Safely Navigating Injuries

By Art Riggs
[Q & Art]

Dear Art,

My spa has an excellent reputation for therapeutic bodywork and working on injuries, but recently we had two clients report that acute symptoms for which they sought treatment had flare-ups after their sessions. Do you have suggestions for safely navigating the line between therapeutic and relaxation bodywork?

—Striving for Safety


Dear Striving,

I’ll offer some specific treatment suggestions in a bit, but let’s begin with some general thoughts. The most important rule is to never work on anyone if you don’t feel confident in the safety of the techniques you use. It is a sign of competency, not inadequacy, to be honest and say you don’t feel comfortable working with a certain condition. 

I learn something important from recognized luminaries in every issue of Massage & Bodywork. However, working on injuries is very much learning by doing rather than simply studying techniques. Videos offer the invaluable benefit of seeing the intangibles of touch and pace, but there is nothing like taking hands-on workshops or working under the supervision of a mentor to learn at the deepest level. Be patient in expanding your skills working with injuries; the fun of this work is the incremental expertise that comes with practice.

That said, let’s explore some specific strategies that should prove helpful in safely working with most any complaint a client may have.

Set realistic goals and communicate with your client before the session. Take pressure off of yourself by letting your client know that your goal is to facilitate the natural healing process, not offer a miracle cure. I often say, “Let’s see if we can get you moving in the right direction by putting some energy into the area and relaxing some tension.”

Plan shorter sessions. Particularly for low-back complaints, lying in one position for too long and overworking are often the causes of increased symptoms. It is sometimes beneficial to suggest 30-minute sessions on a more frequent basis and not spend too much time on the area of complaint.

Take advantage of side-lying work. Especially for low-back complaints, I often only use side-lying positions, allowing clients to choose a position in the neutral, pain-free range. As muscles relax, have your client move knees forward or back to decrease or increase pelvic tilt, which helps override spasm and offers freedom in the lumbar vertebrae.

Use frequent movement throughout sessions. Painful areas aren’t happy being immobile for extended time periods. I often have people change position four or five times during a session, moving from prone to supine to side-lying, and back to either prone or supine.

Work satellite areas. I rarely begin work on specific areas of complaint; instead, I often begin on the neck in a supine position to introduce the client to my touch and relax the nervous system. As you sense the development of trust and relaxation, move toward the problem area, sensing any defensiveness and sometimes retreating to other areas for a while to give the body a chance to assimilate the work.

Ask for active movement rather than passively moving joints through range of motion. This is critically important for recent acute injuries involving joints, especially with the low back and neck. When working to increase range of motion, such as for shoulder restrictions, have your client move back and forth from comfort into restricted areas of movement rather than continually working at end range.

Spend time on areas of primary tightness or compensatory holding that may solidify movement patterns. For example, posterior neck pain may be a response to tightness in the anterior muscles of the pectoral area or scalenes. 

Apply gentle work to the area of complaint. Fear and defensiveness of painful areas often exacerbate symptoms. Of course, appropriate deep and specific work are often helpful, but initially, just addressing the area with a nurturing touch can do wonders to relax holding patterns and recalibrate perceptions of pain.

Finish with relaxation work. It is always a good idea to finish the session with work to nonsymptomatic areas, rather than having your client suddenly jump up and face the world. I believe relaxation work actually stimulates the pleasure centers of the brain, calming the sympathetic nervous system and diverting attention from the problem area.


“Striving,” my biggest concern is that many massage therapists are frightened of the reactions you mention, and therefore do a great disservice to both themselves and their clients by shying away from working with injuries. More research is authenticating the power of our work. Your client’s state of mind is crucial in healing. You don’t have to “fix” someone to provide great benefit. Patiently learn the skills to work in partnership with injuries and complaints, but remember there is a human being behind those symptoms. Your caring humanity is a gift many people just don’t receive in a typical medical setting. 


  Art Riggs teaches at the San Francisco School of Massage and is the author of the textbook Deep Tissue Massage: A Visual Guide to Techniques (North Atlantic Books, 2007), which has been translated into seven languages, and the seven-volume DVD series Deep Tissue Massage and Myofascial Release: A Video Guide to Techniques. Visit his website at