Injury is perhaps one of the largest threats to a massage therapist’s career. In a career that demands a great deal from its professionals both physically and mentally, keeping yourself healthy should be at the top of your priority list.
Everyday, you create a safe place for your clients to relax, heal from injury or deal with chronic pain, to name a few, and you need to make sure you’re providing yourself some of the same kind of care. Sometimes, though, the difficulty isn’t in knowing you need to practice good self-care, it’s understanding exactly how to take care of yourself in a way that helps prevent injuries and reduce the risk of burnout. And what we’re coming to understand is that the recipe for good self-care is a combination of several elements.
The Right Words
Self-care is important to massage therapists—critical to career longevity in a physically demanding profession like massage therapy. Despite the importance of self-care to the massage profession, confusion about terms and concepts surrounding self-care practices still abound.
The terms “ergonomics” and “biomechanics” are often used to refer to the practice of good body mechanics. Some people use “self-care” when describing good body mechanics, while others define self-care as maintaining general health.
This confusion is more than just semantics, however. Not understanding the difference between body mechanics and ergonomics, for example, can leave therapists unsure about the best ways to protect themselves from injury.
In order to clearly communicate on this subject, we need to develop a common language so that we can share evidence-based best practices. With this goal in mind, let’s explore some commonly used terms. At the same time, we’ll explore some commonly held misconceptions about the relative effectiveness of each of these methods to keep therapists well and working.
This term should be familiar to all massage therapists, and you probably have an idea of what body mechanics is in practice. Simply put, body mechanics is about positioning the body and using movement patterns that are the most efficient and effective for accomplishing the task at hand. We often hear about good body mechanics, implying there are right ways and wrong ways to work—and that’s true. But, you need to remember that good body mechanics isn’t the only key to staying healthy as a massage therapist.
Most occupations, massage therapy included, have taught body mechanics for decades in the hopes that the practice will keep those in the profession healthy, and yet injuries persist. One reason why this approach hasn’t been effective is that workplaces are not always set up to allow good body mechanics. Another is that, even with the best body mechanics, tissues in the body can still be injured through overuse and overload.
You’ve probably heard the word ergonomics used to sell everything from chairs to keyboards to toothbrushes. Ergonomically designed items are supposed to fit the user well, be comfortable to use, and in some cases even help prevent injury. Although this definition is an oversimplification of the concept, the description is a useful starting point for a discussion of how the science of ergonomics can help massage therapists.
Ergonomics is the study of the interaction of people with their work, including the space they work in, tools and equipment they use, and the physical and mental demands of their jobs. Sometimes referred to as ‘human-centered designers,’ ergonomists looks at people, including their strengths and weaknesses, and then design the workplace to fit them.
Height-adjustable massage tables are a good example of ergonomic design. They can be set up to fit therapists of different statures, or adjusted to place the client at an appropriate height for deep tissue work or Swedish massage. For an idea of how important ergonomics is to the equipment you use in your practice, consider how difficult it would be for you to practice good body mechanics if massage tables were made as one-size-fits-all.
Good ergonomics is the foundation of good body mechanics, and the evidence shows us that when the principles of ergonomics are applied in the workplace, injuries do decrease. But ergonomics practitioners have learned that simply designing the physical workspace is not enough because the physical demands of some types of work can cause injury even when the best possible work methods are used.
The term biomechanics is sometimes used synonymously with body mechanics, although this description is not entirely accurate. Strictly defined, biomechanics is the application of the principles of physics to the study of the human body and how it moves.
Biomechanists look at the body as a system of levers (the long bones), springs (the muscles and fascia) and hinges (the joints). By modeling the body in this way, we can better understand the most efficient way to create movement. So, although biomechanics helps us to better understand body mechanics, there are other ways this science can help us prevent injuries.
For example, biomechanics also studies forces generated within the body as a result of movement, and the tolerance of the body’s tissues to these forces. Using biomechanical modeling, we can estimate that for every pound of force you generate at the tip of your thumb, the CMC joint at the base of your thumb will experience 10 to 12 pounds of force. Using your thumb to apply deep pressure could create as much as 100 pounds of force in the CMC joint.
Looking at the structures of the thumb, we know that the carpal and metacarpal bones are strong enough to withstand high forces, but that cartilage and ligaments can be damaged from repeated exposure to this type of stressor. Understanding biomechanics can help us determine the answer to this question: “How much is too much?”
You may have learned the importance of strengthening the muscles you use for massage work, such as doing grip exercises to strengthen the flexor muscles in your forearm. You might also have learned that stretching these and other muscles is important for maintaining flexibility and preventing injury.
Going one step further, many massage therapists also learn the importance of strengthening muscles that are underused in massage work, such as the rhomboids, and stretching the ones that are overused, such as the pectorals. All of this advice probably sounded right to you because massage is hard work, so having strong muscles will help to protect you from injury. And athletes stretch before competition in order to prevent injury, so that must be a good strategy, right?
In reality, there is almost no evidence that strength protects us from injury in physically demanding work, and in fact endurance may be more important to preventing musculoskeletal injuries, as well as general health. Cardiovascular, or aerobic fitness, has been shown to decrease the risk of musculoskeletal injuries. Think about it this way: a strong muscle can stabilize the joint, offering protection and helping you withstand the forces acting within the body. If the muscle fatigues, however, your connective tissues are going to have to bear the pressure of those forces, making them susceptible to injury.
But what about stretching? Surely stretching must be good for you and helps prevent injury, right? While stretching has many benefits, the evidence related to injury prevention is less clear. It’s never been proven to reduce injuries in athletes, and for some people, such as those who are already hypermobile, stretching is contraindicated. Warming up the muscles before vigorous activity has been shown to be a benefit, since this makes the muscles more efficient and increases flexibility without the risk of tearing muscle and connective tissue fibers.
None of this is meant to imply that there is no value to range of motion and strengthening exercises. We should just be careful not to count exclusively on doing these exercises to prevent injury. Stretching and strengthening should be part of a comprehensive program of physical conditioning that also includes developing endurance, balance, proprioception and good movement patterns. Such a physical conditioning program can be effective in preventing injury when it’s included as part of a larger injury prevention strategy.
We should also want the same things for ourselves that we want for our clients—a musculoskeletal system that is free from adhesions and trigger points so that our muscles can work efficiently and without pain or restriction.
Self-care is the concept that can and should incorporate all of the other concepts discussed above, along with other elements such as nutrition, hydration and adequate sleep. While injury prevention is one of the main goals of self-care, you should also find ways to include activities to support your mental well-being. The physical demands of massage work are not the only cause of shortened careers in our profession. Mental and emotional demands can lead to burnout if they are not properly addressed.
To be effective, a good self-care program should be comprehensive, not just including bits of each of the concepts discussed here, but integrating them into a unified whole. While we may not yet have all of the answers on how to best protect ourselves, there is enough evidence on what does work to help us develop effective self-care strategies.
Research shows that the most effective approach to preventing injury is multifaceted and holistic, combining all of the concepts discussed here. It’s also very important to understand the risk factors that cause injury, and to examine whether your activities outside of work may be exposing you to those risk factors. Combining all of these tactics is the most effective way to maintain your musculoskeletal health throughout a long, healthy career.
Lauriann Greene, CEAS and Richard W. Goggins, CPE, LMP are co-authors of Save Your Hands! TheComplete Guide to Injury Prevention and Ergonomics for Manual Therapists, 2nd Edition, a textbook on self-care that’s used in massage schools worldwide. Greene is a former massage therapist and is now a certified ergonomics assessment specialist. Goggins is a board-certified professional ergonomist and licensed massage practitioner. For more information, please visit www.saveyourhands.com.