My shoulder started to hurt.
Was this actually happening to ME? Was this the beginning of nagging symptoms leading to the end of my favourite career?
Those thoughts certainly crept into my mind.
One of the most frustrating things a Massage Therapist can experience: an injury.
I imagine a lot of Massage Therapists, as well as many other hands-on health care professionals, experience some form of discomfort or injury during their career. We spend hours each week using our body: our strength, our endurance, our flexibility, our knowledge, our emotion and our passion to help others feel better.
But what do we do for ourselves?
How do we keep ourselves healthy and able to help others?
Those of us who have been therapists for a few years have probably figured out the maximum amount of people we can massage in a day or week and other ways to keep ourselves healthy.
But even when you think you’re keeping yourself healthy, injuries occur.
So what do you do when a nagging, overuse injury creeps up on you?
Possible Reasons For Massage Therapists To Have Shoulder Pain
About two years ago the front of my right shoulder started to burn while I was working, especially when providing downward pressure and while moving client’s limbs.
It also hurt whenever I flexed or abducted my shoulder joint and when I lifted anything with my right arm (groceries, weights). It didn’t get bad enough that I couldn’t work but it didn’t get better either.
After a week I started feeling nervous. After two weeks I was annoyed. I received a few massage therapy treatments that were focused mostly on my pectoralis, deltoid and bicep muscles. While the treatments felt amazing and alleviated some symptoms for a day or two, it didn’t change my problem.
After a month, the symptoms were no better so I decided to start using my own knowledge to rehab myself!
Thinking about my symptoms, I came up with three main reasons why I might have been getting this injury:
- I had been feeling tight and stiff through my upper back. Perhaps this was creating dysfunction in my shoulder?
- I was using a lot of strength during pushing movements and a lot less during pulling movements. Was there some imbalance between the front and back of my body?
- I had been working hard for many years. Maybe I just needed a bit of a break?
Here’s how I addressed each of these questions and how it helped.
Therapeutic Exercises For Increasing Thoracic Spine Mobility
Have you heard of the stability vs. mobility joint by joint approach?
Michael Boyle (Strength and Conditioning coach) and Grey Cook (Functional Movement Systems) have promoted the idea of the joints of the body needing to be either stable or mobile. Starting from the lower limb and working superior here are some of the main joints and their basic need:
- Ankle – mobility
- Knee – stability
- Hip (Acetabulofemoral joint) – mobility
- Lumbar spine – stability
- Thoracic spine – mobility
- Scapulothoracic – stability
- Shoulder (Glenohumeral joint) – mobility
If you think about it, this approach makes sense. For example the hip and the shoulder are very mobile joints, while the lumbar spine does not have much range of motion and therefore should be stable.
From the list above you can see the joint requirements alternate. Now think about what happens if one of the mobile joints loses some of that mobility. For the body to move there will be some compensation occurring. Where is the necessary movement going to come from?
It’s probably going to cause the joint(s) above and/or below to be more mobile that they should be. Here are a few examples:
Decreased ankle mobility -> Increased movement through the knee -> knee pain
Decreased hip mobility -> Increased movement through knee and/or lumbar spine -> knee and/or lumbar spine pain
Could it have been in my case that the tightness I was feeling through my thoracic spine was causing pain in my shoulder? With the stability vs. mobility approach in mind here was my thought on my own situation:
Decreased mobility in my thoracic spine -> decreased stability in my scapulothoracic joint -> dysfunction in my Glenohumeral joint -> shoulder pain
From this thought, I decided to spend time working on increasing thoracic spine range of motion.
Each day before I went to work, and each time I warmed up for a workout, I would go through these mobility drills for my thoracic spine: Thoracic spine windmill, Quadruped extension and rotation, Lunge with touch down and rotation.
Here are the descriptions and pictures for these three exercises.
Thoracic Spine Windmill:
- Lie on your Left side, a pillow placed under your head, arms out in front
- Bend Right hip and knee and place on a pillow, bolster, foam roller, etc.
- Right hip should be above 90 degrees of flexion
- Take a deep breath in
- When breathing out, rotate through the thoracic spine bringing your arm across your body to the other side
- Both shoulders should be in contact with the ground
- Return to starting position and repeat 6-8 times on each side
This is a great exercise you can do with massage therapy clients right on your massage table. I have had success with clients in increasing their thoracic spine mobility by massaging through the thoracic and pectoralis areas and then adding this exercise at the end of their massage session.
Quadruped extension and rotation:
- Begin in a quadruped position – on hands and knees with hips placed above the knees and shoulders above the hands
- Place Right hand on the back of your head
- Rotate your thoracic spine bringing your Right elbow towards your Left elbow
- With a smooth movement, Extend and rotate leading the elbow towards the ceiling
- Return to the start position and repeat 8-10 times on each side
Lunge with Touch Down and Rotation:
- Take a large step back with the Right leg into a lunge position
- Reach down with your Right hand and place it on the ground beside your Left (front) foot
- Rotate towards your Left side bringing the Left arm up
- Rotate your head to follow your hand
- Hold for a breath
- Return to the lunge position and stand up tall
- Repeat, taking a large step back with the Left leg
- Alternate legs for 6-8 repetitions on each side
*Bonus – you get some great hip mobility in this drill as well!
Along with these three thoracic mobility exercises, I also worked on scapular stability through drills such as wall slides, windmills, Turkish getups and scapular push-ups.
I highly suggest being trained on these exercises if you’ve never done them before as they have a lot of important cues. Perhaps this will be in a future blog post! Stay tuned!
Strengthening A Massage Therapist Back To Help Correct Overuse
I’ve loved going to the gym since about 13 years old and have had a passion for strength training for over 10 years. I enjoy being strong and fit.
Strength training is important to me because it allows me to be strong for my career as a massage therapist, and it also is an amazing outlet for any stress or emotions I pick up. I love everything about strength training!
While injured I was probably over using my body, massaging 5 days a week and strength training 4-5 days a week. Since my career required a lot of pushing strength, I needed to compensate by spending more time in the gym on pulling strength.
I increased the amount of time and energy spent on large pulling movements such as deadlifts, hip thrusts, chin-ups and rows.
Four days a week I would do a rowing type exercise: band pull-aparts, dumbbell rows, face pulls, seated cable rows. I would only choose one rowing exercise each day, but made sure to incorporate them into my workout to fix or prevent any imbalances occurring between the front and back of my body.
A rowing movement targets the rhomboid, trapezius, latissimus dorsi and biceps muscles.
Here’s an example of how I would incorporate more exercises to target my posterior body, and especially rowing movements, into my workout each week:
- Assisted Pull-ups – 3-4 sets of 10-12 repetitions (reps)
- Heavy single arm dumbbell row – 3-4 sets of 5-8 reps
- Deadlifts – 5 sets of 5 reps
- TRX, or other suspension trainer, rows – 4 sets of 15-20 reps
- Body weight Chin-ups – as many as possible (usually only 2-3 reps)
- Face pulls – 4 sets of 15-20 reps
- Hip Thrusts 4 sets of 10-12 reps
- Bent over Dumbbell or Barbell rows – 3 sets of 10-12 reps
*Note: these are not my complete workouts, but an example of specific exercises (deadlifts, hip thrusts, pull-ups and rows) that I used.
There are many ways to add exercises that strengthen the back of your body.
This is what worked best for me! The take away from my experiment: if you have anterior shoulder pain (or even if you don’t) and work in a job that requires you to have your arms in front of you or overhead often, it is beneficial to work the back of your body far more frequently in the gym then your pecs and shoulders!
Something I did not do at the beginning of my symptoms, or even before having symptoms, was give myself sufficient rest.
I would massage for many hours a day and still work out. Wasn’t massaging someone a workout in itself?! However, I didn’t want to give up my love for strength training, so I just changed how I trained, as explained above.
The change in training certainly helped, but I would notice if I had a few busy weeks that the pain would creep back again.
Last May, I moved to Iqaluit, Nunavut to spend an adventurous year in the Arctic with my fiancé. I am taking a short break from massaging full time and have been using previous schooling, training and skills in a different job. I still massage part time and also have gotten back into personal training and teaching fitness classes at the local gym. It has been wonderful using my previous education while still being able to practice what I love.
Since moving and massaging less I have felt AMAZING! No pain and no worrying about my body breaking down. Perhaps all I needed was a break?
But what happens when you can’t afford to take a break?
I remember constantly feeling like I couldn’t take time off. I wouldn’t be getting paid for any days off, I was paying off students loans and didn’t have any other income. How do we manage to take some well deserved rest?
Try to find other avenues of income. I started supervising the student clinic and assisting a teacher at the local massage therapy college. Soon I was lucky enough to teach some of the courses myself. I also taught anatomy courses for fitness professionals on weekends. There are lots of ways we can use our knowledge to gain other or extra income.
While I am looking forward to moving back to my hometown and being back into massage therapy full time, I am also going to be more aware of needing rest or time off.
So What Worked?
As mentioned above, I spent a lot of time working on increasing and, now, maintaining my thoracic spine mobility.
I added more strength exercises for the back of my body to compensate for the amount of pushing I did during massage work. I took a break from massaging full time.
I still do the same, or similar, mobility drills for my thoracic spine daily. I still work on scapular stability. I still deadlift, hip thrust, row and try hard to perform chin-ups (Why are they so challenging!?!!). I still massage and hope to for many years to come.
Since incorporating thoracic mobility exercises into my daily routine I have found that I no longer feel tight through my back nor through my neck (an added bonus!). More movement through my thoracic spine allows for my other joints around it to function as they are intended. As hands-on therapists we need to figure out what is best for our own health so that we can continue to help others. Use your own knowledge to create a plan to keep yourself healthy and injury free so you can have a long, rewarding career. Don’t give up on what you love!