Is there a commonsense way to make you a pain-free, durable, and productive massage therapist? In this episode of The ABMP Podcast, Kristin speaks with massage therapist and author Mark Liskey about how pain-free techniques became a focus of his practice and teaching, incorporating table support to help regulate pressure, and advice to practitioners on how using massage tools is an effective method in taking pain-free to the next level.
Mark’s book, The Pain-Free Massage Therapist: The common sense way to make you a pain-free, durable, and productive massage therapist
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Fascia Research Society (FRS) was established as a membership organization to facilitate, encourage, and support the dialogue and collaboration between clinicians, researchers, and academicians, in order to further our understanding of the properties and functions of fascia.
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0:00:00.2 Kristin Coverly: Fascia Research Society invites ABMP podcast listeners to attend the sixth international Fascia Research Congress, September 10th through 14th, 2022 in Montreal. The event includes eight keynote speakers, over 60 parallel session talks and posters, seven full and eight half-day workshops and a two-day fascia focused dissection workshop. The line up of keynote speakers and workshops is already available on the Fascia Research Society website and the full congress schedule will be out June 3rd. Register for the sixth international fascia research Congress today, at fasciaresearchsociety.org.
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0:01:51.3 KC: Welcome to The ABMP Podcast. I'm Kristin Coverly LMT, my co-host Darren Buford is taking some much deserved time off, so I am solo podding with you guys today, and I'm very happy to welcome Mark Liskey to the podcast. Mark is a massage therapist of 30 years, massage business owner, CE teacher, blogger, writer and co-producer and co-host of the International Take Care Of You school event, an annual self-care conference for massage therapists. He is the author of The Pain-Free Massage Therapist, a DIY body mechanics strategies and techniques book, for eliminating pain in the massage room and extending massage careers. You can access free instructional body mechanics videos at his website, painfreemassagetherapist.com. Welcome Mark.
0:02:39.2 Mark Liskey: Thank you, Kristin. Kristin, it's great to be here. I sound more important than I am with that intro.
0:02:45.3 KC: Hardly. My guess is you had to edit that down to get that, you do so much. [laughter] So we're so excited to have you here with us. There are so many things we can talk with you about, but we are gonna focus on a very important topic for all massage practitioners, pain-free body work. So let's jump right in. As massage therapists who want to be able to continue doing the work that we love, as long as we want to, we are always intrigued and in need of finding new ways to practice pain-free. How did pain-free techniques become a focus of your practice and teaching?
0:03:23.1 ML: Well, it's sort of long story, so when I first started massage school about 30 years ago, I got out of massage school and I cut my teeth at a chiropractor's office. So he started throwing me body parts like legs and arms and necks and backs. And I was a bit confused, needed some more help, so I went to Neuromuscular Massage School. And Neuromuscular Massage School, if you're not familiar with that it's a... The massage is more precise, it's origin insertion, so you're using your thumbs a lot. So it was sort of a burnout proposition for thumbs, but they had an alternative. The had this thing called a T-bar Massage tool, and the T-bar was a great thumb replacement. However, when you grip the T-bar, your fingers went around the stem and down to the tip, and you used that to control a T-bar. So as you massage as day went on, your distal finger joints would start to have problems, so it saved your thumbs but then it hurts your distal finger joints. Okay, so I used it sparingly and judiciously throughout massage, and that worked fairly well, and I was like, "Well, that massage tool... Maybe it's a different massage tool that I need."
0:04:44.0 ML: So I went to my dad who was like this... He can make anything. He's a depressionary kid, so he can make anything from anything. So I had him make massage tools and I would use the massage tool, and once I started using massage tool I'd be be like, "Wow, my thumb still hurt." Then I was like, "Well, maybe it's not the massage tool, it's how I use the massage tool. So I started to... I had him make this one massage tool, it was this big mammoth massage tool, it was like 16 inches long and it'd sit on the front of my shoulder. Right.
0:05:15.7 KC: Oh. Interesting.
0:05:17.1 ML: Yeah, so I could use it and I really didn't have to use my hands a lot, except to guide it, so my hands felt fine, the problem was, it looked like a pre dentistry type massage tool. It was so... It just looked like... It was scary. So I could only use it on people face down. And it had very limited application cause it has such a small precise point on it. So I was like, "Okay, that sort of work, but I really can't use that." So I just continued to massage and then about 20 years into massage, my wife and I really wanted to expand our business. So I started to really increase my workload. And that's when it started to hit me. I went to the doctor was diagnosed with cubital tunnel syndrome, cervical radiculopathy, unstable shoulders, and I was about done. So I had to make a decision, quit massage or figure out a way to work through this. So I went, gave myself a year to experiment in my massage room. And that's when I came up with strategies and techniques to help me, and then I just started teaching the massage therapist who worked for us. And then that led to CE courses and then lastly the book. And to me it's sort of my driving force because that's self-discovery and that like, "Oh, I rescued myself from the jaws of career ending, my career ending." So it has that of kind of feel to me.
0:06:42.3 KC: Mark, one are the foundations of your pain-free approach is to lean, and I think some practitioners do that intuitively, but I'm sure there is a much more thoughtful way to do it, how can practitioners incorporate more leaning into their practice?
0:06:57.0 ML: That's a really good question because it, it seems like, like you said, like people like naturally massage therapists, you lean, but what I found was I really wasn't leaning as much as I thought I was leaning. I was basically muscling my way through the massage using my upper body. And then there's some leaning afterthought going into that. So to me, the easiest way is to take your legs out of it. So try leaning while you're sitting. So you set you're... Let's say you're working on cranium or you're working on feet, or you're working on IT bands instead of take... Keep your arms glued to your side. So you can't move your arms, pretend like they're glued and then just lean and you'll realize like how much you're not leaning when you're actually doing the massage that you're just like using your upper body, your shoulders and your hands.
0:07:44.9 ML: That's... That's a very easy way to start to get into the idea of like, oh, I'm not using my torso in this case because you can't use your... Your full body when you're just using your body... Your torso to lean. So that's what I do with, people coming in when they're just really, you know, not resistant to it, but they just don't have an idea of what it means to lean. I just start with something simple like that. So, and then if you're standing, it becomes a little more complicated because it depends on what you're leaning with. Are you leaning with your forearm? Are you leaning with your fist? That will change your table height because when you're leaning with your fist, you're gonna need a lower table.
0:08:27.3 ML: Like an example of that is like, if you went up to the back of a couch and you were wanting to lean with your forearm on the couch, you could pretty much probably lean all your body weight onto the back of the couch with your forearm. But then you try it with your fist, it's not gonna work. You just don't have enough distance between you and the couch to leverage all your body weight onto the couch. So if you move to the front of the couch and lean on the cushions, you could do like a plank or push up, there you're leaning your body weight onto the couch. So when you're leaning, standing up, my first suggestion would just be, again, how much are you leaning with your regular table height? And if you can't leverage your whole body weight onto the client, that would be like firm pressure. Then maybe that's when you wanna start adjusting like your table height to experiment. So again, the whole thing is an experiment. Like there's no, you're gonna have to work with these strategies and techniques to figure out what works for you.
0:09:27.2 KC: Absolutely. And speaking of tables and table heights, chapter two of your book is titled use the table for support and to regulate pressure. So tell us more about that. I don't think oftentimes we think of our table as one of our body mechanics tools, as, you know, as something that we can really work with to help the way that we feel during and after a massage. So tell us more about that and also more about table height and what you recommend in general.
0:09:54.3 ML: Yeah. So in terms of supporting... The table supporting my body weight, supporting me as I were, that was... I discovered that when I switched to fist, because what happened with me was I'm limited in how I can do massage because forearms, which was my main tool, was what cause me issues now. So leaning with forearms would bother my neck and my shoulders. So I had to take them out of the equation. So this came in. So for me, that meant lowering the table so that I could have that leaning distance. When I did that, that's great for firm pressure because I'm leveraging all my body weight first leaning. I'm just... I'm just shifting my body weight forward. Right? I could use all my body weight lean onto the client and my, the client table is supporting me basically. So, but when you went back to like medium or light pressure, now I had to shift my weight to the back of my heels, right?
0:10:50.6 ML: So now my back is supporting my body weight, helping support my body weight I'm in slight flexion too. So that kind of positioning with that kind of load on is a strain. So I had a problem and, like everyone, like who, who says, "Oh, I can't work on a lower table because you know, it's gonna hurt my back." Well, it will hurt your back if you do that. My leg just found its way to the table. Like eventually it just like naturally was like, I need something to lean against. And once my leg found the table, it was like, oh, okay, now I'm supporting my body weight with a table and now I can actually get more vertical if I wanted to. I can actually take that flexion completely outta my back. So that became the... To me, the big discovery of just like, oh wow, now I can lean against the table with the back of my leg, the front of my leg, side of my leg. It doesn't matter. I need a leg against that table when I'm doing massage.
0:11:42.3 ML: So that helps support my body weight and get my back and the pain and then to regulate pressure. It just became that, you know, when you're leaning, you're leaning... If you're using firm pressure, you're leaning into the person with most of your body weight. But for lighter pressure, which you're basically doing is now leaning into the table. So it's that combination of you regulate the pressure, not by your upper body, but basically about how you're leaning into... Where you're leaning. Are you directing your pressure to the table or to the client or both? So an example of would be like 50% of my pressure is in the table. 50% of my pressure is into the client. That's what we would call medium pressure. So that's how you can regulate pressure and also support your body. Well, as you're doing the massage part.
0:12:35.1 KC: I am gonna encourage every practitioner. I know I'm gonna do this in my next session to really test that, to test the idea of having your leg make contact with the table and then regulating your pressure based on how much you're leaning into the client's body for deeper and how much you're leaning onto the table for lighter pressure with the client. That is fascinating. And I can't wait to try it. So thank you so much for that tip. That's great. Okay. Part two of my question was, what about someone who doesn't have a hydraulic table and they use multiple techniques? So sometimes they are using forearms and other times, fists and other times, palm thumbs, how... What do you recommend as far as setting the table height that makes it a happy medium for body mechanics?
0:13:17.7 ML: Yeah. So that is one of those questions you have to work with. But what I would say is that if you're gonna use forearms and fists like a therapist who works for us. That's what she does. Her tables has to be lowered to accommodate fist, and then she's gotta accommodate to that. So she's gonna be leaning against the table a lot. So the higher your table is the less you're going to have to lean against a table because you don't need to support your back as much. Because your table's higher you're not flex... You're not in flexion as much. But with her, if you watch her, she has it set lower so she can do both. And she is like completely using a table in all aspects for supporting her body weight.
0:14:00.4 ML: So if you're gonna use a combination, you're probably gonna wanna use a lower table. Forearms. If you're just forearms, you have the option of a higher or lower table. A lower table, you can generate more of your force by leaning on the person. A higher table, you can generate less by leaning, but you can use your back leg in a asymmetrical, like a lunge stance to push from. So you have both, you have both leg and leaning power, but less leaning power than you would if you had a lower table. And if you're just using your fist, then you have to have a lower table. So for me, since I was fist, I decided, "Okay, I don't have an electric table, a hydraulic table", so I would adjust it for everybody coming in at first. So this person's lighter pressure and I raise my table. And so I was like, "You know what, this is not gonna work." So I just kept my table as low as possible, in fact I've taken my legs, like the extension legs, off the table.
0:14:57.0 KC: Oh wow.
0:14:57.3 ML: Yeah, so for me, it's very low, but for my body type, it works really well because I just use that table. Like if you randomly pulled that table out from me during the massage, 95% of time I'd fall on my face because I'm leaning so much into the table or the client. So there's rarely rarely a time when I'm not leaning into the table.
0:15:18.1 Speaker 3: Let's take a short break to hear a word from our sponsors.
0:15:21.2 KC: Anatomy Trains is delighted to invite you to our in-person fascial dissection workshop, May 30th through June 3rd, 2022. We're excited to be back in the lab with Anatomy Trains, author Tom Myers, and master dissector, Todd Garcia, in Todd's Laboratory of Anatomical Enlightenment in Boulder, Colorado. Join students from around the world and from all types of manual, movement, and fitness professions to explore the real human form, not the images you get from books. Visit Anatomytrains.com for details.
0:16:00.0 Speaker 3: Now, let's get back to the podcast.
0:16:01.6 KC: Mark, when you talk about taking pain-free massage to the next level, you include using massage tools, which might be new for a lot of people. So let's talk about them. What type of tools do you find to be most effective and what advice do you have for practitioners who haven't used tools before but might wanna dip their toe into it, give it a little try?
0:16:19.7 ML: Sure, so the tools that I find most effective are the tools that I use the most, or what I would call pressing tools. So they have a handle and a stem, or they have some kind of area where you can put your hand on it so that you can lean into the tool, 'cause I wanna lean and pin the tool. So you might think that there's limitations with that, but with any kind of pressing tool, you can actually... You can do a variety of things, you can press, you can glide, you can scrape. Again, it's not the tool that's limiting, it's how you use the tool that's gonna be limiting.
0:16:56.5 ML: So I would recommend using a pressing tool, so a pressing tool is anything that where you can actually pin the tool comfortably without hurting your hand. Let me give you a couple of other examples of... So we talk about a T-bar, that's a pressing tool. So that's a very simple, it's a wooden tool that has a handle and a stem, and then right in the middle, so it looks like a "T". A L-bar is a wooden tool, typically, that has a handle on a stem, but the stem is offset, so it looks like an "L". And a lot of times you'll have different diameter widths for L-bars. So that some are smaller and some are bigger.
0:17:33.2 ML: There's plastic tools like Thera Press. There's a company called Career Extenders that he makes his own specialized tools, which are really cool, and they also have the advantage of you being able to pin the tool. So those are some of the tools that I use. For the first time massage therapist, or for a massage therapist first time using massage tools, I would recommend using a guide finger. The biggest question I get with massage therapist is like, "Oh hey, I'm gonna use this massage tool, I'm gonna lose all sensitivity with it, right, 'cause it's not hardwired to my brain like my thumb is. So I really don't wanna try it, I don't even wanna try it 'cause it's a hunk of wood or a chunk of plastic". And that's true.
0:18:20.1 ML: It is, that's what it is. But if you put a guide finger next to the stem of the massage tool, right by the tip, then you now have that as your palpating tool. You have that as your sensing device. It also supports the tool so that you can actually relax your hand. So you can find the areas you wanna work, you can decide what kind of pressure you wanna use with the massage tool, and you can do it that way. You can also do an exploratory stroke before you do the massage tool, use the massage tool. So you can just glide and find out where you wanna work and then apply the massage tool. So those kinds of things take away that, "I'm losing sensitivity with the massage tool". Will a massage to ever be like your thumb? No. But it can be pretty close, if you're using your finger, your thumb, your knuckles, your fists, whatever it is as the guide finger next to it, then you're pretty close in allowing you to feel what you wanna feel. And at some point, my wife disagrees with me a lot about this, But, 'cause she's like, "No way that this could ever feel like an extension of your hand," but to me it does, it feels like an extension of my hand, but it could be that I've been using massage tools for so long.
0:19:24.4 KC: Mark, let's talk about working in different areas of the body and with different parts of our hands, fists, knuckles, palms. Are there certain techniques that are better in certain areas of the body, or what advice do you share with people? In your book, you have different chapters based on hands and wrists, shoulders and arms, neck and back. So what advice do you have for people in different areas of the body, what works where?
0:19:49.4 ML: To me, it's variety. So it's about having options. 'Cause when you start running out of options, you start putting more wear and tear on body parts. So if we just broke it down to different areas of the body. So like feet, most people will use their thumbs. So some other options would be like knuckles, fists, and massage tools. Massage tools are great with feet.
0:20:15.6 ML: Cranium, jaw muscles, and everywhere fingers really get beat up a lot, especially with that supine, neck hole traction, you can start to incorporate palms more. So you can try to use palms instead of fingers. It's not you wanna take out your fingers the whole time, but if you can reduce the usage of them 20-30 % of the time, it can be helpful.
0:20:41.5 ML: Back. For the back, that's a great area where versatility and variety is not there for a lot of massage therapists. With back, you can... Typically it's what fists and forearms but now you can... There's other options like knuckles, hand body part combinations, I'm big on that. So combining a knuckle and a fist, from two different hands or two different hand... From for your two hands.
0:21:06.7 KC: Two of your many. Yean, just take two.
0:21:06.8 ML: Yeah, you could have a knuckle thumb, you could have double thumbs-up, there's just... You can just create your own body part combinations. And again, the massage tools are great for back muscles. I use them probably 90% of the time. And that gives you, enough variety that you're mixing it up during the course of the massage, during the course of the day that you're not overusing a body part.
0:21:37.7 KC: I love it. And too I know you encourage people to get creative, one of the things you talk about is using two palms and two hands to simulate a squeeze. So you're saving your fingers from sort of a C squeezed butt.
0:21:49.5 ML: In some ways, I can just be considered a wimp. Because, I'm like, "How do I massage? Make it effortless?" I think one time I was gonna call it... I forget what I was going to call it, something about effortless. And my wife was like, "No that just sounds like it's lazy massage. Like you're not... "
0:22:05.2 ML: But the idea is to be efficient, and the squeezing, that was really one of the things when you're doing a lot of massages, it's like it adds up, you're squeezing, squeezing, squeezing. So with traps, that's a great area where to me, I substituted, squeezing 90% of the time with a pressing motion between two hands. And I got it down to where it may not feel exactly like a squeeze, but it feels good. If I asked the person at that table, it feels good. It may not feel exactly like it. But it's a substitute that's worked for me. And the test for me was when I was changing over, I was really nervous that year, because, I am changing my style of 20 plus years, and I had clients that long, these are... And they're gonna notice things, they're not gonna be like, "What... That's different, why are you doing that?"
0:22:58.8 ML: And no one walks, no one... You know what I mean there? I didn't get any kind of... There were some people early on, new clients that were maybe less interested, there was... I did lose a few there. But I picked up a lot more because I can do more massages now. And people now accepted my style as it is as they're coming in because they've never seen the old style too. So, both my old clients, none of them did... There's no change with that. So, that was my test, as I substitute something else, oh, my God! Jamie's gonna feel like, "Ah! Stop doing that." That's... I just wanna let people know that you can do this, you can change your style, you can even eliminate a signature move that's hurting you that one that you identify with that is you think no one else down the street can do it like you do it. You can change that, and you can still have clients. So, I think it's also psychological as you go on. The more years you add on to your career, the more psychological barriers you have to change.
0:24:04.9 KC: Absolutely. And what I find is my 20-plus-year clients are the ones that give the best feedback. So I'm most comfortable asking them like, "Okay, how does... I wanna try something different? Let me know what you think pros and cons," and they really will give honest feedback. I think they're the best ones to try new things with.
0:24:19.8 ML: I agree. I have one client, he was... Therapeutic boundaries have long been gone with that one. We're friends too, right? We got into this thing where, I'm like, "What should I be today? Should I be friend or therapist? Because as a friend, I'm gonna yell at you. As a therapist, I will shut my mouth. What do you want me to do?" So but he'll just be like, "No, no."
0:24:43.8 KC: Oh, that's great. [chuckle]
0:24:43.9 ML: It's weird but it's helpful because I never... No one told me, I'm probably digging my nail in on this prone or the supine move that I... But I'm just, shut out now. And I'll be like, "Okay. Oh, stop it, I'll figure out a different way." And so, yeah, the old ones are good ones. Right?
0:25:00.2 KC: Exactly. Mark, I'm curious when you're teaching practitioners, these techniques, how do you encourage them to go back to their practice and be creative themselves? What advice do you give them to explore and really find things that work for them?
0:25:16.2 ML: Wow. Okay, so that one I've never been asked before. Yeah, that's a really good question. I think that most people have the inhibition of change. Change is the hardest part because they're not used to trying different things like body parts, for example. So, I literally sometimes take people and I change the positions of their hands. And allow their hands to explore. If you're just typically, thumbs down and you're moving along, I'm asking you to take your hands and just let them find the positions. Let them just move over. Let them find... Let one finger rest on top of another finger. Let a thumb... Never have that thumb's been there before, let it move there and to that little nook and cranny be next to your knuckle. I like to take them through this whole exercise of just exploring, just trying different body parts is trying to put different combinations together and making it their own. I was working with one massage therapist and she was working on my IT band. And she starts and I was like, "What the hell's that? That feels great." And she's...
0:26:28.1 ML: I look and I ask her, and she's got her fist in her palm, and she's using the back of her hand going up my IT band. It's something I've never done, and it just worked really well for her and it was comfortable. It fit how she does massage. So I think it's more about just getting in that creative moment, of just letting yourself use... Allowing yourself to break some rules. I guess that's what I'm trying to say, break some rules. Not the rules that you shouldn't break, right? But just some rules that you learn in school. Like this is the way I do effleurage. This is the way I do... This is the way I press. This is the way... Well, you do it that way, because you learned it that way and it's become routine. It's become a habit, and some habits are good, some habits are bad. Some habits were good, but they don't serve you well now. See what I mean? So it's that re-examination of just being like, "Okay, I've got to allow myself the freedom to explore and try something new."
0:27:27.4 ML: And if it doesn't work out, like with your client, they'll let you know and it's not a big deal. It's like, "Okay, so I make an adjustment." Maybe it wasn't the technique that was bad. Maybe it was just my application of the technique that I need to change. And then trying it out with people who are friendly, kind, like colleagues, clients that you know, with the people that can give you the good feedback that allow you to make the change and not be like, "Oh, never gonna do that again."
0:27:53.2 KC: I wanna thank today's guest, Mark Liskey. Mark, where can listeners go for more information and to connect with you?
0:28:00.0 ML: So, to connect with me, the easiest way is just email me at firstname.lastname@example.org. And for more information, there's on our... The painfreemassagetherapist.com website, there's free instructional videos. There is more information. You can download a form that will help you prioritize your pain issues so that you can develop your own blueprint for your massaging pain-free. And there's just... Any time you need help, just contact me. I'm here. That's what I do.
0:28:32.8 KC: Mark, thank you so much for all the great information you shared with us today. I know it's gonna help our listeners do what they love longer.
0:28:39.8 ML: Thank you, Kristin. It was really a pleasure to be here. I love your show, and I just I love the guests that you bring to your show. And I'm really honored to be on the show.
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