I think we need to use hydraulic tables just as much as physical therapists do, and for the same reasons. In fact, I wonder if I would have developed my shoulder tendonitis if I had been able to use a hydraulic table at work.
Karl J., Atlanta, Georgia

Dear Karl,
I certainly do agree with you, and I believe that massage therapists should use electric or hydraulic tables. To avoid massage-related injury, a massage practitioner must be able to quickly, easily and repetitively regulate the height of her table as she works.  There just is no way to do that with a stationary table.

Maintaining comfortable, natural body postures while massaging is vital to the prevention of massage-related injury.  In a neutral, natural posture, the therapist uses her body effectively and efficiently, expending the least amount of energy necessary to perform her chosen techniques. The relationship of the height of the massage table to the height of the practitioner must be such that the practitioner is able to keep her body in a natural, neutral posture while she massages. If this relationship of table height to practitioner height is not ideal, the practitioner's body may become overstressed. She may become tense, tired or strained, all of which can lead to injury. This "ideal height" changes from massage to massage, as well as within a single massage.  From one massage to another, the practitioner will have clients of different sizes, weights and body shapes.  A slightly-built woman may add only three inches of height when she lies down on the table, while a large man may add six inches.  So when we discuss table height, we are really talking about the height of the table plus the height of the client's body as he or she lies on the table.

The massage therapist using a stationary table has to assess the combined height of table and client's body before the client lays down, or else ask the client to lie down just for a moment and get up again so she can know how much to adjust the table height. Once the massage has begun, she has to hope that she won't have to ask the client to get off the table so she can adjust it again if she miscalculated the first time. Many massage therapists have just enough time to change the sheets and take a deep breath before their next client comes in, let alone adjust table height. In my experience, few therapists end up changing the table height between clients. As a result, the therapist may find herself working in uncomfortable and unnatural positions during the next massage.

Within a single massage, a therapist will use a number of different techniques performed in a number of different positions. For some techniques, the therapist will be sitting at the client's head or feet as she works.  For others, she will be at the side of the table.  The client may be asked to lie prone for some techniques, supine for others, and on his or her side for still others. The therapist will concentrate some techniques on a small area, and others may require her to sweep her arms along the partial or full length of the client's body. Each time the therapist changes position or technique, she is likely to find that she needs to adjust the table height so she can continue to work comfortably and efficiently. If she is using a stationary table, she will have to ask her client to get up and down off the table a number of times during the massage, which is disruptive to the massage. Since she doesn't want to disturb her client, she will likely continue to massage, even if she is uncomfortable, and will put herself at risk of being injured.

For these reasons, a hydraulic table is a necessary investment for any massage therapist who wants to have a long, healthy massage career.  The massage therapist who uses a hydraulic table will also enjoy the added benefit of increased body awareness, one of the most important factors in preventing injury.  She will be constantly monitoring her comfort level as she massages, since she knows that she has an option; changing the table height, that may alleviate her discomfort. The therapist with a stationary table knows there is nothing she can do about the table height once the massage begins, so she has less stimulus to monitor her comfort level.

Sometimes a subtle adjustment in table height, perhaps less than an inch, can make the difference between feeling comfortable and relaxed while massaging, or feeling tense and strained.  Such subtle adjustments are only possible with a hydraulic table.

More Helping the Healers

Lauriann Greene is a massage therapist and the author of Save Your Hands! Injury Prevention for Massage Therapists which is used by massage schools in North America and in five other countries; and by physical therapists, chiropractors, and other manual therapists to help prevent injury.  She has also taught "Save Your Hands" workshops in numerous locations across America.

Please note: This column is edited by a medical doctor to make every attempt to ensure medical accuracy of the answers given; however, the recommendations and techniques described in this column are meant as suggestions only, and are not intended to be a substitute for appropriate medical advice and treatment from your own qualified health care provider. Readers who experience any signs or symptoms of injury have the responsibility to seek professional medical advice and treatment.