Pain happens, but chronic, long-term injury doesn’t have to. Lauriann Greene, who coauthored Save Your Hands! The Complete Guide to Injury Prevention and Ergonomics for Manual Therapists with Richard W. Goggins, learned the hard way in 1993, when she was finishing up at the Seattle Massage School and doing her externship at a physical therapy clinic.
Greene, a former professional pianist and orchestral conductor who had, ironically, written her graduating research paper on repetitive stress injuries among musicians, began to feel pain in her wrist and hand. "It was likely the beginnings of wrist tendonitis," she says now. "I continued to work anyway," she adds.
Although she finished school, the pain proved debilitating. "When I got out, I could not practice because it brought back symptoms," she remembers. It took her three years of physical therapy, occupational therapy and plain old resting before she didn’t have pain every day. Today, the symptoms still flare up when she types too much or practices massage.
So instead she researches, teaches and writes about injury prevention. And one thing she’s learned: Most therapists will get symptoms in the course of their careers. It’s how you listen to them—or not—that makes the difference.
According to the 2006 survey "Musculoskeletal Symptoms and Injuries Among Experienced Massage and Bodywork Professionals," conducted by Greene and Goggins, 77 percent of practitioners reported some form of pain or discomfort from their work during the previous two years. Sixty-four percent had sought medical treatment for symptoms, and 41 percent were diagnosed with an injury. Ongoing symptoms were present in 67 percent of the participants.
This pain showed up primarily in the back, neck, shoulder, elbow, hands, wrists and thumbs, with ailments such as tendonitis or tendonosis, osteoarthritis, shoulder bursitis and tension neck syndrome, among many others. "Nearly everyone has symptoms because [massage therapy] is physically demanding," says Greene. "It’s not so much about working while you’re injured. Rather, if injury happens, how do you deal with your work?"
Your first line of defense is to take care of yourself. Life offers its own physical challenges on top of ones you’ll find at work, and so your overall health affects how your symptoms will play out.
Massage therapists need to pace themselves by not overscheduling their days, and eat anti-inflammatory foods such as flaxseed, leafy greens, blueberries and turmeric. Getting enough sleep and finding time to relax are also important.
Taking care of yourself extends beyond the hours you spend at work, too. You need to protect your hands and joints while doing everyday tasks, from lifting children to opening jars to gardening. "Your body doesn’t care where you are exposed to risk factors," says Greene. "It’s a cumulative effect."
For example, avoid heavy lifting using only one hand, use carts instead of carrying heavy bags and use furniture glides to move furniture. You should also push instead of pull, use lumbar support while driving and avoid cradling the phone between your shoulder and ear.
Additionally, don’t forget to get your own bodywork, which is vital to injury prevention. Suzanne Scurlock-Durana, certified massage therapist and author of Full-Body Presence, likens the bodyworker’s life to one of a racehorse, not a workhorse. "We need to take care of ourselves like racehorses, feed ourselves well and get massaged," she says. "Our bodies are our instruments."
Injury prevention is also helped by taking care of your personal and professional environment. Take a look at your table, computer, phone and appointment book, for example, and assess whether they are ergonomically friendly.
"[Good] body mechanics in and of itself does not prevent injury, which is often a complex subject with complex causes," says Greene. "It’s very rare that there is one single cause. The types of injuries that massage therapists encounter are usually cumulative, with a number of different risk factors and risk factor exposures contributing."
Along with your physical office space, you need to pay attention to your emotional well-being. For example, says Greene, your beliefs and attitudes can affect your health, including difficulty setting limits with clients and having unrealistic expectations of yourself. In her book Positive Energy: Ten Extraordinary Prescriptions for Transforming Fatigue, Judith Orloff, MD, talks of "empaths," or people who pick up on the energy, feelings and even symptoms of others. "A lot of massage therapists have this," she says. "They are like energetic sponges, and they get exhausted by it."
Orloff learned this lesson as a practicing psychiatrist. "Even though I was teaching this to others," she says, "I wasn’t honoring my own energy. I went through an energy crash." She had to get back to basics, which for her was meditating, getting into nature and taking time for play. "It’s much easier to help other people than it is to help yourself."
TessaGrace Ahuna, a certified trauma therapist in Colorado Springs, Colorado, agrees. "It’s important for me to be centered and grounded, so I can hold the space," she says. "But I don’t take on what the client is releasing."
In addition to her daily rituals of prayer and meditation, Ahuna also performs a centering ritual outside her therapy room before each client, as well as an invocation with each client, where she asks for guidance for whatever needs to be addressed.
By protecting your own space, you allow yourself to hear what your body is telling you, and listening to your body, says Greene, is essential for a long, healthy career. "Self awareness is a big part of preventing injury," she explains. "It’s knowing your body and being aware of signals your body is sending you."
So start taking note: Do you have a twinge every time you do a particular technique? Do you know the difference between simple muscle soreness and a more serious pain? "Just getting involved in this process is extremely preventive," says Greene.
Open Your Ears, Take Action
Scurlock-Durana says she had a career-changing moment when she listened to symptoms—cysts on her wrists—that arose soon after she graduated from massage school. At that time, she mostly practiced deep tissue work. "I sat down and had a conversation with this little lumpy sore place on my wrist," she says. "It told me I needed to stop doing deep tissue work."
This gave Scurlock-Durana pause. "I wasn’t coming out of sessions feeling juiced and energized," she says. In fact, quite the opposite. She realized her practice was exhausting her. "Step by step, I changed those clients," she adds. "I recognized that my body was sending me signals."
Listening to your body can pay off in spades, agrees Orloff. "Get very quiet. Ask yourself where the symptom is and what it means," she encourages. "You can always pose a question like, ‘How do I heal this symptom?’ Be receptive to the response, write it down and act on it."
The biggest misperception Greene sees with massage therapists and symptoms is that you can somehow work through any injury or pain. "We tend to get this idea as massage therapists that it’s normal to have some amount of aches and pain from doing massage, and that if you just work through it, it will go away," she says.
However, if you don’t pay attention, that’s exactly where the seeds of later injury are typically planted. If we don’t figure out what’s going on, we often keep re-injuring ourselves.
Some may not seek help because they don’t understand what’s happening. So if you have baffling symptoms, invite a friend, colleague or former teacher to watch you work. They might be able to give you insight into your symptoms and what may be causing them.
When you can’t figure out what’s causing the pain or how to make it go away, seek medical help from a provider you trust. "The operative thing is timing," says Greene. "The longer you wait to do something, the more likely it will be that you will have to take time off or it will interfere with your work."
According to the survey done by Greene and Goggins, massage therapists tend to seek care from other massage therapists. "That’s fine," says Greene, "but it needs to be part of a treatment plan where you know what you have."
Healing may take active treatment, and some amount of rest and recovery. Tell yourself it’s OK to take a break. "The greatest healers that I know—and those I trust—are those who deal with their own issues as they come up," says Orloff. "It’s nothing to be ashamed of. It [actually] makes you a better healer."
Ahuna agrees, and walks her talk. She recently took a week off after hurting her thumb while massaging athletes in Colorado Springs’ Olympic Village. She rested, slept and healed. "It’s very important to me to listen to what my body is telling me."
You’ll be in a better place to listen to your body if you plan ahead. Good health insurance may pay for treatment, including bodywork, physical therapy or other forms of help. A good savings plan can be a lifesaver for salary replacement during time off. Disability and workers’ compensation could help as well.
Remember you are taking care of your business when you take care of yourself. "Clients do come back," says Greene. "People don’t come to you because of any one technique you do—but because you’re you, a whole package of who you are."
Even if you can’t take a complete break, you can still learn how to work effectively—and safely—with low-level symptoms. When Ahuna can’t take a complete rest, she’ll do self-massage, seek bodywork from others, or simply make time to sink into a hot bath with essential oils at the end of a long, achy day.
Try modifying your technique when working, using your elbow or knuckle instead of your pained thumb, for example. You might also incorporate lighter techniques into your practice for the days when you have flare-ups. During those times, build in more time between sessions so you can stretch and relax, or ice your injury.
And here’s another reason for continuing education: You can tuck different, less physically demanding modalities into your toolbox, such as lymphatic drainage, craniosacral work or energy work for when your body needs a break. "There are so many forms of bodywork that you can do that are less physical, especially if you work for yourself," says Greene.
Think of symptoms as your friends, telling you to pay attention. "With early and effective treatment, most symptoms subside and go away," says Greene. But you may need to adjust to a new normal, since any time you get an injury or symptom, you can assume there is at least one thing you’ll be changing.
However, it’s all training for life. "Life is about change and adapting to circumstances," says Greene. "It’s not always easy, but very possible." This attitude will help you if you ever come to the point where giving up your practice is a real possibility. "I had to stop working as a practicing massage therapist," says Greene. "I went into research, writing and teaching, and I have had a lot of success. I want to defuse the idea that there is not life after massage therapy. There are many ways to stay in the profession."
Whatever happens, the key words echoed by each expert are: Be good to yourself. "Massage therapists are my heroes," says Orloff. "Be aware of the healing, sacred work that you are doing."
Getting Better Without Going Broke
How do you best protect yourself from disability? Drew Tignanelli, a certified financial planner in Lutherville, Maryland, has some tips on how you can keep your practice going—even when you can’t.
Keep track of your expenses. What does this have to do with disability planning? "Most people don’t know where they spent their money last year/month/week," he says. "if you have that record and you do become disabled, you can quickly assess where you have been in the past and quickly put a new budget in place for your new income environment."
Also, watch your cash flow. "if we had to account for every nickel we spent, Starbucks wouldn’t exist," he says. Nothing wrong with your java habit; just be aware that $15 a week can add up to $1000 a year.
Have emergency savings. "The general rule of thumb is to always have six months cash available that you can draw on," says Tignanelli. Why six months? "Most disabilities don’t last more than six months," he says.
Have good insurance. Try to get a good health insurance plan that will help cover your treatment expenses, if you should need them.
Next, if you are employed by someone else, check to see if you are eligible for workers’ compensation insurance, which typically pays for your medical bills and partial lost wages. in order to collect, you will have to prove the injury is specifically work-related—so make sure you see a health provider who can do that for you.
Do a risk analysis for disability insurance. "You need to analyze your risk. What would happen to your overall finances if you can’t make the money you’re making?" says Tignanelli. "What would you do if you had a disability? this is what we call risk management. You don’t automatically buy the insurance, but you analyze the situation."
Keep an optimistic outlook. "The best advice i can give comes from a more esoteric point of view: there’s always a silver lining, even in the most difficult circumstances in our lives," he says.
If you get injured, what’s the hidden perk? different work? A more selfcaring lifestyle? More compassion for others? "People have proven since the beginning of time that even the most difficult situation can turn into an incredible blessing in our lives."