Due to the physical demands of the job, massage therapists sometimes only have a few good years in their role before injury sets in.
“Your average massage therapist typically has six or seven years in the industry before they have to change careers due to injury,” says massage therapist of 20 years Kayleigh Purser, founder of The Purser Method – a method of deep tissue massage therapy with the main focus being the health and wellbeing of the practitioner.
Purser accredits the longevity of her massage career to an accident in 2013 that caused her to take stock of her physical health.
“I almost had to end my career, partly through injury from massage, and partly from a car crash,” she says.
“I was told by the doctors that if I had not already been doing the job I was doing and already started injuring my body, I wouldn’t have had anywhere near as severe injuries as I sustained.
“The crash forced me to look at what I was doing to my body through work before it actually got to that point where my career was over.”
Massage therapist injuries
“We are in a staffing crisis, not just in the UK, but worldwide,” says award-winning independent beauty therapist Anna Tsankova.
“That’s why it’s super important to understand what we need to do in order to help therapists feel well because they are the ones who take care of the rest of us.”
Tsankova adds, “Therapists rarely do any sort of stretching exercise or preparation on the day before they start work, despite massage being a very physical job.
“Therapist wellness and injury prevention is not often included in curriculums, aside from ‘keep your back straight’.”
While massage therapists are taking care of their clients, there are a number of ways in which they can cause harm to their own bodies – chiefly repetitive strain injury (RSI) and carpal tunnel syndrome.
“We suffer from a lot of swelling and pain in the wrist which can get into the rotator cuffs or into the muscles surrounding the shoulder blade into the neck,” says Purser.
“In spas, I’ve seen external trainers come in to address therapist posture and tell students to squat to alleviate pressure on the back, which technically works, but you’re then expected to basically do a sustained squat, unsupported, for the entirety of your treatment.”
Purser says that because of this she has begun to see a lot of sciatica in very young therapists because the glutes get so tight that they start pressing on the sciatic nerve.
“The entirety of the spine can be compromised, as well as the knees; it can really affect the whole body.
“A lot of courses teach you to use your forearms more to take the strain and pressure off your hands, thumbs and wrists.
“That’s great, but nobody’s telling you about the impact that has on your rotator cuff. Everything I tried would just highlight a different bodily issue.
“It took me years of training, often very obscure training, to come up with the Purser Method.”
Breathing techniques for massage therapists
One day while performing a couple’s massage on another therapist, Purser noticed that her co-worker was holding her breath during the massage and realised she was doing the same.
“I started looking out for it and noticed that every single time I was in a couple’s treatment, the other therapist would be holding their breath and not using their diaphragm properly, so I really started studying what I was doing and the difference proper breathing would make for me,” she says.
Purser went to the lengths of becoming a yoga instructor to learn breath work, better posture and flexibility.
Her method is a combination of Swedish, sports and acupressure massage, yoga, forearm massage, Reiki, breathing techniques and, interestingly, Tai Chi, which is rooted in Asian martial arts and traditional Chinese medicine.
It focuses on gentle, repetitive movements, which allows you to focus on integrating your breath, having bodily awareness and increasing mental focus through visualisation.
Lucie Allen, Professional Beauty Therapist of the Year 2023 and therapist and trainer at New Forest spa Chewton Glen, also credits techniques from Asian cultures for enabling her to avoid injury when conducting a lot of massage.
In this part of the world, people are more accustomed to the practices of intentional movement and the importance of breathing and mindfulness.
“I learned a lot from Thai therapists when working at a Thai-themed spa,” she says.
“They are taught to breathe and use every part of their body rather than just the thumbs. They use the palms, knuckles, forearms, elbows, even the feet.
“There is a real remedial side to it – they find an injury or blockage and literally apply pressure to it. It’s a lot stronger than anything we do with Western massage.”
Thai therapists rely on their body weight to bend and stretch their clients into different positions, hence why Thai massage is often referred to as “lazy man’s yoga”.
“A lot of Thai therapists are small in stature so to be able to do this they need to know how to use their entire body weight and the right positions,” adds Allen.
Going back to breath, Allen has also learned techniques from massage therapist and trainer Beata Aleksandrowicz which help to get your client to breathe better in order to optimise results.
“She [Aleksandrowicz] showed different ways of asking clients to breathe in to be able to push down and get a more effective massage if the client is tensing and you’re struggling to put the pressure on.”
Looking after your mental health as a massage therapist
As well as being highly physically demanding, massage therapy can also be emotionally taxing, as you take on your client’s energy, pains and often complaints.
It’s common knowledge that, across the beauty industry, professionals take on the role of emotional therapist while also conducting the beauty or wellness therapy they specialise in.
While most are happy to do this, it can take its toll on their mental health.
“You are half psychologist when you work with clients,” says Tsankova.
“You have to deliver what you do to make them feel good, but also be extremely diplomatic, and sometimes you’re asked for advice outside of your role.”
Allen also thanks Thai practices for helping her take care of her mind, starting with the absence of shoes during massage to help stay grounded.
“Thai massage is focused on the Zen, or energy lines, which flow through the body.
“They teach you how to separate yourself from someone else’s energy with grounding rituals, affirmations and prayer before and after the treatment, and to push positive energy into the client.”
Purser agrees that “energy is a massive part of any kind of holistic treatment”, adding, “This is because everything we feel, we project.”
This can lead to bad outcomes for the client. “Your client might not necessarily pick up on what you are feeling, but they do pick up on the fact that something’s wrong,” she adds.
“Keeping your body in the best condition is super important physically and mentally,” says Tsankova.
“Making time for self-care is the only way to avoid burnout. It’s a lot of common-sense stuff like water intake, nutrition, socialising and meditation.”
She says this is why it is important to work for spas that understand the strain on the therapist and the benefits of providing a healthy work environment.
Purser adds, “The more focus I put on what I’m doing physically – my breath, my steps, my posture, everything that’s going on through my body, weirdly, the more connected I become with my clients.”
Massage therapy tools
Ergonomics can make all the difference to the strain on a massage therapist’s body, says Tsankova.
“Unfortunately, there are still many spas that only have static tables that are not height adjustable. Depending on the height of the therapist, this can cause a lot of back pain.
“The shape of the table is also important, as different treatments require a different design,” she adds.
“This is why I think therapists should be more involved with testing equipment during the manufacturing process.”
Tools can also play a role in relieving some of the pressure from the therapist.
Allen likes to use bamboo canes on occasion when a client wants a really deep tissue massage.
“It can be really nice on the backs of the legs and back as you can anchor them to roll and iron out the muscles,” she explains.
“Lava Shells and hot stones are really good as well because they break the tension down without having to apply as much pressure, as heat will help to relax the muscles.”
Allen also likes to make use of essential oils and calming rollerballs that can help pull you out of a negative moment and ground you.
Massage training
Above all else, our experts credit training and education as the key to their longstanding careers in massage and have gone above and beyond to understand their bodies and minds, and those of their clients.
“It’s a large-scale problem,” says Tsankova. “There are a lot of short courses that give you a certificate and licence, which would be enough to get insurance and start work, and many spas are desperate for staff so are hiring poorly trained therapists.
“But it’s so important to hire properly trained staff and then be flexible with their lifestyles and needs to help retain them.”
By knowing yourself and your body, what it struggles with and what it needs, you will be able to seek out the additional tools, techniques and training to add to your arsenal to ensure a long and healthy career.
How do you prevent injury as a massage therapist? Let us know in the comments…
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