ELBOW PAIN IN MASSAGE THERAPISTS Why it's happening and self care

body mechanics self care Feb 10, 2021

Massage therapists use their hands and other parts of their arms all day giving massage so when elbow pain starts it's an all hands on deck moment. 

Really, the prevention should have started long before the pain shows up.

Knowledge is power so let's look at why the elbow pain is happening and then how we can prevent and treat it.

Why massage therapists get elbow pain

The short answer is poor body mechanics but that doesn't help you unless you know what you are doing that's causing the pain.

Massage therapists use their hands A LOT during a massage session.  Hands are our main tool.  

You should be using other tools at least 40% of the massage but if you're determined to use your hands, let's see the specific reasons why the elbow pain starts. 

Petrissage and Kneading

While you are using petrissage be aware that your wrists are staying neutral. 

  • any wrist flexion puts a strain on the tendons of the elbow

When kneading, aim to knead without a lot of pressure because the grasping movements required to knead a muscle puts a strain on the flexors of the forearms which can lead to elbow pain.

  • knead with wrists in a neutral position (no flexion at wrists) 

For more pressure try Wringing or Compression strokes as an alternative to deep Kneading.

Doing a lot of neck and head massage

Those massage sessions requiring extended time on a client's neck muscles or cranial work can take a toll on massage therapist's hands. 

Much of neck and head massage work is digit-orientated which strains the hands.  

(See this article for how to save your hands during neck and head massage.)

Think of sitting at the head of the massage table with the client supine while you are doing neck work. 

Take finger-tips curled in the sub-occipital muscles. . . are your wrists flexed?  What about when you want more pressure?  Do you get that from flexing your wrists back towards you?

This is an example of when tendonitis can begin. 

Anytime you flex your wrists while doing massage strokes strain is put on the elbow

Elbow tendonitis 

The pain massage therapists get in their elbow is tendonitis, an overuse injury that can become chronic if not treated. 

Tendonitis is inflammation in the tendons of the elbow.  You may have helped clients with this in your own massage practice. 

Becoming aware of what NOT to do with your hands during a massage will be the first step to preventing chronic tendonitis.

Two things that make your elbow hurt during massage

  • flexion at the wrist joint
  • supination of the forearm

When performing a massage we have a variety of strokes we can use.  Awareness around what each joint is doing while performing that stroke is the key to preventing elbow pain.

Flexion at the wrist joint

Massage work doesn't require a lot of bending at the wrist.  Even though the wrist joint can move doesn't mean it should move during the massage. 

During effleurage, the wrists should be straight.  During compression, the wrists should be straight.  During friction, the wrists should be straight.  Tapotement (percussion) . . . well the wrists are loose so they will move.  

You get the idea.  Bottom line:

Bent wrists = forearm flexor muscles contract = tight flexors = medial elbow pain

Supination of the forearm

The forearm is really cool anatomically, in that it allows the ulna and radius can rotate around one another.  Nowhere else in the body is this possible. 

This is called supination.  When using good body mechanics, there is no reason to repeatedly supinate the forearm during a stroke.  (notice when you petrissage)

When you do, the repetitive supination, especially with pressure, leads to inflammation of the tendons around the elbow.

There are a few places you may want to use this motion and that's fine as long as you aren't already having elbow pain.

For prevention, this is a movement to keep to a minimum. 

Strokes ending with palms up = repeated supination = lateral elbow pain 

The more pressure you need, the fewer moving joints there should be. 

It's important to stack bone one bone, using straight joints and no embellishments.

The pretty swoops some massage therapists put at the end of their strokes are what I call embellishments.  It's like massage caligraphy.

You can massage like



You may have seen a massage therapist with this artsy style to their work.  It could be a flick of the wrist or a swoosh rotation at the end of some strokes. 

Keep your massage strokes straight forward.  No embellishments if you want to avoid elbow pain.

Preventing elbow pain for massage therapists

Best prevention tips for avoiding elbow tenonitis during massage work:

  • Avoid grasping motions with the hands. Scooping with the palms during petrissage should be kept to a minimum
  • Use deep petrissage sparingly.  Try wringing or compression instead
  • Watch to see if you are supinating your forearm as you work 
  • Check-in frequently during your massage on your body mechanics to fix old habits as you notice them
  • Line up your tool of choice (fist, fingers, thumb) in a straight line so when delivering pressure, bone supports bone to reduce muscle/tendon stain
  • Remember your tool should have no tension.  It's an extension of your arm and should be used in a relaxed state
  • Use forearms and elbows frequently during your massage to give your hands a break


Treating acute elbow pain for the massage therapist

Let's briefly look at some treatment options when you are feeling elbow pain.

  • ICE  - this may seem obvious but many massage therapists overlook the easy answer.  Ice after every massage day. If really inflamed, you may even need to ice the elbow on days you don't work.

  • Be aware of your activities away from work.  If you have a hobby that uses the arms in a way that exacerbates the elbow pain, stop those activities while healing.  This could be gardening, a weekend painting project, playing an instrument, knitting, or putting together a piece of furniture using a screw driver. 
  • Avoid the movements talked about in this article while working. Use a wide variety of strokes and tools. 
  • Reduce your workload when possible.  Elbow tendonitis is an overuse injury and heals best with rest.
  • Take a Body Mechanics course.  Investing in yourself is the best thing you can do for your career.

Elbow pain is avoidable as a massage therapist.  The key is knowing when you're at risk (using your tools incorrectly) and being present while working to catch it early.

So ask me questions if you need clarification because why treat it when we can prevent it?  

Until next time

Be fit, be strong, and maintain healthy elbows!


👇 Get a body mechanics checklist as a handy reminder of the best ways to use your body to avoid pain. Click the image below. 👇







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