The demand for massage therapy and other types of bodywork is at its highest, as is the opportunity for work. From employment in a spa, athletics facility, chiropractic office, or hospital, to independent practice, newly licensed therapists have more career choices than ever before. To maintain this momentum, we must find a way to ensure that work-related injuries do not slow us down. At the present time, they are sadly on the rise, and the rate of attrition from the profession is growing. However, I am convinced that we can turn this trend around and become stronger than ever before.

In this article you will learn why the answer to healthful body mechanics and injury prevention can be found in developing awareness. As you become aware of your body and its habits of movement, you will start to sense the difference between ease and effort. Then you can begin to discover which habits serve you and which ones hinder you and cause you discomfort. This heightened body awareness leads to an awareness of choice. When you recognize that you have choices, you have the opportunity to embrace change. Choosing change allows you to problem solve and to develop a wide range of body mechanics that will contribute to a sound and effective self-care strategy and longevity of practice.

Body Awareness

Body awareness requires you to become mindful of your body’s movements, responses, and sensations. While developing this mindfulness, you become more aware of subtle movement patterns, such as the posture of your head when working or the shifting of weight when standing. Increasing body awareness requires you to become more self-observant, not only when performing manual therapy, but also during everyday life.

Try a short self-observation exercise now: Freeze your current reading position, but be sure to continue to breathe. Notice the position of your head. Is it lilted to one side? Is it hanging forward? Is it comfortable?

Notice the position of your shoulders. Are you holding them up? Do the muscles of your neck feel at ease, or are they a bit tense?

Notice the position of your arms. Are they comfortable? Are your holding one or both elbows out to the side?

Notice how you are using your hands. Are they relaxed?

Notice how you are using your fingers and thumbs. Are they being held in a tense or relaxed manner?

Notice the position of your legs and feet. Are your legs crossed? Are your feet in contact with the ground?

Finally, notice how you are breathing. Are you breathing deeply or shallowly? Are you breathing from your chest, from your abdomen, or do both seem involved? Does your current reading position allow you to breathe freely?

Now stop holding your reading position and move around.

When you apply body awareness as a massage therapist, you discover the most effective yet effortless way of working. Whether applying deep tissue, lifting and moving a limb, or manipulating energy, your body’s movement (mechanics) is guided by your inner sense of awareness. Body awareness also enables you to become self-reliant in troubleshooting situations of discomfort or pain. When working alone in a practice or clinic, nothing is more valuable then the ability to problem-solve body mechanic issues, (i.e., wrist pain and back discomfort). Armed with body awareness and, in turn, self-reliance, you can rest assured that your body mechanics are in good hands—yours.

Postural Habits

What comes to mind when you think about your postural habits? Is it the way you stand or walk? Is it the way you gesture when talking? We learn and form habits from the beginning of life, and continue the process until we die. Some even say that the process of learning habits begins before birth. In Habits: Their Making and Unmaking (Liveright Publishing Corporation, 1949), psychologist Knight Dunlap writes, “The process of learning is the formation of a habit,” which he defines further as “a way of living that has been learned.” As we mature, we begin to recognize that some of our habits serve us well, whereas others do not. “Bad habits” are harmful, either to our health, to others, or to the pursuit of our goals, whereas “good habits” promote our health and well-being, help us achieve our goals, and/or contribute to the well-being of others.

As a massage therapist, you are likely to transfer many of your everyday postural habits into your working environment. For example, think about the posture you use when sitting at your computer. Do you tend to sit with proper alignment, or do you sit with a forward bent posture? Now think about how you sit when working with a client. Do you transfer your computer posture to your massage stool? Becoming aware of your everyday postural habits is a first step toward understanding how you integrate them into your body mechanics during massage therapy. With postural awareness, you can sense which of your postural habits serve you and which ones can contribute to work-related discomfort, pain, or injury.

Musculoskeletal Awareness

Take a moment and think about the last time you gave a massage. How did your body feel during the session? Did you experience moments of discomfort or pain, for example, in your back or hands? Or were you able to perform the entire massage without discomfort? When you become more aware of your postural habits, you begin to discover which feel comfortable and easy and which cause you discomfort and increase your risk for chronic pain or injury. To understand how you can work competently, without effort or pain, you need to become aware of how your musculoskeletal system can work for you, not against you.

The skeleton, specifically its joints, can most easily maintain the body’s balance and strength when it is in proper alignment. The skeleton’s bones and joints are in proper relative position so that its symmetric design supports the body to endure the force of gravity. When the skeleton is properly aligned, with all of its bones stacked one on top of the next, it can endure not only the powerful force of gravity, but up to 2,000 pounds of atmospheric pressure (image 1).

In contrast, when the skeleton deviates from vertical alignment, balance is severely compromised. For example, if you stand with a “slumped” posture, moving away from vertical alignment, effort in the neck and back increases to offset the force of gravity (image 2). In this case, you are working against gravity instead of with it.

This lack of musculoskeletal efficiency is often seen in the body mechanics of massage therapists, for example, when standing too far away to apply direct pressure or when attempting to lift a client’s limb or head. In image 3, we see that the therapist must lift by bending forward using her neck and back, thus compromising alignment. If she were to use this strategy consistently, she could develop chronic pain.

Proper alignment allows your muscles to perform efficiency by evenly distributing the work of the postural muscles symmetrically and reducing the amount of work that they must do to maintain balance. This gives you the freedom to perform your massage with ease and comfort (image 4).

 On the other hand, if you worked asymmetrically—that is, with a shoulder held up, or a hip projected out—your muscles would be too occupied with maintaining your balance to perform massage efficiently. As you can see in image 5, the therapist is using an enormous amount of effort, specifically muscular contraction, not only to maintain balance but also to perform the task. Although such deviations in alignment will probably not lead to pain or injury if they occur once in a while, frequent use of this kind of improper alignment will lead to muscle tension, pain, and injury.

The bottom line is this: the reason why some body mechanics feel easy and some difficult depends on how you use yourself, specifically your musculoskeletal system, in gravity. Awareness of musculoskeletal efficiency and how to put it to good use empowers you to work smarter, not harder.

Awareness of Choice

As you have learned, identifying your movement and postural habits and sensing the difference between ease and effort leads to increased musculoskeletal awareness. This, in turn, leads to an increased awareness of choice. Having a choice, no matter the situation, gives you a sense of freedom and ultimately improves your quality of life. Moshe Feldenkrais, founder of the Feldenkrais Method, believed that your advantage as a human being is your ability to perform the same act in at least three different ways.  Can you, right now, find three different ways of holding this magazine?

Relative to your body mechanics, awareness of choice allows you to develop a wide range of easy and dynamic alternatives for any given movement or posture. You do not have to rely on just one way of working; instead, you can explore several options, choosing those that feel easiest for you. There’s just one catch: you must be willing to consider the idea of change.

Becoming aware of the choices you have and acting on them requires you to move from the familiar and step toward something new. Changing how we do things isn’t always easy; for some it’s down right scary. Nonetheless, embracing change allows you not only to become aware of your choices, but it gives you the freedom to act on them.

Choosing Change

As mentioned, work-related injuries are on the rise. A key to avoiding such disorders is applying the specific levels of awareness discussed so far. However, at times this is not enough. When you are in a situation where your body is feeling uncomfortable, you need to be able to problem-solve the issue immediately. Let’s look at how this can be done.

First, it is important to realize that the main reason massage therapists experience work-related injury is overuse, which can result from many things. From limiting yourself to one or two parts of the hand for performing all techniques, to the way you position yourself when working, without awareness, overuse can creep up on you anytime. If you use the same approach—that is, the same positions, techniques, and sequences—over and over again, you also use your hands habitually. The sad truth is, many therapists go through the same routine, time after time, despite the fact that they are in pain during the process.

Second, changing the way you are working—that is, a position, part of the hand, and/or technique—is the best strategy for solving uncomfortable body mechanics during a treatment. In other words, you must stay constantly aware of all your options. As discussed, an awareness of choice allows you to develop a wide range of comfortable and effective alternatives for any given situation. When your treatment plan is flowing and your body feels comfortable and pain-free, well done. But in the case where something doesn’t feel right for your body—for example, your back starts to ache or your hands start to hurt—that is the time to start thinking on your feet. 

Finally, massage therapy is an organic and dynamic process in which you and your client work closely together to create the best possible outcome. Thinking about your process this way might help you to realize that there are many different ways to work with a client. If a certain technique is causing your body discomfort or pain, chances are it is not the best choice for your client either. Open your mind to a wide range of possible solutions, remembering that if you are working comfortably and pain-free, your body and ultimately your career will remain healthy.

The following options are always available to you. Use one or more of them during a session whenever you feel discomfort arise or when something creative is called for.

Change Your Position

If working in a certain position doesn’t feel comfortable to you, change your position. For example, a lengthening stroke from the head of the table might cause you to stretch too far out, causing tension in your shoulders or back. In this case, an option is to change your position to the side of the table. From this position, you might find it most comfortable to work with one side of the back at a time.

Change Your Client’s Position

Many therapists get into the habit of using only the prone and supine positions, no matter what. Expanding your options for client positioning will greatly improve your comfort level when working. For example, if you find that your table is too low and you do not have an electric lift table, instead of working with the discomfort in your lower back, turn your client onto his or her side. This brings the body to you, making it much more comfortable for you to work. Thinking about your work from an ergonomic standpoint can help in this kind of situation. Ask yourself: how can I bring my work to me, rather than conforming myself to the work?

Change Your Tool

If you are using a certain part of your hand and it starts to feel uncomfortable, change to a different part. For example, discomfort commonly arises when the fingers and thumbs are used for applying deep pressure. If this happens to you, immediately change to your knuckles, fist, or elbow. If you lack confidence, you might be tempted to work with the pain, rather than changing to another option. Don’t let yourself fall into this pattern. Anytime you feel uncomfortable, no matter the level, find a way to change your working tool. This will serve not only you, but also your client.

Change Your Technique

Changing your position, or your client’s, and changing your tool all sound reasonable to you, right? However, changing to a different technique is an option that many therapists never consider, perhaps because it would make them feel that they are not a good therapist. The truth is, if you have tried all of the above options, and you still feel uncomfortable in your body, changing your technique is the next logical step to take. For example, if you are feeling uncomfortable while applying deep pressure with your hands to release a muscle, you could try using your forearm, elbow, or a hand-held tool. You could also switch from one kind of stroke to another to facilitate the same outcome, or you could try a different modality. Basically, you need to use your knowledge and creativity to find the best solution.

Finally, one last but important point: When your lower body (feet, legs, and pelvis) is moving to support your work, and your upper body (rib cage, shoulders, head, and arms) is moving to facilitate it, your entire body moves in synchrony, becoming your greatest tool. Using your entire body to support and facilitate the movements of your hands reduces the effort in your back, neck, shoulders, arms, wrist joints, and hands; in other words, you prevent overuse. You also dramatically increase your quality of touch and your effectiveness.

Think about the last time you heard a live performance by an excellent musician (for me, the cellist Yo-Yo Ma comes to mind). Can you remember the quality of his or her movements and music? When the entire body is involved in the playing of an instrument, the sounds created are exceptional. The musician’s instrument and body work in synchrony, making the body’s movements seemingly effortless. With this in mind, think about how you use your hands during a treatment session. When your entire body moves in synchrony with your hands, your hands work effortlessly, and your quality of touch is exceptional.

Empowered and Self-Reliant

There is no quick fix that will give you pain-free and perfect body mechanics overnight, as developing healthful movement is an ongoing process. However, now that you’ve read this article, you can feel more empowered and self-reliant in understanding and problem-solving your body mechanics. But don’t let the learning stop here. Make a commitment to yourself to continue this exploration of awareness, and remain open to the unlimited choices that are always available to you. This will certainly enrich not only your massage practice, but everyday life as well.

 Barbara Frye has been a massage educator and therapist in private practice since 1990, served on the faculty of Ashmead College, coordinated IBM’s wellness program, and authored Body Mechanics for Manual Therapists (Lippincott Williams & Wilkins, 2004), soon to be released in its third edition. She teaches the Feldenkrais Method at Pluspunkt Center near Zurich, Switzerland. Contact her at barbfrye@hotmail.com.