Common Massage Therapist Injuries: Causes and Prevention

As massage therapists, the focus of our work is on healing and helping our clients, so it’s easy to overlook the importance of personal injury prevention. However, it’s just as important to pay attention to your own physical well-being since an injury can limit your ability to do your best work for your clients. Given the physical demands of the massage profession, understanding and preventing work-related injuries is essential for a long and pain-free career.

What are the most common massage therapist injuries? Common injuries that massage therapists experience include carpal tunnel syndrome, thumb joint pain, tendonitis, back and neck pain, repetitive strain injuries involving the hands especially, thoracic outlet syndrome, leg and foot fatigue, and muscle strains. Massage therapists are also susceptible to more insidious, chronic conditions like osteoarthritis, particularly in the upper extremities. These injuries are primarily musculoskeletal and often stem from repetitive movements, intense sustained exertion, and insufficient rest.

In this article, you’ll gain helpful insights into the types of injuries prevalent in this physically demanding profession, learn about their causes, and most importantly discover effective strategies for prevention. The goal here is to provide you with injury awareness and practical solutions, as well as a few self-care techniques and treatment strategies to ensure your longevity in this rewarding profession.

Common Massage Injuries

Before we get into injury prevention strategies, we need to first identify some of the most common injuries for massage therapists. Due to the physical nature of the work, massage and bodywork professionals are susceptible to a variety of physical injuries, ranging from acute strains to chronic conditions, which impact their ability to provide services. This section provides a brief overview of some of the most common injuries and their causes, symptoms, treatment options, and prevention strategies.

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome (CTS), a neuropathic disorder, arises from the compression of the median nerve within the carpal tunnel, a narrow passageway formed by the carpal bones and flexor retinaculum on the anterior (palm) aspect of the wrist. This condition is often linked to repetitive motion of the wrist and hand, sustained gripping, and extended periods of wrist flexion or extension; all of which are motions frequently performed by massage practitioners. The syndrome primarily affects the median nerve, as well as the flexor tendons that pass through the carpal tunnel. Symptoms include numbness, tingling, and pain in the thumb, index, and middle fingers, often worsening at night or when using the hands like when performing massage techniques.

Treatment options may include wrist splinting at night, non-steroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation, and in severe cases, corticosteroid injections or surgical intervention. Recovery can span from several weeks to months, depending on the severity and treatment approach. To prevent CTS, massage therapists should focus on ergonomic hand positioning, using massage tools or bigger joints like the elbows for deep work, taking breaks when needed, avoid exceeding your limits, and integrate stretching and strengthening exercises for the wrist and hand. Nerve impingement injuries like CTS can significantly impact the ability to perform massage therapy, especially the tasks requiring fine motor skills or strong grip. Long-term management involves continuous ergonomic practices and regular self-care exercises to maintain wrist health and prevent recurrence.

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Tendonitis

Tendonitis, or inflammation of a tendon, often affects massage practitioners due to repetitive stress on specific muscle groups. This overuse injury commonly impacts the small tendons of the hands, thumbs, wrist extensors, flexors, and rotator cuff tendons. Signs and symptoms include localized pain, tenderness, and limited range of motion, often exacerbated by continued activity.

For treatment, rest is needed, combined with cold treatment to reduce inflammation, and NSAIDs for pain management if needed. Recovery time varies, depending on severity and adherence to rest and treatment protocols. Remember that tendon and ligament injuries tend to heal slower than muscle tissue damage because tendons and ligaments have a less abundant blood supply. 

Preventative measures include practicing good body mechanics and using leverage rather than brute force for deep work, using ergonomically designed tools, and incorporating regular stretching and strengthening exercises for affected regions. Tendonitis can significantly impact a massage practice, limiting the ability to perform certain techniques, and making it necessary to adjust your workload. Long-term management involves balancing work activities, maintaining muscle strength and flexibility, and promptly addressing any recurring symptoms.

***Be sure to see our free resource on Pathology for Massage Therapists for a convenient overview of 135 common pathologies massage therapists should know for the MBLEx and for clinical practice.

Medial Epicondylitis (Golfer’s Elbow)

Medial epicondylitis, commonly known as Golfer’s Elbow, is a form of tendinopathy that affects the tendons attached to the medial epicondyle of the humerus. It’s prevalent among massage therapists due to a primary cause of repetitive forearm and wrist movements, particularly during techniques that require sustained gripping or pronation/supination of the forearm.

This overuse syndrome involves micro-traumas primarily in the flexor and pronator tendons of the forearm muscles, leading to pain and tenderness around the medial elbow. Common symptoms often include sharp pain radiating from the inner elbow to the forearm and wrist, gradual onset of weakness in the hands and wrists, and difficulty in performing tasks requiring manual dexterity.

Treatment for medial epicondylitis typically involves rest, icing or other cold therapy, NSAIDs if needed, and stretching and strengthening exercises. Severe cases might benefit from corticosteroid injections. Recovery times can vary from a few weeks to several months, depending on the severity. Prevention strategies include using proper body mechanics during massage sessions, employing assistive tools to reduce strain, and regularly performing exercises to strengthen the forearm muscles. Long-term management includes maintaining good ergonomic practices and muscle conditioning to prevent recurrence.

Muscle Strain

Muscle strain, also known as a muscle pull, occurs when fibers within a muscle are overstretched or torn due to the muscle fibers being unable to handle the amount of force put on them. In massage therapy, this injury frequently arises from overexertion during deep tissue massage work, prolonged static postures, repetitive bending, poor posture during massage, or sudden, awkward movements.

The most common injury sites for muscle strains are the upper extremity, back, neck, and shoulder regions (rotator cuff injuries); all of which are areas that endure significant tension and repetitive use in massage practices. Symptoms of muscle strain include localized pain, muscle spasms, swelling, and limited range of motion in the affected area. 

Treatment for a muscle strain involves rest, ice to reduce swelling, compression, and elevation (RICE). Mild strains may also benefit from massage therapy, as well as gentle stretching and strengthening exercises after the initial pain subsides. Recovery time can range from a few days to several weeks, depending on the severity of the strain.

To prevent muscle strains, massage therapists should focus on maintaining proper body mechanics, using ergonomic tools, and incorporating regular breaks into their work schedule. While mild strains often heal with self-care, severe strains or persistent symptoms may call for professional medical evaluation. Long-term management includes regular strength and flexibility exercises to maintain muscle health and prevent future injuries.

Thoracic Outlet Syndrome

Thoracic Outlet Syndrome (TOS) encompasses a group of disorders where the blood vessels or nerve tissue between the clavicle (collarbone) and the first rib are compressed, a region referred to as the thoracic outlet. This nerve impingement injury can affect massage therapists due to repetitive shoulder movements, and prolonged forward-reaching or poor postures that can lead to nerve compression in this area. TOS primarily affects the brachial plexus nerves, subclavian artery, and vein, leading to symptoms like numbness, tingling in the arms and hands, and sometimes neck and shoulder pain syndrome.

Treatment for TOS most often includes stretching and strengthening exercises for the upper extremities, shoulders and chest, as well as postural corrections. Recovery time varies, but many people see improvement within a few months. Prevention strategies for massage therapists involve maintaining good posture, taking frequent breaks to reduce muscle tension, and performing shoulder and neck stretches regularly. TOS can significantly impact the ability to perform massage therapy, especially in actions requiring arm elevation. Long-term management involves regular exercises and self-care practices to prevent recurrence and ensure uninterrupted practice.

Tenosynovitis

Tenosynovitis is inflammation of the synovium, which is a fluid-filled sheath that surrounds a tendon. This injury commonly occurs in people who perform a lot of repetitive wrist and hand movements. In massage therapists, this condition frequently affects the tendons of the thumb, and can lead to a painful condition called De Quervain’s tenosynovitis (more on this in the next section). The repetitive nature of massage, especially techniques requiring strong thumb pressure, predisposes therapists to this tenosynovitis.

Symptoms of tenosynovitis include pain, swelling, and difficulty moving the affected tendon, particularly during thumb extension or abduction in the case of De Quervain’s tenosynovitis. Treatment typically involves rest, ice, anti-inflammatory medications, and splinting to immobilize the affected area. Corticosteroid injections may be considered for more severe cases. Recovery time varies but can span several weeks to months, depending on the severity and response to treatment.

Preventative measures include ergonomic and technique adjustments to reduce strain during massage, regular stretching, and strengthening exercises for the hand and wrist. Long-term management focuses on balancing work practices with regular hand and wrist care to prevent recurrence. 

Thumb Injuries

Thumb injuries are prevalent in professions requiring manual dexterity, such as massage therapy, due to their significant role in various massage technique including neuromuscular therapy, petrissage, deep tissue work, chair massage, Shiatsu and many others. These injuries often include conditions like De Quervain’s Tenosynovitis, trigger thumb, skier’s thumb, and chronic injury or cumulative trauma disorders like osteoarthritis. They typically arise from repetitive motions like gripping, pinching, twisting, or sustained pressure, particularly using the thumb. Affected structures predominantly include the tendons (extensor pollicis brevis and abductor pollicis longus in De Quervain’s), ligaments (such as the ulnar collateral ligament in skier’s thumb), and the carpometacarpal (CMC) saddle joint in osteoarthritis. 

Treatment varies based on the specific injury but generally involves rest, ice, anti-inflammatory medication, and thumb splinting. Recovery times can range from a few weeks to several months. Prevention strategies include ergonomic adjustments, regular stretching and strengthening exercises for the thumb, and avoiding repetitive strain. These injuries can significantly impact a massage therapist’s ability to perform certain techniques. Given the thumb’s critical role in effective massage therapy, awareness and preventive measures for thumb injuries are essential for career longevity.

Causes of Massage Therapist Injuries

When working as a LMT, the onset of injuries can be subtle or sudden. From the repetitious nature of the work to the unexpected hazards of the environment, awareness of these injury triggers and common causes is an important prevention strategy. Let’s take a look at some common causes, from the everyday strains of intense sessions to the less considered risks lurking in the workspace. Fortunately, injuries among massage therapists can often be traced back to a few common causes.

As previously discussed, repetitive strain injuries (RSIs) are a significant concern in massage therapy due to the nature of the work. RSIs develop over time and are caused by repeated physical movements, maintaining static positions, and exerting sustained force (like during trigger point therapy and deep tissue massage) which create stress on bodily structures like muscles, tendon fibers, and nerves. The repeated stress on specific body parts without adequate rest and recovery leads to inflammation, pain, and sometimes more severe musculoskeletal and nervous system issues. Many of the conditions listed above are considered to be RSIs, including carpal tunnel syndrome, tendonitis, tenosynovitis, trigger thumb, and bursitis. 

Understanding and mitigating the risks of RSIs involves adapting massage techniques, incorporating breaks, and ensuring proper body mechanics during sessions. Here are some other factors to keep in mind:

• Frequency and Duration: Giving too many massages without adequate breaks can lead to fatigue and injury. For new therapists, there’s a risk of not allowing the body enough time to strengthen and adapt, as it takes time to build up endurance and efficiency in delivering techniques.
• Excessive Intensity: Applying too much force, particularly with fingers and hands, can lead to strain. Utilizing tools can help distribute this force more evenly and reduce the risk of injury.
• Environmental Hazards: Slipping on wet floors is a common risk, especially in spa environments. Ensuring a safe, non-slip workspace is crucial for preventing client or massage therapists fall.
• Physical Load: Carrying heavy massage equipment or supplies can strain the back, shoulders, and arms. Mobile massage therapists have to deal with this as they carry their table to client’s homes, load & unload it from their car, and sometimes up and down stairs. Proper lifting techniques, planning and minimizing the load can help prevent such injuries.
• Poor Ergonomics and Body Mechanics: Working in awkward positions or with a massage table at an unsuitable height can lead to musculoskeletal injuries. Correct posture and ergonomically designed workspaces are essential to prevent these issues.

Being aware of these risk factors and taking proactive steps to mitigate them can dramatically reduce the likelihood of sustaining injuries.

Tips for Preventing Injuries When Working

Implementing practical measures can significantly lower the risk of injuries during a massage session:

Workspace Setup: Using an adjustable or electric lift massage table helps maintain proper height and alignment, reducing strain. Incorporating tools like anti-fatigue mats and using chairs or stools for specific massage techniques can also enhance ergonomics.

Injury-Specific Techniques: For preventing thumb and wrist injuries, adopt grip-alternating methods and use massage tools to relieve pressure on these areas.

Body Mechanics and Ergonomics: Proper alignment is key. Ensure your body is lined up correctly, keeping the direction of force in mind to prevent muscle strain and joint stress.

Regular Breaks: Taking breaks between massage sessions is a great way to prevent overuse and fatigue.

Warm-Up and Stretching: Engaging in a routine of warm-ups and stretches prior to working with clients can prepare your muscles and reduce the risk of injuries.

Diverse Modalities: Practicing a variety of massage modalities can help distribute physical exertion more evenly, reducing the risk of repetitive strain injury. If most of your work involves physically demanding types of massage like deep tissue, then consider learning and offering some of the gentle bodywork and other modalities as well (e.g., lymphatic drainage massage, craniosacral therapy, cupping therapy, ashiatsu, aromatherapy massage), or even popular spa treatments like body wraps. In addition, techniques like bamboo massage incorporate the use of a bamboo stalk to roll, knead and relax the muscles, giving your hands a rest. These strategies will not only give your body a break but will open up new opportunities for generating income.

Body Scanning: Stay mindful of any tension in your own body while performing massage techniques, adjusting posture and technique as needed.

Regular Self-Assessment: Consistently assess your techniques, session duration, and overall well-being to identify any early signs of strain or injury. 

By integrating these practices into your daily routine, you can ensure a healthier and more sustainable massage practice.

Strengthening and Conditioning Exercises for Massage Therapists

Regular exercise is an important strategy for massage therapists to prevent injuries and ensure a long massage career. Here are some beneficial exercises you want to be sure to include in your routine:

• Core Strengthening: A strong core supports proper body mechanics. Incorporate planks, abdominal crunches, squats and leg raises. Pilates and yoga can also improve core strength, offering stability during massage sessions.
• Wrist and Hand Strengthening: To avoid common injuries like carpal tunnel syndrome and tendonitis, wrist curls, extensions, and grip strengthening exercises are beneficial. Using stress balls or hand grip strengtheners can also fortify these areas.
• Shoulder and Back Exercises: Strengthening the upper back and shoulders can help prevent overuse injuries and relieve low back pain. Exercises like seated rows, shoulder external rotation, reverse flys, and shoulder shrugs using light weights can be effective.
• Flexibility and Mobility Workouts: Flexibility is key in preventing muscle strains. Stretching routines focusing on the neck, shoulders, back, and wrists should be performed regularly. Yoga offers an excellent way to enhance overall flexibility, help avoid injury, and reduce muscle tension.

Massage Self-Care Strategies

Self-care plays an important role in injury prevention for massage therapists. Implementing a routine that includes activities like stretching, exercise, relaxation, and hydrotherapy can significantly reduce the risk of common injuries. Techniques like cold therapy or ice massage after long sessions can also be beneficial in managing inflammation and promoting recovery.

Balancing work hours and ensuring adequate breaks between massage sessions is vital. It’s important to listen to your body and not overextend yourself with back-to-back appointments. Managing client expectations and workload effectively can help in maintaining a sustainable practice without compromising your physical or mental health.

Conclusion

In conclusion, understanding and preventing common injuries like carpal tunnel syndrome, tendonitis, and muscle strains is essential for massage therapists. Emphasizing practices like proper workspace setup, diverse massage techniques, and good body mechanics can significantly reduce injury risks. Incorporating strengthening exercises, especially for the wrists and core, and adopting self-care strategies like yoga and hydrotherapy, are vital. Remember, balancing work hours and taking regular breaks are key to maintaining your health. Prioritizing your well-being isn’t just beneficial for you; it ensures that you can continue providing the best services for your clients.

Please note that the content provided in this article is for informational purposes only and is not intended to serve as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your healthcare provider with any questions you may have regarding a medical condition or treatment.