Because massage is physically demanding, involves repetitive movement and tends to place biomechanical strain on the practitioner, self-care is critical to maintaining a sustainable, long-term practice.
As in athletics, a massage practitioner must first achieve the appropriate level of fitness, then exercise adequately to stay in shape for doing massage. One cannot expect just doing massage will be enough stay fit or to prevent injury.
Stretching for massage therapists is necessary, as is strengthening.
Take Care of Yourself
It is ironic that in a healing profession like massage, many practitioners neglect to take care of their own musculoskeletal health, failing to follow the very advice they give to their clients.
A surprising number of therapists continue to work in spite of their injuries—and as a result, many leave the profession when their symptoms become too severe.
For a survey a few years ago, most massage therapists listed their overall health as good or very good, and 75 percent reported some level of musculoskeletal symptoms in the previous two years, primarily related to their work.
Despite their symptoms, more than 40 percent of these injured practitioners decided not to make any changes in the way they practiced.
This survey also revealed 20 percent of massage therapists have considered giving up the profession because of their symptoms.
Generally, injury prevention consists of a number of practices. They include using good body mechanics, receiving regular massage, stretching regularly, exercising aerobically and training for functional strength.
Beyond these physical practices, appropriate rest is also a critical component. This means taking enough time between client sessions to relax, rehydrate and counteract the effects of the work, as well as knowing how many client sessions you can effectively perform in a day and in a week.
Sustain Your Massage Therapy Career
In this article, we’re focusing on two aspects of self-care: stretching and strengthening.
For most massage therapists, table work requires certain muscles to be used repetitively, causing them to become short and tight.
Picture your own posture at the table; you’ll probably see you’re standing with your scapulae protracted, shoulders flexed and internally rotated, your forearms pronated and your wrist and fingers flexed.
You may also find you stoop a little, collapsing your chest even more, and hold your head forward.
The hypertonic muscle groups that develop from performing massage include the serratus anterior, pectoralis major and minor, teres major, subscapularis, anterior deltoids, forearm pronators and the wrist and finger flexors.
If your body mechanics are less than excellent, you may also be overstressing your upper trapezius, levator scapulae and suboccipital muscles. These are the muscle groups we’ll focus on stretching as part of our self-care practices.
Stretching for Massage Therapists
As you continue to mentally review your posture at the massage table, notice which muscle groups are overstretched. These would generally be the antagonists to the muscles in the hypertonic category listed above.
Even though they’re overstretched, they’re likely to feel tight, and they’ll tend to be weak because their hypertonic partners inhibit them.
This group includes the scapular retractors (middle trapezius and rhomboids), shoulder external rotators (infraspinatus, teres minor and posterior deltoid), forearm supinator and the wrist and finger extensors. These are the muscle groups we’ll focus on strengthening as part of our self-care program.
Hypertonic muscles can inhibit their antagonists due to the reciprocal inhibition reflex. Stretching the hypertonic groups diminishes the inhibition of their antagonists and allows them to be more fully engaged during the strengthening work.
Please remember stretching should never cause any discomfort. The following stretching for massage therapists’ health can easily be done between client sessions. Developing a routine that works for you will contribute to your long-term flexibility.
“Everybody welcome” is an excellent, dynamic stretch that addresses many of the tight arm and torso muscles discussed above. Dynamic stretching does not include any bouncing motion, but is done in a controlled fashion. The stretch begins with your arms down and medially rotated, wrists crossed.
Stand tall and lengthen your spine, maintaining the natural curves in your back and neck. Take a breath in and, as you exhale, consciously draw your shoulder blades together as you lift the arms up and out as you laterally rotate and supinate.
Breathe in as you return to the starting position and exhale each time you stretch. Repeat this motion eight to 10 times, with the intention to easily increase the stretch each time. You can also vary the angle of abduction to fully stretch the pecs.
If you notice individual muscles are particularly tight, you can add specific stretches to your routine. For instance, you may notice you’re limited in external rotation or your ability to horizontally abduct your arm. To improve these motions, perform facilitated stretching in a doorway.
To improve external rotation, stand at a doorjamb with your elbow bent to 90 degrees and held against your side. Externally rotate your humerus as far as you can comfortably, and place your forearm against the jamb.
Press against the jamb with moderate force to isometrically contract your internal rotators. Breathe normally as you push. After six to 10 seconds, stop pushing, take a breath in and exhale as you stretch by contracting your external rotators again.
Maintain your new range of motion (ROM) and take a step to once again place your forearm against the jamb. Repeat this stretch protocol three to four times.
To improve horizontal abduction, abduct your arm to about 90 degrees with your elbow bent and place your forearm against the jamb.
Stand tall and lengthen your spine, maintaining the natural curves in your back and neck. Press against the jamb with moderate force to isometrically contract your pecs. Breathe normally as you push.
After six to 10 seconds, stop pushing, take a breath in and exhale as you stretch by horizontally abducting your humerus.
Maintain your new ROM and take a step to once again place your forearm against the jamb. Repeat this stretch protocol three to four times.
Hypertonic forearm pronators may limit supination (normal ROM is 90 degrees). To stretch the pronators on the right side, supinate your right forearm as far as you can and wrap your left hand around the radial side of the right wrist and hand.
Keep both wrists in neutral. From this starting position, isometrically contract your right pronators. Breathe normally as you do this.
After six to 10 seconds, stop pushing, take a breath in and exhale as you stretch by supinating your right forearm to a new ROM. Repeat this stretch two to three times for both arms. Watch a video on arm stretches from Mayo Clinic.
Wrist and Finger Stretch
Hypertonic wrist-and-finger flexors can limit extension and set the stage for more serious injuries, such as medial epicondylitis or wrist and hand pain.
Performing facilitated stretches for these muscles helps maintain them at their proper length and tone. To stretch these muscles on the right arm, keep your elbow straight and extend the wrist and fingers.
Place the fingers of your left hand across the fingers and thumb of your right. Your left hand provides resistance as you attempt to flex your right wrist and make a fist with the right hand.
Hold this moderate isometric contraction for six to 10 seconds, breathing normally. Then stop pushing, take a breath in and exhale as you stretch the flexors by extending the wrist and fingers.
Repeat this stretch two to three times for each forearm and hand.
Simple Strengthening Exercises
The following strengthening exercises are ideal as part of a self-care routine. They’re all done with resistance bands, which are easily available and easy to keep handy in your treatment room.
As with the recommended stretches, perform some of these strengthening exercises between each client session.
The Power Band Pulldown
The “power band pulldown” is an excellent upper-body exercise to counteract the muscular imbalances that result from performing massage (thanks to Bob King for teaching me this one).
To perform this exercise correctly, you must be able to comfortably abduct and externally rotate your arms and retract your scapulae. If you can’t achieve this ROM, keep working on your flexibility until you can achieve this posture.
Sit or stand comfortably and lengthen your spine, maintaining the natural curves in your back and neck. Grasp a length of resistance band securely in each hand. Lift your arms above and behind your head to the starting position.
Be sure to maintain your head in a neutral position, avoiding jutting your chin forward. As you exhale, slowly pull the band down and out to the base of the skull then slowly return to the start as you inhale.
Consciously focus on scapular retraction and depression as you perform this exercise. Repeat eight to 10 times, several times a day.
The Seated Row
Another excellent exercise to help strengthen the scapular retractors and open the chest is the “seated row.” Securely attach the resistance band at shoulder level to a fixed object.
Sit comfortably and lengthen your spine, maintaining the natural curves in your back and neck. Grasp the ends of the resistance band in each hand, and abduct your arms to about 90 degrees with your elbows bent.
Exhale as you retract your shoulder blades and pull back on the band as far as you can go comfortably.
Inhale as you slowly return to the starting position. Repeat eight to 10 times, several times a day.
Strengthening the supinator muscles helps maintain proper balance with the pronators. To strengthen your supinators, sit comfortably with your arms at your sides and your elbows bent. With your forearms pronated, grasp the resistance band.
As you exhale, slowly supinate each forearm as far as you can comfortably go.
Inhale as you slowly return to the starting position. Repeat eight to 10 times, several times a day.
A Healthy Massage Therapy Career
Achieving a sustainable massage therapy career is a fine balance between working enough to earn a living and making the time to maintain health and well-being.
It’s important for practitioners to educate themselves about proper body mechanics, body usage and the overall ergonomics of their work environment. Watch a video on body mechanics.
They must look at their self-care practices to ensure they’re taking actions to prevent musculoskeletal injuries.
Regular practice of the stretching and strengthening activities outlined in this article will be an effective addition to your self-care strategies—and will keep you on a road to a long, healthy massage therapy career.
About the Author
Robert E. McAtee, L.M.T., C.S.C.S., C-P.T., maintains an active, international sports therapy practice in Colorado Springs, Colorado, and is the co-author of Facilitated Stretching, a best-selling proprioceptive neuromuscular facilitation stretching book used by fitness professionals worldwide.