Preventing Back Strain

Back Pain Need Not Be An Occupational Hazard for MTs

By Meir Schneider, PhD

Back problems, from low-back pain to scoliosis to poor posture, are ubiquitous in our modern world. While our clients spend days bent over desks and cramped behind computers, we spend our days stretched over a massage table focusing all our attention on our clients. It is no wonder that so many of us suffer, ironically, from the very back strains and injuries we are hoping to prevent in our clients. Many of us accept our discomfort as part of the dues of improving the lives of those we serve; we see it as a necessary occupational hazard of our profession. But it need not be—there are solutions.
Back pain and injury come primarily from operating through strain, instead of through ease and grace. By taking special efforts to reduce that strain in our movements, we can prevent the discomfort and injuries that result from daily use.
I would like to share with you a handful of simple things bodyworkers can do to prevent, or at least reduce, the strain on their bodies. It is possible to come away from a long day of administering bodywork feeling refreshed—not achy and tired.
These tips and exercises are especially useful for bodyworkers, but everyone can benefit from their efficacy and simplicity.  

Isolate the Movement
In my new book, Awakening the Power of Self-Healing (Self-Healing Press, 2017), I describe how people who use their hands for fine activities more than others tend to have more shoulder and back pain. Massage therapists, musicians, and sign-language interpreters are known to develop repetitive strain injuries, or repetitive use syndrome, related to the use of their hands.
I am now in my 60s, and I can tell you that in nearly 45 years of practice, I have not had one day of soreness in my hands. At times, my client load has been greater than 15 hours a day. One of the principles that has kept me in good condition for all these years is “dividing the muscles,” or muscle isolation.
When we work on clients (or at a computer), we typically use much more effort than is required. Nearly all of us hold tension throughout our bodies as we use our hands. Over time, that tension accumulates and restricts blood flow, pinches nerves, and results in the back, shoulder, arm, and neck pain to which we are so accustomed. There are two main ways to deal with this tension: by becoming more flexible and by using only the necessary muscles for any given task.

Exercises to Separate the Movements
At my School for Self-Healing in San Francisco, I remind my students to always think about separating their fingers from their wrists, their wrists from their elbows, and their elbows from their shoulders when working on clients. We imagine that our fingers are moving themselves. The relaxation that happens when you create separation between your fingers and wrists gives the hands new life when they massage, and keeps tension from building in the shoulders and upper back. We visualize that our heads stretch all the way up to the ceiling, maybe to the sky. We imagine that one shoulder stretches to one side of the world; the other one stretches to the other side of the world, creating space in our joints and vertebrae. Now, you try the same. Notice how you feel lighter, more relaxed, and less strained.
Here are a few additional exercises to increase your flexibility and ability to isolate your movements, thereby preventing shoulder and back pain:

Exercise One
Get down on your hands and knees with your arms turned out and around so your fingertips point toward your knees (Image 1A). This position is difficult for most of us. Bend and straighten your elbows, while lowering your chest as close to the floor as you can, and then back up. Do this 10 times. Then, modify the exercise any way you can: close your hands into fists, cross the arms; instead of turning the hands out and around to point toward your knees, try turning them in and around to point toward your knees (Image 1B)—whatever way you can do it. Always ask yourself, “How flexible are my hands?” The more flexible they are, the better off you’ll be.

Exercise Two
Be careful not to overextend your wrist with this next exercise. Place the fingertips of your left hand on the left outside section of your chest, near your armpit (Image 2A), so you can flatten your palm onto your chest and the heel of your hand is in the middle of your chest. Tap on your forearm as you stretch all your fingers (Image 2B). Do the same thing with the right hand (Image 2C). This is a fantastic exercise to loosen you up.

Exercise Three
Hold the fingers of one hand and move only the thumb in a rotating motion in both directions. Gently pull the thumb down toward the wrist, and then tap all over the radius—from the lateral side of the elbow to the thumb side of the wrist—to loosen up the origin of the thumb muscle. You may find that quite a few of these targeted muscles are tight and rigid. You may even ache; but afterward, you’ll find that your thumb moves with greater ease.

Exercise Four
Gently open and close your hands, feeling that the fingertips are doing the work. Next, tap your fingertips against a nice, soft surface, like a mattress or massage table, using a loose, bouncing motion, about 100 times. This loosens up the wrists.

Conscious Attention to Isolation
One thing is clear: how we take care of ourselves, physically and emotionally, affects our practice in a major way. Our hands convey our emotions. Take special care to keep the neck and shoulders relaxed while you use your hands, and take time to recover when you need to. Imagine that your fingertips are leading your motions, as if they are being moved like marionettes on strings. The neck doesn’t need to be involved—let it do its job of holding the head. This conscious attention is the first step toward independently moving your muscles.
If you learn to separate the effort of your fingers from your wrist, your wrist from your elbows, your elbows from your shoulders, and your shoulders from your neck, you will be able to work without tension along the whole chain. We are all students of this concept, regardless of which discipline we use. Adapt the concept of isolation to your particular practice.

Time for a Break
Do you take breaks? Real breaks? Many of us take coffee breaks or food breaks, but what about a real body-mind break? Here are some more self-preservation techniques you can try.
When it’s time for your next break, go outside, get a few minutes of sunshine, exercise your eyes by looking into the distance, and breathe clean air. Consider taking a short walk. Walking backward and sideways can help loosen muscles we don’t regularly use. Move your arms up and around in a rotating motion, stretching backward. That’s a real break for your body, mind, and spirit. If all we have in front of us are the same four walls or a massage table all day, it is no wonder that the eyes begin to stiffen and the body quickly follows.
Here are two specific exercises to help rejuvenate your body and mind:

The Sunning Exercise
At my school, we love to take people outdoors and do an exercise called “sunning.” We use the sun to relax our eyes and bodies and, thereby, prevent strain and injury in our backs, shoulders, and necks.
To do the sunning exercise, we close our eyes, face the sun with our noses pointed directly toward it, and slowly move our heads all the way from side to side, shoulder to shoulder. It is important not to tense or lift the shoulders.
When the head moves all the way to the left and away from direct sunlight, the pupils expand. When the head moves to the middle, facing the sun, the pupils contract. And when the head moves all the way to the right, they expand again.
When my students practice this, we create a kind of loop—while people are moving their heads from side to side, they massage each others’ shoulders. As we sun, we allow our partner to relax our shoulders by doing a deep and relaxing shoulder massage and we reciprocate to the next person.
That sounds easy enough—there’s nothing challenging intellectually about moving the head from side to side while massaging someone’s shoulders, but 90 percent of the people have a difficult time doing it. Most of us tense our shoulders while moving our hands, because we never learned to separate and relax the shoulders or the neck from our hand movements. Sunning, done in partnership this way, not only relaxes the eyes, but also helps increase awareness of muscle isolation and reinforces that concept.

Give Your Eyes a Break, Too  
As a result of nearly 45 years as a bodyworker and teacher of my Natural Vision Improvement method, I am keenly aware of the connection between our eyes and the rest of our body. One of the first places strain makes itself known is in our eyes, but most people don’t make the connection. For example, we don’t notice how much effort it takes for our eyes to look at close objects or how relaxing it is to look far away. We also don’t notice how we strain to pay attention to our central vision and neglect our peripheral vision. These imbalances lead to stress throughout our bodies.  
The simplest way to overcome these imbalances is to take breaks and look into the distance at least once or twice an hour. It’s best if you can go outside and look at distant treetops, over the ocean, or at the sky. If that isn’t possible, look out a window at whatever there is to see. Don’t try to focus on anything. Just let your eyes gently scan. Wave your hands at the side of your face to wake up your peripheral vision while you use your central vision to look long distance, which allows the lens of the eye to assume its relaxed position. This gives the tiny muscles of the eye a chance to rest, while improving blood flow. It also helps to prevent cataracts, which are caused by a stiff lens.  
It takes considerable effort to utilize our close vision, as the eye uses muscles to bend its lens to the proper position. Tension in the eyes has a drastic effect on the rest of our bodies, and the strain there tends to be reflected in our faces, jaws, shoulders, and in virtually all our muscles. Utilizing our near vision extensively, without taking breaks, gradually builds tension and strain in the eyes and body. Over time, that tension limits circulation and can lead to stiff muscles, vision problems, and back and body pain. By relaxing the eyes, and giving them the attention they require to be healthy, we reduce the strain on our bodies. The relaxation in the eyes is reflected in the rest of the body, minimizing our strain and stress.
To further relax the eyes, mind, and body, practice palming. Place your hands gently over your eye orbits—the cheekbones and forehead (don’t touch the eyeballs or eyelids)—and, with your eyes open, imagine a deep blackness. Try to do this for at least six minutes at a time in intervals throughout the day—it makes a huge difference.
Try alternating between looking into the distance and palming for periods of six minutes or more to totally and completely relax your eyes before your next session of bodywork.

More Tips to Stop Back Pain
In addition to the suggestions already provided, there are a few other things we can do as therapists for the benefit of our backs and bodies:
• Utilize a stool whenever you can while working with clients. Giving the client a nice facial and scalp massage is a great opportunity for the therapist to change positions and sit for a few minutes.
• Make sure your work shoes are specifically meant for a long day of being on your feet.
• Pay attention to your surroundings. Your back, neck, and shoulders will tense up if you feel claustrophobic, tired, or overworked. Find moments throughout your day to pause and consciously lower your shoulders, practice some deep breathing, and ground yourself.
• Keep moving. Try not to maintain one position for too long. When you create movement in your own body, you transfer the sense of movement through your vibrations to your client’s body. That transfer creates movement in their bodies—make sure it’s positive movement!
• When it’s time to do computer work, make sure to take a break every 20 minutes or so. Stand up, grab one ankle from behind you, and pull it up to give the front of your thigh a good stretch as you look up to the ceiling. Push your chest forward, so your neck doesn’t shorten or wrench. Open your eyes and move them in a rotating motion. Look at the four corners of the ceiling while stretching your leg backward and your chest forward. Do this for about 10 breaths for each leg. This simple stretch will make a huge difference for your back and sitting will be much more comfortable.

Learning from Pain
It’s important for us to understand that life is movement and movement is life. Whatever stops us from moving will stop our clients from moving. If you are working on releasing the tension in a client’s back while you are carrying great tension yourself, you are going to have to work that much harder. But self-care changes the story for both client and therapist. If we treat all parts of us, and work on all parts of us, and care for ourselves first, we function at our best and are better equipped to help others do the same.
Self-care is simple, free, and of amazing value. I would like to invite all of you to take care of yourselves first, so your life is fuller and happier and you ultimately can be of maximum benefit to your clients.

Meir Schneider, PhD, LMT, is founder of the School for Self-Healing in San Francisco. He healed himself of congenital blindness and developed an original holistic approach to health through a unique combination of therapeutic massage, movement, and natural vision-improvement exercises for prevention and rehabilitation of degenerative conditions. A globally respected therapist, educator, and bestselling author, Schneider’s latest book, Awakening the Power of Self-Healing, will be published by Self-Healing Press later this year. To learn more, call 415-665-9574, email, or visit