Dear Jenny,
I do believe it is possible to do massage full-time, but I think maintaining a full-time career and staying healthy takes rigorous attention to your body, your attitude, your personal and professional lifestyle, and your technique. From your letter, I see a number of areas where you are lacking the necessary skill or attention to stay healthy. I hope as we go through each of these areas, you can make the necessary adjustments to resolve the problems you're experiencing.

You say you spend most of your time massaging in a position where you are half leaning over the table. It is very important that you remain as upright as possible as you massage. The moment you take your body out of a neutral, anatomical posture, you are reducing your body's ability to create movement efficiently. You are straining your lower back, and forcing your gluteals to work overtime to stabilize you so you don't fall over, causing pain in these areas.

You can get out of this half-leaning-over posture by changing the position of the client, changing your position relative to the client, and/or changing the height of your table. It will take some experimentation on your part to see which changes work best for you. I encourage you to do this experimentation with a friend or teacher, not with a client. That way you will not feel pressured to perform, but rather can really take the time to concentrate on your body and your reactions as you experiment.

Massage therapists tend to work with the client lying prone or supine on the table. These client positions encourage the practitioner to bend over the client, especially if the table height is too low. Try instead to work with the patient in the side-lying position, which permits the practitioner to remain upright as she performs her techniques. If she remains perpendicular (at right angles) to the client's body, there is less tendency to bend over. The side-lying position can be the most comfortable for the client as well, especially clients with back or neck pain.

You can also try changing your position relative to the client. For example, many massage therapists position themselves at the client's head to do long strokes down the back, especially at the beginning of a massage to spread oil and warm up the tissues. By the time your hands get to the client's waist, you are half bent-over. Instead, try standing at the client's side, still facing down the length of the client's body (still at right angles). Raise the table height so you can remain upright (a massage therapist who wants a long, healthy career needs to use an electric table that allows her to adjust table height easily as many times as she needs to during a massage).

You mention that your wrists are bent back as you apply pressure during most of each massage session. I'm not surprised that your hands go "dead" in this position, as you are placing pressure on the nerves and blood vessels of the wrists, which can quickly lead to injury and loss of sensation in the hands. Again, it is important to keep your body in a neutral, anatomical position to allow it to work efficiently. You must keep your wrists straight as you massage. You are correct that you are inviting injury by massaging with your wrists bent back, hyperflexed. In fact, to be able to hyperflex your wrists and apply pressure, you have to be half bent over - one problem leads to another! Your posture also would encourage you to lift your shoulders up toward your ears, causing strain and pain in that area as well. As you remain upright in your work, you will find it easier to keep your wrists straight and your shoulders relaxed. Remember that you can also use other parts of your upper body to apply pressure. Try using your elbows or forearms.

The fact that you hurt all over - low back, gluteus, arms, shoulders - indicates to me that you are generally uncomfortable using your body for this type of work. I imagine that your schooling did not include nearly enough instruction in body mechanics. I strongly suggest a good body-mechanics refresher course, perhaps from the continuing education department of your school. A course in the Alexander Technique or Feldenkrais would also help you learn to use your body in a more efficient, organized manner.

The fact that you're young and fit augers well for your ability to recover from whatever injuries or incipient injuries you may have already sustained. If you can, try to take a little time off to work on your technique and body mechanics. You will go back to work feeling refreshed and ready to start again with a different, healthier approach that will serve you better in the long run.

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.