Massage therapy is an incredible profession. It is a great way to help people on many different levels, from stress reduction to addressing various medical conditions. One of the positive aspects of massage therapy is its democratic approach to styles and methods.
There are, however, two subjects in massage therapy where free choice is not applicable and the practitioner needs to obey established scientific recommendations. The first is Trigger Point Therapy, and the second is correct Body Mechanics during the application of various massage techniques.
Why are these two topics of such capital importance? Unscientific application of Trigger Point Therapy is the one of rare instances in massage therapy where the practitioner can, and frequently does, harm the patient. We discuss this issue separately in the previous issues of Journal of Massage Science and in the Video Library of MEDICAL MASSAGE PROTOCOLs.
Inversely incorrect body mechanics is an equally important subject because it can physically harm the practitioner, greatly restrict his or her technical potential, and prevent him or her from building and sustaining a long term successful practice.
Body mechanics, as it relates to massage therapy, can be divided into three aspects: Balance, Stability, and Leverage.
Balance is an even distribution of weight enabling someone or something to remain upright and steady.
Stability is the state of an object or structure being not likely to give way, to remain firmly fixed.
Leverage is the exertion of force by means of a lever, or an object used in the manner of a lever. In correct body mechanics, we combine balance and stability in order to be able to apply leverage.
While lecturing, we have noticed the majority of massage practitioners are not aware of the importance of correct body mechanics, and frequently, have been taught to use it inappropriately. We realize that what you read below may contradict the way you are working with clients, in some cases for many successful years. However, we ask you to try out the information we share with you here. We guarantee it will change your practice forever.
This video shows the common way practitioners position themselves while working on the client, using superficial effleurage strokes along the lower extremity as an example. What is wrong with working this way? The answer is – everything. Not one single aspect is conducted correctly. Everything the practitioner does goes against the science of body mechanics. She strains and exhausts herself, restricts her technical potential, and damages her body, while accomplishing very little for her client. Let’s itemize the errors:
1. The table is too high for the practitioner
2. The practitioner does not have contact with the table, and her feet are in one line
3. The center of gravity is located behind the practitioner
4. The practitioner keeps her hands far from her body
5. The practitioner does not use the weight of her upper body as a structural component of the strokes
This combination of errors prevents the practitioner from achieving and maintaining balance and stability, making it difficult, if not impossible for her to apply any significant leverage during the strokes. Now we will look at each of these errors separately.
HEIGHT OF THE TABLE
Correct table height is a critical factor in minimizing body stress, and in conducting the strokes efficiently during the massage. Tables with electric power height adjustment are great, but they are also quite expensive.
This video demonstrates the most common test for determining the appropriate table height for the practitioner. He or she should stand very close to the table and place the fist on the tabletop, with the upper extremity straight in all joints. The practitioner should not lean forward. The fist has to slightly touch the tabletop. This is a very simple, valuable and commonly used test.
However, practitioners frequently use the outcome of this test incorrectly (see Fig 1). Let us assume the practitioner used the test to establish the correct table height. Then, he or she gets into the most commonly used body position: knees slightly bent and no body contact with the table. The table is now too high, putting additional strain on the practitioner’s body, especially during the application of strokes with stronger pressure. The fact the practitioner bends the knees immediately makes the table too high.
Fig. 1. The table height and body position
a – incorrect body position which makes the table to high
Notice: there is no contact with the table
b – correct body position
Notice: the practitioner’s forward thigh contacts the table
THE PRACTITIONER DOES NOT HAVE CONTACT WITH THE TABLE AND HER FEET ARE IN ONE LINE
Maintaining a distance between the table and the body (i.e. upper thigh and leg) is the common way massage sessions are conducted. The explanation from proponents of this recommendation is: the practitioner should avoid contact with the table for fear of “invading the clients personal space” or “getting too close”. From our point of view this doesn’t make any sense. In questioning several instructors at length about this recommendation, it seems the main concern lies in keeping the practitioner’s pelvis area away from the table to prevent the client from “misinterpreting the practitioners intention”. We believe this is a groundless fear that is easily addressed with proper draping and, above all, a professional demeanor. This professional recommendation jeopardizes the practitioner’s health and practice.
The table is the practitioner’s greatest ally, and he or she should use it in any way possible, instead of avoiding contact with it. Why is contact with the table so important? Let’s look at the basics of body mechanics from the perspective of the practitioner.
We think everyone agrees with the basic statement that a tripod is more stable than a structure with only two points of support. However, when walking or standing we rely on two points of support. This is why we need a very complex interaction of several anatomical and physiological components to maintain our balance.
Only humans are able to move about in an upright position. This unique ability is the result of constant interaction of the vestibular apparatus in the ear and the musculoskeletal system, specifically, the lower back muscles and gluteal muscles.
Understanding and correctly exploiting these muscles is professionally important for all practitioners. As an example, animals that walk on all four legs do not have quadratus lumborum muscles in the lower back, and their gluteal muscles don’t need to completely lock the opposite hip joint with every step.
If the practitioner relies only on the two-point system of support, while physically working for hours, he or she will exhaust the lower back and gluteal muscles and consequently build up excessive tension in these muscles. As a result, vertical pressure starts to be distributed unequally between the intervertebral discs, as well as within those discs sustaining the greatest pressure. Wear and tear on the stressed discs becomes unavoidable. This is why lower back pain and tension, as well as disc abnormalities are the very common professional hazards for the massage practitioner. How can body mechanics help the practitioner avoid these problems? Keep constant contact with the table, and never arrange the feet in one line while conducting the strokes.
The first part of the video shows the practitioner positioned incorrectly next to the table, keeping a distance between her forward thigh and the edge of the table. The second part shows the application of the same effleurage strokes with the practitioner’s thigh in contact with the table. The final part shows another example of correct body mechanics using the application of kneading techniques. The small white arrow indicates the space between the practitioner and the table, while the large white arrows indicate where the practitioner’s body is in contact with the table during the kneading techniques.
By maintaining constant contact with the table using any part of the thigh or knee, the practitioner transfers his, or her, weight from two points of support to three. Sometimes the contact area can be very small (e.g., a bent knee against a leg of the table), but it makes a huge difference for the practitioner because three points provide substantially greater balance and stability.
The other advantage of body contact with the table is that the practitioner now has the freedom to engage the weight of his or her upper body to apply greater leverage during the execution of the strokes. We will discuss this issue in detail below.
The second point to remember is that the practitioner should not keep the feet in one line. This will make the practitioner less stable during the application of any massage technique.
The video above shows a small experiment. In the first part, the practitioner’s feet are arranged in one line while working on the client, and as you can see, even a small push on the chest causes her to lose her balance. In the second part, the practitioner’s feet are arranged correctly. Her feet are slightly spread apart, with one foot behind the other (right foot in the video). You can see she is much more stable when the same push to her chest is applied.
This video above demonstrates incorrect and correct feet arrangement during the application of kneading strokes on the lower leg. Also, notice that the practitioner’s left thigh is in contact with the table.
Therefore, when the practitioner uses table support and correct foot positioning, his or her body essentially becomes a tripod. As a result, the lower back muscles and the gluteal group do not need to constantly fight gravity to stabilize the body during the massage strokes. These muscles cease working in an isometric mode (i.e., constant tension) and switch to the more favorable isotonic mode (i.e., contraction-relaxation).
It is very unhealthy for skeletal muscles to constantly work in an isometric regime because a lesser amount of oxygenated blood flows into the working muscles. In contrast, the contraction-relaxation of muscles in the isotonic regime provides the muscles with optimal oxygenation.
THE CENTER OF GRAVITY IS LOCATED BEHIND THE PRACTITIONER
The human body has its center of gravity uniquely located in each of us. Generally speaking, the center of gravity in the standing human is at the level of the upper pelvis when we define its location along the vertical axis of the body (see Fig 2).
The location of the center of gravity is also defined by the horizontal axis. Along the horizontal axis, the center of gravity in the standing human with average weight is located slightly posterior to the point of intersection between the vertical and horizontal axes, because soft tissue mass on the posterior aspect of the body are heavier as compared to the anterior aspect (see Fig 2a).
Fig. 2. Center of gravity and body types
a – center of the gravity in the balanced body
b – center of the gravity in the body with extra weight in the abdominal area
c – center of the gravity in the body with extra weight in the gluteal area
Blue line – vertical axis of the body
Red line – horizontal axis of the body
Green circle – center of the gravity
However, the location of the center of gravity along the horizontal axis in the standing human varies between individuals due to varying body shapes and weight.
If we examine the location of the center of gravity along the horizontal axis using the vertical axis as a starting point, we find the center of gravity will tend to be located more anteriorly (in relation to the vertical axis) in those who have extra weight in the belly area (see Fig 2b), or will shift more posteriorly (in relation to the vertical axis) in those having extra weight concentrated in the gluteal area (see Fig 2c).
The situation becomes more complex when we begin to move. When we move, the center of gravity constantly shifts along the horizontal axis while remaining stable along the vertical axis.
This is important information for the practitioner hoping for a long and productive career. If the practitioner employs body positioning with knees bent, no body contact with the table, and feet arranged in one line, his or her center of gravity shifts more posteriorly along the horizontal axis (see Fig. 3a). This greatly affects the lower back, abdominal, and gluteal muscles, as well as the muscles of the pelvic floor. The consequences of this were discussed earlier.
Fig. 3. The center of gravity and the practitioner’s working position
a – center of the gravity when the practitioner uses the incorrect body mechanics
b – center of the gravity when the practitioner uses the correct body mechanics
Green circle – position of the center of gravity
To use body mechanics correctly, the practitioner should shift the center of gravity anteriorly along the horizontal axis by slightly leaning the upper body forward during the application of massage strokes (see Fig 3b). Using the table for support as previously discussed, he or she will find this easy to do because the lower back muscles will not need to fight gravity anymore.
THE PRACTITIONER KEEPS HANDS FAR FROM THE BODY
This common mistake greatly contributes to the practitioner’s fatigue and exhaustion. Imagine that one needs to lift a heavy object. To do so, one would instinctively try to keep the upper extremities as close as possible to the body to increase leverage and decrease the chance of injury. In the same way, an electrician or surgeon doesn’t work with their upper extremities extended far from the body. This would increase fatigue and decrease precision of the hands for the performance of necessary tasks. The natural body response to any work executed by the upper extremities is to keep them closer to the body.
If you have been keeping your hands far from your body while applying massage strokes, please try to change this habit. It makes you more vulnerable to injury and greatly decreases your stamina.
Why must the practitioner keep his or her hands as close as possible to the body when applying any massage technique? Extending the upper extremities far forward makes the practitioner less stable because the center of gravity now shifts too far anteriorly along the horizontal axis of the body. In this position, the practitioner needs to increase lower back tension in order to fight against gravity, which pushes the body forward. Additionally, with the upper extremities extended forward, the practitioner will physically struggle with the application of strong massage techniques. This is because he or she will be unable to engage the upper body weight as a structural component of the execution of the strokes.
If the practitioner intends to use long strokes, he or she should, in the course of the stroke, take one or two steps forward alongside the table instead of leaning his or her body and upper extremities all the way forward.
The video shows incorrect and correct body positioning and arrangement of the upper extremities during the application of long massage strokes (effleurage, in the video).
THE PRACTITIONER DOESN’T USE THE WEIGHT OF UPPER BODY AS A STRUCTURAL COMPONENT OF THE STROKES
All the issues discussed so far will help the practitioner make the final and most important adjustment of body mechanics: Incorporate the weight of the upper body into every massage stroke. If you have contact with the table, position the feet correctly, slightly shift your center of gravity forward, and keep your hands closer to your body, you will have achieved optimum balance and stability. You will be able to use the weight of your upper body to apply leverage as a structural component of every massage technique. The next four videos show the application of different massage techniques where the practitioner first does not, then does, use the weight of the upper body as a structural component of the strokes.
This video shows the application of effleurage strokes first without, and then with, the integration of the upper body into the massage strokes.
This video shows the application of friction strokes first without, and then with, the integration of the upper body into the massage strokes.
This video shows the application of kneading strokes first without, and then with, the integration of the upper body into the massage strokes.
This video shows the application of percussion strokes first without, and then with, the integration of the upper body into the massage strokes.
As these videos demonstrate one important factor, that of adding the weight of the body to any massage technique makes it less physically challenging. The practitioner unlocks his or her waist, and consequently, the previous incorrect tensed body position changes into a continually fluid movement as the practitioner moves around the table. This dance-like approach to the massage routine prevents exhaustion and injury, and at the same time frees the practitioner creatively and spiritually. This is an important advantage of correct body mechanics as these components of the session, as much as anything else, affect the client on the table. The client feels rejuvenated after a massage session conducted by a practitioner whose body is under minimal tension.
Adding the weight of your upper body to your work offers yet another great advantage. Correct body mechanics using the weight of the upper body as a structural component in the execution of strokes is the only way the practitioner can correctly and easily execute the more complex massage techniques, e.g., effleurage with unequally distributed pressure, friction-kneading, or scrolling kneading, to name a few. Remember, the diversification of techniques is a critical tool in controlling the Phenomenon of Adaptation, one of the massage practitioner’s worst enemies!
A final advantage of engaging your upper body weight into the strokes is that it increases the fluidity of the strokes, an aspect greatly appreciated by the client. We encourage you to try a small experiment. Work on a friend or family member and apply the same massage strokes in the same area, first without, then with, upper body engagement. Ask your friend or relative to describe the difference in the sensation they felt between the two methods. We are prepared to bet that they will experience the second method as much more relaxing and nurturing.
Finally, we would like to emphasize the professional importance of correct body mechanics one more time. We realize it is difficult to break already established patterns and that some readers will ignore our plea. We strongly encourage and entreat you to try to change incorrect body mechanics. It will save you from strain and fatigue, and what is more, it will greatly contribute to your building up a healthy, robust, and resilient long-term practice.
Advantageous exploitation of correct body mechanics allows for great diversity within the arsenal of the seven basic massage techniques, and we guarantee that this diversity will be greatly appreciated by your clients and help your practice grow.
For Dr. R. Turchaninov bio click here
Stephen Ryason was born in Seattle, WA, and currently resides and works in Scottsdale, AZ. He has been a full-time Massage Therapist since 1996. He practices medical massage in his clinic in Scottsdale. Aside from his passion for more knowledge related to his career, his hobbies include: golf, back country fly-fishing, and aviation. He is a licensed helicopter pilot. Stephen may be contacted through this website.
Category: Stress Reduction Massage
Tags: 60 Variations of 7 Basic Techniques, Journal of Massage Science 2009 #6