Work Smarter, Not Harder: Body Mechanics for Massage Therapists

The true value of learning and practicing good body mechanics is the years you can add to your career.

March 7, 2014

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You’ve understood the importance of good body mechanics from the time you were working your way through your massage therapy program. From helping to prevent injury to allowing you to work with your clients more effectively—the true value of learning and practicing good body mechanics is in the years you can add to your career.

Calculating the Risk

Massage therapy is a demanding profession with a wide variety of physical risk factors, including repetition, force, awkward postures and mechanical stress, to name a few. In combination, some of these risk factors become even more problematic.
 
For example, force and posture.
 
According to Mohr, required force comprises a few components: the force a massage therapist needs to generate when working on a client (for example, the pressure a massage therapist needs to use to help a client deal with low back pain); the posture and positions a massage therapist uses during a massage therapy session; and personal factors, such as prior injury or a decrease in physical capability.
 
Now, maximum voluntary contraction (MVC) is the maximum amount of force a person can generate in any given posture, and is used to calculate the percent of maximum force that a person needs to use in order to achieve a desired outcome.The higher the MVC used, the greater the risk of an injury.
 
Here’s how it works: Let’s say a therapist can generate 40 pounds of force using good posture, but only 28 pounds of force using poor posture. If a client condition requires 10 pounds of force be used, a massage therapist using good posture will need 25 percent of their MVC, while a person in bad posture needs 36 percent MVC. Here, the probability for injury or fatigue is minimal.
 
That changes fairly dramatically, however, as the client requirements for pressure increase. If the client requires 25 pounds of force for the desired outcome, good posture needs 62 percent MVC, leading to some fatigue, while poor posture needs 89 percent MVC, and can lead to fatigue and injury. Increase slightly to a client requirement of 32 pounds and a massage therapist in good posture needs 80 percent MVC, which may result in fatigue or injury, but is not even achievable in poor posture.
 
These numbers clearly illustrate how using proper body mechanics, how thinking about the postures and positions of your body during a massage therapy session, can really impact the physical toll performing massage therapy can take on you.

Common Injuries Among Massage Therapists

According to 2006 data from the U.S. Bureau of Labor Statistics shared by Mohr, more than half of injuries suffered by massage therapists were sprains/strains, and more than half of injury sources were from worker motion/position. Additionally, more than half of injuries were to the upper extremities, including the hand and wrist.
 
Cumulative trauma disorders are fairly common in the massage therapy profession, and read like a laundry list of injuries most every massage therapist has heard of—if not experienced: tenosynovitis, epicondylitis, biceps tendonitis, trigger finger, gamekeepers thumb, carpal tunnel syndrome, rotator cuff tendonitis, thoracic outlet syndrome and ganglions, to name a few.
 
Many of these conditions have a few potential causes, ranging from repeated or forceful flexion to overuse to repetitive motion, and symptoms include numbness, tingling, reduced range of motion, swelling, stiffness and weakness.
 
What’s tricky about these conditions is the sometimes gradual way they become debilitating. For many massage therapists, the start of injury may present with symptoms that only occur when they’re actually performing massage, for example, and go away with periods of rest. Then, symptoms might become more persistent, not resolving with rest, until they eventually become constant and perhaps limit or necessitate a complete break from doing massage.
 
Having this information, knowing you’re at risk for injury, is helpful. But what can you do to mitigate the risk?

How Good Body Mechanics Can Help

Influenced by the work of Sandy Fritz, Mohr, who has a background in ergonomics and massage, gave attendees several tips on what they can do to reduce the risk of injury while also increasing the level of work they’re able to do with clients.

Table height

First, when preparing for a massage therapy session, make sure you’re working at a proper table height. According to Mohr, a higher table translates to less low-back bending and a more normal wrist angle. Conversely, lower massage table heights cause the massage therapist to bend over more, moving their center of gravity forward and increasing the stress on their low back. Additionally, wrist angle in extension becomes greater and increases the stress on the intra-wrist structures, reducing grip strength.

To calculate proper table height, Mohr suggests starting with the table at half of your own height. Then, adjust slightly up if you have longer legs and slightly down if you have a longer torso.

Stance

Start with your feet, and, when they’re aligned, other body parts will fall into place. Place your feet shoulder width apart with your toes pointed forward. Try using an asymmetric stance, where one foot is forward and the other back. When massaging, face the direction of the stroke with your toes, hips, shoulders and head aligned, and remember that your back foot should remain on the floor.

Mohr suggests that massage therapists use the arm that is associated with the direction of the stroke, with the forward foot matching the arm being used. In other words: if the massage stroke is going left, use the left arm and put your left foot forward. Also, be sure to fall into (lean on) the client to generate pressure from your core instead of pushing with muscles.

Stroke

Whenever possible, Mohr explains, massage therapists should use an uphill stroke. Once your stroke is over the hill, you lose the mechanical advantage and need to push harder to maintain pressure on the client. Using bolsters is a great way to create hills you can lean into, and be sure to stack your joints, as bending your elbow requires effort in your triceps.

Remember, too, that for many strokes, including when you use your forearm, you’re going to want to keep your hand, fingers and wrist relaxed. Also, the upper arm should not be more than 45 degrees away from the body.  If you need to make a longer stroke, take a step forward and then continue the stroke, don’t reach out with the upper arm.

Force

Mohr suggests that massage therapists use their forearm, supported fingers or fist when considering ways they can generate force during a massage therapy session, steering clear of both the thumb and the elbow.

Also, think about how you can use counter pressure to increase the force you apply to your clients. For example, you can grasp your massage table and pull back or up, using the table for leverage. Or, instead of pulling with your arms or shoulder muscles, using your own body weight to pull by grasping and leaning back.

There are two things that almost never change about the massage therapy profession: how passionate massage therapists are about what they do and how physically challenging the work can be. Self-care is all about staying healthy and injury free, and learning—and using—good body mechanics is a great place to start. And, learning how your work can be just as effective without being as hard on your body will help keep you in the profession you love.

Body Mechanics Field Study

During his session on reducing injury and increasing output with proper body mechanics at the AMTA 2013 National Convention, Edward Mohr shared some interesting results of a field study he conducted that focused on testing the strength capability of 18 massage therapists.

For the study, the massage therapists applied force at three different table heights: 29 inches, 34.5 inches and 39.5 inches. Three postures were tested—standing arm push (poor posture), stacked joints without locking the back knee (good posture), and stacked joints with a locked back knee (best posture)—and data was collected with an Ergo-FET digital palm gauge.

At each height, five data points were collected: standing arm push, standing arm push with counter pressure, stacked joints without locking the knee, stacked joints with locked knee, and stacked joints with locked knee and counter pressure.

Results showed that with stacked joints, by locking the back knee, applied force increased by 20 percent.  More importantly, when compared to a standing arm push, applied force increased by 34 percent when joints are stacked and knee locked. In other words, stacking and locking joints and properly transferring body weight allows massage therapists to achieve the same amount of pressure while decreasing the amount of effort needed. (Note: for individuals with lax knee joints, do not hyperextend the knee when “locking” the knee).

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