Ep 194 – Pain-Free? Thumb-Free? Yes, Please! with Eric Stephenson

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0:00:50.3 Darren Buford: I'm Darren Buford.

0:00:51.5 Kristin Coverly: And I'm Kristin Coverly.

0:00:53.0 DB: And welcome to the ABMP Podcast, a podcast where we speak with the massage and bodywork profession. Our guest today is Eric Stephenson. Eric is a 20-year massage veteran and Chief Wellness Officer for Elements Massage, a 250-unit franchise system headquartered in Denver, Colorado. Eric is also cofounder of imassage, Inc in Delray Beach, Florida, an education and consulting company dedicated to extending the careers of massage therapists and spa practitioners through customized continuing education, focusing on preventing injury and workers' compensation claims. Eric creates continuing education specializing in teaching deep tissue massage that doesn't harm the therapist or the client. All of his workshops focus on saving your hands with his no-thumbs approach in core body mechanics that help prolong your career. In 2014, he joined the board of directors of the International Spa Association in Lexington, Kentucky. His experience as an entrepreneur, consultant, and speaker in the wellness industry have taken him around the world. For more information about Eric and the good work he's doing, visit imassageinc.com. Hello, Eric, and hello, Kristin.

0:02:00.0 Eric Stephenson: Hello! Hey, Kristin. Hey, Darren. Great to be here again. Thanks for having me.

0:02:03.3 KC: Thank you so much for coming back. A repeat ABMP podcast guest. We love having our conversations with you. And there are so many things that we could talk to you about. Today, we're gonna focus in on the approach that you created: Your pain-free, no-thumbs, deep tissue techniques. I'm so curious, where did the motivation come from to originally develop those techniques? Was it something that was happening for you in your own practice? Were you noticing it in other massage therapists? Tell us a little bit about that origin story.

0:02:32.4 ES: Yeah, well, I love talking about this, and I just wanna say hi to all the ABMP Podcast listeners out there, and thanks again for having me on. It's always a pleasure to come on and talk with colleagues and people in the tribe. Yeah, the deep tissue approach that I came up with basically started back when I went to massage school. I went to school in the late '90s, and it was a time when I had only had one professional massage in my life, at that point. And I felt called, like many of us do, to get into massage, and it was really interesting, because I didn't realize it at the time, but the school that I went to here in North Carolina, the Body Therapy Institute, as it turned out, was probably one of the top schools in the country, and I had no idea. And it wasn't until I began traveling and teaching continuing education years later, that I would understand how good my education was.

0:03:25.7 ES: So I think that my approach really came from a host of mistakes I made in my own practice, one of which was I remember one client working with her, and she was requesting some deep pressure into her back, and I was really getting in with my thumbs, and she was requesting more pressure and more pressure, and I wasn't really listening to my own boundaries. I wasn't listening to my own body and I ended up really harming myself. My thumbs locked up, my arms locked up, and I spent... I remember that night, I went out to a Mexican restaurant, and I had two ice pitchers delivered to the table. And I remember the server was like, "Well, you must be thirsty." I said, "No, they're for my thumbs." So I would take a bite of my burrito with my right hand, put the left thumb in the ice bucket, and vice versa with the left hand. So it really is sort of a funny, not so funny way of saying that, yeah, it was part my own practice. But then also, I would have clients over the years that would say, "I went and got a deep tissue massage. I left bruised. I'm in more pain now than I was when I went in for my massage. Why is that? Should that be happening?" And all of this, along with the continuing education that I've had really sparked my interest in helping practitioners practice massage that doesn't harm themselves or their clients.

0:04:45.0 DB: Eric, what mistakes do you see practitioners commonly make when doing deep tissue work?

0:04:50.4 ES: I think a lot of the mistakes that we make are really foundational, and they go back to some core competencies of massage. So the way that I teach my workshops is pretty opposite from the way most continuing education that at least I've attended work. Many times, when I go in to take the CE class, the instructor will present the anatomy, the physiology, and then immediately go into technique. And certainly, that's one approach, but I find that probably the most important part of massage is to simply be present. And if I ask the listeners out there, "How many of you have ever had a massage from a therapist that was not present?" I'm sure just about everyone would raise their hands. And so the next question is, "Would you go back to that practitioner?" And not many people will. So really, the bedrock of career longevity, therapeutic massage, really high-quality client interaction is therapeutic presence.

0:05:40.8 ES: So I find that many times, we're not as present as we could be to listen to the signals that our body is truly sending us about what's working and what's not working. So I think that that therapeutic presence really is the bedrock of everything, and once you've got that established and you're truly paying attention, there are some biomechanic principles and some ergonomic principles that are really founded in ancient movement practices like tai chi and qigong that translate so beautifully to the massage table. So many times, I'll find that practitioners really aren't following good guidelines around how to use their resources, because A: Simply, they weren't taught, or B: Let's face it, gravity gets a hold of you, and sometimes, you just forget to do the things that you need to do. So I tell my students all the time you need to remember to remember some simple biomechanic principles, and I think that that therapeutic presence, along with the body mechanic, ergonomic piece are really some of the big mistakes that we as practitioner make.

0:06:39.9 KC: I like that you brought in, too, thinking about tai chi and other gentle movement practices, because I think we get in our head and, like you say, we're not present, that we think we're only focusing on the client's body, when we really need to also be focusing on the way our bodies are moving. Is that right?

0:06:56.4 ES: Yeah, that's exactly right. I mean, it really is that piece around self-care, right? So many times we work with clients that sit at the desk all week, and they get out on the golf course on Saturday morning, they start swinging a club, and of course, their body is contracted, it's been static all weekend. A lot of times, as therapists, it's the same for us, we need so we really need to make sure that we're moving our bodies and getting some sense of moving beyond the massage table. We need to make sure that we're practicing that self-care so that we can truly be in a place, so when we step up to the massage table, we have strength, but also length in our body, right? And that's what practices like yoga, tai chi, qigong really do. They give you that strength, but they also give you that length in your body that goes a long way to keeping you healthy.

0:07:41.9 KC: Okay, let's talk about different positions that a massage therapist might be in when giving massage, and what they can do in each of those positions. Let's start with standing, because 95% of the time, massage therapists are standing while they're giving a massage session. You teach all over the world, Eric. What have you observed in therapists that is kind of a common thing we're doing wrong when we're standing and giving massage, and what can we do to start making that change, to start working in a way that's better for our body mechanics when we're standing at the table?

0:08:14.8 ES: Great question. So it all starts out with trying to figure out what your intention is, and I talk about this a lot in my workshop, so what is your intention? The intention of a Swedish massage could be relaxation. It could be, "Take me away to the pink clouds. Help me to reduce my stress." It could be, "I just want to escape from the worries of my daily life." So the intention of a Swedish massage is mostly horizontal, in other words, the direction is back toward the heart traditionally. So the table height is so crucial as it relates to your intention, so if you're moving in a horizontal movement, then the movement I teach, again, comes right out of ancient bodywork practices like tai chi, that would dictate really following a specific stance that begins in your feet. And as Ida Rolf said, "What starts in your feet, ends up in your hands." So if your feet are in the right place, then you can track through your feet, through your pelvis, and a place called center. In traditional Ayurveda, it would be called your Hara, or in Oriental approach, it would be called your Dan Tien, right? So this place is just below your belly button, and it really is what I consider to be your GPS of every single massage stroke that you do. So if your GPS isn't pointing in the right direction, you're gonna end up in a very distant land.

0:09:35.3 ES: And what I find a lot of times is, the feet don't start in an optimal position, 'cause look, there's no right way to do a massage. I can't say, "This is the right way to do a massage," because it simply doesn't exist. There's a million ways you can do a massage, but of course, some are more optimal than others. And so, I see a lot of practitioners not paying attention to their feet, and then what happens is their pelvis starts to distort. It's going in different directions, so their GPS gets off from tracking in the directional stroke, and then of course, we suffer from one of my teachers used to call "tiltus headus too muchus forwardus", which is really bringing our head forward and staring down at everything that we're doing, which creates a lot of pressure on the spine. So I think it's really paying attention to the feet, and then really tracking your body all the way up through your pelvis, making sure that your center is pointing in the direction of the stroke, and then of course, paying attention to the alignment of the spine, and really seeing with your hands, making sure that you're keeping your head in alignment. You're making it look graceful, just like a dancer would, right? Massage therapy is an art, not a blue-collar construction job. You wanna really make it look graceful as you're doing it, so I think that those pieces are some of the big ones that I see, and where we could probably use more focus in our day-to-day practice.

0:10:54.4 Speaker 5: Let's take a short break to hear a word from our sponsors.

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0:12:10.0 S5: Now let's get back to the podcast.

0:12:12.9 DB: Okay Eric, we talked about standing. What are some ways practitioners can work better while seated? And should they increase working more seated than maybe they currently do right now? I was really particularly intrigued by what Kristin said, by probably most of the massage being done, 90% of it standing up.

0:12:29.5 ES: Yeah, this is always a point that's interesting for me to talk to massage therapists about. And early in my career, I did not sit a lot. I think most of my seated work was done at the head and at the feet, and probably a lot of practitioners who are listening would agree with that. But I have to tell you that over the years, I've gotten really savvy at being in a seated position. Of course, it's a huge part of what I teach in my workshops, and I would say that ultimately and optimally, 25%-30% of a practitioners work could and should be done in a seated position, and so obviously, that's going to be the head and the feet, but it also could include work done to the forearms. It could include working into the tibialis anterior muscle in the lower leg.

0:13:12.1 ES: And of course, the more pressure that you're putting on your leg is the more energy you're using, so you have to take into account that you can do massage like you're driving a Prius getting 65 miles a gallon, or you can do massage like you're driving a Cadillac getting 18 miles a gallon, and ultimately, it's up to you, right? You can choose. And so, over the years, what I've done is really checked in with clients and said, "What is the difference between me standing and me being in a seated position? Does it feel the same? Is the quality of touch the same?" What I found is that if I'm truly present and I'm using my resources optimally, that doing a lot of seated work takes a lot of pressure off my body, and it creates a sense of ease and really conserves my energy. Now, having said that, there are certain biomechanic principles that we can follow as massage therapists to do optimal seated work. In other words, most of the time, we have both of our feet out in front of us when we're doing seated work. And years ago, I took a workshop from a physical therapist that showed us the correct way to get out of a chair and get into a chair, and I thought, "Wow, this is gonna be interesting."

0:14:20.1 ES: And what she ended up demonstrating, Darren, was a position, really, that was a seated horizontal movement that was dropping one leg down, so that the iliums could sort of pivot on each other, and it allows the practitioner to move from their center rather than moving from shoulders. So simply by dropping one knee down towards the ground and setting up your ischial tuberosities, you can leverage from your pelvis and use the same biomechanic principle as you would in standing, but when both feet are out in front of you, of course, that makes it difficult for your pelvis to individuate and a lot of practitioners end up working from muscular effort through their shoulders.

0:15:00.4 KC: I'm curious, Eric, what do you recommend that practitioners use? I'm guessing it is a stool that's adjustable with wheels, but I know some therapists also sit on a therapeutic or exercise ball. What are your thoughts on that?

0:15:13.9 ES: Yeah, certainly, it's gonna be individual to every practitioner, but what I'll often talk with therapists about is if you are gonna use a stationary table, in other words, the table is not gonna move during the session, then you certainly want to use a stool that is adjustable. So the stool will allow you the flexibility to put your body mechanics and your ergonomics in the right position. If you're using a stationary table with something like a ball that is stationary, it becomes much more difficult to truly use your resources optimally, because both of them are at static heights. So I would say that the optimal situation, if you have it, is to have a hydraulic table, an electric table, and an adjustable stool, so that you have as much flexibility as possible.

0:16:00.0 KC: Eric, I really liked how you said, when you were practicing, giving massage at different areas of the body while seated, that you asked your clients for their feedback on how did it feel? Same? Different? You know, let me know. I love that idea, and I would encourage our listeners to get together with a colleague and try some of these things with each other and give each other honest feedback about how does it feel different? How does it feel seated versus standing, and then going into our next type of movement and positioning around the table, kneeling. Talk to us about kneeling, because I can guarantee not many people are incorporating a kneeling stance into their sessions.

0:16:39.6 ES: So kneeling is another way to move your body, and certainly, there are many ways to approach this, and the thing to really keep in mind is that you really wanna protect your patellar tendon and your patella when you're kneeling. So when I do massage it, I have two pillows underneath the table, and those are not for the client, those are for me. And if I am going to kneel, I'll pull those out and make sure that one of them is underneath one knee. So sometimes, I'll see practitioners working with both knees down on the ground, and certainly, if you were to move forward without the client underneath you, you'd fall over. So one of the things that you wanna do as a practitioner is make sure that one knee is down and one knee is up. So just like the horizontal movement that I was talking about, where you're tracking your body in a horizontal trajectory, you wanna do the same thing in kneeling, so you're moving from your center into your front leg. That leg that is on the ground is providing you stability through the pillow, and of course, your other foot is providing the stability so that you can move in.

0:17:42.6 ES: And that way, if the client wasn't there, you still would have enough ground underneath you where you wouldn't tip over. So kneeling is another viable option, but again, you wanna make sure that, A, you don't have any compromised knee conditions, right? Two, that you truly have some sorta supporter bolster pillow underneath your own knee, and that you're moving from your core, from your center into your front leg, and your spine is straight, you're following all of the biomechanic principles that you wouldn't standing. But it's definitely a viable option when done optimally.

0:18:17.4 DB: So excuse my ignorance here. Kneeling, are you talking about the client being on the ground, or that the table has the ability to lower that low?

0:18:27.0 ES: Yeah, that's a great question. It's interesting, because oftentimes, when the practitioner is kneeling tableside, it will be almost at the same height it would be in a seated position. I'm six two and I'm a tall guy. So sometimes, a practitioner would say, "Yeah, that works for you, but I'm five two, or I'm five foot, and my arms aren't as long as yours." And what I say to people all the time is, optimally, what you wanna do is find a place where your body is tracking with certain biomechanic principles. So one of those is, of course, what I talked about with the feet, where they have to be in the right position. The other is, is you really wanna make sure your spinal alignment is placed so you've got a nice straight spine all the way through the crown of your head as often as possible. And then, the third is to really track your shoulders, so if your shoulders are elevating at all toward your ears, then probably, your table's too high. And if you're breaking your spinal alignment to try to get down to the client or the guest, then of course, your table's too low, so by tracking those things, whether you're in a standing, a seated, or a kneeling position, you're able to modify the stool and/or the table to be at that optimal place.

0:19:37.5 DB: Okay, Eric. You mentioned this earlier a little bit about forward head posture. How does using poor body mechanics affect that and digital compression?

0:19:46.7 ES: Yeah, a lotta listeners probably will identify, when they go home at the end of their day, potentially being in pain. And this is one of the things that I talk about in my workshop. So at the end of your day, you don't wanna go home and have to pop an Advil with a corona on the couch and feel like you don't have enough energy to make dinner, or walk your dog, or have a life, right? You wanna be able to have a life. [chuckle] This is very important. So one of the things that practitioners often will complain about is pain between C7 and their iliac crest, right? Somewhere on their backs, especially through their rhomboid, maybe their mid-spine. And I've had a lot of therapists over the years come to my workshops, and what they'll comment on is the body mechanic piece, and specifically around spinal alignment. So some of the research actually shows that for every inch your zygomatic arch, in other words, your cheekbone, comes forward of your coracoclavicular joint, you add an extra 10 pounds of weight to your spinal column, so your erector column really has to work hard to hold your head up.

0:20:48.9 ES: And so the typical practitioner might have three or four inches of forward head posture, so that's an extra 30 or 40 pounds of pressure coming through the spine. And again, if you think about doing massage with your hands and having eyes in your hands, so you're actually able to see with your hands, which all practitioners are able to do very well, then that enables you to really lift your head out of the work and rely more on touch. And it's not necessarily closing your eyes, because of course, you wanna see the client's facial expression, their breath cycle, all of those things. But you can do a lot of work by just aligning your spine and really trusting your hand's in the right place. You can look down, of course, to make sure you're in the right place, but that extra 30 or 40 pounds of pressure is a lot. And so if you just shifted that one thing, you may be tired into your day, which is normal, but that pain, you may find, actually goes away, and that's what a lot of therapists comment on.

0:21:47.3 ES: I believe the second part of your question has to do with the thumbs, Darren, and it's much the same thing. I call it the no-thumb zone when therapists come into my workshop. They're not gonna use their thumbs. Thumbs are great for palpation, but some of the research has shown that for every pound of pressure that you do in a vertical direction into a trigger point or a muscle contraction, for every pound of pressure you exert through that digit, 10-12 pounds of pressure goes to your carpometacarpal joint. And so I'm not great at math, but I know that if a typical therapist has five pounds of pressure, that's up to 60 pounds of pressure that can potentially go through their carpometacarpal joint. So therapists will come up to me all the time and say, "Eric, I have a ganglion cyst right here," and they'll point to that joint. Or, "I have a blown-out thenar eminence, so I have an impinged brachial plexus. What do you think that I'm doing wrong?" And the first question I'll ask them is, "Do you do a lot of deep work in a vertical direction with your thumbs?" And they'll just sort of shake their head, and I'll say, "If we can get you to shift that one thing and simply start using different tools, then you probably will see that pain and that dysfunction shift."

0:22:55.6 KC: I love that. Okay, Eric. Listeners, I'm sure, have been getting a lot of great nuggets all throughout this conversation, but what is one thing that they can do today? What's one of your favorite tips that they can have an awareness about during their next session that they can shift to start making change towards better body mechanics?

0:23:16.7 ES: Yeah, it's really great. I would say that the biggest thing is to remember that the more present you become, not only will you be able to shift to what you're doing with your own body, but the therapeutic alliance between you and the client will escalate greatly. So one of the things that I talk a lot about in my workshops is the fight-or-flight nervous system and the rest-and-digest nervous system. And its practitioners were really, really familiar with this, but what we need to understand is that when you go too deep too quickly, then what you can potentially do is alert the fight-or-flight response through the part of the brain called the amygdala. And as soon as the amygdala lights up and senses that it's in danger, it's very hard to get the amygdala to quiet down. So by learning some principles of neuroscience and some of this emotional intelligence piece, practitioners can really figure out that a big part of deep tissue massage, I would say massage in general, and actually relating in a therapeutic way to other human beings, is to really control how much you're activating their fight-or-flight system, because people are coming in stressed out. They're already coming in in a fight-or-flight response through most of their day, and it's up to us to really quiet that response down.

0:24:28.2 ES: So you know, speed is the enemy of depth. And Ida Rolf, again, used to say, "It's not how deep you go. It's how you go deep." And I think if we can really pay attention to managing that fight-or-flight response in our clients, and using our body mechanics to apply pressure, but not having that pressure be too much too soon, then what we find is deep tissue massage really becomes more of an "allow, don't plow" approach, and the nervous system is actually working with you rather than against you. And of course, that's one of the big secrets to deep tissue massage, is learning how to manage and really work with your client's nervous system and their amygdala in their brain.

0:25:15.2 DB: I wanna thank our guest today, Eric Stephenson. For more information about Eric and the good work he's doing, visit imassageinc.com. Thanks, Eric, and thanks, Kristin.

0:25:24.6 ES: Thank you both, and thank you to all ABMP listeners. Keep doing the great work out in the world. It's very, very important.

0:25:31.2 KC: Thanks for helping us do that great work in a way that will save our bodies.

0:25:35.1 ES: You're so welcome.

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