Massage Therapist: The Basics of Therapeutic Massage and Bodywork Application

Key Topics:
- Holistic principles and mind-body practice
- Effects of massage
- Soft tissue techniques
- Client positioning and draping
- Massage and bodywork tools
- Client self-care
- Standard precautions
- Body mechanics for therapists
- Tips for answering questions on therapeutic massage and bodywork application
 

Therapeutic massage and bodywork application is the apex of what you have been working toward: the integration and application of knowledge and skills in the performance of safe, hygienic, beneficial treatment on clients. Therapeutic application has both theoretical and practical components. It is just as important for you to understand, for example, the physiological and psychological effects of treatment on clients as it is for you to be able to carry out effective soft tissue manipulation.
Other significant practical components of therapeutic application include appropriate client draping and positioning and following standard precautions to create a safe and hygienic environment. Part of your practice will be teaching clients how to be more proactive about self-care, such as stress management and relaxation techniques. Finally, you will want to practice your own brand of self-care by making sure you are following guidelines for appropriate body mechanics so that you do not injure yourself in the course of your work.

For examination study, at a minimum, you should be able to do the following six things:

(1) discuss the theoretical underpinnings of massage practice, including the mind-body connection and the holistic nature of treatment; (2) describe the benefits of soft tissue manipulation; (3) explain appropriate client draping and positioning; (4) identify and describe soft tissue and related techniques; (5) discuss appropriate body mechanics for the therapist; and (6) apply standard precautions necessary for a safe and hygienic practice.

This guide highlights important information and gives you some practice questions in these areas. If you are having trouble understanding the information or answering the practice questions, take some time to review your textbooks and notes from school.
The number of questions you will need to answer on therapeutic massage and bodywork application varies by exam. If you are taking the MBLEx, you will be required to answer a total of 125 questions; of these, about 17 percent, or around 21 questions, are on this topic. If you are taking the NCETMB, you will be required to answer a total of 160 questions; of these, about 22 percent, or around 35 questions, touch on this topic.

Holistic Principles and Mind-Body Practice
For health-care practitioners, holistic means consideration of all aspects of a person’s being—physical, mental, and emotional—when providing treatment to that person. Massage therapy is considered a holistic practice because it impacts so many aspects of the client. In addition, massage therapy is not just about treating symptoms but rather is about establishing the root cause of problems and resolving them in order to restore balance and alignment to the body.
The mind-body connection is about the interaction between the psyche and the physical body; it is based on the idea that everything that happens to one also impacts the other. Just as the mind processes pain experienced physically, the body responds to how you feel and what you think. For example, if you are feeling stressed or depressed, you might experience back pain, headaches, or exhaustion. You might develop insomnia or experience a change in appetite. These physical manifestations can be addressed through massage treatment; similarly, experiencing the release and relaxation of massage can help ease feelings of stress or other emotions.
You can facilitate mind-body healing with clients by helping them to become more aware of the link between the way they feel and their physical holding patterns. You can promote client self-care using tools such as meditation or relaxation or visualization and guided imagery.

Stress and the Body
The human body responds to stress (real or perceived threats) in an automatic, complex chain of reactions which result in the release of hormones such as adrenaline and cortisol into the bloodstream. Adrenaline surges increase heart rate, elevate blood pressure, and boost energy levels so that the body is able to respond physically when necessary. Cortisol is the primary stress hormone; when released into the bloodstream, it increases sugar (glucose) levels and enhances the brain’s ability to utilize this substance. Cortisol curbs nonessential bodily functions like the digestive and reproductive systems and triggers mood, motivation, and fear responses in the brain.

Constant exposure to cortisol and other stress hormones can cause or increase the severity of a variety of health conditions. Some of the known issues resulting from constant stress include:
- Heart disease
- Issues with digestion and nutrition; obesity
- Increase in anxiety and depression; memory impairment
- Problems with relaxation and sleep
- Worsening of conditions of the skin, such as psoriasis or eczema

The Relaxation Response
One of the best solutions to the problems caused by chronic stress is known as the relaxation response. The relaxation response is activated by the parasympathetic branch of the nervous system in the body. It is exactly what it sounds like: the body responding to some activity or stimuli by releasing tension, slowing down, and relaxing into a calmer and more restful state. The relaxation response can be triggered by a number of different activities, such as meditation, guided imagery, and, of course, therapeutic massage. As a skilled bodyworker, you can help your clients to access this state of balance and relaxation.

The Mind-Body Connection
Although psychological counseling is out of the scope of practice for massage therapists, the mind-body connection is still a relevant concept. The mind-body connection is the belief that the mind and the body do not operate separately but rather form an integrated whole. In other words, anything that affects one also affects the other. Many people pursue alternative health therapies such as meditation, yoga, and massage, in order to forge a stronger mind-body connection.
The mind-body connection is based on the work of William Reich, who pioneered the theory that emotional energy can be locked into a person’s tissues and eventually be the cause of physical dysfunction and pain. Following this logic, the mind-body connection also means that any mental or emotional distress or pain experienced over the course of one’s life has also been experienced on some level by the physical body.
For example, being exposed to an emotional situation may manifest itself as a tendency to hold tension in a particular part of the body, such as by clenching the jaw or tensing the upper back. This tension may result in chronic pain. Touch therapies such as massage can release this pain but may also make clients feel emotional without understanding why. If a client responds emotionally during a session, you should stop and ask if the client needs anything, such as privacy, a tissue, a bottle of water, or an end to the session. If you feel overwhelmed by the client’s response, you might refer that person to a more appropriate mental health practitioner.

Exercises: Holistic Principles and Mind-Body Practice
Choose the option that best answers the question.

1. Taking a holistic approach to health care means focusing on (A) the client’s spiritual needs. (B) external factors affecting the client’s condition. (C) all aspects of the client’s being. (D) the client’s personal energies.
Practitioners who approach clients from a holistic perspective must consider all aspects of the person’s being, including his or her physical, mental, and emotional states. The correct answer is (C).

2. Feelings of extreme stress can result in maladaptive (A) musculoskeletal asymmetry. (B) physical holding patterns. (C) range of motion. (D) repetitive movement injuries.
Because the body manifests what the mind thinks and feels, experiencing emotions such as extreme stress can result in maladaptive physical holding patterns. The correct answer is (B).

Effects of Massage
Massage therapy has many positive effects on clients, both physically and psychologically/emotionally. Physically, massage treatment relaxes tight muscles, promotes the flow of the circulatory and lymphatic systems, promotes healthy release of toxins, and facilitates physical and postural awareness for clients.
From a physical perspective, massage can
- improve circulation.
- promote healthier skin.
- alleviate pain and tension.
- reduce muscular tension and stress.
- improve flexibility and mobility.

Massage also has psychological and emotional benefits. Remember, psychological and emotional issues can manifest themselves in the body in physical ways. For example, a client might be suffering from an aching back or a stiff neck as a result of holding in emotional tension. The physical manipulations of massage can trigger the release of these emotions.

From a psychological perspective, massage can
- facilitate the release of emotional tension.
- induce a sense of relaxation and well-being.
- reduce feelings of anxiety and depression.
Due to the implications of touch and the strong mind-body connection inherent to bodywork practices, you may find that some of your clients respond quite emotionally to treatment. It is essential that you recognize how to most appropriately handle such situations using both verbal and nonverbal communication (give the client a moment to compose himself/herself, provide a tissue, offer to discontinue treatment, ask if the client would like to be alone for a few minutes, etc.).
Regular massage can promote a greater degree of alertness, a more balanced sense of well-being, and the ability to deal more effectively with stress. Remember, though, your focus should always be on the physical treatment of the client. The psychological benefits of massage are secondary to the physical effects of treatment. Dealing with emotional issues is firmly outside your scope of practice.

Exercises: Effects of Massage
Choose the option that best answers the question.

1. The circulatory benefits of massage include all of the following EXCEPT (A) improving circulation. (B) detoxifying blood. (C) increasing blood flow. (D) reducing cholesterol.
Though massage has many circulatory benefits, it is not an effective means of reducing cholesterol. The correct answer is (D).

2. During a session, your client suddenly becomes very emotional. How should you respond? (A) Ignore her and continue the massage. (B) Stop the massage and leave the room. (C) Use your communication skills to alleviate the situation. (D) Reprimand her for her behavior.
In the event that a client becomes emotional during a massage, you should use your verbal and nonverbal communication skills to gently diffuse the situation and determine the most appropriate course of action. The correct answer is (C).

Soft Tissue Techniques
Certain soft tissue techniques form the basis for a variety of therapeutic modalities. In order to be an effective massage therapist, you should be able to perform and understand the purpose of these techniques.
- Static touching/holding: Static touching and holding involves placing the hands or fingers on the client’s body without moving them. Static holding allows the client to adjust to your touch.
- Gliding (effleurage): Gliding involves smooth sliding movements of the hands over the entire body or over particular body parts. Gliding allows the client to become used to your touch. It also warms up tissue prior to more involved work.
- Kneading (petrissage): Kneading involves lifting, rolling, squeezing, and stretching movements. Kneading is useful for working out adhesions and stretching and loosening the muscles and fascia.
- Percussion (tapotement): Percussion involves striking the client’s body in a rapid motion. Percussion might include slapping, pinching, or pounding movements, for example. Percussion should be used only in appropriate applications.
- Friction: Friction involves the application of pressure in specific ways; for example, circular friction is a common movement. Friction loosens scar tissue and adhesions and is useful for stretching and the promotion of flexibility.
- Compression (pumping): Compression is a form of friction in which a pumping motion is directed at the belly of the muscle.
- Rocking: A form of vibration involving a gentle swaying of the body or of particular body parts.
- Shaking: A form of vibration involving a gentle trembling of the body or of particular body parts.
- Traction: Traction involves the use of a drawing or pulling force and is useful for alleviating pain.
- Vibration: Vibration involves a continuous shaking or trembling movement using either the hands or an electrical apparatus. Vibration can be stimulating or relaxing, depending on the application and the speed of the strokes.

Other Techniques
Other common techniques you should understand and be able to perform during treatment include:
- Range-of-motion movements
- Relaxation techniques
- Stretching techniques

Exercises: Soft Tissue Techniques
Directions: Choose the option that best answers the question.

1. Which soft tissue technique involves lifting, rolling, squeezing, and stretching movements? (A) Percussion (B) Kneading (C) Compression (D) Gliding
Kneading, also called petrissage, involves lifting, rolling, squeezing, and stretching movements. The correct answer is (B).

2. The percussion technique is primarily based on (A) striking of the body. (B) swaying of the body. (C) a pumping motion. (D) smooth sliding movements.
The percussion technique is primarily based on rapid striking of the body. The correct answer is (A).

Client Positioning and Draping

Positioning
As you get ready to begin a massage session, instruct the client to assume a comfortable position on the massage table. Position the client so that the body part upon which you will work is in front of you, close to you, and facing upward. Depending on the treatment, the client may be lying face up or face down. You may need to assist the client in assuming an appropriate position.
Once the client is on the table, his or her comfort is of the utmost importance. Some clients may experience difficulty if they attempt to lie in a certain position without support. In such cases, use cushions and/or bolsters for added support. You may choose any type of cushion, as long as it is clean, properly covered, and washable. When the client is face up, you can add support by placing bolsters under the knees. If the client is face down, you can place the bolsters under the ankles. No matter where you place the bolsters, make sure they are under the sheet so that they do not come in direct contact with the client’s skin.
Some downward-facing clients may also benefit if you place extra support under the chest, as this will help support the cervical spine. For this form of support, the client’s chest should be lifted three to four inches off the table while the head rests comfortably forward. Clients who suffer from severe low back pain may require extra support under the abdomen when lying face down. In this case, the client’s abdomen should be lifted about six to eight inches off the table. Those who have trouble lying back with their head resting on the table will likely require extra support both for the head and neck as well as the small of the back and the back of the legs.
In some cases, you may need to accommodate for clients who cannot lie on the massage table at all. In such cases, you will need to work with the client in a seated position.

Draping
Draping refers to the use of linens to keep the client appropriately covered during the course of the massage session. Draping properly ensures the client’s warmth, comfort, and privacy. Proper draping, which is often required by law, is also an important part of maintaining appropriate client boundaries.
 
Note:
The massage therapist is responsible for providing clean linens for every client.

In most cases, the treatment session begins when the client and therapist begin the intake interview. Once the interview is complete, you can show the client around the treatment room. The client will need to know, for example, where to hang clothes and how to get on the table. You should leave the room so that the client can get undressed in private. The client will disrobe to his or her comfort level and get on the table, under the clean sheets you have provided. After a few minutes, you can reenter the room to begin the session.
Keeping the client warm at all times during the session is very important, as a person who is chilled is virtually incapable of relaxing. Ideally, you should try to maintain a continuous awareness of the client’s level of comfort. Even if the treatment room is kept at a generally mild temperature, some clients may become too cool or too warm. Remember to monitor the client’s comfort level and adjust the draping as needed. For example, an electric mattress pad or a flannel blanket can be useful for warming a client who cools easily.
If you practice in a state that requires you to be licensed, be aware that you may be subject to certain regulations that apply specifically to draping practices. Such laws often require that certain body parts be kept covered at all times. In some states, you may be allowed to temporarily remove draping while working on, for example, gluteal muscles or breast tissue.
After the massage is completed, clients should be allowed to get up and redressed following a procedure that will ensure safety and protect his or her privacy.

Exercises: Client Positioning and Draping
Choose the option that best answers the question.

1. As you are about to begin a massage, the client tells you that he wishes to proceed without draping. How should you respond? (A) Remove the draping at his request. (B) Ignore him and begin the massage. (C) Tell him the draping must be kept on. (D) Suspend the massage session and ask him to leave.
In this situation, you should make sure the client understands that draping is not optional. When applicable, you can let the client know you are legally required to follow proper draping protocol and that such rules are in place for the client’s safety and protection. The correct answer is (C).

2. For clients requiring extra support of the cervical spine, you can place a bolster under the (A) abdomen. (B) head. (C) chest. (D) neck.
When working with clients who need extra support for their cervical spine when lying in a downward-facing position, extra support should be placed under the chest. The correct answer is (C).

Massage and Bodywork Tools
Many massage and bodywork tools are available to assist you in providing treatment. More advanced tools such as ultrasound require specialized training and expertise and so are considered outside the scope of massage therapy. However, some of the other tools you might use with clients include:
- Electric and manual massagers
- Hot/cold packs
- Rollers
- Stones

Hot/Cold/Hydrotherapy Applications
Some therapeutic treatments involve the use of hot and cold agents, either alone or alternating, or the application of water in some way. You will need to understand how to safely use these modalities. Some treatments are beyond the scope of massage practice, so you should also know what you can and cannot do for your clients.
- Hydrotherapy involves the use of water during treatment. Water can be used in its normal state (cold or hot) or in the form of steam or ice. The effects of water treatment vary greatly depending on the particular application.
- Heat therapy involves the application of heat to some part of the client’s body. The treatment may take the form of dry heat, such as a heating pad or sauna, or moist heat, such as a heating pack or steam bath. Heat therapy is used to increase circulation and promote relaxation. Heat treatment should not be used on any area that is inflamed.
- Cryotherapy involves the application of cold to the client’s body. The treatment may take the form of an immersion bath, ice massage, or application of a cold pack. Cold therapy is used to improve circulation and reduce inflammation. It can have either a stimulating or depressive effect depending on the length of treatment.

Exercises: Massage and Bodywork Tools
Choose the option that best answers the question.

1. All of the following treatment devices are considered to be within the scope of practice for massage therapy EXCEPT (A) rollers. (B) ultrasound. (C) hot stones. (D) electric massagers.
Ultrasound is outside the scope of practice of massage therapy because it requires specialized training and expertise. The correct answer is (B).

2. A client presents with localized redness and swelling. Given that the results of your assessment indicate that massage is appropriate, what treatment might be appropriate for soothing this area? (A) Hot stone therapy (B) Roller therapy (C) Heat therapy (D) Cryotherapy
Redness and swelling are generally signs of inflammation. Cryotherapy can help to soothe inflammation. The correct answer is (D).

Client Self-Care
Part of treatment is educating clients on activities that promote self-care. When possible, you can help your clients to better manage their health by teaching them stress management and relaxation techniques. Encourage clients to pay attention to how they feel and what they are doing with their bodies.
Some key elements of self-care include the following:
- Awareness: One of the key ways you can assist your clients in taking better care of themselves is to help them become more aware of themselves. Through your treatment, you can teach clients about their typical physical holding patterns, movement patterns, and issues with gait, body alignment, and so on.
- Decreasing pain: In the event they are injured or experiencing pain due to some other condition, clients should know and follow the Rest-Ice-Compression-Elevation (RICE) technique.
- Increasing safety: Corresponding closely to an increase in awareness, clients can also increase personal safety simply by learning to move and hold the body correctly.
- Modifying activity: When a client’s daily activities lend themselves to the possibility of injury, you can help them consider ways to make those activities safer.
- Stretching: Showing clients the appropriate way to stretch and encouraging them to stretch frequently promotes maximal flexibility and an increase in range of motion.
- Strengthening: Clients should recognize that they can maintain their health if they engage in activities designed to improve cardiovascular health and increase strength and endurance, such as cardiovascular exercise and weight-lifting.
- Self-massage: You can help clients to relieve muscle pain and soreness between treatment sessions by showing them how to perform some basic self-massage techniques.
- Relaxation: Sharing relaxation methods, such as breathing exercises and visualization techniques, can help clients learn to become calmer and deal more effectively with stress.

Exercises: Client Self-Care
Choose the option that best answers the question.

1. A client could most increase his or her physical endurance through (A) stretching exercises. (B) self-massage activities. (C) strengthening exercises. (D) breathing techniques.
A client’s physical endurance would best be increased through strengthening exercises such as weight-lifting. The correct answer is (C).

2. Which element of self-care could be used to improve flexibility and range of motion? (A) Self-massage (B) Breathing exercises (C) Strengthening (D) Stretching
Stretching is the primary way for a client to improve his or her flexibility and range of motion. The correct answer is (D).

Standard Precautions
Safety and hygiene are important everywhere, but are paramount for those working in a health-care field. Recognizing and identifying potentially hazardous conditions will allow you to offer a safe and effective practice to clients. A large number of diseases are caused by the transmission of infectious organisms like viruses, bacteria, and fungi. Since it is impossible to completely cleanse the environment of these microorganisms (also called pathogens), it is best to focus instead on reducing their numbers as much as possible in order to prevent the spread of disease.
You can remove pathogens from surfaces and objects in three primary ways.

1. Sterilization: The most effective means of pathogen removal is sterilization. This method completely destroys all living organisms on surfaces and objects and is commonly used in environments such as operating rooms in hospitals. Due to the degree of difficulty and the time required to effectively sterilize any environment, however, this method is generally not used in massage practices.

2. Disinfection: A method of pathogen removal that is almost as efficient as sterilization is disinfection. This method effectively destroys all pathogens except for bacterial spores. Disinfectant substances are powerful and can be used on all surfaces and objects. Some commonly used disinfectants include ammonia compounds, phenols, chlorine bleach, and alcohol. Professional-strength disinfectants are particularly potent and should be used with great caution. They should not be used as hand cleaners, as they may cause skin damage.

3. Sanitation: The most commonly practiced method for decontamination in massage practices is sanitation. Sanitation practices remove a significant number of the pathogens that normally accumulate on surfaces. In most cases, sanitation can be achieved using water and soap or some other form of detergent.

One of the most important and commonly practiced forms of sanitation among massage therapists is thorough hand washing. During thorough hand washing, you vigorously scrub your hands with soap (antibacterial, preferably) and warm water. After briefly wetting the hands, apply the soap and work it into a lather. Scrub for up to thirty seconds, making sure to reach all parts of the hands, including the areas between the fingers and thumbs, around the nails and cuticles, and along the forearm. When scrubbing is complete, rinse the hands and dry them with a clean towel. You should wash your hands before and after every session.
On occasion, you might encounter certain circumstances under which special hygienic precautions may be indicated. Normally, massage is not performed if a highly infectious or contagious disease is present and you should not be exposed to bodily fluids in the normal course of events. However, sometimes these situations occur. Under those circumstances, the additional risk needs to be handled appropriately.
In some cases, it is the client who is at an increased risk. Some clients may present with substantially weakened immune systems and may be particularly vulnerable to any pathogens to which they are exposed. Proper hygienic precautions on your part are of vital importance for you and clients alike.

Universal Precautions
Universal precautions are standard practices utilized in health-care settings to avoid contact with others’ bodily fluids. Universal precautions are designed with the assumption that all blood and bodily fluids present risk for blood-borne diseases such as HIV and hepatitis. They are intended to control the spread of infection by protecting individuals from exposure to blood or to bodily fluids that might contain blood.
Some of the universal precautions that apply to massage treatment are discussed below.
- Hand-washing: Thorough hand-washing is mandatory before and after every session. Hands and other skin surfaces should be washed immediately in the event that you come in contact with blood or other bodily fluids.

- Gloves: You may need to wear gloves for a variety of reasons.
If you have an injury or sore on the hands, you should wear gloves to work on clients. However, note that if you develop skin lesions or weeping dermatitis, you should not practice massage until your condition improves.
If there is even a remote possibility of direct contact with a client’s bodily fluids, mucous membranes, non-intact skin, or items or surfaces contaminated with blood or bodily fluids, wear gloves.
If you wear gloves, put them on before beginning the task and remove them immediately once the task is completed. Discard the gloves and immediately wash your hands.
- Linens: If any linen becomes soiled with blood or other bodily fluids, collect it carefully, without undue agitation.
Store the linen in a leak-proof bag until you can transport it to the laundry or a soiled linen container.
Although there is little risk of catching disease from soiled linen, you should still follow hygienic and common-sense methods for storing and processing linens. Handle soiled linens the minimal amount necessary.
Wash linens in hot water with appropriate detergents. Dry using a heated dryer as heat kills germs. Contaminated linens can be treated by adding one cup of chlorine bleach to the wash water.
- Surfaces: Walls and floors are generally not associated with disease transmission. As such, it is not so important to sanitize or disinfect such surfaces, except in the event of accidents or spills. However, it is still advised to clean these surfaces regularly using appropriate products.

Sanitizing Objects and Surfaces
You can sanitize most of the objects used in your practice with a wet sanitizer. This is a receptacle that contains disinfectant solution and is large enough to allow complete immersion of objects. Prefabricated wet sanitizers are available for purchase and come equipped with a cover that prevents the solution from becoming contaminated. Some states may regulate the type of receptacle used for this purpose.
Before you immerse any objects in the wet sanitizer, wash them with hot water and soap. Rinse the objects thoroughly in order to prevent contamination. After being immersed in the wet sanitizer, the objects should be removed and rinsed again. Then dry them with a clean towel and place them in a dry sanitizer until they are once more needed for use.
Another way to sanitize objects is to use moist heat. In this process, the objects are placed in boiling water (212° Fahrenheit) for about twenty minutes. Finally, many hospitals and other medical facilities utilize a device known as an autoclave, which sterilizes objects using high-pressure steam.
You should also maintain clean surfaces in your practice for both disease control and aesthetic purposes. All surfaces should be cleaned and sanitized on a regular basis.

Some of the surfaces that require regular sanitary attention include:
- Floors: Carpets should be vacuumed regularly and shampooed as needed. Solid floors should be swept daily, sanitized with detergent and water, and disinfected.
- Massage tables and bolsters: Remove oils from these surfaces using a spray-cleaner or soap and water, then disinfect them.
- Restrooms: All restroom surfaces should be sanitized with detergent and water and then disinfected with a commercial disinfectant. A chlorine bleach solution may also be used. When using a disinfectant, spray the surface and wipe dry. Afterwards, spray the surface again and allow it to air dry. Ensure that the restroom is properly stocked with appropriate paper products as well as liquid antibacterial soap.
- Other surfaces: All other surfaces in the treatment area should be sanitized either with soap and water or with commercial cleaning solution.

Exercises: Standard Precautions
Choose the option that best answers the question.

1. Which of the following most accurately describes disinfection? (A) It is commonly used to remove pathogens from surgical instruments. (B) It completely destroys all pathogens. (C) Its most common form is hand washing. (D) It destroys all pathogens except bacterial spores.
Disinfection practices destroy all pathogens except bacterial spores. Only sterilization can destroy all pathogens. The correct answer is (D).

2. Sanitization via moist heat involves the use of (A) heated chemicals. (B) an autoclave. (C) boiling water. (D) steam cleaning.
Sanitization via moist heat involves the use of boiling water. In this process, the object to be sanitized is placed in boiling water for approximately twenty minutes. The correct answer is (C).

Body Mechanics for Therapists
In addition to attending to the physical needs of your client during each session, you must also be aware of your own body. Poor posture, bad techniques, and improper workplace design can all lead to stress and strain on your body, increasing the possibility that you will injure yourself.
Before you can begin to develop a system for ensuring your physical health in the workplace, you must understand the basic sciences involved. Body mechanics, commonly known as biomechanics, refers to the mechanics of the body’s muscular activity and movement. Proper body mechanics increase strength and energy and decrease the likelihood of injury. Kinesiology is the study of the way the body moves as well as the body parts involved in each movement. You have already learned how to apply kinesiology to your practice; you should also take care to apply it to yourself.
The importance of observing and improving your body mechanics is critical because proper movement patterns decrease the possibility of injuries that may affect your ability to do your job and, in turn, may affect your business. You must take as good care of yourself as you do your clients.
Ergonomics is concerned with the way people interact with systems, equipment, and each other in the workplace. It is about designing work environments that optimize both your physical well-being and your ability to be productive.

Ergonomics has three basic principles, as follows:

1. Work activities should be designed so as to allow the worker to assume a number of different, healthy, and safe postures.

2. When performing work activities, exert muscular force using the largest suitable muscle groups available.

3. When performing work activities, hold the joints around the midpoint of their range of motion. This is especially important when considering the use of the upper limbs, head, and neck.

One of your primary concerns in the treatment area should be the height of your massage table. Your table should be situated at the correct height for you to comfortably work on the client without needless bending and stretching. Your table should be adjustable so that you can adjust it based on the size of the client, when necessary.
When working on a client, stay in a neutral-spine position. Keep your back straight, knees slightly bent, elbows close to the body, and wrists relaxed. Avoid placing all of your pressure on your thumbs. Try to work from the center of your pelvis and let your legs do the heavy work.
Since your hands are your primary tools of trade, you need to take especially good care of them. Avoid exaggerated wrist angles by staying behind the massage movements instead of on top of them. Do not hyperextend your wrists or use the heel of the hand when applying compressive forces. Use your forearms and elbows to do pressure work or to perform deep, gliding strokes. When you need to apply pressure with your fingers or thumbs, do so using the palmar side of these extremities, rather than the tips.
Of course, some of your physical needs may not be readily identifiable until you are actually working on a client. For this reason, it is important to remain conscious of your body and body movements at all times during a session. If you notice that a certain movement causes discomfort or pain, stop immediately and readjust your posture or change the technique.
Finally, remember to pace yourself. Massage is a physical profession and it is easy to burn out. Though it may seem worthwhile to do as many massages as possible every day, remember that massage is strenuous work. The key to longevity in this type of career is to pace yourself carefully. Avoid taking on more than you can handle.

Exercises: Body Mechanics for Therapists
Choose the option that best answers the question.

1. The study of how the body moves and the body parts used in each movement is referred to as (A) kinesiology. (B) body mechanics. (C) ergonomics. (D) biomechanics.
Kinesiology is the study of the body’s movements. The correct answer is (A).

2. When working on clients, you should exert force from your legs instead of your torso because (A) you can reach farther with this technique. (B) the legs are a larger muscle group. (C) doing so prevents overextension of the arms. (D) doing so negates the need to adjust table height.
You will recall that one of the principles of ergonomics is the dependence on large muscle groups to exert force when possible. The legs are the largest muscle group in the body. The correct answer is (B).

Tips for Answering Questions on Therapeutic Massage and Bodywork Application
- Follow the logic: The application of therapeutic massage and bodywork is the pivotal moment of your studies. It is here that you integrate everything you have learned for use on both your examination and your massage table. To achieve the highest degree of success, follow the logical chain of information, from your initial study of anatomy and body systems to your review of kinesiology and body mechanics to your experience with therapeutic assessment and application.
- Focus on the basics: Most massage modalities have their roots in the fundamental soft tissue techniques discussed above. Pay careful attention to these techniques in your studies.
- Remember the client: The client-centric point of view as you answer the examination questions. When presented with scenarios, consider each answer carefully, and select the one that is best for the client. Always consider the client’s needs first.