Occupational wellness is the ability to achieve balance between work and leisure time, to manage workplace stress (physical/mental/emotional), and, and to build relationships with colleagues (University of CA, n.d.). This blog discusses the “science of self-care” for massage professionals, examines massage-related injuries, and offers suggestions for injury prevention. Other dimensions from Hettler’s wellness model are physical wellness, intellectual wellness, social wellness, emotional wellness, and spiritual wellness.

Massage-Related Injuries. Massage is a method of manipulating soft tissue using compression and decompression for therapeutic, palliative, and self-care/wellness, or recreational purposes (DeDomenico, 2007; Ernst et al., 2006). Greene and Goggins (2006) and Jang et al. (2006) found approximately 70% of massage practitioners had experienced work-related pain and musculoskeletal symptoms. Sixty-five percent of practitioners reported pain during or after performing massage (Greene & Goggins, 2006). Common pain locations were fingers and thumbs, wrists, elbows, and shoulders, followed by the neck and lower back (Greene & Goggins, 2006; Jang et al., 2006). Chumnanya, Perngparn, and Sayorwan (2013) had similar findings among Thai massage practitioners who knelt during most of the session, but in differing locations which ranged from lower back, followed closely by upper back and neck areas. Among the symptomatic group, 80% sought treatment from another massage practitioner, 69% received chiropractic care, and 30% received acupuncture (Greene & Goggins, 2006). These findings suggest massage practitioners have a strong preference for complementary and integrative health care. In contrast, only 19% received care from medical doctors and 14% received care from physical therapists.

A later study identified several factors that contributed to massage practitioners working less because of injury, which include physical exhaustion, mental fatigue, having more years in practice, being female, and having higher continuing education costs. Physical exhaustion had the strongest relationship to massage-related injury followed closely by mental fatigue (Blau et al., 2013).

Using evidence as a foundation, featured next are suggestions to prevent injury. Each practitioner should be sure to weigh all the pros and cons of each work situation to see what a good fit is for them and respect that others may choose different situations that fit their unique needs.

Manage Physical Exhaustion While Providing Quality Massage. Physical exhaustion or being body fatigued due to energy expenditure had the strongest relationship to injury (Blau et al., 2013). Massage is classified occupationally as “hard work” with the highest intensity associated with the use of friction (Wiecke et al, 2018). Practitioners should find a way to prevent physical exhaustion from the effort of providing massage without reducing the amount of pressure the client requests or the amount required to produce the desired outcome. Turkeltaub et al. (2014) discovered massage recipients had a stronger preference for high-intensity touch (6.7 on a 10-point scale), perceived high-intensity touch as more efficacious, and were more likely to receive future massages for self-care. This study indicates simply using lighter pressure as a means to reduce physical exhaustion may not be welcomed by the client and can negatively affect client retention. Effective strategies to reduce physical exhaustion while performing massage using adequate pressure may be to (Blau et al., 2013; Greene & Goggins, 2008):

1) Increase/maintain muscle strength through regular physical activity. Practitioners should prepare themselves physically by applying principles of physical wellness. Blau and colleagues (2013) suggested female practitioners strengthen their upper muscular limbs (e.g., shoulder, arms, neck) and all massage and manual practitioners continue strengthening exercises throughout their careers.

2) Have adequate space in the massage room and use flooring that reduces fatigue from prolonged standing. Greene and Goggins (2010) recommend at least 3 feet (1 meter) of open space around all sides of the table and urge practitioners to work on traditional wood flooring (not laminate flooring over concrete), carpeting with a cushion backing, and foam-backed vinyl flooring. Antifatigue mats can be placed around the massage table.

3) Wear appropriate attire. Massage attire should feel comfortable, allow freedom of movement, and look professional. Avoid wearing loose-fitting clothing, watches, bracelets, dangling necklaces, or hair styles that may drag on the client’s body. For example, a practitioner wearing a large baggy shirt may subconsciously lean away from the table to keep the shirt from brushing against the client, which changes the practitioner’s posture to a less efficient stance. Shirt sleeve length should be midarm or higher so the forearms can be easily used to apply massage techniques. The advantages of wearing synthetic cooling fabrics to improve endurance, or compressive garments to reduce fatigue, are not supported by research (Abdallah, Krug, & Jensen, 2015; Chaudhari, 2017). Shoes with softer insoles, arch support, and a depression for the heel constitute the best footwear for balance, performance, directional control, and productivity (Carley & Lachowski, 2017).

4) Lower the massage table to take advantage of gravity and body weight. Massage table height should be set lower when performing compressive techniques while standing to utilize gravity and body weight (Anderson, 2018; Greene & Goggins, 2010).  Table height should be adjusted higher to perform small, more detailed, low-force techniques while seated or standing or while applying decompression or traction. Because most massage practitioners employ a combination of techniques during a single session that utilize compression and decompression, an adjustable massage table (electric or hydraulic table) is recommended, particularly for practitioners who have a full-time massage practice (Greene & Goggins, 2010). If the practitioner does not have an adjustable table, a lower working height is recommended, as the majority of massage techniques performed involve compression. Setting the correct massage table height will allow massage practitioners to generate greater compressive forces, while reducing the strain on the practitioner’s body (Mohr, 2010).

5) Sit for approximately 25% of the treatment time.

6) Use a variety of techniques to reduce repetitive motion.

7) Build in recovery time within a day of treatments. A minimum of 15 minutes is recommended between clients to rest, stretch, take a stroll, consume refreshments, and mentally “let go” of the previous client and to be ready for the next one (Blau et al., 2013; Greene & Goggins, 2008). This suggestion helps reduce both physical and mental fatigue.

Manage Mental Fatigue. Blau et al. (2013) also found mental fatigue or work exhaustion (feeling overwhelmed and emotionally drained) a significant risk factor that correlated with injury-forced work reduction among massage practitioners. Following a self-care plan that includes emotional wellness strategies may reduce the risk of mental fatigue, as well as responding empathetically when interacting with clients.

Be Part of a Positive Supportive Work Community. Mental fatigue may be partially due to work isolation, as many massage practitioners work alone without onsite supervisor or co-worker support (Fortune & Gillespie, 2010). Lack of social support is also a risk factor for injury (Adriaenssens et al., 2015; Blau et al., 2013). Positive interactions with co-workers and talking with peers and supervisors were shown to promote career longevity (Alexander et al., 2015; Killian, 2008). Therefore it is vital massage practitioners build and maintain a positive and supportive work community and participate in team-building activities. Participating in massage organization–sponsored events, attending conferences/conventions, and sharing experiences and challenges with colleagues can be an incredibly fulfilling experience. This helps us feel simultaneously as though we are a necessary part of the team and we are not alone.

Keep Learning Through Educational Efforts. Another important factor that had a protective effect on injury was education, both the level of formal education of workers (Pustułka-Piwnik et al., 2014) and lower continuing education costs for massage practitioners (Blau et al., 2013). Be a lifelong learner and consider participating in more formal education and in continuing education. Learning new techniques and adding them to the session in ways that replenish rather than deplete the practitioner’s energy and interest may reduce the risk of massage-related injury.

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Massage Therapy: Principles and Practice 6 Edition (Amazon)

cropped-susansalvo41.jpg  Dr. Susan Salvo is a massage therapist, author, educator, researcher, explorer, and perpetual student. To learn more, check out the “About Susan” tab. You can contact Susan at susansalvo@hotmail.com.

Renee-Michele-headshot 2019 Dr. Michele Renee began her career as a massage therapist in 1998. After several inspiring and successful years, she expanded her scope of practice, first with chiropractic and later with a master’s degree in acupuncture. Today she runs a multidisciplinary clinic in Minneapolis, MN and serves as the Director of Integrative Care at Northwestern Health Sciences University. Drawing from many years of teaching and administration in the health sciences, Michele shares her varied experiences in education, patient care, and many paradigms of healing with health care practitioners across the US. She lives in beautiful Minneapolis, MN with her foster son and four furry friends. You can contact Michele at dr.renee@stockheart.com.