Massage therapists have an advantage over many other professions in that we can use our understanding of kinesiology to improve our body mechanics and prevent injury.
Massage movements usually occur as closed kinetic chains, sequencing between the pressure of our hands on the client and the pressure of our feet on the floor. Pressure is often applied with pushing and pulling actions. To push and pull safely and effectively while giving massage, it helps to understand the biomechanics of each action.
• Push places compression stresses on the body.
• Pull places tensional stresses on the body.   
Push is a closed-chain action that loads the joints into axial compression, which engages weight-bearing muscles—the single-joint or small-area muscles close to the core. The weight-bearing muscles work in weak, yet sustained, isometric contractions that stabilize joints in a neutral position, independent of the multi-joint muscles that produce movement.1 Pull is also a closed-chain action, although it moves in the opposite direction of a push and is more work because it requires grasp, which engages more muscles.
Leverage, Whole Body Weight, and Neutral Joint Position
An efficient way to exert force in massage is by leaning into your hands, then pushing with your feet. Leaning with your whole body uses body weight to minimize effort while maximizing force. Leaning from the ankles maximizes leverage because it engages the whole body as a lever arm, and the longer the lever arm, the more efficient the leverage (Image 1).
By studying early motor development, we learn that all movement patterns are some combination of four basic actions: yield, push, reach, and pull. Yield precedes push by relaxing the body and then modulating the gradual pressure exerted in a subsequent push. A push is more effective when body weight is first yielded into the hands.
Applying pressure slowly allows a gradual compression of weight-bearing joints, giving you time to adjust into a neutral alignment. It also gives you more control and activates light contractions in core muscles, while leaving the multi-joint muscles free for movement.
To avoid injury while pushing and pulling, it is critical to maintain neutral joint position, particularly in the spine. This allows compressive or tensile forces to travel through the center of the joints, which dissipates stress in any one vertebral segment. If the spine is bent or the hips or shoulders twisted or hiked during force applications, mechanical stresses will pool in poorly aligned segments, making those areas susceptible to injury (Image 2).
pathways of force
Another key element of efficient force application is to push or pull along a pathway that travels through the core of the whole body. A “line of force” is the pathway along which compressive force passes from one joint to the next along a kinetic chain. Ideally, the force of a push is channeled through the bones, which are well adapted for compressive loading. A “line of tension” is the pathway along which tensional (stretching) forces pass through the body. Ideally, the tensional stresses of a pull pass through the core of the body to avoid overstretching tissues at a break in the kinetic chain.
For every force there is a counterforce. In the field of gravity, a downward push is countered by an upward ground reaction force (GRF), which provides resistance of an equal magnitude in the opposite direction. For example, when walking, the ground reaction force from pushing off with the back foot provides a counterforce that propels the body forward. 
To utilize GRF in massage, increase pressure into your hands by pushing down and back with your back foot using the same amount of pressure. When applying traction, push down and forward with your front foot while leaning back to stretch the client. Stagger your feet in the direction of force to create a rocker-like base of support for shifting your body weight.   
Keep in mind that these concepts apply to all pushing and pulling activities, so you can use them to move more efficiently and protect your back throughout the day.
Note
 1. C. Richardson, P. Hodges, and J. Hides, Therapeutic Exercise for Lumbopelvic Stabilization: A Motor Control Approach for the Treatment
and Prevention of Low Back Pain, 2nd ed. (Edinburgh: Churchill
Livingstone, 2004).

Mary Ann Foster is the author of Therapeutic Kinesiology: Musculoskeletal Systems, Palpation, and Body Mechanics (Pearson Publishing, 2013). She can be contacted at mafoster@somatic-patterning.com.

Exploring Technique
Push and Pull in Force Application

1. To push, face in the direction of your stroke, align your spine in a neutral position by lightly contracting core muscles, then lean into your hands. Press your back foot into the floor to increase pressure (Image A).

2. To pull, sit back like a water skier with your spine straight, elbows straight but unlocked, and shoulder girdle anchored on the back by contracting the lower trapezius and latissimus dorsi. Press down and forward with your front foot to increase the degree of stretch (Image B).
Explore alternating pushing with pulling strokes to counterbalance compressive and tensional forces.

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