Key Points
• Finding new ways to press, squeeze, and glide can help reduce the repetitive use injuries common for massage therapy and bodywork practitioners.
• Experimenting with different body-part combinations, angles of pressure, and positions around the table can help you massage pain-free.

If you massage the same way day in and day out, you could be setting yourself up for an overuse injury. That’s what happened to me after 20 years of massage. At that time I was diagnosed with cervical radiculopathy, cubital tunnel syndrome, and an unstable shoulder. In other words, my body was falling apart, and I needed to resolve my pain issues in the massage room or find a new career.
For a year, I experimented with different massage strategies and techniques. Eventually, I found new ways to press, squeeze, and glide that allowed me to massage pain-free. I’m going to share some of those techniques with you now. Let’s start with pressing.

Knuckle-Thumb Combination Replaces Thumbs

Thumbs are perfect for focused pressure and palpating, which also means they get overused. An alternative to pressing with a lonely thumb is to press with a combination of body parts, like the knuckle-thumb configuration in Image 1.  
With the knuckle-thumb configuration, I direct pressure into the knuckle of the third finger of my left hand. The fourth knuckle on the same hand and the thumb on the left hand brace and support that third knuckle. In the picture, you'll notice the supporting thumb is bent to fit comfortably next to the third knuckle. This is not a mistake. In this case, that thumb’s primary role is for palpation, not for delivering pressure.

Thumb-Thumb Technique

This next example of combining body parts, thumb-on-top-of-thumb, is not a thumb substitute; instead, it’s a thumb-enhancer (Image 2).
When you put a thumb on top of a thumb, you lessen the strain on both thumbs by spreading out the workload. Compare this technique with how you usually press with your thumb. The next time you’re doing a massage, use one thumb to press into a calf. Then try using the thumb-on-thumb configuration shown in Image 2. If your hands are positioned how they are in the picture, you’ll notice less strain on your thumbs.
You can experiment and create your own body-part combinations by standing at the side of the table, placing your hands on the client’s back, and then gliding with your hands together, allowing your fingers to explore different positions.

Massage Tools Replace Thumbs

If you really want to take thumbs out of the pressing equation, try a massage tool, like the T-bar. But don’t grip the T-bar as shown in Image 3, because that will eventually strain your finger joints.
Instead, pin the T-bar between your hand and the area you’re working on. Then put a guide finger next to the stem of the T-bar to stabilize it in your hand. Lean into the massage tool to generate force, and then relax the holding hand, like in Image 4.
If you’re worried about losing sensitivity with a massage tool, you’re not alone, but there’s no need to worry. The guide finger next to the stem of the massage tool not only stabilizes the massage tool but also serves as a sensor and a palpation tool.

Gliding Massage Tool Replaces Thumbs and Forearms

Gliding with a round-tip massage tool, like a round-tip L-bar or a TheraPress, is not hard to do with some practice. To simulate a thumb or elbow glide, place a finger, thumb, or knuckle next to the stem of the massage tool or hold the massage tool with two hands (Image 5).
If you’re new to massage tools and don’t feel comfortable sensing the tissue with your guide finger, do one or two exploratory glide strokes with your thumbs, knuckles, fists, or forearms before you do your massage tool gliding stroke. That way you’ll have a mental road map of the soft-tissue terrain so you can anticipate what’s coming up when you glide with your massage tool. If you’re coming up to an area you think may be sensitive as you glide with your massage tool, lighten the pressure, glide over the area, and then come back to it to apply the appropriate therapeutic pressure with the massage tool.

Gliding Knuckles and Fists Replace Palms and Forearms

I’m sure you’re used to gliding with your palms and forearms, but have you ever tried fists or knuckles? Fists and knuckles have an advantage over palms because your wrists can remain neutral in a fist or knuckles glide. A fist or knuckle glide is easy to do on iliotibial (IT) bands while you’re sitting, and if you rest your forearms on your thighs as you glide, you can minimize the work your shoulders and arms are doing (Image 6).

Pressing Replaces Squeezing

A two-hand press can simulate a squeeze without making your hands work so hard. The upper trapezius is my favorite place to do the two-hand press.
First, picture a typical one-hand, upper trapezius squeeze: The client is prone while you sit on a stool. You wrap your fingers around the top edge of the anterior aspect of the upper trapezius while your thumb of the same hand presses into the posterior side of the upper trapezius, and you squeeze.
To try a two-hand press, move your stool to the front of the massage table so that you’re facing the head of the client. Slip a hand underneath the front edge of the anterior upper trapezius edge. Place your other hand on top of the posterior upper trapezius and press your top hand into your bottom hand (Image 7). I prefer to use knuckles or a massage tool for the top hand and fingertips for the bottom hand. If you can, rest the forearm of your bottom hand on your leg to reduce the workload in that shoulder and arm. Your bottom hand should be doing the least amount of work.

When Do You Practice With Your Massage Tool?

When experimenting with a massage tool, don't use paying massage clients as your testing ground. You need clear feedback, so grab a massage therapist friend or someone you trust to give you instant and honest feedback. Don’t just settle for one opinion. Get as much reliable feedback as you can. I have the benefit of getting a lot of feedback from many massage therapists when I teach my massage tools classes. That information has helped me become proficient and confident with massage tools.
At some point as you practice with a massage tool, you’ll arrive at the “Now what?” moment. The “Now what?” moment occurs when you feel comfortable using a massage tool on friends, but you’re still hesitant to use a massage tool on a paying customer because you don’t want to take the chance of ruining the massage for the client by having an awkward moment with the massage tool.
You take the awkwardness out of using a massage tool by getting good with transitions. Here’s an example of an awkward massage-oil transition that I recount in my book, The Pain-Free Massage Therapist:
I remember taking a particular neuromuscular therapy (NMT) course and my partner for the day was a chiropractor. As you might expect, he knew anatomy inside and out, and during that seminar he showed me some tricks of his trade for palpating and working near the spine.
I didn’t feel I had much to offer him until I was the one on the table and he was the one practicing the NMT technique. He took the oil bottle, held it six inches above my back, and squeezed. Oil oozed all over my back, and then I felt his hands slap it around to keep it from dripping around to my front. What if you did that during a paid massage—how many clients would you have in your phone contact list?
How you introduce the massage tool to the client cannot be the transitional equivalent of squirting oil on their backs from six inches away. In fact, the introduction should be seamless.
A lot of the time clients don’t even know I’m using a massage tool on them.
What’s the secret to my sneakiness?
I keep one hand on the client as I pick up the massage tool. So the massage tool needs to be close enough for me to reach. That contact hand is not a floater hand. I’m making firm contact with my client. There is intention—directionality, if you will—in my touch.
In other words, my brain is focusing on the contact hand as I transition to the tool. My client experiences that contact hand as me doing massage, and massage continuity is not broken. The reverse is also true. If I’m transitioning from using a massage tool and want to put the massage tool down, I keep my guide finger/hand/fist on the client as I’m putting the massage tool down on the table.
That’s it. Once you get the hang of keeping a hand on the client when transitioning, you can then get super-efficient at getting the tool in and out of your hand smoothly.

Give Yourself a Pat on the Back

If you’re ready to try out some new ways to press, squeeze, and glide, give yourself a pat on the back because change is not easy, especially for massage therapists in the massage room. I’m not saying “especially for massage therapists” to be critical of us.
Here’s what I mean: Imagine your client walks into your massage room with a sore back. He has a trigger point that needs attention, but you have two iffy thumbs. What are you going to do? My guess is you’re going to do whatever it takes to get him out of pain, even if it means pressing on a trigger point with iffy thumbs—and putting yourself in pain. Am I right?
But here’s what’s changed: You now have more options for iffy thumbs and other overused body parts. Continue to build your portfolio of options, and my bet is that you’ll be able to do massage for a long time.