The profession of massage therapy is rooted in providing treatment and care for others; but, what about self-care for you, the therapist?
Are you working to prevent common overuse injuries that plague clinicians? How are you providing self-care when injuries do arise?
Many massage therapists’ careers are cut short due to the repetitive physical stressors associated with their work. Thoracic outlet syndrome; carpel tunnel; nerve entrapment; neck pain; low-back pain; and de Quervain’s syndrome, also called tenosynovitis, are some of the most common issues from which massage therapists suffer.
Most often, poor body mechanics are at the root of all of these conditions and can be corrected through simple awareness, changing body positioning or using kinesiology tape.
Cornerstone Knowledge
A concrete understanding of core-to-extremity function as it pertains to mobility, stability and strength should be a cornerstone of knowledge for every clinician to provide successful treatment for clients, as well as self-care. You can’t be a mechanic if you have no idea what the parts are and how they are meant to work together.
While the field of massage therapy is continuously expanding its base of knowledge as it pertains to movement, movement assessment and movement as medicine, ironically, we are often quite negligent about applying that knowledge to our own well-being. If you are a clinician suffering from chronic pain, take a literal step back and re-evaluate the body mechanics you’re using when you treat your clients.
If you’re a therapist who uses posture screening or coach’s eye to evaluate your clients’ movement patterns, turn that camera around on yourself. It will be the most enlightening and worthwhile selfie you’ve ever taken.
In this article, we will look at two conditions: low-back pain and de Quervain’s syndrome. Please note: It’s important to seek the professional care of a doctor in any case of pain (chronic or acute) to determine if there is an underlying medical or orthopedic issue before incorporating any exercise.
If you are not experienced in assessing movement, corrective exercises should be prescribed by a functional movement professional, physical therapist or chiropractor, as there are multiple levels of entry with each movement pattern.
Low-Back Pain
In many cases, massage therapists will suffer from low-back pain due to the constant forward flexion with rotation to the left or right, depending on which side of the treatment table they are standing. This posture of forward flexion with rotation coupled with anterior pelvic tilt, loss of pelvic floor stability, oblique contribution and gluteal function as the base from which force is being applied is a recipe for pain in the lumbar region.
Maintain this train wreck of a position for several hours a day three to five days a week and most massage therapists will feel like they need to carry their low back around in a backpack—especially if they are doing a lot of deep tissue work.
A simple and mindful way to address underlying cause is to start correcting core function. Doing sit-ups has nothing to do with this. From a corrective exercise standpoint, we would begin with re-establishing a balanced relationship between the diaphragm and pelvic floor by incorporating breathing exercises, rolling patterns, the basic dead bug exercise or heel slides—depending on the level of ability and proprioceptive and mechanical awareness present.
Strengthening the transverse abdominus, pelvic floor and diaphragm is a great first step in using movement as medicine. In addition to addressing the functional integration of the core, the function and mobility of the gluteals within the hip joints play a big role in low-back pain. Having the mobility of your hips assessed by a professional peer is recommended; an immobile hip complex will certainly create low back pain.
A simple hip-bridge exercise is one method that can be used to strengthen hip extension to contribute to the realignment of the pelvis. Additionally, using kinesiology tape is an easy and powerful self-care tool that can facilitate postural correction and even pain relief for this issue.
The mechanical disadvantage of the common treatment position can be treated using the taping applications in the photos below. This taping application is a good starting point, but with more complicated conditions the application can become more complex.
The Upper Cluster
Do you have stiff and achy neck or shoulders? How about headaches? Do you experience numbness and tingling in your pinky and ring finger or your whole hand? If you’re a massage therapist, chances are you said yes to experiencing all of those at some point.
Let’s revisit that train wreck posture we just talked about for low-back pain and a dysfunctional core. Travel up that kinetic chain along the posterior fascial lines and you might just find inhibition in the middle and lower trapezii, and a lot of tension in the upper trapezii. Does this sound familiar?
It probably does, because the majority of the people you treat come to you for the same upper “shoulder” pain from jockeying a computer desk all day. For the massage therapist, excessive use of the upper trapezii can arise from the repetitive motion of trying to go deeper for the clients who think they need to be bruised in order for a session to be effective. It can also arise from a basic upper-crossed syndrome in which the pectoralis minor is excessively tight, causing a forward-shoulder position, forward-head posture and overactive extensors of the neck.
If you have upper cluster pain, what should you do? First, read the disclaimer noted above about seeking clearance from your medical doctor. Next, start with postural correction much like you did for the low back. Overactive upper traps can also be an indicator of a diaphragm that isn’t contributing to proper breathing patterns and stability, so using diaphragmatic breathing exercises as a self-care foundation should still be at the top of your list.
You’ll also want to incorporate exercises to strengthen the posterior chain. Posterior rolling patterns, the “superman,” scapular retraction and depression, I’s, T’s, and W’s and wall angels are just a few of the movements that can be used to reestablish balance and strength between the anterior and posterior chain and help to alleviate symptoms of thoracic outlet syndrome.
One helpful taping method in this scenario can be a continuation of the low-back-and-glute application, or as an independent application.
De Quervain’s Syndrome
Pain in the thumb along the radial side of the wrist and weakness in grip strength can be a debilitating issue for any clinician. Other symptoms of de Quervain’s syndrome include spasms and the occasional burning sensation in the hand.
Research is split over whether this is an overuse injury related to occupation, but evidence suggests that repetitive motion involving wrist bending, abduction and flexion of the thumb, as well as twisting motions, contribute to symptoms associated with this issue. (Not enough attention is paid to the cause—Which is possibly higher up the chain with dysfunction of the shoulder girdle, but that conversation will be saved for another time.)
Correcting the upper cluster can have positive effects that can offer relief or contribute to prevention of this painful syndrome. A kinesiology taping application for pain relief is typically very effective in cases of de Quervain’s syndrome.
Prevention = Longevity
Self-care is a critical component to the longevity of your career as a massage therapist. The most effective method of self-care is prevention, which is why understanding and incorporating correct body mechanics should be the cornerstone of your self-care routine.
Setting up a video camera to record your movement patterns or having a professional peer observe them for you is a proactive strategy for self-assessment. If you’re unsure of how to assess movement, seek out the services of a movement specialist well versed in the Functional Movement Screen or Selective Functional Movement Assessment.
In addition, training in kinesiology taping is a great investment not only for self-care—because sticking to the basics (pun intended) of proper mechanics is where it all starts.
About the Author
Stacey Thomas, L.M.T., S.F.M.A., F.M.S., N.K.T., C.F.-L2, has been dedicated to human movement and athletic performance since 1997 and certified as a sports massage therapist since 2005. She holds certification in Functional Movement Screen, Selective Functional Movement Assessment, Neurokinetic Therapy and CrossFit Level 2, as well as other training and soft tissue modalities. She is credentialed by educational organizations regarding human movement and soft tissue treatment. You can find her in one of her three Front Range, Coloado, clinics treating athletes or teaching courses for RockTape.
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