MASSAGE THERAPY RISK FACTORS YOU HAVE CONTROL OVER. Avoid burn out and make the money you want.

body mechanics self care Feb 26, 2022

You CAN massage as long as you want.  With the current number of injured therapists rising, the need for awareness around body mechanics and self-care is increasingly important.   In a recent study, 83% of massage therapists reported work-related pain in the wrist or thumb at some point during their careers.

The Massage Therapy Foundation has an ongoing Ergonomics Project which was explained in a podcast I happened upon this morning. 

Here is my synopsis of the podcast. 

You, massage therapist, have control over 4 of the 5 risk factors that lead to injury.  

You have control over EVERYTHING but genetics.  If you were born with scoliosis, for example, your massage career health may require more attention than someone without a genetic health condition. 

So what can you control?  

According to Stefan Shulz from Briotix, the 5 risk factors their company uses to determine a risk profile for any profession are:

  1.  Force - deep pressure can hurt more
  2.  Awkward posture - yes, we all get lazy
  3. Excessive repetition - hello, we massage all-day
  4. Contact Stress - how many sessions, how close together
  5. Other environmental factors - genetics  

When applied to massage therapy I’ll bet you can see the first 4 are easily applied to our table work and can be controlled. 

What the company then goes on to do is find solutions within 3 areas to mitigate these risk factors. 

  1. Control over the equipment massage therapists use.  Our massage table being our main piece of equipment requires the correct table height for each individual. 
  2. The pace of our work and the length of the exposure.  This is under the control of your boss if you are employed somewhere, but even then you should have a say in how many sessions you do in a day.  If you are self-employed you have complete control over the number of clients seen and the breaks you allow yourself.
  3. Behavioral solutions.  Body mechanics, stretching, strengthening.  All things a therapist can do on their own without other input.  

Circle This!  Number 3.  Commit to memory! This is good news (and better not be new news if you’ve been with me more than two days).  The Fit MT has all kinds of solutions for #3.

You are in control of overuse injuries.

Even if you have scoliosis, it doesn’t mean you can’t be a massage therapist for 30 years.  Maybe you just stretch more and have a specific exercise routine that works for you. 

If you’ve ever experienced pain during your massage career, you know how it zaps the fun out of an otherwise amazing job.  

Take a look at 5 common mistakes causing hand pain. 

I’ve seen it repeatedly over the years.  It doesn’t matter if the massage therapist is new to the industry or has been in it 20 years, at least one of these mistakes is the cause of the therapists’ hands hurting.  

Mistake #1  Too close to your work

Have you ever noticed yourself on top of your massage work?  You know that too close feeling when you may be trying to get deeper pressure by leverage but you feel a strain in your wrist or hand?  I think all massage therapists have felt this at some time or another.  

Sometimes this lapse of good body mechanics practice may stem from laziness or fatigue.  Some days lack focus results in mistakes with body mechanics or my favorite one, massaging in a room that’s too small.  This can leave you cramped and running into a wall when you need a deep lunge. 

Aim to line up your work with a relaxed wrist angle, arms distance away from the table.  This means your feet may need to take a step back to get the correct angle.  Remember, the tighter the angle gets at your wrist, the more at risk you are for pain.   

Mistake #2  Bone isn’t supporting bone (stack your joints)

Stacking the joints leading to your massage tool (hand, fist, fingers) may have been taught to you a different way.  Some massage schools just say, “line up your work” but don’t break it down joint by joint.  When talking about stacking joints, it’s also important to remember if your feet aren’t in the right place first, then everything else is thrown off.  

Imagine you have a client on the table in a prone position and you are going to effleurage down their back.  For the effleurage, your tool is an open hand. 

Here’s the checklist to be sure your joints are stacked correctly.  

    Your hand is placed on the body arms-length away as we talked about above. 

    The wrist is at the correct angle and relaxed.

    The elbow joint should be slightly bent, leading straight into the shoulder's glenohumeral joint, supported by an engaged serratus anterior muscle.  The serratus anterior is important so the rest of the arm can remain relaxed.  

As you effleurage down the back in this way, everything from the shoulder joint down can stay relaxed, propelled by the weight shift from your legs.  Brilliant!  Ahhh, this is how it’s supposed to feel! 

The same joint stacking rule applies and is even more important when your working tool is a finger or thumb.  Straight fingers will lead to the straight wrist joint, to the straight elbow joint, to the supported shoulder joint.  

 This example using the fingers as a tool has phalanges supporting metacarpals, supporting carpals, supporting radius and ulna, supporting humerus.  As long as you let bone support bone leading from your tool, the muscles have a better chance of staying relaxed as you massage.  

Mistake #3  Grasping harder to get more pressure

You know that client who’s always saying, “You can go harder, you won’t hurt me.”  Well, I have a limit to how deep I can go.  Sometimes getting more pressure hurts!  Hurts your hands, hurts your back, just hurts.  But it doesn’t have to.  Let’s look at why your hands might be hurting when getting deeper pressure for a massage stroke.

First off, your hands have intrinsic muscles made for fine motor skills.  Those fine motor skills, like touching your thumb to the first finger to pick a berry from a branch, aren’t meant to be used for deep pressure.  This is why your hands tire quickly if you massage by grasping constantly.  

One of the main questions I get when people hear I’m a massage therapist is, “Don’t your hands get tired?”   I know what they mean because before massage school I would just massage with my hands and yes, they got tired!  But massage school teaches us tricks of the trade like using your whole body to massage, not just your hands.  More pressure should always come from your legs rather than upper body muscles. 

Limit the scooping and grasping movements that wear hands out and lead to pain.  Think about how else you can get the same result.  What other strokes could replace the one that’s causing you pain?  This is sometimes where a new favorite way to do something is born.

Mistake #4  Using hands too often

Using hands too often is a mistake?  But I need my hands to do massage!  

Of course, massage therapists need their hands to do massage but don’t forget about all the other tools available.  Did your massage school teach you how to use forearms and elbows? Now’s the time to get good at using them.  Using other tools will give your hands a much-needed break.  Especially if your goal is to see over 20 clients a week.  

Within your hands, there are fingers, thumbs, knuckles, and fists.  Use these tools as often as you can, with proper body mechanics, of course, to give your hands rest.  Be sure you know how to protect these smaller tools so additional problems aren’t created in the spirit of resting your hands.  

Exercise:  Try a practice massage session on someone who is not a paying client, using these tools throughout the entire massage.  No open hands allowed!  Have fun, you can do it. 

Mistake #5  Curling fingers 

I left the common mistake of curing fingers for last because it seems to be the most widely UNDER-talked about cause of hand pain.  I’ve watched many different massage therapists in my clinic (with education from different states) use their fingers in this same curing motion. 

Think about when you sit to begin 10–20-minutes on the neck with the client supine.  With their head in your hands, do you curl your fingers to massage the neck muscles?  What do I mean by curl the fingers? 

Within the hand are the metacarpal phalangeal joints and then the different phalangeal joints.  You know, those 3 bones of each finger? Many therapists curl three of those four joints while doing neck work.  This is done unknowingly.  It’s just how the hands work naturally and the therapist’s focus is on the client, not their hands. 

There is a lot of tension created with the curling of these joints.  Not only does the hand have tension, but the strain on the hands increases greatly when you add the weight of the client’s head and any force you need for something like traction or deep friction.  

Strain to the hands is caused by bending the finger joints. Remember learning in anatomy that muscles contract to bend joints?  Muscles contracted means the hand is not relaxed.  

Self-care for hands

When your hands hurt or are tired at the end of a workday, it’s time to take action.  Don’t let it go and hope it’s better tomorrow.  

Ice your hands if they hurt.  Rub a pain-relieving cream on the wrists and hands. Stretch and rest.  Find a combination of self-care that works for you. 

I could say, bottom line, stop doing these five mistakes, but that’s easier said than done.  Some therapists will already have created a habit.  Those habits are hard to break.  It’s worth having an experienced therapist watch your body mechanics at the table to pinpoint where you are going wrong.  

Also, if you’re already in pain, there are more steps to take.  There are stretches, cryotherapy, hand and arm exercises, and tools to rehab from the pain and get back to massaging pain-free ASAP.   You now have the basics, and control over your massage career is worth every bit of time it takes to make a change.  Pay attention to these five mistakes during your next massage.  Awareness is the first step to change.  

You got this, and let me know how I can help.   

If you’d like a free body mechanics checklist, get it by clicking the picture below. 👇


Be fit, be strong, and protect your money-makers!



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