body mechanics Mar 10, 2021

As a student in massage school, we had the luxury of the instructor's eyes on us, making corrections to our body mechanics. 

We had time to learn and practice good body mechanics, and now, months or years later, maybe we've gotten lazy, picked up bad habits, or made adjustments because the room we work in is too small. 

The main reason massage therapists' bodies begin to hurt is bad 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
  • fitting as many clients into a day as possible

To help therapists who are in their first year out of massage school and those who've been massaging for 20 years, here are the most important body mechanics practices to stay working pain-free.    

Massage Therapist Body Mechanics Best Practices 

Using Feet and Legs

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

Get grounded - planting both feet on the floor beneath you is the beginning to build the rest of your body mechanics on top of.  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.  

Use different stances - A bow stance or archers 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 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 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. 

Getting 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.    

Head and Shoulders

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 used correctly, it prevents the scapula from retracting when you use that arm. 

The scapula can protract and retract.  If you hold your arm in front of you in a straight line, you can practice this motion in the air.  Now imagine you used that arm for a massage stroke, and as you applied pressure, the scapula retracted, you just lost all your pressure. 

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.  

Tools and How to Use Them

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. 

Tools - Massage tools available for use include hands, fists, fingers, thumbs, knuckles, elbows, and forearms.  Yes, also parts of legs and feet if doing something like Thia Massage or Shiatsu, but we are sticking to traditional table work for this discussion. 

Stack joints - This is a simple rule to follow and will lead to many years of pain-free massaging.  When you approach the massage table with your thumb as a tool, for example, you should have the joints from the thumb and up the arm stacked in a straight line.  You can also think of this as 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 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 is the grasping motion of the hands.  Grasping, especially when using pressure, puts a lot of strain on the hands.  Have you ever heard someone who's not a massage therapist say, "My hands are already tired; how do you do this all day?"  

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 is a double whammy and is bound to bring tendonitis.  

Avoid -  Unlike the limited movements above, there are a couple of things to avoid completely during massage work.  One is curled fingers and bringing your fingers toward you for a massage stroke. 

Let's say, for example, you are working seated at the head of the table on your supine client's neck.  Many massage therapists cup the scalp in both palms and massage the occiput with fingertips (see picture above).  If you've tried this for more than 2 minutes with gravity and the weight of someone's head in your hands, you know those fingers and hands get tired quickly! 

Instead of bending the fingers and curling them into the palms, let's bend at the metacarpophalangeal joint and hold.  Then use the table as a fulcrum to push into the sub-occipital muscles.  Just as effective for the client and much easier on your hands. 

The other thing to avoid completely is thumb circles.  I often get resistance to this statement.  I know we love to circle our thumbs, but they wear out easily, and there is a safer way to circle the thumbs.

If you use a braced thumb and compress, then circle, it saves your thumbs, and the client doesn't know the difference.  

Best Tips for Success

As a massage therapist, you really are an athlete in what you do.  It would help if you had a certain level of fitness and conditioning to see clients full-time.  

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.  Really, 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 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 shift at the wrong table height is enough to start an injury on your already overworked body.

Can you use heat, cupping, or a topical analgesic to make your work easier?  Add one of these and let it sit while working on a different part of the body.  When you come back to the area, it should respond to your work faster, and you saved your hands a little.   

Become ambidextrous -  The faster you can work easily from both sides of the massage table, the better.  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. 

No one knows the challenges a massage therapist faces in keeping their body healthy except massage therapists themselves.

Sometimes, even we don't know until we are in the middle of an ongoing busy schedule.  

These Body Mechanics Practices should be re-visited periodically because there is always somewhere we can improve.  If today it's head placement, next month it may be core strengthening.  

Make comments below or ask questions for clarification.

Until next time

Be fit, be strong, and use good body mechanics.

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