It's no secret that being a massage therapist is physically demanding. Many therapists leave the field prematurely while others work in pain, leading to job dissatisfaction, resentment, and possible injury. Beginning therapists often ask what they can do about work-related pain and how to avoid it. They are often told to "work smarter, not harder," but are seldom told exactly what that means. There are many ways in which a therapist might "work smarter" and probably many suggestions that seasoned therapists could give newer colleagues. These are some of my own ideas, given in no particular order.
Show up ready for the job
It's important to show up for your job well-rested, well fed, and in decent physical and emotional condition. Make sure you get enough sleep and don't skip meals. Keep nutritious snacks available. You don't necessarily need to work out with weights but those who do often have a much easier time on the job. Take adequate breaks so that you can maintain your stamina and enthusiasm throughout your day. Lie down on the table for ten minutes and put your feet up. Your last appointment should be just as good as your first - don't cheat your clients or yourself! Stay curious and keep learning. Your work will be less stressful if you enjoy it. If you work for an employer who expects you to keep a schedule that is too demanding, have a conversation with them about creating a reasonable working environment. It's not good for the therapist, the client, or the employer if your schedule is not sustainable.
Learn about how the body works
There are many misconceptions in the field of massage therapy about how the body works. The concept of "deep tissue" massage is probably based on erroneous assumptions that we can somehow target specific tissues. Massage therapists are taught that their pressure on muscles, tendons, ligaments, and fascia will somehow lengthen or "release" them or that they need to "break adhesions" with pressure. This misunderstanding leads to relying on mechanical force, creating unnecessary stress on our body. Once we understand that we cannot change tissues by pushing on them, we realize we don't need to wear out ourselves and our joints.
Learn about how massage works
If we're not changing tissues by exerting mechanical pressure on them, then what makes the changes we feel? The short answer is that we're stimulating nerve endings in the skin and it's the nervous system that makes the changes. Once this is fully appreciated, we think differently about what we're doing. We realize we can't force the nervous system to change, that we can't beat it into submission, we can only coax it into relaxing. WE don't make the changes, the body makes the changes. It's our job to learn how to communicate with the body in a way that makes it feel safe, allowing it to turn down the volume on tension and pain.
Learn current pain science
One of the most useful things massage therapists can study is how pain works. This can help the therapist work more efficiently and effectively. It's not necessary to use a lot of pressure and cause pain to the client. In fact, it can be counterproductive and sensitize the nervous system rather than calming it. By giving up hurting our clients we also give up hurting ourselves. Understanding current pain science can lead to treatments that are more comfortable for the client and easier on the therapist's body. If you're not sure where to start with the pain science, there are a list of articles, books, and videos at the end of this article on putting pain science to work in your life.
Learn modalities that don't strain your body
There are a number of modalities available to massage therapists that are taught in a manner that is compatible with current science, feel comfortable to the client, and will not place undue strain on the therapist's body. Dermoneuromodulating (DNM), taught by Diane Jacobs, Jason Erickson, and others, is based on current knowledge of how the nervous system and pain work and is easy on both the client and the therapist. Walt Fritz, PT, teaches MFR (a misnomer but a recognizable name) in a manner that is compatible with our current understanding of how the body works. Pillossage and Hot DNM incorporate the use of warm flax pillows. They feel great to the client and are easy on the therapist. An added bonus is that the gentle warmth of the flax pillows is soothing to the therapist's own hands. If you'd like to learn more about Pillossage, would like to find a class, or sponsor a class near you, get in touch and we can talk about that.
Use your hands differently
Massage therapists often brutalize their hands, pushing hard with their thumbs and fingers day after day for years. I know the hazards of over-relying on your thumbs: I almost put myself out of business about 12 years ago when I subluxed the CMC joint of my right thumb. It forced me to learn to work without pushing hard with my thumbs and I'm still in practice. Mostly I've given up pushing hard into tissues but what does a therapist do when a client wants a lot of pressure? Rather than pushing hard with my thumbs on a sore place, I'll exert some firm (not hard) pressure with the heel of my hand and then put a sustained sideways stretch on the skin in whichever direction feels best to the client. The addition of the skin stretching seems to intensify the sensation, thus satisfying the client's craving for pressure without irritating already irritated tissues. I will also sometimes use the pads of my fingers held together with the joints slightly curved so that they are supported by each other and the weight of the force is distributed between them. I mostly stay away from using a lot of pressure, though, and try to help retrain my clients' nervous system to respond to a little kinder, gentler treatment. Many are surprised to find that they don't need to endure pain to get rid of their pain.
Much of the advice given about body mechanics does not make much sense to me. One cannot give a formula of where to place our feet, for instance when we are constantly adapting to changing circumstances. It's more important to understand principles. Line up with your work so that the weight of your body is behind what you are doing and whatever force you are using is transmitted efficiently. Stack your joints. What this means is that your joints are in a "neutral" position where the maximum amount of contact is made between the bones of the joints. Todd Hargrove gives an excellent description of stacking joints in his book A Guide to Better Movement, which I think every massage therapist should read. Gregory Lehman's class on when biomechanics matter is also highly recommended.
One of the most valuable things I learned from my Russian massage teacher Zhenya Kurashova Wine is the importance of staying relaxed. Too often when I watch other massage therapists work, they look tense and strained. Their hands and arms look tense, their shoulders are hunched up, their back looks tense. It's exhausting and hurts just to watch them! When your hands, your arms, and your body are relaxed and you are lined up with your work, not only is it less fatiguing on you as a therapist but it feels better to the client. You can feel the difference yourself right now with your own your hand. Place it on your upper leg and make your hand tense and rigid. Notice how that feels, then relax your hand and spread your fingers just a bit. Notice the difference. Which hand would you want to massage you?
Russian massage strokes
Russian massage is a system of massage but you don't need to have a comprehensive understanding of it to incorporate the strokes into your massage. The strokes feel great to the client and they only use one hand at a time. That means that each hand and arm is working just half the time. I've made a couple of brief videos demonstrating Russian effleurage and circular heel of the hand friction. Try them and see how they work for you and your clients.
Find a massage therapist who has been practicing for at least ten years and is not in pain from their work. Ask them to watch you work with an eye towards helping you massage with more ease. If you don't have someone available locally who can help you out with this, get in touch with me and we can work something out using video or Skype.
Educate your clients
Often we face the dilemma of clients wanting a lot of pressure, even to the point of hurting them, and hurting ourselves in the process. What can we do? First, we need to educate our clients. Many have been brainwashed into thinking that it's the pressure that makes the changes. If you understand that massage works via the nervous system, not by mechanical pressure changing the tissues, then you can then help your clients to understand that, too. Clients have often been taught that massage needs to be painful to be effective. By educating clients about how pain works and that causing pain may actually sensitize their nervous system, we can counteract this idea of "no pain, no gain." Some clients crave intensity. I'll tell them that I'll work firmly but not hard because I don't want to injure them. I'll try to meet them halfway, so to speak, and give them enough weight to try to satisfy their craving for intensity, adding the skin stretching along with it, and, over time, try to gently back them away from needing such a high level of stimulation. I compare it to someone who is listening to music at a dangerously loud volume. If you turn it down abruptly, it will feel to them as if they can hardly hear the music, but if you turn it down incrementally, they may slowly adjust to a safer level of volume. If clients continue to insist on what seems to be excessive pressure, I will tell them about the case reports on PubMed where clients have been injured by massage, sometimes permanently, and let them know I don't want them (or me) to be the subject of the next case report. If a client still insists, then perhaps it's time to let them go and hope they don't get injured by another therapist.
I hope this will help massage therapists get ideas about how they can work in a manner that will allow them to have a long and enjoyable career. We talk about sustainable practices regarding the environment but we need sustainable practices in our job, too. If we don't work in a manner that we can maintain over a period of many years, we'll end up putting ourselves out of work. Not only will we lose a job that we love, we may end up living with chronic pain as a result of it. Our clients will lose valued therapists, our employers will lose their most experienced employees and have to start over with new hires, and our field will lose therapists just as they are beginning to mature in their profession.
I'm sure that other seasoned therapists have ideas not mentioned here. If you're an experienced therapist and have other ideas you'd like to share, please feel free to leave a comment. (I'm sometimes a bit slow about approving comments so don't worry if it doesn't appear right away.)
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