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To Shrug or Not to Shrug
By Joseph E. Muscolino, DC

Bonus material from Work Smarter, Not Harder: Body Mechanics for Massage Therapists, mtjs winter 2006 CE course. To take the exam, visit www.amtaonlinetraining.org.

It seems universally understood that when doing massage therapy it is bad body mechanics to work with our shoulders up at our ears. In other words, elevated scapulae at the scapulocostal joints, or what could be called shrugged shoulders are bad.

I must admit that I accepted this sacred cow of body mechanics for many years. After all, we always tell our clients that they should relax and let their shoulders drop. And who doesnt have tight muscles of scapular elevation (upper trapezius and levator scapulae), most likely due to our stress patterns of holding our shoulders up in the uptight posture? Therefore, it seems perfectly reasonable that when we see massage therapy students or practicing therapists with their shoulders up at their ears while working on their clients we instinctively tell them to relax and let their shoulders down.

But recently, I started noticing that my shoulders were often up high when working on clients. This puzzled me because I felt relaxed while doing these massages, and I pride myself on having good body mechanics. Yet, I told myself that shrugged shoulders could not be right, so I dropped them and continued with the massage. However, I often found myself in the posture again.

It was when I was demonstrating proper body posture/mechanics while teaching a deep tissue workshop that a particularly astute participant pinned me down with the question Is working with elevated shoulders always bad? I was a bit shocked to hear myself answer no. It was the first time I ever said that out loud. It seemed heretical. What I realized at that moment is that working with shrugged shoulders is not necessarily right or wrong. It depends on why our shoulders are up there.

Most of the time, it is likely that our shoulders are shrugged because our table is set too high (see Guideline No.1 in the winter 2006 issue of mtj or at www.amtaonlinetraining.org ). In that case we are trying in vain to get over our client. In this scenario, we actively contract our scapular elevators to raise our shoulders. Staying like this for more than a moment or two will certainly lead to tight and painful muscles. In this circumstance, working with shrugged shoulders is definitely bad.

However, when the table is set low and we are directly over the client, if we simply lean into the client and relax our scapular muscles, then our shoulders will naturally be pushed up toward our ears. As a law of physics states: For every action, there is an equal and opposite reaction. If we are pressing down on our client, our client is pressing back up on us, pushing our shoulders up. In this scenario, if we do not want our shoulders to rise in the air then we would actually have to exert muscular effort to hold them down. In a case like this, shrugged shoulders would actually be the more relaxed and less effortful posture to assume, and good body mechanics.

The one drawback that might exist to allowing the shoulders to passively rise is that the shoulder girdle will be slightly less rigid. This would result in a loss of a small amount of pressure and control when transmitting force from the core through the shoulder girdle to the client. However, I believe this loss is negligible and, depending upon the circumstance, may be outweighed by the benefit of having relaxed musculature. Further, having a relaxed shoulder girdle creates a more fluid base from which to work, decreasing the possibility that the client may sense rigidity in our technique.

When working on your clients, examine your own shoulder posture (having a mirror in the massage room is an excellent way to monitor your posture). If your shoulders are up high, feel whether you are actively working to keep them up there or whether you are relaxed. If you are working hard to hold them up there, then I recommend that you lower your table and relax your shoulders. However, if they are comfortably relaxed up there, then maybe there is nothing wrong with letting them be there!