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Lean into it: The body mechanics strategy that saved my career


October 19, 2021
By Mark Liskey, LMT

 I was about to become a massage injury statistic. Yes, I could live with the intermittent stabbing pain between my shoulder blades, but not the constant hand and elbow numbness. The doctor had names for my conditions – cervical radiculopathy, cubital tunnel syndrome and an unstable shoulder. He also had a solution: Quit massage.

I thought long and hard about hanging up my hands, but here’s the thing, for 20 years of conducting massage I had overcome other injuries and pain conditions. So, I had some confidence that I could figure this new pain situation out, and I gave myself a year to experiment. 

The year experiment
For the year experiment I had three rules: One, eliminate massage techniques that hurt my body. This rule forced me to give up my forearm, my go-to body part because it exacerbated my neck and shoulder conditions. 

The second rule was anything is on the table. If I wanted to try massaging with my knee, so be it. Why? I wanted leeway to find the best adaptive response for a particular situation. For example, during the experiment, I discovered that a thumb braced against a knuckle was great for precise pressure in the shoulders, but it wasn’t a broad enough stroke for the erector spinae. When I let my hands explore, they settled on a fist-thumb combo. 

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The last rule was to use as many techniques and strategies as possible. I reasoned that changing things up would prevent overuse injuries and lessen the chances that I would trigger a recurrent condition. 

At the end of the experiment, one strategy stood out from the rest because it proved to be the foundation for generating force effortlessly and effectively no matter which technique I used. It was leaning, using your body weight to generate force.

Lean to generate force
I was first introduced to the strategy of leaning to apply pressure by a massage therapist named Xentho, aka, X. One day X showed up at my office door looking for a job. I should mention that he was a 250-pound rugby player who looked like he could push a client through the table. I wondered how clients were going to react to his physical stature.

Well, X had an answer for that: “Let me work on you,” he said to me. With some reservation, I agreed to get on the table, and to my surprise, X didn’t break me. He had great hands and his pressure was spot-on from my calves to the neck. I hired him right then and clients loved him.

Later X showed me his trade secret for perfect pressure – he leaned on clients – and he did it so effortlessly, it looked like he was sleeping. As it turns out, there is research that supports leaning as an effective way to generate force.  

The research behind leaning
The basic concept of leaning, or using your body weight to generate force, is simple. You transfer your body onto the client by shifting your center of gravity from your heels to the balls of your feet.

In 2010, Ed Mohr, massage therapist and once ergonomics engineering manager, published a study, Proper Body Mechanics from Engineering Perspective, in the Journal of Bodywork and Movement Therapies.1 His goal was to find the best body mechanics for producing maximal force and he pitted pressing with the upper body against leaning.

Massage therapists in the study were equipped with Ergo-FET digital palm force gauges. They were instructed to press against the edge of a massage table facsimile at three different heights, using three different body mechanics positions. The positions were BEST (leaning in an asymmetrical stance with back leg locked), GOOD (leaning in an asymmetrical stance, back leg not locked) and POOR (pressing with no, to little leaning). The results were clear and confirmed my experience – good leaning and best leaning beat no/minimal leaning in maximal force output by 12% and 34% respectively. 

X’s leaning was scientifically supported and it served me well for the many years I leaned with my forearm, but as I mentioned earlier, forearm leaning exacerbated my pain conditions. Now, I was experimenting with fists. 

For a year, I lived in fear of the dreaded client-head-pop-up followed by the comment, Something has changed about your massage, Mark. But out of a thousand plus massages that year, only one person liked my forearm better than my fists. I’ll take that. 

Working on a low table comes with a warning: With light pressure, massage therapists could stress their backs. The solution is to widen the stance and lean into the table to support your body weight.

Fist leaning
To understand the difference between forearm and fist leaning stand behind the back of a couch. Pretend the top of the couch is a client on your table. Now place your forearm on the top of the couch and lean. It’s not hard to apply pressure, right?

Next, try the same thing with your fists straight out in front of you. You can’t generate as much force as you could with your forearm, right? That’s because the back of the couch is too high for you to transfer all of your body weight onto it. 

Now walk around to the front of the couch and lean with your fists into the cushions. At this lower height, you’re able to leverage your body weight onto the couch and generate more force than you could at the higher (back of the sofa) height.

It didn’t take me long to understand that I needed to lower my table for fist leaning. I also discovered that working on a low table came with a warning. With light pressure, you have to “hold back” some of your body weight from going onto the client, and this action could stress your back. 

The solution is to widen your stance and lean into the massage table to help support your body weight.

 Whether you are a high table leaner or a low table leaner will be determined by your massage style, body type, chronic conditions and acute injuries.

Experimenting with fist leaning taught me another key element to pain-free massage. 

Stack your arm joints
If I asked you to hold a push-up position with arms bent or arms straight and locked, which one would you choose? Okay, that was a no-brainer – straight and locked. 

There’s a reason why the straight arm positioning prevails. Mohr explains: “Whenever the body utilizes muscle force, energy must be expended. When a joint is stacked (in straight alignment), forces acting on the joint go straight through and do not generate any rotational force that must be counteracted by the muscle.”2 

In the study, Mohr’s computer modelling showed that an un-stacked elbow was a limiting factor to applying maximal force.3

Test it out on your couch. Place your forearm on the top of the couch with your elbow and shoulder in a straight line, and lean. Do you feel how all the tension is taken out of your upper body because your arm only needs to stabilize your body? 

Now, do the same thing, but this time let your elbow extend out from your shoulder so that they are not in line. I bet you won’t want to hold that position too long.

So far, I just talked about leaning while standing, but leaning while sitting is a great way to give your back a rest.  

Massage tools can only help save your hands if the massage therapist is using it correctly.

Sit and lean
Wait, you can lean while sitting? Yep, lean in with your torso, and you’ll be able to generate enough force for necks, shoulders, arms, sides of legs and feet. 

To take your seated lean to the next level, rest your forearms on your legs as you lean. Your neck and shoulders are doing minimal work because they are not involved in supporting the weight of your arms. 

Lean with a massage tool
Massage tools save hands, right? Not if you’re gripping the massage tool to hold it. This can hurt your hand. But if you lean, you can pin the massage tool between your hand and the tissue you’re working on. Put a guide finger from the non-holding hand next to the tool and you can stabilize the tool with minimal effort so that the gripping hand can relax.

Leaning In a Nutshell
I recommend starting at your normal table height to get a baseline for comparison. Choose your point of contact (palm, fist, or forearm), stack your arm joints and lean. As you start to figure out how leaning works with and/or changes your massage style and pain conditions, experiment with different table heights. If you’re leaning on a low table make sure that you use the table for support.

To take muscle strain out of your shoulders and neck, sit and lean with your forearms on your legs. You can save your hands by leaning and pinning a massage tool between your hand and the client’s tissue. 

You’re probably not going to look as chill as X laying down the forearm lean. But who cares as long as leaning helps you massage pain-free, increase your massage weekly max, and extend your massage career.

REFERENCES:

  1. Ergonomics, Volume 14, Issue 2, Edward G. Mohr, CPE, CSP, NCTM, “Proper Body Mechanics from an Engineering Perspective.”
  2. Ergonomics, Volume 14, Issue 2, p. 141, Edward G. Mohr, CPE, CSP, NCTM, “Proper Body Mechanics from an Engineering Perspective.”
  3. Ergonomics, Volume 14, Issue 2, p. 148, Edward G. Mohr, CPE, CSP, NCTM, “Proper Body Mechanics from an Engineering Perspective.”

Mark Liskey is a massage therapist of 30 years, CE teacher/provider and massage business owner. His blog www.makethemostofmassage.com provides massage therapists with the extra knowledge and specific tools to massage pain-free. Take the massage pain-free quiz and get an instant video to help you solve your pain issue: https://www.makethemostofmassage.com/can-you-massage-pain-free/.


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