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A while back I was with my family at a local restaurant, and it should have been a great time, but I was distracted. I felt a sharp, electrical pain that seemed to connect my neck to my hand, a pain that I often felt in the massage room. It was now unrelenting, and I thought my massage career of 20-plus years was coming to an end. Long story short, eventually, I figured out how to resolve this pain, but I was left with this nagging question: Why did it take me so long?

A while back I was with my family at a local restaurant, and it should have been a great time, but I was distracted. I felt a sharp, electrical pain that seemed to connect my neck to my hand, a pain that I often felt in the massage room. It was now unrelenting, and I thought my massage career of 20-plus years was coming to an end. Long story short, eventually, I figured out how to resolve this pain, but I was left with this nagging question: Why did it take me so long?

The answer is simple: I didn’t have a plan.

In a minute, I’m going to show you how to create a plan to massage pain-free, but before I do, I have a message for the seasoned massage therapists out there: You’re never too old to massage pain-free.

Yes, it’s easier when you have a plan from the start. Then you can make minor adjustments as you go along, rather than having to make major adjustments all at once. But if you’re willing to put in the effort now, my bet is that you’ll be massaging pain-free soon and loving your work again.

Your plan to massage pain-free must answer two important questions: how you will address areas of your body; and what areas need to be addressed. We’re going to start with how.

Part 1: The How of Your Plan

If you’re going to solve a problem, you need to have a process, and the process for massaging pain-free has three steps: observe, experiment and adjust. Sounds pretty easy, right? It is, but there’s a potential pitfall to avoid, which I’ll point out a little later. First, let’s look at observe.

When I say observe, I’m specifically talking about paying attention to your body as it relates to your pain in the massage room. Once you understand which techniques and body positions are causing you pain, you can then experiment with alternative techniques, different body positions and body-part substitutions.

By the way, I’m using the word experiment in a loose sense. You can’t set up a double-blind, placebo-controlled study, but you don’t need that degree of control to understand what’s working and what’s not.

For example, one observation I made during my experiment was that my fingers hurt when doing supine neck work. So, for a week or so I did prone neck work with knuckles and double-barred thumbs instead of supine neck work, and my fingers felt better. From that information I can reasonably conclude that prone neck work with knuckles and double-barred thumbs is easier on my fingers than supine neck work.

Once you find a winner in your experiment, you must then make the adjustment in your massage routine. Duh, Mark. I know, this seems obvious, but here’s the potential pitfall.

How many times have you heard yourself say—I know this is not good for me—but yet you continue to do the action that’s not good for you? We all do. Maybe we continue with the action because it’s too much work to change it or we just like the old way of doing things. The point is, old habits die hard and to massage pain-free you need to consistently apply the adjustment that allows you to massage pain-free until it becomes your new habit.

Years ago, a massage therapist who was working for us complained of shoulder pain when she was doing bodywork. So, the two of us went into the massage room to figure out what was going on. She did a subscapularis massage technique and exclaimed: There’s the pain!

This should be easy, I thought. I showed her a different technique and boom—no pain when she did the new technique. Problem solved. A couple weeks later the pain was back. When I asked her if the new move was now hurting her too, she said no because she hadn’t been doing it.

I was confused until we talked some more and she reluctantly confessed that her subscapularis technique was her signature move and she couldn’t give it up.

That made me think about a signature move I had stopped doing so that I could massage pain-free. It wasn’t easy. The thought of giving it up felt crushing to my massage self-identity.

But I can tell you firsthand that you’re more than your signature move. How do I know this? Because when I eventually did replace my signature move with a move that was easy on my body, my clients didn’t stop coming. In fact, I grew my business because now I could see more clients since I was no longer in pain.

Part 2: The What of Your Plan

Observe, experiment and adjust are the how of the plan to massage pain-free. Now, let’s look at the what, the areas of your body that need to be addressed. To do that, I’m going to have you make two worksheets.

At the top of one worksheet write “Now” and at the top of the other worksheet write “Future.” The Now worksheet is where you’ll write in your current injury and pain conditions. The Future worksheet addresses potential new injuries and pain conditions that you want to avoid. (Click here to download a NOW Worksheet to Prioritize Pain Issues, which you can fill out, from author Mark Liskey.)

On your Now worksheet make three columns. At the top of the first column write “Inside the Massage Room.” For the next column write “Outside the Massage Room,” and in the last column write “Priority.”

Under the In the Massage Room heading, list all the areas of your body that are sometimes or always in pain when doing massage. Under the Outside the Massage Room heading, list all areas of your body that are sometimes or always in pain when you’re not doing massage. The areas that appear in both columns are your highest priority.

So, under the Priority heading, list the always-in-pain areas that occur both inside and outside the massage room, followed by the sometimes-in-pain areas that occur both inside and outside the massage room. Next, in the Priority column, draw a line under the list you just made. The pain areas above that line are first priority.

Under that line in the Priority column, add the rest of the Inside the Massage Room list and, lastly, add the rest of the Outside the Massage Room list. These pain areas are second priority.

You have successfully prioritized the pain and injury areas on the Now worksheet and can start to take action to get out of pain. Note that the first-priority body areas, the ones that appear both “In the Massage Room” and “Outside the Massage Room” must be addressed in the massage room and outside the massage room, in daily life.

How are you going to address pain areas in daily life? The same way you’re going to address them in the massage room—observe when you’re in pain, note what you’re doing while you’re in pain, experiment with ways that don’t cause pain and adjust in daily life by applying the new ways that don’t cause you pain.

Part 3: Your Future Worksheet

Can we predict a future injury or pain condition? No. But we can reduce the chances of having an injury or pain condition by following some basic, common-sense thinking.

We know that repetitive movements, such as squeezing muscles, and static posture, such as hunching over a client, do not make for happy bodies. If you’re feeling the deleterious effects of repetitive movements or static posture now, imagine what it could feel like 10 years from now if you don’t change something in your work habits. We’re going to make changes now so we can avoid pain in the future.

On your Future worksheet write, “I am going to (1) use as many body parts as possible to apply pressure (2) change massage stances frequently, and (3) become ambidextrous.”

You may have noticed an underlying theme here—it’s options. The more massage options that you have in the form of techniques, strategies and tools, the less likely you are to overuse a particular part of your body. This is really important, so important that I’m going to give you a job for your future self. The job is for you to continuously create options for yourself in the massage room.

For example, if you press with your thumbs all the time, think of ways you could replace your thumbs. Here are some ways: Use knuckles, combine a knuckle and thumb or use a massage tool.

Round-tip L-bar in the lamina groove
Round-tip L-bar in the lamina groove | Courtesy of Mark Liskey

If you stand most of the massage, experiment with more sitting when working head, feet, IT bands and calves. If you find yourself hunching for long periods of times, try switching to a one-hand massage so you can straighten up.

3Part, Life, PainFree, Plan ⋆ Your 3-Part Plan for a Pain-Free Life
Massage posture back stretch | Courtesy of Mark Liskey

Also, don’t let yourself get comfortable using only your dominant hand. That is a surefire way to get an overuse injury. Instead, slowly and strategically mix in using your non-dominant hand to massage. You may never feel that your non-dominant hand could entirely replace your dominant hand. That’s OK. The goal is to feel competent enough to use your non-dominant hand so you can give your dominant hand a break.

Let Your Plan Evolve

Creating a plan to massage pain-free isn’t and shouldn’t be a big deal. Start by simply paying attention to your body in the massage room. When you experience pain, note what you’re doing and how your body is positioned. Then, experiment with new ways to get the job done. Incorporate the strategies and techniques that make your body feel good; discard the ones that cause you pain.

Lastly, sometimes even a replacement move will need to be replaced. Why? Over time your body will change and what worked for you at 30 may not work for you at 40 or 50 or 60 or 70 or 80 or 90. But a changing body is not a career-stopper if you have a plan. If you do, you can go back to the plan, figure out where you need to adjust, make the adjustment and massage on—pain-free.

Mark Liskey

About the Author

Mark Liskey, LMT, CNMT, is a massage therapist, massage CE provider and author of “The Pain-Free Massage Therapist,” a body-mechanics strategies and techniques book for eliminating pain in the massage room and extending massage careers. You can access free, instructional body-mechanics videos at painfreemassagetherapist.com. His articles for massagemag.com include “Stacked Vs. Unstacked Joints: The Body Mechanics Study That Matters.”

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