Massage therapy is a very rewarding profession: We get to take people who are a bundle of muscular and fascial stress, worry and tension, and in a mere 60 minutes, transform them into calm, relaxed and happy people. Massage is so important, I often wonder why every massage therapist does not take the time to get one every two weeks—but from what I have heard, from hundreds of massage therapists, is they are the last ones to book a massage and so just live with aches and pains.
I know that each of us has a life beyond our table. We have family, social and community demands that take our time and energy. Often, we are too busy to check in to our own well-being and notice if we are beginning to feel some aches or stress, or constantly held muscular tension. In a perfect world, we would have our own biweekly massage to get our muscles back into good shape, more relaxed and fully functioning.
We as the givers would become the receivers at regular intervals and at regularly scheduled appointments—which would keep our own bodies healthy, while helping support our colleagues’ practices.
But if we don’t have time to book a massage, self-massage is the best way to ensure healthy, pain-free, strong muscles and fascial systems.
Self-care can be done anywhere. At home, while watching TV or helping our kids with their homework; in our treatment room between clients, on break, during lunch. Even a small amount of self-care can really help keep our muscles in tip-top shape.
As massage therapists, we have to assume certain workplace postures, and we use the same muscles day in and day out to perform the task of massage. This can lead to dysfunction in areas commonly associated with problems for massage therapists:
- Front of shoulder, from having arms in flexion
- Upper trapezius, from looking downward to the client
- Quadriceps, from long lunges as we provide long effleurage strokes to the client
- Wrist and finger flexors, from pressing downward onto the client as we hold the wrist in extension and pronation
Self-care compression is an excellent way to bring our attention to these areas of chronic muscle tension or restriction, and facilitate relaxation and release of chronic habitual holding patterns. Just a few minutes per day doing self-care could mean the difference between a long and healthy massage therapy career and one cut short by muscle pain.
Areas of dense muscle fibers, also known as trigger points, can develop in any muscle of the body. While there is no single reason for this adaptation, the development does not always have to be a bad thing. We can develop trigger points in areas of past injury, or from chronic, low-level, long-held muscular tension.
Over time, we develop habitual tension patterns and we accept these areas as chronically tight and dense. The body can deal with this less-healthy segment of muscle tissue; however, if not resolved with self-care or bodywork, these trigger points can make muscles weak, painful, restricted in range of motion, and low in metabolic endurance. As our muscles are held in the tightened position, we develop a local energy crisis.
A research study published in 2010 in the Journal of Bodywork and Movement Therapies, “Effect of ischemic pressure using a Backnobber II device on discomfort associated with myofascial trigger points,” indicated that subjects who regularly applied self-care in the form of held static compression for 20 to 30 seconds using a Backnobber tool, with release for 30 seconds, repeated for a cycle of six times every other day for one week, experienced substantial changes in pre- and post-sensitivity of the treated and nontreated trigger points. These results indicate that a self-care protocol using a tool was effective in reducing trigger point irritability. This is great news, and suggests scientific data may support the importance of self-care for the massage therapist as well as the client.
Self-applied compression and stretching can bring an exchange of local nutrients to the area and allow the muscle proteins actin, myosin and titin to unlock, so that nutrient-filled blood can enter the area and replenish the cell’s energy cycle.
6 Steps for Self Massage
1. Heat. Gently warm up the area to be treated, with a heat source like a hot pack, hot shower or hot tub soak; or broad movements like running in place or performing swimming strokes.
2. Identify. Determine the area needing to be worked on. Remember, 85 percent of the time, trigger points refer pain to a somewhat distant area, so follow the charts of Janet Travell, M.D., and David Simons, M.D., to best determine the muscles that could be causing your pain or problem. Detailed referral patterns by muscle can be found here.
3. Compress. Apply compression using gravity-assisted weight into a commercially produced tool or a tennis ball or bounce ball—not your own hands or strength. Keep discomfort to a level 5 out of 10, and hold for 20 to 30 seconds with just 20 percent of your strength being used.
4. Stretch. Bring the area into the stretch position, then use 20 percent of your strength to contract, hold for 20 seconds and coordinate the exhale on the relax and further stretch part. It is best to focus on a long, slow, 15- to 20-second long, deliberate exhale, rather than a deep inhale. This can help us activate our parasympathetic system and allow relaxation of long-held muscle tension.
5. Range of motion. Move the area you have just worked on, and all joint segments near it, in the most pain-free range you can. Focus on being relaxed and smooth in movements.
6. Repeat. Follow this sequence every day, until you notice the changes holding. As you get better at noticing taught-banded, painful muscle areas, you can reduce the frequency and the duration of your self-care sessions. You will be better at zeroing in directly to the most troubling areas, getting the necessary work done, and moving on to other areas.
While it is wonderful that we massage therapists do not have to sit at a desk all day, our daily postures and muscular efforts can, over time, lead to problems. Let’s start at the top and work our way down.
As we stand over our treatment tables, it is very easy to get into the habit of looking downward at the client we are treating. Tight muscle segments can develop in the trapezius and suboccipital muscles, and they in turn can refer pain to the back of the head, side of the neck, forehead or face. The traps—those pesky “coat hanger” muscles as described by Travell—can be a source of chronic tension and pain for anyone who works with their hands or arms while in torso or hip flexion.
Self-Care for Upper Trapezius
To provide self-care compression for the upper and transverse traps, we can use a tool that can reach behind us and provide the treatment for us. It is best to focus on being relaxed in the upper back to allow the traps to relax. With the compression in place at the top of the traps, gently press into the upper curve of the tool so the pressure goes downward. You can add an element of stretch by side-bending your neck to the opposite side.
Self-Care for Wrist-and-Finger Extensors
Stand in a balanced lunge with your arm resting against the side of your torso or thigh. Press the hip into the arm, and with that force press the arm into the tennis ball or Tiger Ball against the wall. Relax your shoulder, pecs, neck and lower arm. Do not look downward to the ball; simply feel where it is pressing into.
After a few minutes of compression, add an element of contract/relax of the extensors by pressing the fingers into the wall using 10 percent of your strength. Hold for 15 seconds, then exhale and relax. Compress with the ball again into the extensor muscles, and you should notice they are less painful or sore.
Self-Care for Supinator
Since we spend many hours with our wrists pronated and extended while using our finger flexors to press into clients, it would be a good idea to supinate the hand, then use a tool to gently apply compression to the supinator muscle as well as the extensors.
Seated, relaxed, and with your wrist gently in flexion off the edge of the table, use a Jacknobber, Knobble or other handheld tool to apply pressure to the area. Contract and relax by resisting supination with your other hand. Hold for 20 seconds, exhale and relax to further supination.
Self-Care for Quads and Thighs
Our leg muscles and fascial system are constantly working to support the effort of the arms and hands. Trigger points in the rectus femoris muscle can refer pain into the thigh and downward to just above the kneecap. Using a rolling pin or a handheld massage roller like the Tiger Tail tool shown on page 63, stand in a lunge and apply even, downward pressure on the quads as you work your way toward the knee.
We all should be aware of our postural habits. By that, I mean working, sitting, standing and sleeping posture. Our head-and-neck posture while texting or gaming or working on the computer can have a huge impact on muscle function as well.
The position in which we sleep can also greatly affect muscles. If we take a look at the figure of a person on an anatomy poster, you will see what the anatomical neutral is. We should always try to work, rest, sit and sleep in the most neutral posture as possible. Side-sleeping is OK as long as the arms are kept near the torso and in as close to anatomical neutral as possible—not overhead, scrunched up, or tucked under your pillow with your head resting on them. No matter what, we all should avoid sleeping on our stomachs in the prone position, as this is a surefire way of keeping our muscles and fascial system out of neutral and in a stressed position, further creating dysfunction in muscles.
Since massage therapists look down a lot for work, be sure to keep your head and neck in as close to neutral alignment as possible, and not crunched up or pushed out too far forward. Can you alter the way you massage and try to keep your posture upright and not hunched over your table?
Best yet would be investing in a hydraulic lift table, so you can change the height of your table from day to day to change the way you habitually use your muscles. Prevention of muscle pain also means participating in regular strengthening and stretching movements that bring your muscles fully onto the short as well as fully onto the stretch.
Bottom line: You work in a physical profession, so you need to be physically fit. Yoga, Zumba, aerobics classes, swimming and weight training are examples of activities to engage in to keep muscles healthy. And just as you recommend massage to keep clients healthy and fit, you too must choose to book massage sessions and practice self-massage between them.
About the Author
Mary Biancalana, L.M.T., is a board-certified myofascial trigger-point therapist and president of the National Association of Myofascial Trigger Point Therapists. She is founder and owner of the Chicago Center for Myofascial Pain Relief, Advanced Trigger Point Seminars and Trigger Point Sports Performance. She is proud to be a dynamic continuing education provider, as well as an author of books, articles and digital media teaching materials.