing some massage techniques?” Anderson asks. “For smaller areas and fine muscle groups, take a seat while you’re working.”

Resnick also encourages massage therapists to think carefully about their schedules. “Make sure to schedule only as many clients as you can adequately handle in a day,” she says. “And be sure to schedule enough rest during the day.” Strength training, stretching and regular exercise
can help, too. “It is important to stretch the anterior aspect of the shoulders and strengthen the scapula stabilizers,” Resnick adds. “Neck musculature can be regularly stretched, too.” One of Resnick’s favorite stretches is the wall angel. “I often will do a few between clients to realign my scapula and neck,” she says. “This helps to reinforce good posture.”