After more than 20 years as a licensed massage therapist, Milwaukee-based Karen Keene will soon transition to working with hospice patients. She's planned this segue into semi-retirement for a while, although she kept pushing back the date after she began using her breath and body weight to create all the force necessary for deep-tissue work—while simultaneously putting less strain on her body.
“When I first started studying ways to adjust my body mechanics—so I’m not always burning out my back, wrists, thumbs and hands—I wondered if the changes would effect my deep-tissue work. I wasn’t convinced that I could achieve the same level of pressure,” Keene recalls.
In fact, just as Keene began to rely even less on brute strength and freshen up her emphasis on using body weight, she also started working with elite athletes and NFL players through a pro training facility in Waukesha, Wisconsin. Since these athletes had such large muscle definition, she assumed she’d need to revert to her “old ways.”
Not so! “Client feedback was unbelievable. These powerful athletes thought my new technique was ‘fantastic’—better than ever—and they kept booking sessions,” Keene says. “Since I felt strong, my career was going well and my clients were very happy, I never felt rushed to retire.”
A growing number of massage therapists are similarly adding body weight and breath awareness to their tool kit. And like Keene, they’re saying “so long” to musculoskeletal injuries that can diminish deep-tissue work and shorten a massage therapist’s career, including carpal tunnel syndrome; hand, thumb and wrist pain; and lumbago.
The Fundamental Premise
The essence of using body weight and breath awareness to boost self-care and maintain exemplary deep-tissue work involves blending fundamental principles from both massage techniques and Eastern practices like qi gong or tai chi—all of which encourage more relaxed and comfortable movement. At its core, developing a massage practice based on body weight and breathing awareness frees you from a reliance on more physically demanding work and the risk of injury that comes with that approach.1
The concept of body weight involves leaning into the client and organically using your body weight—rather than muscular force—to engage tissue. The massage therapist’s physical weight is irrelevant, since force is created, increased and decreased by moving your lower body.
“When you lean rather than push onto tight tissue, the massage experience is deep without being painful for the client or strenuous for the practitioner,” explains Shari Auth, DACM, LAC, LMT, creator of the Auth Method.2 “With much less effort, the practitioner’s body drops onto the first layer of tight tissue. As that first layer releases, the practitioner drops onto the next layer of tight tissue.”
David M. Lobenstine, LMT and continuing education teacher, is on the same page, although he refers to leaning as pouring.3 Lobenstine, who’s written extensively about why it is essential to “Pour Don’t Push,” says the basic concept comes down to this: “Your delicate, finely tuned arm muscles—and ever more finely tuned thumb and finger muscles—aren’t meant for five back-to back deep-tissue sessions a day. So there’s a huge rate of burnout as well as injury among massage therapists.”
Breath awareness is the ideal complement for a smarter use of body mechanics, Lobenstine says. “Fundamentally, you want to stay aware of your breathing before and during a massage session, which helps you stay in tune with your body mechanics. The combination is an incredibly potent form of self-care.”
In full agreement, Auth adds, “Slow, deep breathing relaxes the mind and body and is therefore a crucial tool for massage therapists.”
Quick Start: Body Mechanics
How you choose to incorporate breath awareness and body weight into your deep-tissue work comes with technique variations and creative license, giving the massage therapist options. With that in mind, here are the most basic techniques and tips that will help you better use your body weight and increase your breath awareness—so you can stop pushing into the client’s tight muscles and stop jeopardizing your own health.
Head-to-toe stance. When performing massage, you want to feel strong in the lower body and relaxed in the upper body. Your back is straight, core engaged and chest open.
Borrowing a principle from qi gong, Auth likens this stance to a tree with imaginary roots coming out of the soles of the feet, the legs strong like tree trunks, and the arms loose and bendable like tree branches blowing in the wind.
The Lower Body
When using your body weight to lean into the client, you generate force through your hips and legs. “You create each stroke by leaning your hips forward and pouring your body weight into the client,” Lobenstine says.
In addition, says Edward Mohr, LMT, BCTMB, “Your hip and leg muscles and joints are larger and stronger than those in your back and shoulders, so injuries are less likely.”4
Place your feet about shoulder-width apart, facing the direction that you want your body weight to go.5 “Everything starts with the feet and, when aligned, other body parts will fall into place,” Mohr says.
The goal is to lean your hips forward to create the stroke, keeping your spine in a straight line with your back power leg and that heel anchored to the floor. Do not bend at the waist or twist, and use your bent front leg to adjust your pressure. When leaning in, the front knee does not go past the toe, Lobenstine adds. “You want to lean in the direction that you think the client’s tissue wants to release.”
The Upper Body
As you begin to rely more on body weight, it’s important to note that your hands, wrists and fingers play a smaller role in the massage process.6 “Those little joints, from the fingers to wrists to elbows to shoulders, essentially remain stable, barely moving at all,” Lobenstine says. “Instead, each stroke is created by movement at the hips and knees and feet—so the upper body becomes the conduit for lower-body movement. As we lean into the client moving our lower body, we’re doing all the same strokes, but with our upper-body joints merely stabilizing, rather than straining. In this way, we dramatically cut down on wear and tear.”
The arm: Generally speaking, use the arm associated with the direction of the stroke. So if you’re stroke is going left, you would use the left arm with your left foot forward.
The forearm: When using the forearm, keep your upper-arm straight forward, aligned with your front leg. Resist using your other hand to push your forearm.
Auth recommends that massage therapists rely almost exclusively on the forearms, reserving hand work for the client’s fingers, toes, head and face.7 “The forearms are more durable than the hands, fingers or thumbs, so you can work longer with less wear and tear on your body—and that means increased career productivity and longevity,” Auth emphasizes.
Learn more by taking AMTA's Continuing Education Course: Self-Care for Massage Therapists: Body Mechanics.
Regardless of technique choice, Mohr offers the following upper-body distress signals—and suggestions to set things right.8
Arm muscle quiver. Step back and reposition your body because you’re pushing into the client rather than leaning.
Avoid overreaching. Achieve optimal compression and gliding by keeping your upper arm within 45 degrees of the body. If necessary, take a step forward in the direction of the stroke rather than stretching.
Quick Start: Breath Awareness
Burning up energy during a massage can result in unproductive breathing patterns. You may be pushing, pressing and gripping with such exertion that you find yourself out of breath, panting or holding your breath through each stroke.
To avoid this downward spiral, stay aware of how and when you inhale and exhale. Begin by breathing from your diaphragm, and pay more attention to your exhalation than your inhalation.9 “Deep, intense inhalation revs up the nervous system, while a slower, longer exhalation calms the nervous system down,” Lobenstine says.
Feel how an easy exhalation slows down the body and helps you become aware of any tension you’re holding.
When it’s time to take a breath in, imagine the spine being lengthened by that easy inhalation from sacrum to skull.10
Use your breath as a reminder to pour rather than push into the client.
Self-care Tip: Read Massage Therapy Journal's "Self-Care for Massage Therapists: Using Mindfulness" to learn more about how this practice can be incoroporated into your self-care regiman.
The Massage Therapist’s Table
In addition to increasing and decreasing pressure through your hips and legs, the massage table also gives you a way to control force. Mohr suggests ways to adjust the massage table so you can better lean your body weight into your client.11
The table should be high enough so you can lean your body weight into the client as needed and, at the same time, keep your spine in line with your straight back leg. Table height should start at approximately one-half of your overall height, or about mid-wrist. If the client is overweight, try dropping the table a little lower. Petite clients may require a slightly higher table.
After reviewing all these tips to use body weight and breath awareness to your advantage, Lobenstine is quick to add that there is no one right way to massage. “What’s essential is that you cultivate your capacity for easy, flowing movement and resist the temptation to become stagnant and locked in one position, which ends up overusing and abusing your own muscles,” he says.
Looking beyond your career, Mohr emphasizes that learning to use your body weight and breath awareness today reaps significant benefits tomorrow. “You want a career, but you also want to enjoy every minute once it’s time to retire,” he says. “You want to play golf, pick up your grandkids, enjoy life or take on a hobby! You won’t be able to do any of this if you have debilitating back or shoulder problems because you spent your entire career doing things improperly.”
Self-Care for Massage Therapists
Healthy Hands: How to Properly Take Care of Forearms, Wrists, and Hands | 2.0 CE credits
Avoiding Burnout for Massage Therapists | 2.0 CE credits
Lobenstine, David M. (2017, September 15, AMTA 2017 National Convention). Pour don’t push: How to massage with greater depth and ease.
2. Auth, Shari. “Auth Method.” Auth Method, www.authmethod.com.
3. Supra note 1.
4. Mohr, Edward. Proper body mechanics demonstration. YouTube, 24 Feb. 2014, www.youtube.com/watch?v=asP4qZ0bx4w.
6. Supra note 1.
7. Auth, Shari. The more you know | Massage Therapy Journal. American Massage Therapy Association. August 15, 2012. Accessed July 15, 2018. https://www.amtamassage.org/articles/3/MTJ/detail/2635/the-moreyou-know-7-waysmassage-therapistscan-work-smarter-not-harder.
8. Supra note 4.
9. Lobenstine, David M. (2017, September 15, AMTA 2017 National Convention). Pour don’t push: How to massage with greater depth and ease.
11. Supra note 4.