4 Common Issues Massage Therapists Deal With

by Apr 26, 2020Injury Prevention, Massage Injuries, Self Care0 comments

Let’s dive into the 4 common issues and injuries therapist’s deal with throughout their career and some ways that you can effectively treat them.

Why have you selected this article? 

Is it because you have lower back or neck pain that just drives you insane when you are in session?

I think we all have been there: 

There is always some nagging or underlying issues that bodyworkers deal with in their own body.

Is it something that just comes with the territory or is it something we can prevent?

In this article you will explore self care techniques for common areas like low back, neck, shoulders and wrists, that will keep you in the game for longer and have you feeling much better at the same time! 

After all. . . I can’t make recommendations for my clients on how to better their own self care if I am not doing it myself, right?

You never want to wait for an injury to happen, so it’s best to take preventitive measures to ensure that these issues don’t arise in the first place!

Lets jump right into the first issue, and I would venture to say . . . one of the most common areas of pain we face in our body as therapists. . . 

#1 Lower back pain

 

You may agree, and you probably experience lower back stiffness when you stand and work for long periods of time. 

For therapists this is a big issue:  There is much axial load on our spine when we are standing for long periods of time. 

One session won’t affect you much, but when you multiply that by hours of work in one day X days in the week you work X the years you’ve been in practice. . . 

 That’s A LOT of standing!

 Over time, bodyworkers may develop:

  • SI Joint issues 
  • L4/L5 disc ruptures 
  • Bulging discs

These are just common issues, obviously other things can happen as well, and if you tend to have a slouching (kyphotic) posture, this can worsen your issue! 

How do we help treat these issues and continue to work without pain and stiffness by the end of the day? 

 Keep reading on!

Don’t Be Afraid To Sit Down

 What? Did he just say sit down? Isn’t that the reason why some of our clients low backs hurt?

 Yes. For them. 

 But for us, prolonged standing can have similar but different effects. 

I believe highly in the 60/40 rule:

Stand 60% of your session. 

Sit. . . you guessed it. . . 40%  of your session.

If you are going through more severe pain now, I invite you to sit more than that.

It also matters how you use your stool, I use the seated power stance, for more effective deeper work. 

So let’s break it down. 

If you have a 60 minute treatment:

  •  Stand for 35 minutes
  •  Sit for 25 minutes

Yes, this seems like a lot.

But look at the bigger picture. If you have 6, hour treatments in one day, that’s over 2 hours that you are not standing and 2 hours towards your back not hurting! 

This is exactly what I did to nurse a bulging disc that I was working through, and it will work for you too! 

Low Back Stretches

This is a really good series of stretches that I did and continue to do 3-4 times a week to relieve my low back pain, while still working 6-8 hours a day! I like to spend 2-3 minutes on each stretch.

Cat and Camel

 

Before getting into the main series of low back and hip stretches, I first like to use the Cat and Camel to warm-up the spine a bit just to get a bit more blood flow.

McKenzie Pressup

The great Robin Mckenzie created and perfected this stretch/exercise. It is a really good one if you have a posterior bulging disk (like I had).

Start with hands prone a little outside of shoulder width.

Work up just to where you have beginning of slight pain and back down. 

Repeat through the range of motion and try to work your spine and erectors up higher every time you do it! 

Contraindication: if you have an anterior bulging disc, this may not be a good idea, as it can make it worse.

 

Pigeon Pose

This is my bread and butter glute stretch.

One of the overall effects of standing for long periods of time is the over activity of the glute max, and if your toes are pointed either in or out, lateral and medial hip rotators too. 

 Doing this as is will be really effective, but you can hit different corners of the glute and hip while in pigeon pose by:

        Going into trunk rotation

        Slight lateral flexion of spine

        Combination of both movements

 

 

Psoas Chair/Couch Stretch

You may be mad at me after this one, but nonetheless, it is very effective!

Now that you are sitting a bit more, psoas stretches will ensure that your hip flexors are more relaxed.

For this one, it is a standard hip flexor stretch, with the stretched leg back on your couch or chair seat, but for the psoad piece, you will turn to the opposite side to stretch it.

You should feel this deep in the muscle belly!

Lower back manual release

 

 

Lateral Gluteosacral Release

This great for stiffness right around the sacrum. 

It can get a bit iffy when we are talking about working right on the sacrum, which can be done. . . 

But for this technique we will be using a ball and roll just lateral to the sacrum at the beginning of its glute attachment. 

 

 

Pick a few tender points and apply an up and down friction for a few minutes until it releases.

 

QL Release

Again, we are using the ball to affect the QL, just proximal to Illiac Crest.

Start with light resistance on the ball on spinal erectors and roll laterally until you reach QL.

It will help you to access this muscle by anteriorly tilting your pelvis – it is deep within the thoracolumbar fascia and transverse abdominals.

QL will be tender for most, so you will definitely know when you get there.

#2 Neck pain

I use to stare down at my work a lot, I just wanted to make sure that I wasn’t running over any bony landmarks! 

This is a tendency, as a massage therapist – just like the above lower back issues – that can have negative long term effects on your neck and posture:

   Bulging posterior cervical discs

→   Tight and spasmed cervical neck muscles

→   Headaches

 Do you know how much your head weighs? 

 10-11lbs, I kid you not. 

Now take a bowling ball (10lbs) and glue a stick in one of the holes.

Yep! This simulates your spine and head.

If you hold the stick in your hand and lower it down with your forearm, it gets heavier about every inch that it drops from the starting point. By the time it is at its heaviest, it may feel about 40lbs!

This is what happens to your neck when it is bent. Millenials feel this all too much with all the use of their cell phones. 

So how do we relieve these neck issues? 

Start by fixating on a point above eye level.

Your head will follow suit, just make sure you are not actually tilting your head back to look at your chosen point. 

Just use your eyes.

This is a proper position that will ensure that your head and neck’s relationship is neutral. 

neck stretches

 

Yes Stretch

This stretch is most effectively done by tilting your whole torso to the side you want to stretch, as to get into a deeper stretch.

It will stretch that all too tight and contracted SCM muscle, and all posterior cervical muscles (trap mainly) 

Drop your neck to the side and start by put your neck in flexion, then extension. 

This one feels great!

no stretch

Same setup as the yes portion but for this we are putting the neck in unilateral flexion (side-to-side motion)

This will stretch the SCM, scalene, trap and levator scap.

Neck manual release

The release technique will:

 →    Release tight SCM

 →    Help with cervical posture

 →    Break adherence to scalenes 

 →    Help with headaches/migraines

 →    Help with breathing

Most of us know the role SCM plays in neck movement.

Being that it’s job is to put our neck into flexion and opposite side lateral flexion.

That is the exact position we are putting our neck into when we look down at our work. 

Start this release technique by lying supine on the ground.

Prop your head up with a good sized pillow.

This last piece is important because we are taking the slack out of the muscle we are working. 

You want your head about 4-5 inches off the floor.

Depending on what side you want to start with, look toward the opposite side (look right to work left SCM) 

This will ensure that the muscle stays relaxed while working. 

There are two ways to do this effectively:

    One handed technique

    Two handed technique 

 

one handed technique

With the one handed version we will be: 

 →    Grasping medial edge of SCM with the thumb 

 →    Grasping other 4 fingers on lateral edge of muscle

If you are having trouble locating SCM. . . 

Don’t dig deeper

The carotid artery, jugular vein and other structures are deep to the SCM. If you are feeling light headed or going to pass out, that’s not where we want to be! 

(anatomy of neck pic)

To locate SCM put neck into flexion while laterally flexing SCM

You will immediately feel it pop up. 

You have it grasped now. To release just stay on the muscle for as long as needed while gently moving head back and forth. Breath deep and think about it melting in your fingertips. 

two handed technique

Sometimes the one handed version can feel poky, instead use the two handed version. 

Same positional setup as the first, but we are using 4 fingers of both hands to palpate the muscles. 

For the next issue, keep reading on!

#3 shoulder joint pain

 

This may not be an issue every bodyworker will deal with, but it definitely can happen. 

Some typical shoulder issues we deal with: 

    Shoulder tendonitis 

    Thoracic outlet 

    Shoulder impingement

    Inflamed pec major/minor

    General upper back tightness

It also doesn’t help that the shoulder joint and capsule is so complex! 

After all. . . it is responsible for 6+ movements. . . 

The muscles pec major, anterior deltoid and serratus are the main stabilizers in all of the pushing techniques that we use in practice.

So it is common for them to stay contracted and develop overuse issues, as we commonly push more then we pull.

This constant pushing also places a lot of torque on the shoulder and creates dis-traction in the joint capsule. 

These two things together are good for short term, but they can create long-term effects.

You may be connecting the dots already: 

Yes, there is a power struggle between front and back of the body:

  • Pecs and delts are become stronger
  • Traps, rhomboids and lats become weaker in response

Much like the issues that office workers we work on have, but for different reasons.

I really believe that you must loosen the tension on the front of the body. . 

And strengthen the muscles of the back. If you would like a plan for strengthening your body to prevent injuries like these, check out the MT Hybrid Athlete Program course and program as well as the exercise index for in depth tutorials on exercises specifically tailored to MTs!

For now, I will talk to you about some stretches and different ways to manually release the pecs, traps, subscap and serratus!

Shoulder joint stretches

foam roller pec stretch

I like this one the best for stretching the pec major. 

Often times I see a lot of therapists and people go to town on the “doorway” stretch for pecs, and while it feels good, it may be adding to the overuse and torque in your shoulder. 

I like the use of the foam roller because you use gravity as your weapon: 

    This will not force the pecs into submission, making it a more effective    stretch.

    Longer time spent in stretch will promote parasympathetic response.

Just breath into the stretch and imagine your arms falling to the floor. 

You can change the area of the pec that you are stretching by simply moving your arms up or down. 

Behind the back trap stretch

“Why are you telling us to stretch the trap when you are saying the problem is in the front?” you ask. 

Well. . . just like you want to work on your clients symptom areas, you want to stretch yours as well.

I believe, with problem areas, your body has an interesting defense mechanism that tries to create tension by forming knots in the symptom area. (i.e. the traps and rhomboids, when the pecs are tight) 

This in turn tries to set the scapula back by to where they were before. 

I think this process is automatic when we have tension. 

Just look at other self regulating autonomic systems of the body . . . 

    Respiratory 

→    Peristalsis

→    Adrenals  

This is just what your body wants to do when there is external forces “attacking” it. 

I love this stretch in particular. 

You are not only targeting the trap, but the levator scap, and the anterior deltoid! 

To do this:

  1.   Place the arm of the side you are stretching behind the back. 
  2.   Take  other hand and place on opposite temple.
  3.   Pull head to opposite side (to right, if you are stretching left side)
  4.   Try and touch chin to opposite clavicle

Anterior deltoid stretch

The anterior delt is another muscle that gets pretty banged up and overworked being a massage therapist.

For this stretch, a surface that is about chest height will work best. 

Start with your hand on the surface you are using in supine.

From there start to turn your body away from your hand and keep the arm in flexion. 

You will instantly feel the stretch. 

You can make the stretch more intense by simple squatting down.

Shoulder joint manual release

 

Pec release

For this we will be positioning our bodies on the edge of a wall with space to move the arm freely.

Use any type of ball. 

I like to try and find a few areas that are tight and spend a few minutes on each. 

Once an area is found, move arm from abduction to contract pec and adduction around to the back of the body to put the pec into a stretched position.

 

Trap/rhomboid release

This one can be standing or lying supine on the ground. 

Start with the arm of the side you are working on behind the back. (If you shoulder impingement, just have arm in normal anatomical position.)

Use a ball and spend a few minutes on each trigger point, knot or tight area. 

Multi-directional friction can be used for a more intense experience!

If you have made it this far, you have made it to the very last common issue that therapists deal with! 

Keep reading on. . . 

#4 Hand and wrist pain

Here we go again. . . 

Virtual raise of hands. How many of you have suffered hand or wrist issues while being a therapist? 

I should see a lot of hands. 

I think the biggest cause of this is improper body mechanics when dealing with wrist position. 

And second, just overuse in general. 

I see a lot of therapists with their wrists severely  hyperextended which is a big no-no! Neutral wrist/hand position is highly underutilized in our field. 

To see my what I mean by this, read part of my body mechanics article on wrist/hand placement

What can happen over time with improper use of hands, wrists, thumbs and fingers:

    Wrist tendonitis/overuse

    Carpal tunnel

    Thumb tendonitis/overuse

    Tarsal arthritis 

    Chronically tight forearms

    Tennis elbow

This seems like a lot, but I have seen it all in therapists I’ve trained and worked with. 

A little hyperextension isn’t necessarily a bad thing, but I’d like to see  more therapists using a soft fist or forearm for better wrist position. 

This will help immensely, because you will keep the wrist in proper alignment.

When there is a straight line of force, and not a broken line at the wrist like when we hyperextend, there will be a better transfer of force.

Let’s read on to see how we can fix these issues and keep our wrists and hands healthy. 

Wrist and hand stretches

bipedal hand/wrist stretch

I love, love, love this one. 

For the bipedal stretch, we are just starting out on our knees and hands. 

To stretch the wrist flexor group, keep your hands in prone position right below your shoulder in a straight line and simply lean forward. 

To make this stretch more intense, turn your palms and fingers in towards your body and lean forward. 

For the wrist extensor group, have your hands in supine,resting on the ground, palms up and fingers toward the body and lean back away from your hands.

 

Manual release methods

You can effectively release the forearms musculature with your fingertips or even elbows but I prefer the tacked pin and stretch, especially for extensors.

It will really lengthen those tight and contracted fibers.

The use of a ball is the most practical in this situation.

Find a tight area, put pressure on the ball and put the wrist and hand through its full range of motion. Use transverse friction to make this even more intense!

Use on flexors and extensors

summing it all up

 

I really hope these techniques will help you overcome any issues you are having right now. 

Additionally, like I stated above, I think it is a really good idea to do preventative work to try and heed these issues before they even start. 

If you don’t have any of these issues, it can be a good idea to start them anyway just to keep yourself in check and make sure your body and tissues are healthy for your job. 

At the moment, I don’t have any pain and I reckon that it is from doing these stretches and release techniques day in and day out, about 3-4 times a week. 

Let’s quickly go over what was talked about in this article: 

  • Lower Back Pain: Sitting is not the devil, and if you have low back pain try the Pigeon Stretch to release tight glutes. 
  • Neck Pain: Your head weighs about 10lbs, so the SCM release technique is very good if you tend to constantly look down at your work.  

 

  • Shoulder Joint Pain: Being a MT, here will always be a power struggle between the front and the back of the body, it is good to make sure you are giving as much love to the front as you are to the back of body. 

 

  • Wrist/Hand Pain: Strokes using soft fist and forearm use will be more effective than hyperextended wrists. If you are experiencing pain, the tacked pin and stretch will have you feeling better.

It doesn’t matter whether you’ve been a therapist for years or you’re just starting out, you don’t want to wait for an injury to happen, you want to take the bull by the horns and make sure that your body is bulletproof when things try to come your way.

This is what Successful Bodyworker is all about and we will make darn sure that you that you are undeniably confident about being injury free!

Therapist Challenge

If you experiencing any of the above pain areas or nagging tension, try these techniques for one month and comment below how they’ve helped you!

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About Me

My name is Zack Mayfield and I am in the constant pursuit to help each and every therapist achieve strength, better self-care and longevity in their career!

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