The Massage Therapy Foundation (MTF) recently completed phase I of its study on ergonomics for massage therapists.

The goal of the MTF’s Ergonomics Project is “to provide safety parameters for massage therapy work which may include identifying risk factors, examining practice environments, and analyzing the essence of how typical massage therapy work tasks are performed.”

The massage therapy profession has grown in leaps and bounds over the last three decades through the expansion of practice models, educational approaches, and certainly through the discovery of research.

This growth has created the need to look at the profession and its trajectory by identifying elements that help determine the next steps into the future of our work. This includes the creation of a best practices model for workplace safety and techniques for the work that we do.

The staff at the MTF felt we could impact the profession in a very meaningful way that touched every practitioner, practice setting and school. This is how our Ergonomics Project came to be.

After 18 months of inquiry, investigation, data collection and research, we are excited to share with you some of our fascinating discoveries that we believe will make a significant contribution to the health and longevity of massage therapy professionals.

What is Ergonomics?

It is important to understand the importance of workplace safety and wellness, and the overarching definition of what ergonomics really is. Many think ergonomics is a synonym for body mechanics in massage therapy work, but that is not entirely accurate. It has a much broader scope, looking at several factors of how multiple job tasks are performed, not just one.

Ergonomics, while very precise in its observation of workers, involves both factual data and creativity and seeks to provide adaptation of work tasks for individual workers. Ergonomics takes an analytical look at the nature of how work is performed in all different types of job tasks and professions and seeks to provide guidelines and recommended adjustments to minimize risk factors to prevent potential injury, or more specifically, the cumulative effects of performing work tasks that lead to repetitive stress injuries (RSIs) from continuous exposure. 

Think of how different types of jobs are done. Repeated, documentable injury cases that have a direct correlation to RSIs often influence changes in the performance of work tasks.

Did you ever wonder why workers at a construction site must wear hard hats or why waste collectors have automated lifts for trash receptacles on their trucks? In both examples, the protective equipment and adaptations, respectively, are now in place to assure the safety and longevity of the workers and lessen the risk of potential injury.

Moreover, it is the protected right of workers to be able to perform their work in a safe environment; this assurance is overseen by the federal- and state-level organization called the Occupational Safety and Health Administration (OSHA). 

Ergonomics and Massage Therapy

This project was conducted in a collaboration between the MTF—which contracted a renowned ergonomics firm—and Briotix Health to achieve our two main objectives:

1.  To determine the demands of massage therapy work and establish parameters for work preparedness, whether for new therapists fresh out of school or experienced practitioners actively working; and

2. To discover what level of risk massage therapy work has and what preventative measures can be taken to reduce that risk (if any).

In order to create a comprehensive report worthy of establishing best practices for massage therapy work and training, two phases of discovery in data collection are needed using various levels of ergonomics technology and analysis. The MTF formed a workgroup to help guide the project and give it structure, which enabled Briotix Health to do the analyses needed for discovery.

This workgroup comprised a diverse group of massage therapy professionals with significant knowledge to contribute to the guidance of this project in the areas of education, research, workplace health, and practical experience in the massage therapy workplace. It is this think tank workgroup which created the structure for the first phase of this project that is reaching completion.

Feedback from Therapists

Our first step was to develop a survey to collect some specific information from currently active massage therapists about the work they do from day to day and where they perform that work.

While this data was readily available in annual industry reports, we sought to have the information in real time directly from therapists and educators themselves. We received 700+ responses from this survey, which helped us establish some observation parameters and develop unique research questions that would drive our next steps involving live, on-site data collection.

Through the guidance of the MTF Board of Trustees and suggestions made by the workgroup and Briotix, the cities of Baltimore, Maryland; and Portland, Oregon, were selected as project sites.

During Phase 1 of the data collection process, we collected more than 600 data points through the use of video capture, professional ergonomics analysis tools, extensive measurement of various factors (including application of force, stroke delivery, technique usage and body position), in addition to qualitative analysis to help provide an accurate picture of the nature of the work that massage therapists do.

In addition to observing therapists’ applications of work, we also wanted to look at the environments in which therapists work to gain even more insight. Between the two cities, we analyzed a fairly good cross-section of typical work environments, including a franchise location, a private multi-location day spa/wellness center, and two multi-practitioner private practices.

In these site visits, we measured rooms and equipment, observed usage of equipment and tools, weighed items, reviewed schedules (including frequency of breaks and lengths of typical sessions), considered the business aspects of practice, discussed self-care techniques, and added other environmental factors to get a sense of a typical workday for the average massage therapist.

Analyzing the Data

All of this data was analyzed by the ergonomists for over three months, then compiled into a comprehensive report, job analysis and recommendations for safe practices. Here are some general concepts from this Phase 1 report of discovery:

• Massage therapy work has been determined as a moderate-risk job for developing RSIs if no self-care or intervention is employed.

• Massage therapists have long duty cycles, meaning that while we may not necessarily work full-time in the truest sense of that definition, the time spent in doing our work is very long in comparison to other types of professions. Long duty cycles mean more opportunity for potential injury and risk.

• Due to the physical nature of massage therapy work, physical conditioning and maintaining specific health levels are key factors in career longevity.

• There is some setup of the massage work environment, and preparation for a workday by a massage therapist, that can be improved upon to promote the health and safety of the massage therapist worker.

• All of these elements can be incorporated into entry-level training and education to help mold future massage therapists and their workplaces to be proactive in implementing these best practices as standards for the profession.

Next Steps

While the workgroup, board and staff at the MTF are crafting strategies based on this extensive report, our plan is to conduct a strategic dissemination of this valuable information to the profession. A white paper is currently being drafted to create a best practices document based on the discovery and recommendations of this report.

There are additional plans to provide instruction and training of both active practitioners and massage schools to help them learn to adopt these best practices to promote career longevity. 

As we continue to unpack this information for practical use in our professional environments, the MTF seeks to progress into Phase 2.

While much has been learned in Phase 1, there are still more specific answers needed in many areas, such as consistency with force application, exertion, exposures, selection, usage, application of certain strokes, and other variations that come with working on different body types. Briotix has recommended the use of wearable sensor technology to help us find the answers to these bigger questions.

Our hope is to gain further support from the profession to raise the funds needed to progress to the next level of technological discovery. The MTF Ergonomics Project has truly embodied the mission of the MTF—supporting research, community service and education for the profession.

We hope we can count on you for your support, in whatever way you can, to help us continue this work for the future and benefit of the massage therapy profession.

About the author

Robin B. Anderson, LMT, BCTMB

Robin B. Anderson, MEd, LMT, BCTMB, CEAS, is Massage Therapy Foundation president-elect; she wrote this article on behalf of the MTF. She is director of the massage therapy education program and health professions online learning coordinator at the Community College of Baltimore County Maryland. A board-certified and licensed massage therapist, Anderson maintains a small private practice, and is a National Certification Board for Therapeutic Massage & Bodywork-approved continuing education provider. For their invaluable help with Phase 1 of this research, the MTF extends special thanks to Community College of Baltimore County, East West College of the Healing Arts, the many massage therapists who took time out of their busy schedules to participate, and the massage facilities that invited us in for site visits.