By David Tuller, MPH
Stacey Kayden used to fantasize about massaging Olympic athletes. She blames her thumbs for derailing that ambition.
"After three or four massages in a row, my thumb muscles would ache and throb and were sore to the touch," says Kayden, who was trained in deep tissue and sports massage. "I'd have five minutes between massages and would run my hands under cold water to reduce the swelling. I have little princess hands, and I knew they weren't strong enough, and that definitely had an impact on my decision not to do this as a full-time career."
Kayden now sees only a few clients a week and works as a special education teacher the rest of the time. Although most massage therapists obviously have not taken the route Kayden has, hand, wrist and other musculoskeletal injuries are a major hazard for those in the profession. In a survey of more than 500 Canadian registered massage therapists, the number one flashpoint for pain from giving massage was in the wrist and thumb, followed by low-back, neck and shoulders. Moreover, because the work is so intimate and often releases powerful feelings in clients, massages therapists are also at risk for emotional burnout.
It's all in the wrist
Thumb and wrist injuries often result from improper technique, says Phoenix massage therapist Kathy Reitsch. "You have to use gravity and the weight of your body to really accomplish some of the work that you're doing, rather than just the wrist, fingers, and shoulders," explains Reitsch, who also owns Healing Arts Registry and Placement, an agency that connects licensed massage therapists with employers. Reitsch calls herself "the body-worker's answer to Yenta, the Jewish matchmaker."
Chris Smith, director of education at the Colorado School of Healing Arts in Lakewood, Colorado, agrees that good body mechanics are key. "If you're forcing too much pressure through the wrist, you can end up with carpal tunnel syndrome," she says. "And when people are pressing down too hard, their thumbs flex upwards. That's not good for the joint, and that tension translates through the wrist and the forearm, and even into the shoulders."
Part of the problem, Smith says, is that many clients request a deep tissue massage even when it is not an appropriate technique -- and therapists who comply put themselves at risk for injury. If they apply more pressure than the muscles can comfortably absorb, they will feel the adjacent tissue start to contract. And that's wrong.
"That tells us the body is not ready for that kind of pressure," she says. "The therapist really has to watch how the body is accepting the touch and contact and depth. If they are working against a client who is not letting them into the tissue, it's not good to continue. They need to say, 'You're tightening up, you're flinching, so how about if we try to work up to that.'"
Proper posture is another key factor to preventing injuries. Smith has been doing massage for 30 years and has never hurt herself. She attributes that, in part, to her prior experience as a ballet dancer, which taught her key principles of body mechanics. She also practices tai chi, which is considered so useful to the development of good technique that it's become an integral part of the training at the Colorado School of Healing Arts.
Tai chi, explains Smith, helps massage therapists learn to work with their torso upright and move from their center of balance. Massage therapists who bend over rather than flexing their knees are prone to back injuries; those who keep their shoulders hunched, raised or rounded forward can eventually suffer an extremely painful pinching of the brachial plexus, a network of nerves that stretches from the neck and shoulders to the arm, forearm, and hand.
Reitsch also has never experienced any major injuries, although she has suffered an occasional stiff and sore back. She recommends that massage therapists themselves get at least one massage a week to relieve their own tension and maintain their health. "One of the things I get to do in this wonderful job of mine is to test therapists before I send them out on a job," she explains with a laugh. "So I sometimes will have three massages in a week. Isn't that great?"
Difficulties of house-calls
Massage therapists also stress the need to stretch before starting the day, focusing in particular on the hands, forearms, and back. Yoga can be particularly helpful in preventing injuries. In addition, practitioners should limit themselves to four to six one-hour massages a day, with breaks of at least 15 minutes between each one, says Maureen Moon, a former president of the American Massage Therapy Association and a 21-year veteran of the business. Although some therapists don't wear shoes, she believes footwear with supportive arches can help save your back when you have to be on your feet all day.
Physical stress is not the only health problem facing massage therapists. Women, in particular, can face difficulties when making out-calls to male clients, who may demand an erotic massage and become belligerent or aggressive when they don't get it. To cope with the situation, many masseuses will take referrals only from people they know well; others make sure to let someone else know where they are going, how they can be reached, and when they will return home. "As long as there are men who think there's only one kind of touch, there are going to be problems," says Reitsch.
Then there's the matter of tuning in too closely to other people's feelings and emotionally burning out. Unlike many health care workers, they control their own hours. But like psychologists and doctors, they are often privy to intimate and painful realities of their clients' lives. People frequently seek out massages when they are under great strain, and the touch can release powerful emotions that cause them to cry or remember past traumas.
Although it's not documented scientifically, some masseuses feel that their clients' energy -- good or ill -- is being absorbed by them. Stacey Kayden remembers once massaging a client's hands and experiencing a sudden revulsion, a desire not to touch them anymore. She did her best to ignore the sensation, but when she finished the massage she asked the woman what she had been feeling. The woman acknowledged that, while her hands were being worked on, she was having flashbacks about being abused as a child.
"When people come to get massage, they're in some sort of pain," explains Kayden. "So when you release that, you sort of absorb it. The energy sort of pulses into my hand. It's very interesting to hook into people's energy, and that's part of the draw. But on a psychic level, it's draining."
Masseuse, heal thyself
In an article in Massage Therapy Journal, massage therapist Dianne Polseno Crawford says her colleagues are ethically bound to try to prevent their own burnout. She notes that the Code of Ethics of the American Massage Therapy Association, a trade organization based in Evanston, Illinois, states that "massage therapists shall accept the responsibility to self, clients and associates to maintain physical, mental and emotional well-being."
In addition to getting regular massages, Crawford tells massage therapists to "take your appointment book and X through two days per week." If a client desperately needs a massage on those days, she advises, refer them to someone else with a similar technique. Because working in isolation can also lead to burnout, Crawford recommends that massage therapists attend professional gatherings, find a mentor to coach them, and consult other therapists about difficult or challenging cases.
American Massage Therapy Association
Dianne Crawford. The Ethical Obligation to Prevent Burnout. Massage Therapy Journal. Spring 1998, Vol. 37, No. 1
A Survey of Musculoskeletal Injuries Among Canadian Massage Therapists, Journal of Bodywork and Movement Therapies, 2008 Jan.12 (1): 86-931: J Bodyw Mov Ther. 2008 Jan;12(1):86-93. Epub 2007 May 10.