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As students in massage school, we had the luxury of the instructor's eyes on us, making corrections to our body mechanics. In practice, it’s natural to get lazy, develop bad habits, or simply not know we are doing anything wrong. Often, pain is the indicator of wrongdoing.

As students in massage school, we had the luxury of the instructor’s eyes on us, making corrections to our body mechanics. In practice, it’s natural to get lazy, develop bad habits, or simply not know we are doing anything wrong. Often, pain is the indicator of wrongdoing.

When Something Hurts …

This is the career you click with. Massage therapy—everything from the atmosphere of the quiet room, to helping people, to having a creative outlet. This is your dream job. Until something hurts.

A little wrist pain, an achy back that comes and goes when it wants, and that darn inner elbow soreness after too many deep tissue sessions. Ugh. And then the thoughts start.  

Thoughts like, “I have to reduce my workload, but I can’t afford to take fewer appointments.” “Will I have to quit if it gets bad?” Am I doing permanent damage?” “Please don’t make me have to fall back on the job I worked so hard to leave.”

And then you decide, “I love massage and will do what it takes to not have pain.”

The main reason massage therapists’ bodies begin to hurt is poor body mechanics. We are really good at modifying and compensating our body mechanics for:

Less-than- optimal working conditions

Trying to accommodate a picky client

Attempting to “go deeper” for a client

Let’s review some body mechanic basics. 

Body Mechanics: Lower Body

Using your feet and legs to your full advantage takes some discipline, but the rest of your body mechanics fall apart if you don’t begin here.

• Get grounded – planting both feet on the floor beneath you is the beginning to building the rest of your body mechanics. Feel the weight of your body evenly distributed between the front, back, and sides of your feet. Spread your toes and lay them evenly on the floor. If you are doing a seated technique, evenly distribute your weight between the sit bones (ischial tuberosity) and stack your spine from there.   

• Use appropriate stances – A bow, or archer’s, stance is when one foot is in front of the other. Massage therapists may use this stance for effleurage, compression or when you need to recruit deeper pressure.

The second widely used stance during massage work is the horse stance or symmetrical stance. This is when feet are hip-width apart, toes pointing forward, and the body facing your work. The horse stance is good for petrissage and tapotement.

• Weight shift – The weight shift is fundamental during your massage work. Depending on the stance you use, you will shift your weight consistently from front to back foot or left to the right foot. This keeps your legs active, reducing strain on your back and helping reduce strain to your arms by using the legs for strength. 

• Get more pressure – Our legs are built for power, more so than our arms, so it would be silly not to use our legs the majority of the time during massage work when needing more pressure.

A good body mechanics practice uses the legs to get power and deliver it through the arms, which are merely a delivery tool. Trying to muscle pressure with the upper body is a sure way to fatigue and put your body at risk of injury. 

Body Mechanics: Upper Body

Mindful placement of your head and how your shoulder girdle is used to approach your massage work will keep the neck and upper back healthy and pain-free.

• Head – The placement of your head is directly related to any soreness or tightness you may feel in your neck. Remember, in anatomy learning the weight of the human head is equivalent to an 11-pound bowling ball? Eleven pounds is a lot when looking down at your work all day or tilting your head to the side to see your work. 

The best body mechanics practice for the head and neck is keeping your head in a neutral position. Tilting or cocking the head, also known as the nurturing head, puts unnecessary strain on neck muscles.  

• Shoulders – Do you find your shoulders have crept up towards your ears sometimes? When we get into the work in front of us, it’s easy to forget the body mechanics we know. Check in periodically and lower those shoulders down away from your ears when you find yourself wearing them like earrings.

• Serratus Anterior – This muscle is important to have engaged on the working arm or arms. The serratus anterior muscle sits under the armpit along the rib cage. When engaged, it prevents the scapula from retracting when you use that arm. 

When the serratus anterior is engaged, it’s working to stabilize your whole arm, making it an effective massage tool and allowing the arm to remain relaxed in the process. 

Consider Adding Tools

• Prevent overuse – Massage tools available for use include hands, fists, fingers, thumbs, knuckles, elbows, and forearms. Using a variety of tools will prevent overuse injury to one area of the body. Get creative and use tools other than open hands at least 40% of the time. You can do this! Practice.

• Stack joints – This is a simple rule to follow and will lead to many years of pain-free massaging. Let’s look at an example of what stacking joints mean. When you approach the massage table with your thumb as a tool, you should have the joints from the thumb up the arm stacked in a straight line.

You can also think of this as the bone supporting bone. The bones of the thumb support the first metacarpal, which supports the radius, which supports the humerus.

When you perform a massage stroke with bone supporting bone, the tension or strain to the soft tissues of that working arm and tool is minimal. Stacking the joints can also be thought of as keeping the joints in a straight line down the arm to the tool you are using. 

• Limit some movements – Some movements of the arm and hand lead to overuse injury when used in excess.

One of these movements is the grasping motion of the hands. Grasping, especially while using pressure, puts a lot of strain on the hands.  Grasping is used in petrissage and kneading but should be kept to a minimum. 

Another movement to limit is supination of the forearm. This is mainly used during petrissage when the scooping motion leaves you supinating a little at each stroke’s end. This supination of the forearm can lead to elbow tendonitis, which is hard to cure without taking weeks off work. 

Grasping and supinating at the same time is a double whammy and is bound to bring on tendonitis.

You’re an Athlete

As a massage therapist, think of yourself as an athlete. This means you need a certain level of fitness and conditioning to see clients full time.

• Engage your core – Having a strong core helps prevent back injury while doing massage work. Always engage your core before lifting a limb for range of motion or even compressions. Engaging your core throughout your massage session is good practice and makes your work feel stronger and more supported.  

• Breathe – Your breath should be flowing as you go through your massage session. One way to keep breathing consciously is to exhale on the exertion or delivery of a stroke and inhale on the backstroke.

For example, during an effleurage down a client’s back, it would be an exhale as you go down the back and an inhale on the way back up.

• Be smart – Work smarter, not harder, to save your body from injury. Always adjust the table to your working height for every massage. If a certain client requires a variation from your normal table height, make a note in their chart so you are ready before they get on the table. 

If you share a room with other massage therapists, don’t get lazy thinking the table height is close enough. Even one day of work at the wrong table height is enough to start an injury on a stressed body.

• Become ambidextrous – The faster you can work easily from both sides of the massage table, the better. Practice, practice, practice until you are comfortable delivering strokes with right and left hands equally. Certain massage techniques may feel awkward with your non-dominant hand, but you leave yourself at risk for injury until you have it down confidently. It will become second nature with practice. 

These body mechanics practices should be revisited periodically because there is always somewhere we can improve. If today it’s head placement, next month it may be core strengthening.

If you feel the need for further training in your body mechanics invest in a course or coach. The longevity of your career depends on you remaining healthy. Plus, work is so much more fun when you feel good.

[Click here to download a free Body Mechanics Checklist from Angela Lehman at The Fit MT.]

Angela Lehman

About the Author

Angela Lehman is a massage therapist of 25 years turned online educator, promoting fitness and nutrition for massage therapists. She runs The Fit MT. With her kinesiology degree specialized in nutrition, she trains therapists in healthy eating, exercise and body mechanics to prolong their careers. Read another of her articles, “The Fit MT: This is How Gut Health Can Super Charge Your Immune System.”

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Body, Career, massage, Mechanics, PainFree

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