You have to cover a lot of territory during a full-body massage session, which forces you to move and change body positions. In many ways, delivering that full-body massage can be easier on your body than doing detailed work. Recently, I discovered another benefit when I’m doing a full-body massage: I can work on my posture.

I Did It My Way (For a While …)
Remember the famous Frank Sinatra song “My Way”? Well, that’s how I did massage for the first 15 years of my career. I used my upper body to generate pressure, and I did a lot of forearm work even though my shoulder was iffy. Eventually, however, doing it my way caught up with me.
My massage injuries accrued (cubital tunnel syndrome, cervical radiculopathy) and suddenly I was forced to figure out different ways to get the job done. It took me some time, but eventually I devised strategies and adopted techniques that didn’t trigger my conditions.
At one point, I realized that most everything I was doing in the massage room to take care of my body had a common element: a neutral (not flexed, extended, or rotated) back.

Why a Neutral Back?
When I think of the importance of a neutral back, I think of my client Doug who hurt his lower back while brushing his teeth. Doug was leaning over the sink with his back slightly arched, and that’s when his lower back locked.
Doug’s story is not uncommon. In fact, over the past 25 years, I’ve heard many stories from back-pain clients who have tweaked their backs doing simple, everyday actions, like turning in the shower to reach for the soap.
I’ve found the same to be true when doing massage. I discovered there was a strong association between my back pain and the position my back was in at the time of the pain. When I could find the neutral position for my back, the pain often went away.  
Though the root cause of back pain can be complex, can vary from person to person, and sometimes is never known, it’s reasonable to speculate that a trigger for a back-pain episode could occur when back neutrality is compromised.
The questions then become: How can I establish back neutrality? How can I maintain back neutrality throughout the massage?

The Massage Table Factor
The foundation for keeping back neutrality and maintaining good posture when doing a massage hinges on the relationship of your legs to the massage table.
If you can lean into the table with one or both legs, the table will help support your body weight and you’ll be in a perfect position to establish and maintain a neutral back.  
Picture my client Doug brushing his teeth when he injured his back. His legs are straight and his lower back is rounded as he bends over at the sink. (This is the same flexed lower-back position I want to avoid when I’m doing a massage.)
Now, imagine Doug brushing his teeth with his legs apart, knees bent, the front of his thighs leaning into the vanity, and his back neutral, not flexed.
In this scenario, Doug is using the vanity as a support to help him stay upright. Instead of flexing his lumbar spine, he has shifted his weight to the balls of his feet, causing his hips and back to move forward. That means he doesn’t need to flex his back to be over the sink because he has moved his whole body closer to the sink. From this supported position, it’s easy to maintain a neutral back.
The same is true when I’m at my massage table: the more I can use the massage table to support my weight by leaning a thigh or both thighs into it, the easier it will be for me to maintain a neutral back.
Now, let’s look at four ways to practice good posture while doing a massage.

1. Low-in-the-Saddle
I’ve lowered my table height over the years to be able to transfer my body weight into the client, rather than relying on my upper body to generate pressure. However, while a low table can be the perfect height for one area, it might be too low for other areas. There’s an easy solution for a table that’s too low in one area—bend from your legs, not from your back.
When I’m working on a low-lying area, my legs are bent and my feet are roughly parallel to each other. I call this stance “Low-in-the-Saddle.” (“High-in-the-Saddle” is when my knees are locked.)
The Low-in-the-Saddle stance is a great time to reset your back to a neutral position because your weight is evenly distributed between your feet, and, when you sink into your stance, it’s easy to maintain a neutral-back posture.
In the image on page 78 (far left), I’m working the cervical erectors with double thumbs. My pressure is coming from my lean into the client’s cervical erectors. When I lean, my weight shifts to the balls of my feet, and one or both legs lean into the table. The combination of being in a balanced stance and leaning into the table/client allows me to be in a well-supported position. In this well-supported position, it’s easy to reset and maintain a neutral back.

2. Breathe In and Lift
When I get tired, I have a tendency to slouch. Though the flexion may only be slight, over long periods of time it’s taxing to the back joints/muscles and may cause or exacerbate a back condition.
To take my lower back out of flexion during the course of a massage, I breathe in while lifting my rib cage up. Next, I exhale while relaxing my stomach and lower back.

3. Back Stretch When Working the Occiput
A new client, Juan, wanted deep pressure in his occiput. He was a big person and my thumbs weren’t cutting it. I was in the early stages of experimenting with leaning and had my table low. I decided to lean into his occiput with my knuckles.
It worked! My thumbs thanked me, and I could actually generate deeper pressure with my knuckles.
With many deep-pressure techniques, I have two hands on the client, but with this move I couldn’t. What was I going to do with the other hand? Hmm … I got it! Stretch.
OK, so I know this looks a little over the top. But here’s the thing: it feels good to reach up with my nonworking arm. It’s a reminder to stand tall, and it also puts me in a slight back extension stretch.

4. Seated Posture
Sitting during a massage provides you with the opportunity to reset your back to neutral and take some strain out of your back muscles. When performing foot, head, and neck work, it’s a great time to take a seat.
The key to establishing a neutral back when sitting is to bend at your waist without flattening out the lumbar curve. Resting your forearms on the table or on your legs provides extra support for your upper torso and will make it easy to maintain a neutral back.

Leaning to Improve Posture
Leaning is an important skill not only for delivering deep pressure, but also for establishing and maintaining good posture (a neutral back). The key to leaning for good posture involves leaning into the client and/or the table.
In general, for lighter pressure, you’ll direct your weight into the table more so than the client. For deeper pressure, you’ll direct your weight into the client more so than the table.
To set a neutral back when doing deep pressure, I picture myself doing a plank while keeping my back neutral (Image A).
For lighter pressure, I picture myself riding a horse (Image B). I shift my weight to the front of my feet (the stirrups). The more I can let the table support my weight, the easier it will be for me to maintain a neutral back.

Advanced Posture
Once I realized how I could work on my posture while doing a full-body massage, I went all in. Not only did I want to deliver pressure more effectively and efficiently than before while maintaining good posture, I also wanted to challenge my body to break bad postural habits.
The back-stretch-when-working-the-occiput move was an example of this. When a client required even more pressure in the occiput, I took it to the next level.
First, I switched my leg position so that my forward leg was the same side as the hand pressing into the occiput. Then, I leaned back into the table and into the client’s occiput. This allowed me to effectively direct my body weight into the occiput. I could regulate my pressure by shifting my weight between the front foot and back foot.
Once I felt comfortable in this position, I reached up with my other hand. In this position, my back was in minor extension, which felt wonderful, since we’re always fighting against hunching our backs during massage. The image below shows what it looks like.
I want to emphasize that I’m not doing a massage-yoga session. If the moment arises during a massage where I can effectively do my work and challenge poor postural habits at the same time, I do. But if what I’m doing is a distraction to the actual massage, I stop doing it.

Massage Posture Recap
Twenty-five years ago, if you had said I’d be working on my posture while doing massage, I would have laughed out loud. For one, I thought I was indestructible, and two, I thought massage was all about the client.
What I didn’t know was that the massage was also about me. If I’m hurt, I can’t do massage. And if I’m in pain, I don’t want to do massage.
When I was forced to face the bad habits that were contributing to my potential massage-career demise, I discovered I could save my body by minding my massage posture. In addition, the more my massage posture improved, the easier it was for me to do my work.
Here are four quick ways you can work on your posture during a massage:
1. Step into a Low-in-the-Saddle stance, lean into the table/client, and reset your back to neutral.
2. When you feel your posture slipping, breathe in, lift your rib cage up, and on the exhalation, allow your stomach and back to relax.
3. While leaning into the occiput with your knuckles, raise the other hand up and stretch.
4. Take a seat if your back is bothering you. While seated, lean from the waist and support your torso by resting your forearms on your legs or the table.
If you take care of yourself, you can take care of your clients for a long time.

Mark Liskey is a massage therapist of 24 years, teacher (www.themassageinstitute.net), and business owner (www.pressureperfectmassage.com). His blog at www.makethemostofmassage.com provides massage therapists with the extra knowledge and specific tools they need to succeed in massage.