Massage & Bodywork

November/December 2013

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@WORK professionals, massage therapists usually look down and bend over to work on their clients. Long periods with the head in a forward-flexed position mean that the posterior cervical muscles must constantly fight gravity as they attempt to pull the head back and resist gravity's downward force (Image 6). Isometric contractions of the back and neck are primarily performed by the longitudinal muscles running the length of the spine: the erector spinae group, multifidi, and semispinalis muscles. Due to the extensive fascial connections and continuity of these muscles throughout the entire spine, biomechanical stress from forward head posture is not limited to just the cervical muscles; it is transmitted down the length of the spine, leading to low-back pain as well. Similarly, bending forward too often during a session puts a significant overload on the lumbar musculature. As the torso moves into the forward-flexed position, the upper thoracic and cranial regions come forward and the entire torso must fight the pull of gravity. I can't overemphasize how frequently this postural challenge plays a role in chronicpain complaints for massage therapists. And unfortunately, so much of it goes back to poor body mechanics. As a continuing education provider, I work with practitioners who are fresh out of school, as well as many who have years of experience. One constant I see is chronically poor patterns of body mechanics that were learned, reinforced through practice, and never corrected. Many practitioners lament their back or neck pain, and possibly even seek the help of other massage therapists. However, this is another case where the pain will likely recur quickly if the underlying biomechanical dysfunction is not changed. Postural change is one of the most challenging aspects of rehabilitation because what is customary feels natural, and adopting a new, corrected posture feels awkward and unusual. It is also important to know when you are adopting good postural alignment in your work because you may feel like you are upright and aligned when in reality you are not. One of the most effective ways to get a sense of your own postural alignment and how it might contribute to back and neck pain is to videotape yourself doing massage. It's important you don't try to make corrections during the videotaped session, but instead proceed as usual. Afterward, look at your positioning and note where the particular challenges might be with the techniques you employ. It is likely you will be surprised to see many instances of poor mechanics when you thought you were in good alignment. The importance of appropriate body mechanics can't be overstated. They can fundamentally change the way you feel about your work, and can make you a significantly better practitioner. I have found my early tai chi and kung fu training highly beneficial to how I work. You do not need to become a martial artist, but practices that Downward pull of gravity on teach good posture the neck and upper back. and mechanics— like dance, martial arts, tai chi, and yoga—are particularly useful for building your core and correcting poor posture. In summary, any physically demanding occupation requires conditioning. Not caring for yourself is, in the end, not caring for your clients. Your dedication to your own care is one of the most important investments in your career that you will ever make. 6 Notes 1. L. Greene and R. Goggins, "Musculoskeletal Symptoms and Injuries Among Experienced Massage and Bodywork Professionals," Massage & Bodywork (2006): 48–58. 2. J. L. Cook et al., "Overuse Tendinosis, Not Tendinitis Part 2. Applying the New Approach to Patellar Tendinopathy," Physician and Sportsmedicine 28, no. 6 (2000): 31. Whitney Lowe is the author of Orthopedic Assessment in Massage Therapy (Daviau-Scott, 2006) and Orthopedic Massage: Theory and Technique (Mosby, 2009). He teaches advanced clinical massage in seminars, online courses, books, and DVDs. You can find more ideas in Lowe's next free enewsletter—and his books, course offerings, and DVDs— at See what benefits await you. 107

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