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Massage Warehouse | Self-Care Articles
How Often Do You Get A Massage?
by Sharon Puszko
How Often Do You Get A Massage?
Get on the Ball
by David Kent, LMT, NCTMB
Get on the Ball
Resistance is Key
by Sharon Puszko
Resistance is Key
Body Mechanics Begin With Balance
by Erik Dalton, PhD
Body Mechanics Begin With Balance
Strength Training
by Teresa M. Matthews, LMT, CPT
Strength Training
Stretch for Power Balls
George P. Kousaleos, LMT
Stretch for Power Balls
Spotlight On Palmaris Longus
by Judith DeLany
Spotlight On Palmaris Longus
Self Care is Critical
by James Waslaski
Self Care is Critical
Inspire to Be Higher
by Mike McGillicuddy, LMT, NCTMB
Inspire to Be Higher
Healthy Body, Happy Practitioner
by Sharon Puszko
Healthy Body, Happy Practitioner
Taking Care of Your Hamstrings
by Aaron Mattes, MS, RKT, LMT
Taking Care of Your Hamstrings
Taking Care of Your Hands
by Bruce Baltz, LMT
Taking Care of Your Hands
Take Care of Your Foundation
by Aaron Mattes, MS, RKT, LMT
Take Care of Your Foundation
(Almost) Anywhere, Anytime!
by Judith DeLany
(Almost) Anywhere, Anytime!
Setting Up an Ergonomic Workspace for Massage and Bodywork
by Lauriann Greene, CEAS and Richard W. Goggins, CPE, LMP
Setting Up an Ergonomic Workspace for Massage and Bodywork
The Business of Self-Care
by Lauriann Greene, CEAS and Richard W. Goggins, CPE, LMP
The Business of Self-Care
For Effective Injury Prevention, Think Holistically
by Lauriann Greene, CEAS and Richard W. Goggins, CPE, LMP
For Effective Injury Prevention, Think Holistically
Reprinted with permission from the May, 2009 issue of Massage Today. Complete issue archives and other resources available at www.massagetoday.com

How Often Do You Get A Massage?

By Sharon Puszko, PhD, LMT

When was the last time you received a massage? This is not a rhetorical question; I really want you to answer this question for yourself. If you have to pause to think about the answer, then chances are you have gone too long without one. I know our lives are rather full between tending to clients and family, running errands, paying bills, and everything that comes with managing a household. But, as the saying goes, one cannot heal others unless they first heal themselves. Taking care of yourself is just as important to a massage therapist as taking care of your clients.

Sharon Puszko demonstrates massage techniques.

Remember all the reasons massage is valuable for your clients? You share with them how massage can help to alleviate joint and back pain, manage fibromyalgia and migraines, speed recovery from injury, increase blood circulation and manage stress, etc. Well, all of these reasons apply to you as well. While we all enjoy the laying on of hands, we can't experience all the benefits of a massage vicariously through our clients: we must lay our hands down once in a while and let someone else do the work so we can practice what we advocate.

In order to best serve your clients, it is important to keep in touch with how receiving massage feels to you. Without regular massages, we can easily lose perspective on how issues of touch affect a client in terms of pressure, temperature, and the frequency of repetitive strokes. Weekly or monthly massages allow us to experience new techniques or ways to modify existing ones for a certain group of clients. For example, as a specialist in geriatric massage, I find it helpful to trade massages with colleagues who work with other modalities.

Sharon Puszko demonstrates massage techniques.

Getting a massage is also important for us as practitioners because it helps prevent injuries common to the profession, such as repetitive stress injuries, muscle strains and carpal tunnel. This advice sounds familiar, doesn't it? I am sure you have mentioned this to more than one of your clients in the past several months. Now it is time to listen to your own advice! Just like athletes, our body is our tool and our work depends on it functioning well. It is for this reason that we must care for our bodies/tool with the same degree of intensity that dancers, swimmers, and runners do.

In a recent survey I gave to students at the Daybreak Geriatric Massage Institute, only 6 percent reported that they receive a massage once per week with the majority responding that they receive a massage 6 times per year or less. The main reason respondents gave for not receiving regular massages was that they cannot afford it more often. Ideally, we should be receiving a massage weekly; if that is not possible than we should strive for a massage every other week. Here are some common reasons given for not receiving regular massages, as well as some suggestions for overcoming these obstacles:

Sharon Puszko demonstrates massage techniques.

I do not want to spend the money. I have to respect this response. Many of us may have experienced a change in our clientele recently, and we must adjust the way we manage our finances accordingly. If you do not feel comfortable spending money on a massage, please consider trading with someone. Probably the most common person to trade with would be another massage therapist. However, if that is not an option for the therapist you like (e.g. he or she only accepts cash), perhaps another form of trade would free up some money to get a massage from the person you prefer. For example, maybe you could trade a massage for a haircut, yard work, babysitting, marketing opportunities, or something else. By not spending money on these other things, you would be able to put aside the money needed for a massage.

I have not found a practitioner with whom I want to trade/pay. The Internet is a wonderful tool for finding people with similar interests. Visiting local massage schools is a great way to connect with fellow practitioners. Check the free daily papers for events related to massage, or postings from local massage therapists. Word-of-mouth also goes a long way, so the more people you talk to, the better chance you have to meet other therapists. Once you start finding people, it is simply a matter of trial and error until you find a practitioner whose work you enjoy, and with whom you can arrange a form of payment.

Sharon Puszko demonstrates massage techniques.

I do not have the time. Really? I believe we all have time for what is a priority to us. Yes, we are all busy, especially those of us who are caretakers of young children, aging parents, or other family members. What rings more true is to say "I do not believe receiving a massage is a priority in my busy life right now." I urge you to reconsider, for all the reasons mentioned. Every massage therapist can find one hour (one and a half, including travel time) each week, or every other week, for something that is a priority. Your challenge, therefore, is to re-categorize massage as a priority in your life.

The bottom line is this: We cannot be an effective massage therapist if we do not take good care of ourselves. It is imperative that we listen to our bodies and respond accordingly to its needs. So please, try turning off your ringer, take a deep breath, lay yourself down on the massage table instead of standing by it, and let someone take care of you for a wonderful change of pace towards self-care and being the best therapist you can be.


Sharon Puszko is the owner/director/educator for Day-Break Geriatric Massage Institute. She may be contacted at spuszko@juno.com or through her Web site: www.daybreak-massage.com.

Reprinted with permission from the January, 2008 issue of Massage Today. Complete issue archives and other resources available at www.massagetoday.com

Get on the Ball

By David Kent, LMT, NCTMB

As massage therapists, it's easy for us to get caught up in caring for clients; however, our work makes us especially prone to injury. This is why practicing regular self-care is so important, particularly when it comes to posture and body mechanics, both of which play a role in causing pain and injury to therapists.

The human body is made up of systems that work together to create balance and homeostasis. When one system is out of balance, it subsequently disrupts the other systems. For example, an individual with poor flexibility and a lack of strength will exhibit improper movement patterns that affect their posture, gait and ergonomics which, in turn, affect form (anatomy), which then affect function (physiology).

David Kent demonstrates how to stretch using an excersize ball.

Dr. Vladimir Janda, a Czech neurologist, categorized muscles into two groups: those prone to tightness or shortness and those prone to weakness or inhibition. He states that muscular imbalance occurs when muscles become too short or too weak, and that the key to total balance is strength and length.

This brings me to my "Personal Daily Self-Care Program," which helps me build the strength, flexibility and balance my body needs to stay healthy. But I also like to have fun, which is why I use an exercise ball.

When I stretch on the ball, my breathing becomes easier, my muscles loosen, my rib spaces expand and my body relaxes. Spending a few minutes on the ball each day has greatly improved my flexibility, strength, coordination and posture.

David Kent demonstrates how to stretch using an excersize ball.
Self-Care Tips for Using a Professional Exercise Ball
Type: Slow deflate
Size: Choose the size according to manufacturer recommendations.
Posture: Maintain good posture before, during and after each movement.
Breathing: Breathe properly both at rest and during movement.
Control: Maintain control throughout the entire movement.
Plan: Develop a strategy to use the ball for a few minutes each day.
Goals: Set realistic goals for improving the performance of your body's systems.

Click here for more information about David Kent, LMT, NCTMB.

Reprinted with permission from the February, 2008 issue of Massage Today. Complete issue archives and other resources available at www.massagetoday.com

Resistance Is Key

By Sharon Puszko, PhD, LMT

Dr. Sharon Puzsko demonstrates the use of a resistance band.

While not every massage therapist carries such a hectic schedule, life does seem to move at a faster pace with each passing year. As massage therapists, it's crucial to make time - even in the smallest increments - to care for ourselves. Massage therapy requires physical and mental agility, and it is our responsibility to our clients to keep our bodies and minds in prime condition. This requires a regular strengthening, stretching and balance wellness program.

I have found the use of resistance bands, exercise balls and stability trainers to be a great strengthening aid for everyday activities. These products are light-weight, durable and portable, making it very easy to incorporate a wellness program into any lifestyle.

Dr. Sharon Puzsko demonstrates the use of a resistance band.

My favorites are the resistance bands because they are low cost and very versatile. They improve strength, mobility and flexibility; I use mine between client appointments to stretch my upper body. I like the fact that resistance bands minimize pressure on the joints and decrease the chance I could injure myself. Spending just a few minutes each day gives me the ability to take a break and revitalize so I can continue to meet all my clients' needs.

Tip for Using a Resistance Band
Type: Progressive-Resistance Bands

Exercise: Resistance Elbow Flexibility and Strengthen Biceps

How To: Stand holding resistance band in right hand with your right foot securing other end of band; this is for stretch resistance. Bend to right, and slowly bring your body to upright position. Pull the band upward, bending elbows in. Bring your hand to shoulder height and hold for four seconds. Make sure to keep your trunk straight. Repeat this exercise 10 times. Repeat exercise sets on left side. Try to do three sets of 10 on each side.

Plan: Develop a mindset that when you have a few minutes to relax, pull out your band to stretch without thinking about it.

Goals: Set a goal and stick to it. This will improve your overall physical and mental abilities.


Sharon Puszko is the owner/director/educator for Day-Break Geriatric Massage Institute. She may be contacted at spuszko@juno.com or through her Web site: www.daybreak-massage.com.

Reprinted with permission from the March, 2008 issue of Massage Today. Complete issue archives and other resources available at www.massagetoday.com

Body Mechanics Begin With Balance

By Erik Dalton, PhD

Square rocker board
Fig. 1: Square rocker board

Many therapists wrestle with maintaining proper body mechanics, but some have discovered a simple exercise tool that dramatically enhances their therapeutic skills. I've found that training five to 10 minutes a day on a rocker board significantly improves my balance, core stability, strength and endurance. Since balance is the critical building block making movement possible, any exercise to improve balance will surface in the quality of your touch.

Round wobble board
Fig. 2: Round wobble board

Clients consciously or unconsciously sense if a therapist is centered and balanced. In the absence of dynamic body balance, therapists' movements often are awkward and jerky, known as the "jiggling hands" syndrome. Conversely, a bodyworker with a firm and steady touch exudes confidence as body weight travels evenly through the hands, torso, pelvis, and into the legs and feet to form a stable working foundation.

How Do Balance Boards Work?
When the body senses a change of surface, it self-corrects to achieve appropriate positions for that particular movement. These rapid adjustments rely on proprioceptors embedded in muscles, ligaments and joints to detect speed and degree of stretch. The body's proprioceptors are highly-refined motion sensors, and balance boards help train these sensors. While the square rocker board (Figure 1) allows for one plane of instability, the round wobble board (Figure 2) provides multiple planes for the most challenging workout. Rocker and wobble boards are fun and safe, but be sure to purchase one with a tactile surface on top and nonskid surface below, such as those depicted in the photos.

Technique Tips

  • Always stay within your functional threshold of balance. Hold on to a wall or doorway as needed.
  • Strive to maintain balance in order to train the body to move efficiently.
  • Pull your navel toward your back without flattening lumbar curve to activate dynamic core stabilizers.
  • Contract your gluteus maximus muscles with more weight shifted to your heels. Slowly rock back and forth to improve posture and restore proper hip-extensor firing order

Regardless of age or ability, daily use of a balance board boosts overall fitness, core strength and therapeutic performance. By improving body and spatial awareness through dynamic balance board exercises, the therapist utilizes less energy, which promotes greater core stability, mobility, agility and touch.


Click here for more information about Erik Dalton, PhD.

Reprinted with permission from the April, 2008 issue of Massage Today. Complete issue archives and other resources available at www.massagetoday.com

Strength Training: The Importance of Strong Wrists and Forearms

By Teresa M. Matthews, LMT, CPT

Teresa M. Matthews shows how to use a flexible resistance bar.
Fig. 1: This flexion and extension wringing movement strengthens forearms, hands and wrists.

As massage therapists, we work with our hands daily and on many occasions, for long periods of time. The constant overuse and necessary repetitive motions needed in our profession undoubtedly put us at risk for wrist injuries. Injuries such as tendonitis and carpal tunnel syndrome can develop over time, and can prove to be both painful and crippling to our longevity in this profession.

Teresa M. Matthews shows how to use a flexible resistance bar.
Fig.2.

With proper self-care and strength training, we can minimize the risk of these hand, wrist and forearm injuries developed from occupational overuse. A flexible resistance bar (see images) is a great tool for helping the massage therapist minimize the risk of injury. It's designed specifically to strengthen your hands, wrists and forearms - muscles which are extremely important to the massage career. In performing a beneficial massage on our clients, it's obvious we are continually using our hands, wrists and forearms and we need to make self-care a number-one priority to ourselves and careers.

Teresa M. Matthews shows how to use a flexible resistance bar. Fig. 3: As we become stronger in this movement, the work we do with our thumbs or the heel of our hand becomes more efficient. It will give us the ability to keep our wrists straight, preventing injury.

We not only use these muscles to do our work, but also in our everyday life, such as typing on the computer or lifting groceries from the grocery cart. Having strong hands, wrists and forearms undoubtedly helps in carrying out day-to-day activities. There are a number of good reasons why massage therapists should participate in self-care and strength training. Unfortunately, we don't spend enough time taking care of ourselves or doing any type of strengthening exercises. I use a resistance bar three times a week, usually Mondays, Wednesdays and Fridays, for just minutes a day.

Using a flexible resistance bar is an easy, effective and a convenient tool for our hands, wrists and forearms. Strengthening the joints, tendons and muscles in these areas will not only improve your performance as a massage therapist, but also will help prevent painful and long-lasting injuries.


Teresa M. Matthews is the president of Health, Wellness & Fitness Professionals, Inc. Contact her by e-mail hwfp@aol.com or phone (904-745-0785) with questions or comments.

Reprinted with permission from the May, 2008 issue of Massage Today. Complete issue archives and other resources available at www.massagetoday.com

Stretch for Power Balls

By George P. Kousaleos, LMT

George P. Kousaleos, LMT demonstrates how to stretch using an exersize ball.

Since the beginning of my structural-integration career 30 years ago, I have been a proponent of combining stretching and strengthening exercises as a powerful tool that keeps one balanced and energized. I use isometric exercises, yoga asanas and resistance tools that support a full-body workout. I credit these exercises for keeping me in good working shape for three decades.

The overall goals of my routine are simple. First, I lengthen the vertical line with standing and floor exercises. I try to lengthen the lumbar and cervical sections of the paraspinals while elevating my sternum. Next, I work on stretching and strengthening the myofascial components of my shoulders and hips. Finally, I complete a series of floor and standing spinal twists that reduce the strain of compression and improve the fluidity of the intervertebral joints.

George P. Kousaleos, LMT demonstrates how to stretch using an exersize ball.

I use a few trustworthy tools that help me accomplish my daily routine. My favorite tool is the large- and/or medium-size exercise ball. I use the large ball for full-body hyperextensions, lateral stretches and pelvic balancing. The midsize ball is great for hip stretches and spinal twists.

I also use small, handheld weighted balls to strengthen my shoulders and arms. I use these tools to help me increase the strength and flexibility of my shoulder girdle.After spending so much of my workday with my arms held forward for bodywork sessions or computer typing, my shoulders, chest and mid-back really need a short workout to return them to a structurally balanced position.

George P. Kousaleos, LMT demonstrates how to stretch using an exersize ball.

Self-Care Tips for Using Exercise and Resistance Balls
Type: Midsize ball

Exercise: Hip stretch

How To: Place the lateral thigh on the center of the ball with the other knee in flexion and lateral leg resting on the ball. Your other leg is positioned directly behind your body. Push slightly forward from the back leg, slowly stretching the hip rotators of the leg on the ball. Maintain balance through the upper body and breath slowly, allowing the intensity of the stretch to increase while exhaling and slightly resting while inhaling.

Type: Handheld weighted balls.

Exercise: Full-shoulder revolutions - Opposite Windmills.

How To: With a ball in each hand and both arms raised above the head, begin by bringing one arm forward and the other backward, completing slow circles in either direction. Repeat for five to 10 revolutions before changing direction of each arm.

Tip: Start with lightly weighted balls and use the complete breath cycle for each revolution.


George P. Kousaleos is founder and president of the CORE Institute School of Massage Therapy in Tallahassee, Fla. He has specialized in structural integration, myofascial therapy and sports bodywork since 1978. He was the first chair of the NCBTMB and served as co-director of the Athens 2004 Olympic Sports Massage Team.

Reprinted with permission from the July, 2009 issue of Massage Today. Complete issue archives and other resources available at www.massagetoday.com

Spotlight on Palmaris Longus

By Judith DeLany, LMT

The forearms and hands are the most important tools used in massage therapy. Preventing the development of career-ending conditions, such as Dupuytren's contracture, is a critical, yet often overlooked, step in self-care.

When these muscles are neglected, consequences can range from nagging, aching arms, wrists or hands, to debilitating chronic pain.

Palmaris longus (PL) is a great example. This long (extrinsic) muscle courses from the medial epicondyle to attach broadly onto the palmar fascia which, in turn, spans into five directions, each of which projects toward a digit (ray). Its tendon is the only anterior forearm tendon to remain outside the flexor retinaculum at the wrist, making it distinctly visible when the wrist is flexed and the hand is curled upon itself.

Although the muscle belly may be absent on either arm or both, its palmar fascia is always present.1 Its tendon may be more easily distinguished from the carpal (wrist) flexors by having the person place all five digital pads together, with the metacarpophalangeal joints flexed and the fingers and thumb extended (as if picking up a marble with all five digits). It may be necessary to simultaneously flex the wrist to make the tendon more distinct.

Palmaris Longus Mediclip Manual Medicine Collection1, (c) 1997 Williams & Wilkins, A Waverly Company

PL may be strained with loaded wrist flexion. The associated palmar fascia may be injured with the use of hand tools that can inflict trauma, such as when pounding on an ice pick, sculpting tool, or kitchen chopper, when twisting with pressure while using trowels in gardening, or when applying pressure with hand-held tools in massage therapy. Associated trauma can result in shortening of the connective tissue of the palm, similar to that seen in Dupuytren's contracture.

Indicators for treatment of PL include:

  • diagnosis of Dupuytren's contracture (see below);
  • prickling sensation to the palm and anterior forearm (from trigger points); and
  • tenderness in the palm, especially when working with hand-held tools.

Dupuytren's contracture is a hand deformity in which the palmar fascia contracts and thickens over time. The characteristics of Dupuytren's contracture2 include:

  • Stage 1: A nodule of the palmar fascia that does not include the skin, with no change in the fascia.
  • Stage 2: A nodule in the fascia with involvement of the skin.
  • Stage 3: Same as stage 2 but with a flexion contracture of one or more fingers.
  • Stage 4: Same as stage 3, plus tendon and joint contractures.

Due to slow progression, observation and minimal or no treatment are often indicated initially for Dupuytren's contracture. A non-surgical intervention of injection coupled with forceful finger extension may be indicated.3 Surgical excision of the fascia may be necessary and the hand may lose up to 25 percent of its grip power as a result.

Palmaris Longus Mediclip Manual Medicine Collection1, (c) 1997 Williams & Wilkins, A Waverly Company

Heredity may be a factor in Dupuytren's contracture, however, it is important to rule out trigger points as part of the problem.4 Trigger points in this muscle may simulate Dupuytren's contracture and may even produce flexion contracture of the fingers. A distinguishing feature is that while Dupuytren's may cause a painful palm, only trigger points in PL produce the prickling sensation. Simons, et al., describe a spray and stretch technique that covers the anterior forearm and hand that is often beneficial to this condition. NMT hand and forearm protocols are also effective. (For hand and forearm treatment protocols, visit www.nmtcenter.com/articles.)

The value of contrast hydrotherapies should not be underestimated, especially when followed with stretching. Not only is this therapy readily available and very inexpensive, it can easily be self-applied, especially to the forearms and hands.

Prevention of injury is the foremost key to maintaining healthy hands. Particular care should be exercised when using tools that can damage the palmar fascia. Work gloves, alternative tools and employed help should be considered for jobs that might place stress on the tissues of the palm.

References

  1. Platzer W. Color Atlas of Human Anatomy, vol. I. Locomotor System, 5th ed. Stuttgart: Thieme, 2004.
  2. Taleisnik J. Fractures of the carpal bones. In: Green DP (ed) Operative hand surgery 2. New York: Churchill Livingstone, 1988:813.
  3. Cailliet R. Hand Pain and Impairment, 4th ed. Philadelphia: FA Davis, 1994.
  4. Simons D, Travell J, Simons L. Myofascial Pain and Dysfunction: The Trigger Point Manual, Vol 1: The Upper Half of Body, 2nd ed. Baltimore: Williams and Wilkins, 1999.

Judith DeLany serves as director of NMT Center, writes textbooks for Elsevier Health Sciences, and lectures internationally in the field of neuromuscular therapy. For more information regarding her work, visit www.nmtcenter.com or call toll-free at (866) 571-7942.

Reprinted with permission from the June, 2008 issue of Massage Today. Complete issue archives and other resources available at www.massagetoday.com

Self Care Is Critical

By James Waslaski

In teaching orthopedic massage seminars throughout the world, I have always emphasized the critical role of therapist self care as a vital part of treatment follow-up in order to live a pain-free life.

I recommend all therapists stretch tight muscle groups and strengthen weak muscle groups to maintain the resting lengths of opposing muscle groups throughout the body. That is the only way to maintain the results of therapy. It was about three years ago when I learned the value of self care firsthand. I had thoracic outlet so bad I couldn't even pick up a pencil in my right hand without dropping it. I could not hold a fork in my hand, and I had to teach my seminars using mostly my left hand and the back of my right wrist. I believe the thoracic outlet came on over time due to poor postures and repetitive movements in doing massage without understanding the importance of taking care of myself.

James Waslaski demonstrates exercises using sports bands.

Following therapy that included chiropractic, myoskeletal alignment, orthopedic massage, lymphatic drainage and isolated stretching to muscle groups like my sternocleodomastoids, scalenes, pectoralis minor and wrist flexors, function was restored to my arm, wrist and hand. After a month of therapy, I was able to avoid having a fusion done to the bones in my neck. My chiropractor aligned the area of the C7/T1 to move a bone spur off the nerve roots in that area. It was then that I had to take responsibility for keeping muscle groups in that area in balance to prevent tightening, which would allow the bones to move out of alignment again. 

A critical missing link in living pain free with no numbness or tingling in my arm came when I started to strengthen weak and inhibited muscle groups such as my rhomboids, middle trapezius, and posterior rotator-cuff muscles, along with my wrist extensors. This involved self care using active isolated stretching to stretch tight muscle groups of the anterior neck and shoulder, and the use of resistance bands to strengthen weak muscles in the posterior neck and shoulder. This total daily therapy lasted only five minutes. It's obvious that tight muscle groups pulled bones onto nerves and blood vessels, leading to the symptoms I was experiencing. The key to being pain free and 100 percent functional came when I committed five minutes each day to stretch tight muscle groups and then strengthen the weak and inhibited antagonists.

I continue to do self care daily. I spend a minimum of five minutes (and up to 30 minutes) per day because I know what it takes to live the rest of my life pain free and hope to inspire others to do the same.


Author and lecturer James Waslaski is the past chair of the AMTA National Sports Massage Education Council. He currently teaches orthopedic massage nationally and internationally, and has produced a videotape series on orthopedic conditions and sports injuries. James is the recipient of the 1999 International Achievement Award for educating medical practitioners worldwide on integrated pain-free healing.

Reprinted with permission from the August, 2008 issue of Massage Today. Complete issue archives and other resources available at www.massagetoday.com

Inspire to Be Higher

By Michael McGillicuddy, LMT, NCTMB

I have been a part of the massage therapy profession for 24 years. Like most therapists, I entered the profession because I find joy in helping others feel good about themselves. Consequently, massage therapists often succumb to the demands of caring for everyone else and neglect taking care of themselves. My goal is to inspire you, the massage therapist, to reach higher than that.

One of the most important choices an individual must make in their life is to take complete responsibility for their own well-being. It's the core of developing high self-esteem and strong self-worth. You can't hold yourself in high regard if you don't take care of yourself. If your time is so consumed with the care of others that you become exhausted, sick, injured or burned out, what message do you ultimately send to your clients? Most therapists learn the importance of teaching their clients to stay healthy in body, mind and spirit. However, are they inspired enough to live that lifestyle for themselves?

Therapists tend to sleep less than the recommended eight hours their bodies need to re-energize each night. They disregard their nutritional needs and avoid the proper amounts of stretch and exercise needed to stay strong enough to do the job. In general, they work too hard and play too little. I encourage you to self-evaluate and take a long look in the mirror. If you see a healthy, energized and stimulated individual looking back at you - great! If you don't see something you are happy with, don't be discouraged - get inspired! Begin by doing small things for yourself; things that not only make your body and mind feel better, but raise you higher and build your self-esteem and self-worth.

image

"Where and how do I start?" might be the question running through your mind right now. Start at the beginning. Be kind to your body and begin a self-care program. This is not something that has to be fancy or expensive. Get more rest, drink water and add a more balanced diet including fruits and vegetables. Take time to walk outside and enjoy the fresh air.

As massage therapists, we need to target specific muscles to stay healthy and active, and prevent injuries. If we neglect to do this, we run the risk of ending our careers much sooner than needed. The abdominal and lower back muscles always are a good place to start, as they are largely over-used in this profession.

image

Unless you have a medical condition that would contraindicate such exercise, I recommend an exercise ball. This is a great tool to assist in doing crunches and keeping the core muscle groups strong. Some therapists like to replace their chair with a ball to sit on because it makes you use your core muscles without even thinking about them. I stretch my back using the exercise ball by laying on it and gently rocking myself back and forth.

For the mid-back, I like to stretch the pectoral muscles in three planes. Place arms straight out in front of you, palms together at chest level. Bring the arms behind you as far as is comfortable. Then repeat the stretch at a 45-degree angle above your shoulders and then at a 45-degree angle down by your waist. I like to use an exercise band to strengthen my trapezius and rhomboids by holding the band in front of me and contracting my muscles, bringing my shoulders toward my spine.

Remember, if you look in the mirror and don't like what you see, don't feel bad - get inspired. Become higher in body, mind and spirit.


Click here for previous articles by Michael McGillicuddy, LMT, NCTMB.

Reprinted with permission from the August, 2009 issue of Massage Today. Complete issue archives and other resources available at www.massagetoday.com

Healthy Body, Happy Practitioner

Creating a Workout Program that Works For You

By Sharon Puszko, PhD, LMT

We all know exercise is essential to maintaining a healthy weight and living a healthy life. While we know all about the benefits of exercise, and we probably even discuss them with our clients, we all too commonly manage to tell ourselves, "I'll begin a new workout schedule tomorrow!" Tomorrow comes and goes. And inevitably, we somehow never managed to fit in that workout, prompting yet another bedtime promise: "OK, tomorrow I am really going to start a daily exercise schedule."

To those of you who have not fallen into this trap and have been working out regularly and eating healthy, I say, "Kudos! Keep up the good work!" To those of you who are just starting to exercise regularly or are still at the "promise of tomorrow" phase - I feel you. It is time to remind yourself that not only does regular exercise help maintain a healthy weight and a healthy heart, but it is essential to being a better practitioner as well.

Massage therapy is a physically demanding job, especially on our hands and wrists. According to an article published in Arthritis and Rheumatism, exercise can protect against carpal tunnel syndrome and other repetitive stress injuries (RSIs).1 The article discusses a study in which participants who engaged in moderate exercise (such as half-hour walks) three or four times a week showed a 16 percent reduction in risk of developing an RSI. The study demonstrates that regular exercise helps restore overall stability to the musculoskeletal system. As practitioners in a field where carpal tunnel and RSI are a real possibility, it is encouraging to hear that exercising regularly can help prevent these conditions.

We also spend a lot of our time in forward flexion while pushing and pulling body parts. Strengthening the core muscles (abdominals, back and glutes) is important to help us maintain proper positioning while working on clients. Strength training and Pilates are excellent options for keeping our core muscles strong. The American College of Sports Medicine (ACSM) and the American Heart Association (AHA) both recommend strength training twice per week. In addition, yoga, tai chi, or a stretching routine are all nice complements to a core body workout and will help release some of the stress and tension we can build up in our backs and hamstrings from bending over our massage tables. While all of the exercises mentioned here can be done at a fitness center, they also can be done at your residence with the help of a book or DVD.

Maybe you are lucky enough to work with clients outside on a tropical beach, but I believe most of us spend our working hours in a room that is rather dark and small. Why not make the most of your time and combine the need for fresh air with a daily exercise program? Biking, walking, jogging, and tennis are excellent options for outdoor exercises. Finding an exercise partner, as well as joining a local biking, running, walking or tennis club, can help motivate you to start one of these sports. If you take up biking, make sure you adjust your seat and handlebars so you are as upright as possible, in order to minimize the strain on your wrists, back and "sit bones" (ischial tuberosity). Remember that your focus should be on exercise and recreation, not on speed, so you do not need to mimic Lance Armstrong when you go for a ride.

Healthy Body, Happy Practioner

The key to maintaining a daily exercise program is to create a program that works for you. Choose sports for which you can realistically create time and that you enjoy. One severe injury could put you out of work for a month or longer, so choose exercises that are appropriate for your body type and age. For instance, my exercise of choice might be downhill skiing. However, as a member of the AARP, I realize that may not be the wisest choice since I am not ready to retire any time soon. Cross-country skiing or hiking, on the other hand, would be more realistic choices.

For those of you preparing to start a new exercise program "tomorrow," take some time today to jot down what physical activities you enjoy, and try to incorporate the outdoors into them at least once per week. Call your friends or colleagues and ask them to join you if you prefer to exercise with others, or use this as an opportunity for some alone time, if that is what you need. Get your monthly calendar out, and write down your daily exercises, so you have a visual reminder of your plan each month. You can even ask a friend or family member to call you every week and have you report on your progress if you need someone to hold you accountable to your workouts.

I wish you the best of luck in your new endeavors, and as always, don't forget to BREATHE!

Reference

  1. Arthritis and Rheumatism, April 15, 2007;57(3):495-500.

Sharon Puszko is the owner/director/educator for Day-Break Geriatric Massage Institute. She may be contacted at spuszko@juno.com or through her Web site: www.daybreak-massage.com.

Reprinted with permission from the September, 2008 issue of Massage Today. Complete issue archives and other resources available at www.massagetoday.com

Taking Care of Your Hamstrings

By Aaron L. Mattes, MS, RKT, LMT

Massage therapists spend many hours bent over patients helping them to relax and alleviate their aches and pains. In doing so, we put untold stress upon our bodies, namely our backs and hamstrings.

Because of this, massage therapists need to learn how to take care of their bodies to prevent any overuse injuries.

One area of the body that takes the brunt of the abuse is the low back. The low back is a complex area of the body because it encompasses many different areas to keep it healthy. In order to have a healthy back, the hamstrings, quadriceps, hip rotators and low back must be flexible. It's also important to maintain strong abdominal muscles to keep the core of the body strong. In this article, we'll discuss the hamstrings.

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The first stretch is the bent knee hamstring stretch. (Images 1A, 1B) This is an especially good stretch for the distal hamstrings (above the insertion). The muscles stretched will include the semi-tendinosus, semi-membranosus and biceps femoris. From a supine position, place one hand under your knee or in front of the active knee to help maintain a flexed hip. Flex the uninvolved leg, especially if you have a back problem. Contract the quadriceps and extend the knee (of the leg to be stretched) slowly to full extension. Do not flex the hip any closer to the chest unless your knee can extend completely. As the quadriceps continue to move the leg, gently assist with a resistance band holding the stretch for a maximum of two seconds. Return to the starting position and repeat eight to 10 times.

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The second stretch we are going to do will be the straight-leg hamstring stretch. (Images 2A, 2B) The muscles this will stretch will include the proximal end and belly of the hamstrings, specifically the semi-tendinosus, semi-membranosus and biceps femoris. From a supine position, flex the uninvolved leg, lock the knee (of the leg to be stretched) and slowly lift the leg using the quadriceps. Give gentle assistance with a resistance band at the end of movement as the quadriceps continue to move the leg. You want to hold the stretch for a maximum of two seconds and return to the starting position. Repeat this exercise eight to 10 times per leg.

These two stretches are great to help improve the flexibility of the hamstrings and will help alleviate stress and strain put on the low back while working with patients.


Aaron Mattes received his MS from the University of Illinois, Urbana-Champaign, 1972, with special emphasis in kinesiology and kinesiotherapy. He has spent more than 250,000 hours in sports participation, sports and health instruction, rehabilitation, athletic training, adapted physical education, sports medicine, training and prevention programs.

Reprinted with permission from the October, 2008 issue of Massage Today. Complete issue archives and other resources available at www.massagetoday.com

Taking Care of Your Hands

By Bruce Baltz

As a massage therapist, you need to take responsibility for your own well-being, and taking care of your hands should be at the top of the list. Increasing flexibility, dexterity and strength of the hands and fingers should be an ongoing commitment.

First, let's talk about endurance, which involves strengthening your fingers, focusing on extension, abduction and adduction. Everyday activities stress our flexors constantly, and they overpower the weaker muscles. Therefore, we should focus on stretching them. I recommend using the following technique for stretching your flexors. The principles are simple:

  • When starting the stretching movement, it is essential that you move each finger by contracting the opposing muscle. This way, your body will be communicating with itself on what you want to accomplish.
  • Assist yourself with light pressure to increase your range of motion, holding for only two seconds.
  • Let each finger come back into a resting position. This is when new oxygen and blood will enter the tissue.
  • Repeat this process 10 times for each joint.
Isolating finger extension.
Isolating finger extension.

A simple hand exerciser also can assist in strengthening the muscles we take for granted and most often neglect. This type of device allows you to strengthen all those neglected hand muscles, and you can incorporate the healing power of warm and cool temperatures to help bring more blood and oxygen into our hands and, at the same time, help release trapped toxins.

After a long shift, your hands will feel tired, if not sore, so a cool application will be a welcome antidote. a hand exerciser that has been cooled in the refrigerator does wonders to sooth your overworked hands. When working with hydrotherapy principles, I have found that combining them with muscle contraction or manipulation enhances the soft-tissue results. Most of us will find that increasing circulation in our hands presents significant challenges, but by using both warm and cool temperatures, you will assist your body in flushing the tissue through vasoconstriction and vasodilation.

Finger abduction. Finger abduction.

To assist in vasodilation, use heat to benefit from the temperature exchange. When working with warmer temperatures, safety guidelines must be followed to prevent injury. Therefore, if you are utilizing any type of hand exerciser, I recommend heating it in the microwave for no longer than 10 seconds. For cool application, place the hand exerciser in the refrigerator for an hour and a half to two hours. Always end with cold; your body will naturally warm itself back up. (Editor's note: Make sure any hand exerciser you are using can be warmed or cooled without causing damage to the device or the user.)

In order for our bodies to function at an optimal level, we must find a balance between strength and flexibility. As massage therapists, this is particularly true for our hands, which are used constantly in our work. If this is achieved, we can work more efficiently, longer and with fewer injuries.

Reprinted with permission from the November, 2008 issue of Massage Today. Complete issue archives and other resources available at www.massagetoday.com

Take Care of Your Foundation

By Aaron L. Mattes, MS, RKT, LMT

Over the past 40 years, I have spent well more than 200,000 hours in training, conditioning and rehabilitating patients as a kinesiologist, personal trainer and massage therapist. As an author, lecturer and clinical therapist I have worked with thousands of massage therapists.

The quality of our work and professional longevity depend on our knowledge and personal health. The foot and ankle are among the most ignored areas of body conditioning as we stretch, strengthen or train aerobically.

The ankle-foot structures are a complex group of joints, muscles, tendons, ligaments and fascia that are designed to hold up the weight of the entire body. The ankle joint is responsible for movement forward (upward) into dorsal flexion and backward (downward) into plantar flexion. The subtalar movements of inversion (adduction) and eversion (abduction) are actions between the tibia, talus and calcaneus bones. Deformities such as hind-foot calcaneous valgus, where the heel turns outward, is often combined with midtarsal phalangeal pronation. Varus heel turns inward is often combined with supination or inward rotation of the midtarsal and phalangeal joints.

Sprains of the ankle or subtalar joints feature ligaments partially or totally torn. Shin splints involve tight calves, painful shins, weak arches, strain tearing of the interosseus membranes between the tibia and fibula and weakness/inflammation of the tibialis posterior and tibialis anterior, both of which are major muscles of the arch. Tight calves are also present with pes cavus (high arch), hammer toes and Achilles tendon problems. Tight calves, including the gastrocnemius and soleus muscles, need to be stretched. The soleus is stretched by bending the knee 90 degrees, placing the hands or an exercise band around the ball of the foot and dorsal flexing the ankle for 10 repetitions with assistance.

To lengthen a tight gastrocnemius muscle, sit with the leg extended and place an exercise band around the ball of the foot with one strand in each hand. Dorsal flex the foot backward and assist with the band for 10 repetitions.

Massage therapists spend countless hours on their feet. The structure of the ankle, subtalar, midtarsal and phalangeal joints requires excellent muscle support. In many cases, orthodox assistance is used to support underdeveloped, overstressed lower leg muscles and joints. Pain and weakness endangers the work schedule and may limit off-hour exercise and planned activities.

Exercise the muscles of the ankle and foot by using an exercise band. Tie one end of the band to something stable and do this:

  • Inversion - Face the band from the side. Clasp the band with the foot and then pull the band inward. Perform a number of series of 10 repetitions.
  • Eversion - Face the band from the side. Clasp the band with the foot and pull the band outward. Perform several series of 10 repetitions each.
  • Plantar Flexion - Face the end of the band. Place one foot on the band and flex the toes as far as possible, release and repeat 10 time. Repeat for a number of sets.
  • Using a flexible foot bar - Roll the bar forward with one foot and backward at the same time with the opposite foot. This will exercise the plantar flexors of the foot. You may also turn the foot in or out while performing this maneuver.

Aaron Mattes received his MS from the University of Illinois, Urbana-Champaign, 1972, with special emphasis in kinesiology and kinesiotherapy. He has spent more than 250,000 hours in sports participation, sports and health instruction, rehabilitation, athletic training, adapted physical education, sports medicine, training and prevention programs.

Reprinted with permission from the December, 2008 issue of Massage Today. Complete issue archives and other resources available at www.massagetoday.com

(Almost) Anywhere, Anytime!

By Judith DeLany, LMT

Modern times have presented us with ever-expanding duties in all corners of our lives. Most of us wear multiple hats as practitioners, teachers, providers, partners, parents and even as caregivers for our own parents or friends.

We are constantly challenged to effectively manage our time and money within a world that seems to be closing in around us. Often the easiest solution is to neglect ourself by omitting exercise, nutritious food, and "downtime" - or sometimes all of these! The occasional sacrifice soon becomes part of the lifestyle with "no time," "no money" and "no space" being daily themes.

As a single mother and a family provider, my own juggling act is a three-ring circus. On top of duties of home, parenting and office, I also co-author referenced neuromuscular therapy (NMT) textbooks, which requires sitting several hours each day to edit, type or read. I also travel extensively for seminars and conventions, which requires sitting on planes, sleeping in hotel beds and being distant from my usual exercise routine. These combinations constantly challenge any attempts to stay fit and offer "valid excuses" for failure.

Good tone in the upper body, as well as the trunk and legs, is needed to prevent injury, especially in the face of the daily demands of our work. Elastic bands offer a great choice for resistance work, especially in the small confines of an office, hotel room or other location where training equipment is not available. They are small (and light) enough to tuck into a desk drawer, luggage or purse, assuring that they are always nearby. Got two minutes to spare? Perform a few reps of one or two exercises. By the end of the day, a routine is done and accomplished in minutes that would have been wasted otherwise.

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Because of the growing concerns of latex allergies, I recommend and use latex-free resistance bands, which come in varying degrees of resistance. Exercises suggesting appropriate use are available on the Web free of charge. Further, practitioners, whose scope of practice does not allow for exercise recommendations, can send clients to these Web sites!

Getting-started tip: Make a short list on index cards or print out several simple exercises from a Web site that can be done in your available space in 1-2 minutes. Place the list and one exercise band in a reclosable bag (to keep them together) and tuck it into a spot where it will be handy when there are a couple of minutes to spare (in a purse, briefcase, carry-on or beach bag). Placing these bags in several handy locations increases the probability of completion.

A varied atmosphere makes it more interesting and the "no excuse" attitude helps you to see possibilities that were actually there all along. Let your imagination run loose and you might discover time for pectoralis flies on a boat, biceps curls at a guardrail in the park, or triceps extensions at the beach.

Technique tips:

  • Use a sturdy support, such as a guardrail, around which to loop the band for steady resistance.
  • Securely hold onto the non-moving end of the band to avoid injury.
  • Isolate individual muscles as part of a routine in order to avoid chronic muscle substitution for those that are weak.
  • Incorporate practice functional movements that encourage coordination of synergists and simulate practical activities used in daily life.

Make those spare minutes in your life all about you. How creative can you be?


Judith DeLany serves as director of NMT Center, writes textbooks for Elsevier Health Sciences, and lectures internationally in the field of neuromuscular therapy. For more information regarding her work, visit www.nmtcenter.com or call toll-free at (866) 571-7942.

Reprinted with permission from the March, 2010 issue of Save Your Hands. Complete issue archives and other resources available at www.saveyourhands.com

Setting Up an Ergonomic Workspace for Massage and Bodywork

By Lauriann Greene, CEAS and Richard W. Goggins, CPE, LMP

Massage

The design of your workspace plays an important role in your ability to prevent work-related musculoskeletal disorders (MSDs) such as low back pain and wrist tendonitis. To guide you in setting up a healthy work environment, you can use principles of ergonomics that have been proven effective in preventing injury at work. These principles can help you lower and even eliminate your exposure to MSD risk factors in your work, like awkward postures and fatigue as a result of using poor body mechanics.

The main goal of ergonomics is to make the workspace fit the worker’s own body, allowing you to use good body mechanics as you work. Let’s talk about some easy-to-apply guidelines to help you arrange your workspace to promote the use of good body mechanics and lower your injury risk.

Massage

The first aspect to consider as you set up your work space is the amount of space you will have to move around your table. Put your table in the room you have been assigned, and measure the amount of space around it. As a general rule, you should have at least 3 feet (1 meter) of open space around all sides of the table. The typical treatment table measures approximately 7 feet by 2-½ feet (2 meters by 0.75 meters), so your work space would need to measure at least 14 feet by 9 feet (4.25 meters by 2.75 meters) to give you adequate space to work. To work efficiently at your table, you need enough room to allow you to stand in whatever place is most comfortable for any given technique. If you are comfortable, you will be more likely to assume relaxed, efficient, naturally-aligned postures while you are working.

Setting up a new workspace gives you a good occasion to evaluate the massage table you are currently using, and decide whether it is adapted to the work you do. The width of the table is an important aspect of this decision. While a wide table may be more comfortable for some larger clients, it encourages reaching out and other awkward postures for the therapist using it. It is best to opt for a narrower table that gives you easier access to the client; some even come with side extensions for larger clients. Tables are also available that are wide at the shoulders and feet, but narrow at the center. These tables better match most clients’ body proportions, and provide the practitioner better access to the low back and hips, which are typically a major focus of hands-on treatment.

Along with width, the height of your table is also an important consideration for your working posture. There really is no one height that is appropriate for every type of technique used in a typical massage practice. Small, precise, low-force movements of the hands should be done at or a little above elbow height while seated in a neutral posture. Work involving larger movements and moderate amounts of force should be done several inches or more below elbow height while standing, also in a neutral posture. As the force requirements of the work increase, the height of the work surface should drop, so that body weight and larger muscle groups can be used to apply the force. Since most practitioners do a combination of different techniques with each client, nearly all massage therapists would benefit from having a power-adjustable table in their workspace. While power-adjustable tables do cost more than other tables, the benefit of being able to adjust the table as you move from technique to technique is well worth that investment in your long-term health, particularly if you do massage full-time. If you currently have a manually-adjustable table, retrofit kits are available that you can attach to your table to provide height adjustment through a hand crank or power unit.

Since you will spend most of your day standing as you work, the flooring in your massage space is another element to evaluate as you set up your work environment. Standing on hard surfaces such as tile, stone, concrete, or thin carpet over concrete is particularly difficult and tiring for the practitioner. Prolonged standing in place on hard surfaces without much movement can result in conditions like varicose veins in the legs. Standing on hard surfaces can also aggravate foot injuries, such as plantar fascitis, and cause low back fatigue. Better surfaces for standing while you work include traditional wood flooring (laminate floors over concrete do not have enough “give”), carpeting with a cushion backing or underlay, and foam-backed vinyl flooring. If you cannot change the flooring in your work space, you can purchase anti-fatigue mats to place around your table. Good mats are about ½ inch thick, just soft enough to provide some “give” under your feet, but not so soft that you sink in and have trouble moving around. The outside edges of mats should be beveled to prevent tripping. Place them on all sides of the treatment table so you have consistent footing.

You may have other tools or equipment in your practice that could use a little ergonomics attention as well. If you use heavy pieces of equipment, like hydroculators, hot stones or equipment for spa treatments, pay attention to how you store and lift them. Try not to place too many tools in one container, to keep the weight down, and make sure the container has good handles to make lifting easier. Store heavy or frequently-used equipment between knee and waist height, so you can lift it without bending or reaching. Better yet, use a cart so the equipment can be wheeled about rather than lifted and carried.

Woman on Computer

Nearly all practitioners use a very common piece of equipment that can contribute to MSDs: a computer. You will need to set up your computer workstation to make sure that the chair, keyboard and monitor are positioned in a manner that promotes neutral posture. There are some very good, free resources on computer workstation ergonomics available on the Internet.

Now that you have adapted your workspace to your body and your work, keep in mind a few other important ergonomics guidelines to help you stay healthy on the job:
• Try to keep a stable workload from day to day and week to week: sudden increases in workload can overload your body and cause symptoms to arise;
• Leave enough time between massage sessions to allow your body to rest and recover from intense physical activity: be sure to leave a minimum of 15 minutes break between clients to give you enough time to rest, stretch, drink some water, walk around a bit, and let go of the previous client to be ready for the next one;
• Build in recovery time and short breaks within a treatment session by alternating intensive hands-on treatment with other techniques like Strain-Counterstrain or Trager that do not require as much hand force or repetitive movements. Another way to give your hands a break during massage sessions is to use modalities that do not use the hands, like hydrotherapy, aromatherapy or energy balancing.


Portions of this article reprinted from Save Your Hands! The Complete Guide to Injury Prevention and Ergonomics for Manual Therapists, 2nd Edition, Copyright © 2010 Gilded Age Press, Inc. All rights reserved.

Lauriann Greene, CEAS and Richard W. Goggins, CPE, LMP are co-authors of the all-new 2nd Edition of Save Your Hands! The Complete Guide to Injury Prevention and Ergonomics for Manual Therapists, the leading textbook on self-care used in massage schools across the U.S. and Canada. Lauriann and Richard have published numerous articles in national massage and spa magazines on this subject, co-authored the first statistical study on injury among massage therapists, and offer continuing education courses, a Certified Injury Prevention Instructor program, and consulting and training to help massage therapists prevent workplace injury. For more information, please visit www.SaveYourHands.com or call 877-424-0994.

Reprinted with permission from the July, 2010 issue of Save Your Hands. Complete issue archives and other resources available at www.saveyourhands.com

The Business of Self-Care

By Lauriann Greene, CEAS and Richard W. Goggins, CPE, LMP

In any business, having a realistic and workable business plan can help the businessperson achieve their career goals and establish themselves successfully in a competitive marketplace.

A crucial component of any business plan is risk management: identifying, assessing and managing potential risks that could endanger a new professional’s career and earning power.  Risk management studies often concentrate on classic risk scenarios, like dealing with a difficult economy, or facing new competition in one’s target market.  An area that is often overlooked, however, is identifying and managing the risks that can put one’s own health, and career, in jeopardy. 

Studies have shown that manual therapists have a high risk of developing musculoskeletal disorders (MSDs) due to the physical demands of their work.  MSDs and their symptoms can have both short and long-term effects on a therapist’s ability to maintain their normal workload, advance in their career and, in some cases, even remain in their profession. When you weigh the potential implications for a therapist’s earning power and bottom line, it becomes clear that therapists need to be aware of these risks and find effective strategies for managing and reducing them. 

Creating Your Risk Management Plan
You can put together an effective injury risk management plan for your own massage practice based on proven workplace injury prevention and ergonomics principles. The study of ergonomics has shown that multiple factors are involved in causing workplace injury. As a result, a successful prevention strategy must be holistic and multifaceted, combining a number of tactics to address all potential causes.  The most important areas to emphasize in this holistic approach to self-care are:

Setting up a Safe Workplace
A therapist’s treatment space must be designed to fit the therapist’s body characteristics and the type of work they do. You need enough space to move freely around their table to avoid static positioning and awkward postures.  Using a power-adjustable table allows the therapist to work comfortably and efficiently as they change techniques and move from one client to another. It is also very important to maintain a consistent, manageable workload from day to day and week to week, with sufficient rest and recovery time between treatment sessions.

Using Good Body Mechanics
Learn to use your bodies in a natural and efficient way, maximizing strength while avoiding overloading vulnerable parts of the body like the hands, thumbs, neck, or low back.  Modify or eliminate any technique that causes pain or discomfort. Plainly speaking, if it hurts, don’t do it.

Woman on Computer

Staying in Shape
Lack of physical conditioning is a risk factor for injury. To stay healthy throughout a career, you must have the necessary conditioning to keep up with the physical demands of your work.  Be sure to develop a multifaceted conditioning program you can practice at least three times a week.

Taking Care of General Health
Getting enough sleep, eating well and avoiding unhealthy habits like smoking can help you withstand the rigors of you work and heal tissue damage before it progresses to the point of injury.

Paying Attention to Emotions
Difficulty setting limits with clients, unreasonable expectations of oneself, or inflexibility about treatment methods can increase risk of injury or burnout.  Learn to be good to yourself, and a long, healthy career will be within your grasp.

Prepare for Unforeseen Events
A good business plan also takes contingencies into account: those cases where, despite your best efforts, unforeseen events can still occur.  Manual therapists can start developing symptoms even if they have been careful and used good prevention techniques.  How much of a financial impact the symptoms will have on the therapist’s work life depends on how early and effectively they choose to address those symptoms.  With early, appropriate treatment, therapists may be able to continue to work as they treat their symptoms, or perhaps only have to take a week or two off to rest the affected part of their body.  By waiting to treat or choosing treatments that are less effective, they may end up with a full-blown injury that can require months off of work for rehabilitation and recovery. They may even risk chronic injury that can interrupt or cut short their career.  It is very important to seek early, effective treatment, and understand the potential consequences of doing otherwise.

Don’t Forget Insurance
Since injury can happen even with good prevention efforts, your business plan should also include obtaining adequate insurance.  Health, workers' compensation, and long term disability insurance all give therapists an important safety net that can keep you afloat financially if injury does happen, as well as peace of mind during your career.

Therapists that develop an effective injury risk management strategy have a significant competitive advantage: the tools to maintain your health and protect your investment in your livelihood throughout a long, successful career.


Portions of this article reprinted from Save Your Hands! The Complete Guide to Injury Prevention and Ergonomics for Manual Therapists, 2nd Edition, Copyright © 2010 Gilded Age Press, Inc. All rights reserved.

Lauriann Greene, CEAS and Richard W. Goggins, CPE, LMP are co-authors of the all-new 2nd Edition of Save Your Hands! The Complete Guide to Injury Prevention and Ergonomics for Manual Therapists, the leading textbook on self-care used in massage schools across the U.S. and Canada. Lauriann and Richard have published numerous articles in national massage and spa magazines on this subject, co-authored the first statistical study on injury among massage therapists, and offer continuing education courses, a Certified Injury Prevention Instructor program, and consulting and training to help massage therapists prevent workplace injury. For more information, please visit www.SaveYourHands.com or call 877-424-0994.

Reprinted with permission from Save Your Hands! 2nd Edition. Complete issue archives and other resources available at www.saveyourhands.com

For Effective Injury Prevention, Think Holistically

By Lauriann Greene, CEAS and Richard W. Goggins, CPE, LMP

Massage

Anyone who has done massage or bodywork for any amount of time knows how physically demanding this kind of work can be. Massage practitioners often use repetitive movements combined with hand force in their work; they may hold pressure or stay in one position for a long time, causing static loading to their tissues; fatigue may cause them to end up working in awkward postures that stress vulnerable parts of their bodies. Repetitive movements, hand force, static loading and awkward postures are all recognized risk factors for developing musculoskeletal disorders (MSDs). The therapist’s age, general health, previous injuries and other personal physical and emotional factors are additional risk factors that can increase their injury risk. Given all of these risk factors, it is not surprising to learn that recent studies have shown a high rate of symptoms and MSDs among massage therapists and other manual therapists as a result of their work. A 2006 study of massage therapists and bodyworkers showed that 77 percent had experienced pain or other musculoskeletal symptoms related to their massage work, and 41 percent were diagnosed with an MSD.1

Before you start thinking about putting your treatment table up for sale, it’s important to understand that injury is NOT inevitable. Many professions have inherent risks, and many people in these professions have successful, long-term, healthy careers. There is a great deal you can do to prevent injuries from occurring in the first place, and to minimize their effects if they do occur. The key to managing your risk of injury is to reduce your exposure to risk factors as much as possible. You can do this by modifying the risk factors you can change (like repetitive movement or awkward postures), and maintaining awareness of and developing coping strategies for those you can’t change (like your age or previous injuries).

Proven methods exist to lower the incidence of work-related injury. Many of them involve making simple but important changes to your activities, both at work and elsewhere; others will take more thought and practice to apply. But taking the necessary steps to prevent injury is much easier and less disruptive to your career than dealing with an injury once it has occurred.

Developing Your Multifaceted, Holistic Injury Prevention Strategy
It would be wonderful to find a single solution to preventing injury. But decades of research have shown that reliance on just one tactic, like improving your body mechanics or doing strengthening exercises, is rarely effective in preventing MSDs. Since multiple factors are involved in causing work-related injuries, a successful prevention strategy must be holistic and multifaceted, combining many of these tactics to address all of the potential causes.

There are five primary steps to injury prevention:
1. Maintaining awareness of the risk of injury in your work
2. Understanding how risk factors cause injury
3. Reducing risk factors through ergonomics
4. Developing good body mechanics and work practices
5. Taking care of your general physical and emotional health, including physical conditioning.

Because a massage therapist’s work is so physically demanding, workplace risk factors play a primary role in causing MSDs among these practitioners. The science of ergonomics provides proven and remarkably effective ways of addressing these risk factors to help you prevent injury.

The main goal of ergonomics is to find ways to make the work environment better fit the worker. Designing your massage space to fit your body characteristics and the type of work you do makes it possible for you to use good body mechanics. You need enough space to move freely around your table to avoid static positioning and awkward postures. Your table needs to be adjustable so you can work comfortably and efficiently as you change techniques and move from one client to another (a power-adjustable table is ideal for this purpose). Equipment like hydroculators or massage stone heaters can be raised to waist level so you can avoid bending to reach them or having to lift their heavy contents in awkward postures. Each change adds up to make your massage space a safer place to work.

Your work schedule can also benefit from some ergonomics help. To avoid injury, you need to balance periods of exertion with periods of rest and recovery. You’ll need to schedule breaks that are long enough for you to do some stretches, breathe and relax your mind and muscles. To not overload your body, you will also need to limit the number of massage sessions you do in a day and in a week. The goal is to have a consistent, manageable workload from day to day and week to week, to avoid any sudden increases in workload, a situation that can increase your injury risk.

Developing good body mechanics is an important part of any injury prevention strategy. Your goal, however, is to have “good” body mechanics, not “perfect” body mechanics. In the real work world, no one uses perfect form at every moment. The idea is to continue to use your body in a natural and efficient way, while doing your best to maintain an approach that maximizes your strength and avoids overloading the most vulnerable parts of your body. You will need to modify or eliminate any technique that causes you pain or discomfort; plainly speaking, if it hurts, don’t do it.

Massage

Your general health plays a major role in your ability to prevent injury. Maintaining good physical conditioning, getting enough sleep, eating well and avoiding unhealthy habits like smoking can have a direct effect on your ability to withstand the rigors of your work and heal tissue damage before it progresses to the point of injury.

Sometimes, despite your best efforts to avoid injury, you may find yourself developing symptoms. In real life, it is difficult to always avoid every risk factor and perfectly control your work environment to stay 100 percent symptom-free. If symptoms occur, recognizing them and getting appropriate treatment as early as possible is the best way to minimize interruption to your work and get you back on the road to health as quickly as possible.

Injury prevention is a concern you share with all massage therapists. Meet with your colleagues regularly, talk openly about your injury concerns, watch each other work and support each other’s efforts to reduce injury risk. Give your own physical and emotional needs the same care and consideration that you give to your clients. Learn to be good to yourself, and a long, healthy career will be within your grasp.

1 Lauriann Greene and Richard W. Goggins, “Musculoskeletal Symptoms and Injuries among Experienced Massage and Bodywork Professionals,” Massage & Bodywork, 2006; Dec-Jan: 48-58.


Portions of this article reprinted from Save Your Hands! The Complete Guide to Injury Prevention and Ergonomics for Manual Therapists, 2nd Edition, Copyright © 2010 Gilded Age Press, Inc. All rights reserved.

Lauriann Greene, CEAS and Richard W. Goggins, CPE, LMP are co-authors of the all-new 2nd Edition of Save Your Hands! The Complete Guide to Injury Prevention and Ergonomics for Manual Therapists, the leading textbook on self-care used in massage schools across the U.S. and Canada. Lauriann and Richard have published numerous articles in national massage and spa magazines on this subject, co-authored the first statistical study on injury among massage therapists, and offer continuing education courses, a Certified Injury Prevention Instructor program, and consulting and training to help massage therapists prevent workplace injury. For more information, please visit www.SaveYourHands.com or call 877-424-0994.

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