This article is written by Robin B. Anderson, MEd, LMT, CEAS, for the Massage Therapy Foundation. 

It seems like it was yesterday. I remember when I first received my state massage therapy license in the mail. Excited to begin working and sharing my passion for helping others through therapeutic touch, I felt accomplished as my schedule filled up with one client after another. Having worked in several different practice settings, each with its own challenges, stresses, and approaches, I initially did not think about how my work would impact me physically, mentally, or emotionally. 

Perhaps that is how many of us began our careers, not really thinking about the long road ahead. When the aches, pains, and fatigue come, however, we find ourselves wondering how long we can continue to do our work and what we can do differently so we can continue to do what we love.

Sometimes, we overwork out of necessity because we need to earn a living. We ignore the signs, accepting things as they are. Currently, massage therapy services are at one of their highest levels of consumer demand, and still we lose too many massage therapists to injuries that end their careers, some of whom may have only been practicing a few short years. 

The Ergonomics Project: Focusing on Long-Term Wellness

There are technologies and evidence-based protocols that aim to evaluate the nature and practice of massage therapy work in hopes of increasing career longevity and the long-term wellness of massage therapists. One example of this is the Massage Therapy Foundation’s (MTF) recently completed Ergonomics Project. The mission of the MTF is to provide research, education, and community service to our profession, and the Ergonomics Project was created with the intention of developing recommendations for safer massage therapy work. This project has been a comprehensive undertaking, the first phase of which spanned 18 months, and we’re hopeful it’ll have many positive impacts on the massage profession.

In-depth analysis was provided by our professional ergonomist partners, Briotix Health in Centennial, Colorado, and we look forward to sharing information aimed at helping massage therapists in a variety of workplaces become advocates and real-life examples of career longevity.

Our Two Main Objectives for This Project Include: 

1. Identify and analyze the ergonomic risk profile of the essential and standard tasks of practice commonly performed by massage therapists in their community workplaces. 2. Establish practical recommendations that massage therapists can consider adopting to minimize their exposures to ergonomic risks in daily practice.

Phase One of MTF’s Ergonomics Project had three main components for data collection and analysis: 

1. A comprehensive practitioner survey.

2. Observations of volunteer massage therapists performing common therapy techniques. 

3. A sampling of common workplace environments for massage therapists.

There were 755 massage therapists who completed the online survey through the MTF website, and 16 live massage therapists from Baltimore, Maryland, or Portland, Oregon, volunteered for video observation of them performing massage. Additionally, four different workplace environments—including a franchise site, day spa, and multi-therapist wellness centers—were sampled.

Data Collection and Findings: What We Know

The survey findings gave the data collectors some good insights on therapists of various ages, from younger to older. Common musculoskeletal discomforts reported were the neck (most prevalent), lower back, and shoulder areas, and 25 percent of respondents indicated they have decreased client load due to their recurring discomforts.

Most therapists indicated that the preference for pressure application when performing massage were mostly in the “medium” to “deep” ranges. A telling and concerning element reported was that the vast majority of respondents personally knew a colleague who left the profession due to a musculoskeletal, work-related injury. When observing our volunteer, in-person therapists performing massage techniques, we opted for as much structure as possible to obtain comparative data for analysis. All participants performed 30 minutes of hands-on massage and were required to work the following body areas: neck and shoulders, full back, and one full thigh and leg.

Therapists were instructed to use whatever techniques they wanted provided that all body areas were completed and addressed within the time frame allotted. Therapists were provided with either an electronic lift or portable, manual adjustable massage table and an open-back rolling stool. At each workplace site, measurements and data were recorded from within the treatment rooms themselves, such as size of tables and other equipment, operational room space, lighting, room temperature, functionality of equipment being used, as well as workday schedules, breaks in between massage sessions, accounts of other work-related time not doing massage, and other job tasks required as part of daily shift work. In total, over 600 data points were collected and examined.  

Self-Care Recommendations and Resources

These Phase One results led to the formal development of practice recommendations for safety and self-care promotion in massage therapy work. Information regarding identification of risky tasks, techniques, and posture is compiled in a Risk Factors and Recommendations Guide for practicing massage therapists and schools.

Self-care and physical conditioning recommendations are packaged together as another reference guide for practical and educational use. Corresponding MTF Research Perch podcasts and other online supporting materials will soon be easily accessible and available.

The Ergonomics Project is one of many worthwhile and valuable resources that MTF provides. Phase Two of this project will involve the use of wearable sensor technology to ultimately give massage therapists even more precise information on work-cycle fatigue and technique usage.   

What Do We Mean by Ergonomics? 

It is important to understand the importance of workplace safety and wellness and the overarching definition of ergonomics. Many may think that ergonomics is equal to body mechanics for massage therapy work, but that is not entirely accurate.

Ergonomics has a much broader scope and looks at several factors of how job tasks are performed, taking an analytical look at the nature of how work is performed in all different types of professions and making adjustments or reasonable adaptations to minimize risk factors that can either cause potential injury or, more specifically, reduce the cumulative effects of performing work tasks that lead to repetitive stress injuries (RSIs) from continuous exposure.  

Think of how different types of jobs are done and how tracking repeated documentable injury cases has a direct correlation to RSIs resulting in certain work tasks being performed differently. Did you ever wonder why jackhammer operators wear earplugs and only operate the device for small progressive amounts of time? Or why many office buildings started using standing desks rather than standard desks in some cubicle workstations?

In both examples, these adaptations or protective equipment are in place to assure the safety of their workers in their work environments.   

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