by Emily A. Smith, Ph.D.

The Keys to Clinical Massage Therapy, MASSAGE MagazineIn clinical massage therapy, there are a few things to keep in mind:

Traction is key
In clinical massage therapy, we make room in the body so our clients can find comfort. How do we do this? Stretching, lengthening, traction and massage. By offering your clients the relief they seek, they will continue to return to you and no one else.

Knowledge of anatomy
It is imperative we, as massage therapists, do our best to be active in knowing our anatomy. It is much more difficult to relieve issues if you do not remember the origin to insertion of the muscle, the fiber directions around the muscles and the action each of these muscles perform. We learn so much in school, and it can be easy to forget some of it if we do not stay active with our knowledge.

Keep up with your studies and stay updated on anatomy. You can do this by explaining to your clients what you are doing and why, as well as inviting them to learn about their bodies. Not only is it interesting to them, but it also provides a sense of comfort that their therapist takes the condition seriously.
Another great way to keep up with your anatomy knowledge is to trade massage with someone who you can both learn from and be reminded of specific parts of the body. When I graduated from massage school, I was nervous I had learned so much information that I might not retain it all. I began to trade work both with my former massage teacher and another expertly trained therapist who became my mentor. They both spoke in correct anatomical terms, and they both continued to teach me. It kept me up-to-date on my knowledge, my terminology and increased my existing knowledge base.

In this industry, it is important to never stop learning. It is also essential to stay true to the knowledge for yourself and your clients.

Achieve your clients’ intended range of motion—stretch it!
So many clients are stressed out, lethargic and have lost their range of motion—and sometimes this is not due to injuries. Instead, it can be easily caused by stress. Of course, other factors contribute, including the fact that a majority of people spend many hours a day hunched over at a desk or computer and do not stretch, exercise or do anything to address the issues in their bodies until they have reached unbearable pain. It’s when this happens that they finally call you and expect you to put it all back together in one session.

There is a lot to do to restore months or years of habitual laziness, stress or ignorance. Do not feel the need to play superman or superwoman in your one session. Be honest with your clients, do everything you can for them and explain that it may take more than one session. In the meantime, be sure to provide your clients with homework.

For instance, a marathon runner came back to me after our first session with much more range of motion in his hamstrings after being out for 10 weeks with an injury. He said to me, “The stretches you gave me were so easy, that I actually did them!” This is key: easy, basic and short on time are required. People do not necessarily want to do the work, so by keeping things simple you can teach them exercises to perform at home and encourage them to partake in their own health care. Stretch your client while they are in a session with you, and give them stretches to maintain your work at home. 

Back to traction
Make the most out of your strokes! When I assisted in a massage class, I noticed the teacher showed a student how to address the trapezius. She told the student to strip up from the shoulder over the trapezius and up the neck. Of course, this is a wonderful thing to do; however, there is a whole other part that could benefit you and your client: traction.

When you address the trapezius muscles and strip from the shoulder, over the belly of the trapezius and up to the occipital, use the other hand to pull that shoulder down at the same time. Therefore, you’re stretching down to turn the muscle off that’s primary action is elevation—hence, going the opposite direction with depression and stripping up the muscle, creating a restored length of the muscle. You don’t want the shoulder to rise up toward the jaw when you’re trying to lengthen the muscle. The muscle will not lengthen when you’ve just allowed it to shorten! You want the muscle to be extended, released and stretched. This is traction.

Traction is not just for the neck; it can be used in every part of massage. This is why knowing the primary action of each muscle is so important. We must be able to turn the muscles off as we massage them. Go the opposite direction of the primary action. Take the path of least resistance to get desired results. 

Absolute presence in the session room
When we are in a session, whether we work in a spa and have several sessions each day or work privately and have our own schedule and breaks, it is important to be actively present to your client. Your clients come to you for a specific issue, and they need your help. People want to be able to feel safe on your table and know what they came for will be addressed. When we are in a space of acknowledging the muscle and going over the actions and placement of that muscle, we are completely present to our client. We have taken over for them for the hour and allowed them to “check out” for a little while as we take care of the situation. We have started a conversation with the muscles.

The muscles provide an excellent map of what your client has been up to. I can tell if clients have been working out, what exercises they have been doing, if they’ve been driving too much, not stretching enough, etc. The muscles provide you with so much information. Tuning in and listening to them will lead you to your desired results.

Muscles can also tell you a lot about your client’s emotional state. The point is, pay attention to the muscles and communicate with them. Make room in your clients’ bodies by relieving them of their tightness and pressure. Give them back their range of motion, and assign them homework to keep your work in tact.

We are blessed to do what we do in our daily lives. There are few other professions where people greet you with a hug, leave you with a hug and tell you they have counted down the days to be able to see you. We make people’s lives more comfortable—and that’s something to take pride in.

Emily A. Smith, Ph.D., is a clinical/neuromuscular therapist from the Atlanta School of Massage. She is trained in the Dr. Vodder Method of Manual Lymph Drainage and Combined Decongestive Therapy, and is a Sivananda yoga instructor and reiki/Karuna Ki master. She has a bachelor’s degree in exercise science and wellness, as well as a master’s degree and doctorate degree in philosophy specializing in comparative religion. She is author of Stretch Therapy and Stretch Therapy II, and produced Come Into Being, a guided meditation CD. For more information, visit