Self Care For the Massage Therapist
4 CE Hours
By Stacey Potter, LMT, Texas CE Provider, BS
Copyright © Stacey Potter 2011
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Learning Goals
Goal 1: The students will identify common injuries suffered by Massage Therapists.
Goal 2: The students will determine affect of stressors both emotional and physical.
Goal 3: The students will practice survival tactics to help prevent injury.
Chapter One
One study stated that 78% of massage therapists have experienced a work related injury (1). What a compelling reason to learn how to prevent injury.
Have you ever noticed how much work giving a massage can be on your body? Your heart rate elevates, your muscles contract, and your body glides through the air in calm deliberate movement as you give to your client. The gift you give isn’t just the rubbing of muscles, but it is more. You give of yourself to focus on the needs of your client. This is a noble profession as hour by hour you are giving your life to heal others.
This is hard work that might not be apparent in the beginning (or if you are under 40). Yet hour after hour that you spend giving to the client takes from you. As we work through massages our bodies began to show the fatigue and eventually injury could result.
Some common injuries massage therapists experience are as follows: Carpel Tunnel Syndrome, Guyan’s Canal Syndrome, Thoracic Outlet Syndrome, Trigger Finger, De Quervan’s Syndrome, Tennis Elbow, Rotator Cuff Syndrome, Back Pain.
Lets start with Carpel Tunnel Syndrome otherwise known as Median nerve compression and or impingement. This is when the median nerve is compressed or impinged. It can be caused by repetitive use and or sustained pressure to the heel of the hand. The symptoms include inflammation and pain in the hand and wrist with tingling and or numbness in the hand and wrist. Weakness and decreased coordination can occur in the hands and or fingers. This could result in not being able to feel part or the hand and gripping may become difficult.
Next we have Ulnar Nerve compression otherwise known as Guyan’s Canal Syndrome. This is when the ulnar nerve is irritated as it passes through the Guyan canal (which is located between the pisiform and the hamate). This is usually caused by pressure on the ulnar nerve. The symptoms of Guyan’s Canal Syndrome are pain and feeling of “pins and needles” in the ring and little finger. One may also notice decreased sensation and or weakness in the hand.
Compression and or impingement of nerves C5 to T1 also called “Thoracic Outlet Syndrome. This is when there is a compression or impingement of the brachial plexus nerves C5-T1. This can be located in the space between the first rib and the clavicle. It is often caused be repetitive motion. The symptoms may include inflammation/pain in cervical and suprascapular region that may radiate distally to the triceps, inner arm, medial forearm and the ulnar side of the hand.
Flexor tenosynovitis is also called “Trigger Finger.” This is when there is an inflammation of the sheath of the tendons that bend and extend the fingers and thumb. This is also caused by repetitive action. The symptoms include inflammation and pain in the palm directly beneath the affected finger or thumb. Movement of the trigger finger may make a painful snap.
DeQuervain’s tensynovitis (syndrome) is when there is an inflammation of the abductor and extensor tendon sheaths of the thumb and radiostyloid process. The symptoms are inflammation and pain in the thumb and radial wrist. There may also be weakness in the thumb when it is moved.
“Tennis elbow” medical alibi Lateral epicondyitis is an inflammation of the common tendinous origin of the forearm extensor muscles resulting from overuse and misuse. The symptoms include inflammation and pain on the elbow at the humeroradial joint. Pain may radiate whether at rest or when in use.
Rotator cuff tears or Rotator Cuff Syndrome is when there is a strain to of the four rotator cuff muscles (suprespinatus, infraspinatus, teres minor, and subscapularis. The symptoms include inflammation, pain, and stiffness in the shoulder. Pain may be present at work or at rest.
The last bad boy of injury we will discuss is one we know all too well because it is our enemy on a daily basis. This would be back pain. It can be a strain or spasm in the muscles of the back. The symptoms are (let me guess) inflammation and pain. The pain may radiate throughout the back and distally.
As you can see all of the above injuries have pain and inflammation as a symptom and many have numbness and tingling. We can’t work if we hurt. Unfortunately for massage therapists if we don’t work we don’t get paid. Therefore, it is of the utmost importance to figure out how not to be one of the 78% of massage therapists who get hurt.
Chapter Two
Emotional Stress
When I worked as a medic it was apparent that I would be welcomed into the most vulnerable and sacred times in a persons life. As massage therapists we are also escorted into a vulnerable place for our clients. We are asked to help relieve pain and help a person relax. Our clients may come into the therapy room with all of the stressors of their lives and if we do our job properly they leave the room with the stressors relieved for a time. We have to be very careful not to pick up that stress. So the first element of taking care of oneself as a massage therapist is balance. When we were in school we studied homeostasis in the body and how to help our clients restore that to themselves. Today we are going to look at homeostasis (balance) of ourselves. Without this balance we will bring the stressors of the day into the massage room. This negative energy rubs off on the client, therefore, we need to leave our problems and the mental to do lists of the day out of the massage room. If we are emotional that affects the client’s energy.
We need to be aware that there are stressors upon all of us. Some may have family, work, money, and other things tugging away at us. I know myself that it takes a lot of effort to relax. I don’t always succeed, but if I go into a massage with the worries of the world on my mind my client seems to tense under my trained hands. I have had to learn how to let it go. There are many different ways to make a spirit strong and I am not going to tell many of you something that you don’t already know. I just want to kindly nudge you into taking better care of yourself. Think about your spirit and what it needs to be strong. Decide what that is for you and take care of yourself before you try to give to others.
When we fly in an airplane the steward stands at the front of the plane demonstrating what to do in the case of an emergency. They say that if the cabin should lose pressure and you are traveling with a child, put the mask on yourself before putting it on the child because if you should pass out then there is no hope for the child or you. Please my friend put the mask on before trying to help another.
This may mean watching that movie, eating that chocolate, taking that run, or meditation. Whatever keeps your emotional homeostasis is what you need to do. When you find yourself with nothing left to give, go and receive. We are giving people and that is why we are massage therapist. Please learn to take the time to fill your spirit before you try to give to your clients.
Physical Stress
That being said, let’s take a look at the physical stressors of our profession. We stand, we push, we pull, we lift, and we work very hard for hours on end. Don’t you just love it when the fifth client of the day says they like deep pressure and you are thinking so did the last four. I used to work on college level football players who at least doubled my weight and they all wanted extra long massages with a lot of pressure. It was known that I could deliver the deep pressure and so I kept busy all of the time. I believe in hard work but I needed to learn how to work a bit smarter or my body wouldn’t withstand the demands of the day.
That is when I began my intensive study into these repetitive strain injuries like Carpal Tunnel Syndrome, Guyan’s Canal Syndrome, Thoracic Outlet Syndrome, Trigger Finger, De Quervain’s Syndrome, Tennis Elbow, Rotator Cuff Syndrome and other injuries seen in massage therapists. Repetitive strain injuries develop because the repeated motion impedes blood flow to the tissues thus inhibiting oxygen exchange between the blood and muscle cells (2). This lack of oxygen then causes pain, inflammation, and weakening of the muscles and tissues. So it starts with repeated motion that causes lack of oxygen and then causes pain.
At this point it is important to point out that there are physiological illnesses that make these injuries more likely. Some of these diseases are diabetes, hypothyroidism, gout, pregnancy, breastfeeding, menstruation, oral contraceptives, arthritis, previous trauma to the area, body weight, drug and tobacco use, anemia, and others (3). If you have one of these underlying variables it is important to seek the correct treatment for your needs by consulting a physician.
Some of the stressors that cause injuries for massage therapists are improper body mechanics, overwork of the muscles, and lack of conditioning in the muscles.
One massage place I worked at scheduled massages every hour for the therapist. We had to clean the room, get our client, look at the intake form, interview the client, give 50 minutes of massage, and get the client out in 60 minutes. Then the next hour we would have another. We worked literally back-to-back 4 to 6 hours without a break. This pace is hard on a body. After the first few days of it I wondered what I was thinking getting into massage. I looked for help from the ‘old timers’ and they gave me a lot of techniques to deal with the strain on the body.
Chapter Three
Survival Tactic #1
One technique is to know thyself. Learn how much was enough massage to give. My limit is three hours then I need a break.
Awareness of the body’s movements, responses, sensations and feelings is vital. Within the framework of the massage I would think about what my body was doing. Am I overusing my thumbs? During massage therapy school the MTI threatened several times that she was going to tie my thumbs to my hand and make me give a massage. I know this is an area I overuse. Do you have an area you overuse? I would also ask myself; am I using my body weight to add the pressure to the client or am I muscling through? I ask these questions as I work. This keeps me thinking about what I am doing to my body.
I will sometimes use a self-awareness exercise like starting at the top of my head and thinking about every part of my body to my toes. This has helped me feel where I may have an injury starting. I have a very high pain tolerance so I have to think about if I am hurting. Becoming aware of my body has helped me troubleshoot the beginning of injuries.
Some questions I ask are as follows. What is the quality of breathing? Is it shallow or deep? Is my head tilted to one side? Are my shoulders relaxed, or are they held up, down, forward, or backward? Is my back in a neutral position? Are my knees bent?
Most importantly it is vital to ask if I am hurting, tingling, or uncomfortable in any way.
Take 10 minutes as you give a massage to start at the top of your head and think about your body as you work. When you are done, chart the areas of concern. List possible alternatives to overusing that area.
Survival Tactic #2: Body Mechanics Outside Factors.
Another survival tactic for a busy therapist is to make sure our body mechanics are the best they can be. Body mechanics includes inside and outside factors.
One of the outside factors is the massage table. The best table is one that can be adjusted easily. When a therapist works on a table that is too high or too low it adversely affects the body mechanics.
Selecting a table is a complicated process. First, the decision of portable table or stationary table needs to be determined. If the therapist can afford it, the best table is an adjustable electric table. This way, as the massage continues, adjustments can be made without interrupting the client’s relaxation. Some things to look at when purchasing a table include quality, strength, stability, and comfort.
When looking at the quality of a table, the wood, braces, cables, screws, padding, leg extensions and face rest are all important. These items need to work together in concert to support each other and our clients (4). In also helps to look at the manufacturer to see if there are any warranties on the table.
It is important that the table have strength and stability. The table needs to support the client and the therapist’s weight. I have stopped massage sessions when the table began to creak and groan and didn’t feel stable. Stability is important because if the tabletop is too flexible the therapist must press harder to make up for the resistance. This reminds me of my medic days when we did CPR. We never tried to perform it on a bed because the patient would just sink into the bed and it wouldn’t work. Your table needs to be firm enough to get the work done yet soft enough to be comfortable. This is a difficult balance to find. One of the most important elements of table selection is to for you to experience your own table. This will give you insight to what the client is experiencing. Is the table strong, stable, and comfortable? Does it have enough room for your arms in the prone position? Is it wide enough for the larger clients? Is the face cradle comfortable? Is there enough padding?
Table height should be set so the therapist uses body weight rather than muscular effort. If the table is too high, the therapist will feel it in the upper back. If the table is too low, the therapist will feel it in the lower back. Table height will be decided by the work being done. The deeper (more pressure) work will require a lower table. One way to determine the correct height of the table is to stand beside the table with hands hanging at your side. For normal massage it should be at the knuckles. For deeper work it should go lower. It used to be interesting to watch the football players’ faces when they saw my table. There would be comments about the table being short for a midget. When I explained to them that I needed it low to get deep work done they would often offer to lower it more.
It is also important for other equipment in the room to be ergonomically correct. The chairs or stools need to be stable, mobile, and comfortable. The space in the room needs to be adequate. Lighting should be bright enough for you to see what you are doing. It is not relaxing for a client to have the therapist stumbling around the room.
You need to be comfortable as well as your client. Therefore, it is important to be aware of clothing. Is it restrictive? Are your shoes comfortable? Is your hair out of the way? Are your nails trimmed appropriately? These are all factors that relate to outside body mechanics.
Survival Tactic #3 Body Mechanics Inside Factors
Now to address some of the factors related to inside body mechanics that will help keep away from repetitive stress injuries.
Let’s face it; what we do is physical exercise. It is important that we remember this as we enter into the massage arena.
Warm Up. Beginning the first session with cold muscles and joints will increase the chances of strain and possible injury (5). So practicing a warming up routine is important. This may include stretching, and range of motion exercises to mobilize the joints. This helps to prevent injury. Remember to move everything around, systematically working the way through the entire body as range of motion is increased. How you choose to do your warm up is for you to decide.
Rest. Studies have shown that rest breaks increase overall performance (6). Fatigue may lead to serious injury (7). This may mean stopping in the middle of the day and taking a few minutes just to relax and breathe. It is also important while giving massage to use a variety of strokes. This helps reduce the repetitive stress.
Drink. About 75% of our body is water. It is important to drink enough to refuel your body. Water helps in digestion; regulates body temperature; helps with circulation; and carries nutrients and oxygen to cells; removes waste and toxins from cells. The big question is how much water should a person drink a day. There are many variables in this. I would recommend the following link for you to take the quiz and determine your own water intake. http://nutrition.about.com/library/blwatercalculator.htm
Breathe. Believe it or not, most people don’t know how to breathe. Proper breathing will improve mental and physical health as well as stamina (8). Healthy breathing develops proper body mechanics to prevent injury. To breathe correctly we must be mindful of our breathing. Effective breathing is deep utilizing as much lung capacity as possible. Inhale deeply using the diaphragm as the stomach comes out. Then exhale completely pushing all of the air out. This allows the body to completely oxygenate and lets the stress melt away.
Summary
In the previous chapters three goals have been presented.
Goal 1: We have identified some of the common injuries massage therapists experience.
Carpel Tunnel Syndrome
Guyan’s Canal Syndrome
Thoracic Outlet Syndrome
Trigger Finger
De Quervan’s Syndrome
Tennis Elbow
Rotator Cuff Syndrome
Back Pain.
Goal 2: We have determined the affect of stressors both emotional and physical.
Emotional Stress-take care of your needs to help take care of others’ needs.
Physical Stress-the physical stressors that cause injuries for massage therapists are improper body mechanics, overwork of the muscles, and lack of conditioning in the muscles.
Goal 3: We have practiced survival tactics to help prevent injury.
Know thyself. Practice during a massage.
Body mechanics includes outside factors.
Table
Chairs and Stools
Space to work
Comfortable clothes, shoes, proper grooming (hair and nails).
Body mechanics includes inside factors.
Warm Up
Rest
Drink
Breathe
You have completed the reading portion of this course. Now log on and take your test.
Footnotes
(1) Watson D. A Report into the Demographic Incidence of Wrist and Finger Damage to Bodywork Practitioners. ShiZen Publications 2000.
(2) Jameson, Timothy J., D. C. Repetitive Strain Injuries Keats Publishing 1998.
(3) Jameson, Timothy J. D.C. Repetitive Strain Injuries, Keats Publishing 1998.
(4) Frye, Barbara. Body Mechanics for Manuel Therapists A functional approach to self-care. Fryetag Publishing 2004.
(5)Exercise – Injury Prevention. Australian Physiotherapy Association. 14 April 2003. www.betterhealth.vic.gov.au. 28 August 2003.
(6) Taylor, Kevin. An Overview of the Research on RSI and the Effectiveness of Breaks. www.workplace.com. Niche Software Ltd. 2003. 15 August 2003.
(7) Rohmert, V. Problems of Determination of Rest Allowance. Part 1 & 2 Applied Ergonomics, Vol. 2,3,4 1973.
(8) Organic Lifestyle Magazine. How To Breathe. August-September 2010, Issue 14, Natural Remedies. http://www.organiclifestylemagazine.com/issue-15/how-to-breathe.php
Self Care For Massage Therapist Test
1. According to the article, what percentage of therapists suffer an injury?
a. 52%
b. 96%
c. 78%
d. 33%
2. Carpel Tunnel Syndrome is also called:
a. Ulnar nerve compression
b. Median nerve compression
c. Radial nerve inflammation
d. Tingling in the fingers
3. The symptoms of Carpel Tunnel Syndrome include:
a. Pain in the hand and wrist with tingling and or numbness in the hand and wrist.
b. Pain in the ulnar nerve.
c. A feeling of ‘pins and needles’ in the ring and little finger.
d. Pain in the cervical region.
4. “Guyans Tunnel Syndrome” affects the;
a. Brachial plexus nerves.
b. Nerve between the pisiform and the hamate.
c. Forearm and extensor muscles.
d. Supraspinatus muscles.
5. Compression or impingement of nerves C1 to T5 is called
a. Trigger Finger.
b. Guyan’s Canal Syndrome.
c. Rotator Cuff Syndrome.
d. Thoraciac Outlet Syndrome.
6. Flexor Tenosynovitis is also called:
a. Trigger Finger.
b. Guyan’s Canal Syndrome.
c. Rotator Cuff Syndrome.
d. Thoraciac Outlet Syndrome.
7. Rotator Cuff Syndrome’s symptoms include:
a. Pain in the hand and wrist with tingling and or numbness in the hand and wrist.
b. Pain and stiffness in the shoulder.
c. A feeling of ‘pins and needles’ in the ring and little finger.
d. Pain in the cervical region.
8. Three of the injuries that reside in the hand are:
a. Carpel tunnel syndrome, thoracic outlet syndrome, guyan tunnel syndrome.
b. Guyan tunnel syndrome, ulnar nerve compression, dequervan’s tenosynovitis.
c. Lateral epiconditis, ulnar nerve compression, carpel tunnel syndrome.
d. Guyan tunnel syndrome, ulnar nerve compression, carpel tunnel syndrome.
9. An impingement of the Brachial Plexus Syndrome is also called;
a. Ulnar nerve compression.
b. Guyan tunnel syndrome.
c. Thoracic outlet syndrome.
d. Tennis elbow
10. The symptoms of rotator cuff injury include
a. Inflammation, pain, tingling, and loss of grip.
b. Inflammation, pain, and stiffness in the shoulder.
c. Radiating pain at rest or in use.
d. Numbness and tingling in hand.
11. How does a massage therapist’s emotional well-being affect a client?
a. A client isn’t affected in any way to the emotions the massage therapist.
b. If we are emotional that affects the clients well being.
c. A professional therapist will use the client to help work through emotional stress.
d. None of the above.
12. What is the first element of taking care of oneself (emotionally) as a massage therapist?
a. When the therapist uses the energy from anger to get depth of massage for your clients.
b. When the therapist mentally does a shopping list while working on a client.
c. When the therapist learns how to balance emotional stressors to keep them out of the massage room.
d. When the therapist talks through their problems with the client.
13. Why is it important to take care of our emotional well-being before working on a client?
a. Without a emotional well-being we cannot help others relax well.
b. It is healthy to use emotional stress to work on the client.
c. We can give to others emotionally when we are stressed.
d. All of the above.
14. Why is it important to think about physical limitations while working?
a. It is important to know limitations when working on a client.
b. It is important to remember that we have to push ourselves physically for the well-being of the client.
c. It is important to use all of our strength to get the deep pressure for the client.
d. It is important to ignore pain and work through it.
15. If a massage therapist has a physical limitation, it is important to:
a. Know your disability and seek compensation from the government.
b. Seek medical assistance in knowing your limitations and needs.
c. Work through the pain so it will go away.
d. All of the above.
16. It is important to know your limitations as a massage therapist because;
a. When you know your body, you can avoid injury.
b. You can push past the pain and continue to work well.
c. It isn’t important to know your limitations.
d. You don’t have to work if you can get government help.
17. What is a self-awareness exercise?
a. A self-awareness exercise is when you can recognize your need for food.
b. A self-awareness exercise is when a personal inventory of the body from head to toe as you work.
c. A self-awareness exercise is done in deep meditation.
d. A self-awareness exercise is when you know what you believe.
18. Why is it important to have good body mechanics?
a. Body mechanics helps the therapist avoid injuries by practicing good techniques.
b. Body mechanics have no affect on the body
c. All of the above.
d. None of the above.
19. What are some of the outside factors for body mechanics?
a. The massage table adjustment, massage room, chairs and stools in the massage room.
b. The parking space, waiting room, and break room.
c. time off, recreation, and rest time.
d. None of the above.
20. Why is it important to warm up before giving a massage?
a. working with warm muscles can cause injury.
b. working with cold muscles can cause injury.
c. working with warm muscles will make the therapist tired.
d. None of the above.
Thank you for completing the continuing education course for Massage Therapist Self Care.