Take the strain

Injuries caused by repetitive massage movements can put an early end to a therapist’s career. Suzanne Braithwaite looks at what the industry can do to help

Training in massage treatments often focuses on the client’s perspective, from equipment to keep them comfortable, to their enjoyment of the treatment, and new massage techniques used. However, a 60- or 90-minute massage can put a huge amount of pressure on the therapists’ wrists, fingers and thumbs, especially if they are not performing the techniques correctly. For example, having the bed too high or leaning over the client will put strain on their wrists, shoulders and lower back. 

In fact, a UK study on the demographic incidence of wrist and finger damage by surgeon D. Watson found that 88% of massage therapists who had been giving five or more treatments per week for more than two years, suffered from injury. Meanwhile, at least six workers leave their jobs in the UK forever due to repetitive strain injury (RSI), according to the Trades Union Commission.

RSI is a term used to describe the pain felt in muscles, nerves and tendons, caused by repetitive movement or overuse. It’s something a therapist may experience if they are performing massage day in day out, but there are ways to prevent it or improve the condition.

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Champneys college principal Rachel Halling says her spa managers see a huge number of newly qualified therapistsentering the business having already picked up bad habits. “If they are to have a prolonged career, especially when working in a busy spa, this needs addressing straight away,” she says.

When new therapists are employed at any of the Champneys resorts or day spas, group trainers carry out an initial assessment of their massage techniques, observing therapists during induction to assess their posture and hand techniques and give them guidance on improvement such as exercises to strengthen their legs and arm muscles, changing their stance to use body weight, and ensuring the correct angle of the wrist joint and thumb.

WristUsing equipment wrongly can also be a contributing factor of RSI. Beata Aleksandrowisz, founder of London based massage training school Pure Massage, advises that a simple, smaller couch is often better than the large, more complex tables. “It’s fundamental that therapists have proper access to the client’s body, without having to lean over them,” she says.

Another problem is having the table too high. “For a full body massage, therapists should keep the table lower, so they are bending their knees and utilising their whole body. If the client is high up then a therapist will feel all the strain in their shoulders,” she says. “There’s no way you can effectively perform a massage and give the right pressure if your body is not engaged and you are not using the right muscles. This is crucial if a therapist wants to have a long career in massage.”


Beata Aleksandrowicz’s five top stretching techniques to do before performing a massage.

1. Stand tall and distribute bodyweight evenly under your feet. Hang arms loosely by the sides of your body. Lift your arms above you head, interlace fingers and turn palms towards the ceiling. Maintain position for 10 seconds, while trying to lift the ceiling on each out breath.

2. Sit on a chair with your feet touching the floor. Give yourself a hug, with your left hand on the right shoulder and right hand on the left shoulder. On the out breath, press your feet into the floor while lifting your spine. Then twist your torso towards your left, looking behind your left shoulder without twisting your pelvis. Hold for 10 seconds then change sides.

3. Stand tall with weight evenly distributed under your feet. Put your arms behind your back and interlace fingers. Pull your hands away from the body and hold for 10 seconds.

4. Stand tall with arms by your sides. Using a broad movement, make big forward circles with your shoulders, imagining the stretch is going from the middle of your chest and opening up the whole area. After five circles repeat with a backwards circle motion.

5. With arms by the sides of your body, slowly pull your shoulders towards your ears as high as possible and then vigorously drop them down. Repeat five times.

TOP TIP - “Make sure you start every stretch gradually on the in breath, hold for 10 seconds breathing slowly, then gradually release on the out breath”

Self Care

“When Swedish massage was first introduced it used to be a 15-20 minute treatment but can now last as long as 90 minutes,” says Aleksandrowisz. “If a therapist is expected to perform three massages a day they have to be fit.”

Just like an athlete, who trains to have physical endurance, she says therapists need to take more care of their bodies. “They need to understand their body is a tool so they should eat, sleep, and exercise as if they are in training,” she advises. “The general rule is to keep fit so I would suggest keeping the body flexible and supple. Yoga and pilates are perfect exercises, as breathing and stretching is much better than cardio for the style of work they are maintaining.”

backShe also suggests therapists turn up to work earlier to perform warm-up stretches (see box out) before starting a day of massage and remember to eat regularly to fuel their day as they are exerting a lot of energy. “Some therapists need guidance from their employers about this so spas should be ensuring that they have breaks when needed and suitable snacks to keep them going,” she adds.

While therapists should be maintaining a healthy lifestyle to stay injury-free, Aleksandrowisz encourages them to take up these habits even if they are already suffering from RSI. “Those with RSI or carpal tunnel syndrome firstly need to rest and take medication if needed. However, those who do end up taking steroids for relief often go back to the same habits, so their situation doesn’t improve.”

Pressure Points

Employers do have a legal duty to prevent work-related RSI and make sure that the symptoms of anyone who already has the condition do not get worse. And it appears that UK salons and spas are conscious of the dangers of RSI, with our recent PB Insider survey revealing that salons limit their therapists to just two hours of massage a day, while most spas will let their therapists massage for up to four hours a day.

Dormy House Spa in Worcestershire limits the length of therapists’ shifts to eight hours, making sure they have short breaks between massages and that they only perform a maximum of three massages in a day. Its therapists alternate between treatments so they are not performing massages back to back.

Champneys is also mindful of preventing RSI by varying treatments on a therapist’s daily schedule and limiting the number of hours for body massage. It also provides regular staff training workshops on maintaining good posture and alternative massage techniques, as well a providing hydraulic beds to allow the height to be adjusted.

ElbowFeedback from most product brands suggests that the onus is very much on the therapist to know what they are doing, as well as the spas and salons to actually train their staff in avoiding RSI. However, Decléor and Carita’s director of training Fiona Brackenbury feels that there should be a duty of care from the brands, too. “It is our responsibility to look after our spa and salon accounts, as well as protect their therapists,” she says.

Decléor created its Red Island wooden tool to give therapists an alternative to using the fingers and thumbs. “It takes the pressure off the therapist’s wrists. It is moulded with a bulbous end, which is placed in the therapist’s hand and a smaller rounded end, which is great for massage on intricate areas,” she says. Likewise, Elemis says its massage treatments are designed with the welfare of the therapist as well as the client in mind. Angela Kwakwa, the brand’s head of training and education, says, “Techniques such as the use of the elbow and forearm enable the therapist to use their body weight. Also the basalt heated stones we use in the Elemis Aromastone therapy and Face and Body Sensation treatments help to relieve the clients muscular tension without the therapist using their wrists, hands or thumbs to provide the pressure.”

Equipment and tools such as this are a step forward, but it appears training is the key to preventing RSI and many people feel the brands should be doing more. Aleksandrowisz agrees, “We have to invest in training; not just to make sure therapists are performing correctly, but to stop the huge turnover of therapists that is still happening.”

It seems a shame that just when therapists get to a really experienced level and in their prime, they are quitting, which is not just having a negative impact on the industry in terms of standards, but is also costly. PB


Marcella Carnevale, Massage Therapist

“The techniques I have learnt from training are great for avoiding RSI. I don’t really use my fingers and thumbs, never for deep work anyway, as I use my forearms andelbows instead and lean in with my body weight, so it’s far less taxing on the body. I always try to do some swinging of my arms and wrists before a fully booked day and stretches to open my arms and chest. I also do the cat stretch to limber up my back and if I get the chance, I often repeat these between clients. We all work part time so I do, on average, two to three shifts a week, varying from five to eight hours, with the legal amount of breaks. I only use my body in the treatments, not any other additional equipment. I think the biggest thing that’s helped me loosen up my body and improve my treatments is focusing on breathing deeply, which helps me relax. I also have an open stance that allows energy to flow freely and I make sure to bring my attention back to my body during the treatments. My advice to other therapists is to constantly question what they are doing during treatments. Can I do less? Could I relax my arms and hands more? Is my back feeling relaxed and my tailbone tucked under? It feels like the less I try to make something happen, the more I allow the massage to flow in an unimpeded way, which is great for my body and also feels good to the client.”


David Wright, consultant in all aspects of employment practice and law

Legal cases do occur when therapists undertake repetitive tasks. The most famous example is when two therapists employed by Virgin Airways to pamper their first class passengers were awarded £230,972 and £70,545 by the High Court, which found that the number and duration of pressure point massages they performed had caused the problems. What you need to do as an employer The preventative responsibility of the employer is key, so make sure you can show evidence of:

• Undertaking risk assessments and revisiting them. This is going to help with prevention but also protection if you receive a claim. Ensure your equipment is ergonomically sound and professionally checked.

• Breaks: the working time directive specifies a minimum of 20 minutes’ break if the shift is six hours or more. Some salons believe that if you pay for the break it doesn’t matter if staff get it. This is wrong; the break is for health and safety reasons. In busy salons with repetitive tasks it might be good sense to have more breaks.

• Appraisals present another opportunity to discuss directly with staff if they are suffering any symptoms. There will be cases where staff are reluctant to complain as they worry about the financial implications of a period of sickness. A claim can be very expensive to defend in terms of legal and other costs. It could be even more expensive if you lose. At the first sign of an injury or symptoms that might relate to RSI you should ensure the employee makes an appointment with their GP and the issue is investigated. If the GP suggests any changes to the role or hours in a fit note, do your utmost to accommodate them.