An image of a female massage therapist cradling her elbow, to illustrate the concept of elbow pain in massage therapists.

Any massage therapist who has ever felt pain in their body knows all too well how it siphons the enjoyment out of giving a massage. Elbow pain may be one of the top inconveniences during work, because the pain is there at almost every stroke.

Elbow pain can occur on either the inside or outside of the elbow. Once the cause of the pain is identified, steps to healing can begin.

Causes of Elbow Pain

The pain in the elbow is caused by overuse or because the muscles surrounding the elbow joint were not strong enough. Both lateral epicondylitis (outside elbow pain) and medial epicondylitis (inside elbow pain) take time to materialize and may not go away as quickly as they seemed to appear.

Massage therapists who develop elbow pain usually have three repetitive movements or habits that caused the elbow pain.

These are: supination of the forearm during a stroke, wrist flexion, and grasping with force.

1. Forearm Supination

Supination of the forearm isn’t required in many massage strokes. There may be times you supinate while performing petrissage or kneading, but when using good body mechanics, there is no reason to repeatedly supinate the forearm during a stroke.

When you do, the repetitive supination, especially with pressure, leads to inflammation of the tendons around the elbow.

Massage therapists often supinate and flex the wrists for a double whammy.

Takeaway: Strokes ending with palms up mean you have supinated and are putting pressure on the elbow.

2. Wrist Flexion

Any time you flex your wrists during a stroke, strain is put on the tendons of the elbow.

Picture sitting at the head of the massage table with your client supine. While working on the neck, it is common to hold the client’s head in your hands. This means your arms are in a supinated position. This is the first caution, but by itself not terribly problematic.

Next picture how you use your hands to work around the base of the skull, to friction the sub-occipital muscles, or to elongate the neck. If you bend your wrists the flexors of the forearm contract. Bent wrists put more pressure on the elbow, then add the weight of a client’s head and the fact that your arms are supinated and there is a recipe for elbow pain.

It is worth noting, flexed wrists often happen simultaneously with flexed fingers. Both actions contract the muscles of the forearm. When these muscles aren’t strong, elbow pain occurs.

Takeaway: While you are using petrissage, be aware that your wrists are staying neutral.

3. Grasping with Force

With petrissage and kneading, there are some grasping movements with the hands. The problem arises when forceful grasping is used.

The scooping motion with a side-to-side petrissage is an acceptable massage stroke but not to be used for deep pressure.

When kneading, aim to knead without a lot of pressure because the grasping movements required to knead a muscle puts a strain on the flexors of the forearms, which can lead to elbow pain. Always knead with wrists in a neutral position.

When deeper pressure is needed, try wringing or compression to prevent elbow pain.

Takeaway: The more pressure you need, the fewer moving joints there should be.

Heal Your Elbow Pain

All three of these movements, when occurring frequently, may lead to inflammation of the tendons of the elbow causing pain for massage therapists.

With the right care and a little strengthening, you can heal your elbow pain and be sure elbow pain never returns. The approaches to elbow pain we will look at here are: rest, ice, massage, topical pain relievers, taping and strengthening.


The main thing to heal elbow pain is resting it. Stopping the movement that caused the pain is the first step. Notice if you are using any of the above-mentioned movements during your massage.

It is not realistic to stop working for 6 to 12 weeks; however, by noticing the movements that cause the pain, you can begin to modify your massage strokes to allow your elbows time to rest.

Move towards using the hands and fingers less to give the forearm muscles a break.

Use this time to develop your skills with forearms, elbows and fists in your massage strokes.


One of the things that will help your elbow pain at the beginning is applying ice to the area. Regular ice cubes in a plastic bag work but my favorite is a reusable gel pack from the drugstore. Look for one that comes with a sleeve to insert the ice pack into with a Velcro strap attached. These make icing simple as you go about other activities.


Self-massage is possible to heal your elbow pain faster. Here are some techniques massage therapists have reported working for their elbow pain:

• Gentle friction where the tendon attaches to the bone.

• Pin and stretch. Moving the elbow joint and wrist in separate pins.

• Ice massage directly over the pain point.

• Slow stripping of forearm muscles distal to proximal (toward the inflamed part of the elbow)

Topical Pain Relievers.

Analgesics and essential oils with anti-inflammatory properties may be helpful to manage elbow pain.


Consider taping your elbow while you aren’t at work, because some elbow tapings require much of the forearm to be covered in tape. Forearm taping doesn’t meet sanitary measures for a day of massaging clients unless you can wear the tape in an area that won’t come into contact with clients.


Massage therapists need to lift heavy heads and limbs during sessions, so getting stronger lets you work longer.

Building strength is a must to getting your elbow pain better and making sure it doesn’t return. Weakness is a factor making the body susceptible to overuse injury.

Once the acute stage of inflammation is calmed down, by using the self-care listed above, it is time to begin exercises.

A resistance band is a good way to begin gaining strength in the forearm muscles. Both wrist flexion and extension against resistance are helpful for elbow pain. Along with rows, bicep curls, and tricep extensions.

When the resistance band feels easy, holding a dumbbell for the exercises is the next step.

Holding 5- to 10-pound dumbbells while exercising, gives you grip strength. Holding the dumbbells trains the muscles and tendon attachments to carry a load, which prepares the body for massaging multiple clients.

Always train your muscles for the workload of clients you see and avoid a steep sudden increase in the number of massages you perform.

Massage On

Keep these causes and cures for elbow pain in mind and share with a friend so we are all massaging with healthy elbows.

[Watch a free webinar: Best Body Mechanics with Angela Lehman, The FitMT, here.]

Angela Lehman

About the Author

Angela Lehman is a massage therapist of 25 years turned online educator, promoting fitness and nutrition for massage therapists. She runs The Fit MT. With her kinesiology degree specialized in nutrition, she trains therapists in healthy eating, exercise and body mechanics to prolong their careers. Search to read her The Fit MT column on topics including body mechanicsgut health and more.