Along the way, you have probably developed your body awareness and learned some new techniques.
I want to help you go beyond the basics, and fine-tune the areas of poor body mechanics that may be breaking your flow. No matter what type of work you do, there are always options for positive change.
When we are fully present, we do pretty well. When we are stressed, distracted, pushed to do deeper work, hungry or fatigued, or need a massage ourselves, we can hit the crumple zone. Shoulder-slumping becomes a default posture when we lack focus.
It is in those crumple-zone moments that we perpetuate our own postural distortions and contribute to repetitive stresses and their resulting injuries. Just as we encourage our clients to look for lifestyle factors that affect posture, we must be vigilant about our own. Changing your mechanics only slightly makes it possible to increase both the depth and effectiveness of your work. Tiny twists and tilts of the wrist, ankle, pelvis and neck combined with better use of knuckles and forearms can make all the difference between a healthy career and injury for a massage therapist.
Forearm Compression—Before: This is the most common misuse of forearm pressure. The wrist is bent and jammed with the other hand; the hand’s anterior surface is used for pressure, which puts pressure directly on the therapist’s ulnar nerve; and the therapist’s torso is leaning forward while the shoulders are tight.
Forearm Compression—After: The forearm is properly used as a lever, propelled by the other arm while the hand is relaxed. Pressure is transferred almost effortlessly by tilting the head down onto the shoulder and directly through the elbow, so that no pushing is needed. The torso is straight and the neck is relaxed. The therapist leans in with body weight to increase pressure.
Iliotibial Band Compression—Before: Using the archer stance is good, but the torso and head are forward. The wrist and arm are straight, but pressure is difficult to increase, so use this position only for effleurage.
Iliotibial Band Compression—After: From horse or archer stance, simply leaning into the iliotibial band and anterior tibialis at the same time requires little effort. Hands are relaxed, and the posterior forearms are contacting the client, avoiding pressure on the therapist’s ulnar nerve. The therapist’s head is up, keeping her neck straight. Pressure can easily be intensified by simply leaning in with body weight.
Quadratus Lumborum Direct Pressure—Before: Braced thumbs should be used only briefly. The quadratus lumborum and many other sites require caution and precise locating skills. Pressure into this or any other area with the thumbs should be limited only to locating, not to applying excessive pressure.
Quadratus Lumborum Direct Pressure—After: Pressure does not only have to be applied by pushing; why not pull for a change? The therapist stands on the side opposite the quadratus lumborum (or numerous other muscles), and pulls back while leaning body weight away from the table. Pressure is varied according to how far back the therapist leans. Look up and exhale.
Neck Seated—Before: Sit down when you can. If your stool does not roll, you will find yourself leaning forward and straining your own neck while treating a client’s neck. Your precious thumbs are often your best tool for focused work, but even with occasional use must be protected by keeping your knuckles straight.
Neck Seated—After: An exercise ball is my favorite stool. It helps to keep me from slumping, and it rolls in any direction easily. Using a ball, you can lean forward or back while strengthening your core. While treating anterior neck muscles, turn your thumb sideways to apply pressure while keeping the thumb knuckle straight.
Thumb Detail—Before: The anterior cervical region is an example of an area that requires precise locating before applying pressure. Although a therapist may not often treat this area, doing so can cause a great deal of damage to the thumb over time.
Thumb Detail—After: The working hand’s thumb is tilted sideways, so application of pressure does not bend or hyperextend the knuckle. The nonworking hand is used only to stabilize the client’s head, and does not apply any pressure or lifting; however, it can roll the client’s head into any needed tilt. Sitting on an exercise ball allows the therapist easy shifting to change angles.
Fingers Direct Pressure—Before: Direct pressure to a deep, tight muscle such as the levator scapulae can put stress on the therapist’s fingers, even though the fingers and wrist are held straight.
Fingers Direct Pressure—After: Any muscle requiring direct, focused, deep pressure or compression is best treated with knuckles, held straight, as is the wrist.
Inner Arm—Before: An area fraught with endangerment sites, such as the inner arm, requires a lighter touch, and effleurage is shown here. The therapist’s wrist is slightly bent, indicating too much pressure. The head and torso are both forward. This means you are working harder than you need to be, and in a way that is possibly injurious to the client’s endangerment sites.
Inner Arm—After: Flipping the working hand over to use the back of the knuckles ever so lightly is all that is needed in an endangerment-site-laden area. Take advantage of the chance to lighten up, lift up and exhale. There is no need to work harder than indicated.
Reflexology—Before: Thumb-walking is a necessary part of foot reflexology, and can become tiring quickly. Overuse must be avoided to protect yourself. As a precise methodology, there are very few ways to adapt reflexology techniques, so mix it up when you can, and rest when needed.
Reflexology—After: Here is another way to do thumb-walking, which will help avoid therapist fatigue. Mix up a precise modality any way you can, to change the angle of the thumbs and your body overall.
At the time she wrote this article, Mirra Greenway was owner and director of Greenways Wellness in Sarasota, Florida. She owned the Massage Therapy Institute of Missouri for 18 years, and celebrated her 40th year of practicing massage in 2014.
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