Friday, September 17, 2010

Core Exercises for Massage Therapists

My response to the discussion question - what exercises one might do to strengthen the muscles
used in proper body mechanics.

Massage requires the application of sustained pressure applied from a stable position with the least amount of effort, muscular activity, and compressive force to the joint. In order to accomplish this, the massage therapist must remain as relaxed as possible and utilize proper body mechanics.

There are many types of relaxation exercises that can be employed by the therapist, many of which include breathing, especially from the diaphragm. Rhythmically breathing in through the nose and out through the mouth, feeling the abdomen rise and fall, is the simplest.

Stretching is another good general exercise for the therapist to use to remain relaxed. Gentle, full-body stretching between the giving of massages can relieve tension and consequent muscle ache.

Periodically getting a massage is another way in which the therapist can remain relaxed. A full body massage achieves relaxation, promotes circulation and soothes tired muscles.

Proper body mechanics; that is, posture (stacked & stable), balance (weight transfer), and leverage however, are critical to the physical well-being of the massage therapist. In order to strengthen the body for the rigors of performing massage therapy, it is most important to strengthen the core muscles; that is, the muscles of the torso. The torso includes the muscles of the abdomen, pelvis, shoulders and back.

Most core training exercises are performed on mats on the floor. However, massage therapists perform their daily work standing up with arms outstretched and weight loaded through the legs. Therefore, from a functional perspective, it makes sense to do some core exercises in an upright posture. Basic Pilates floor exercises and standing yoga poses are an ideal combination for this purpose.

Standing postures teach you to create a good balance point, and that requires you to engage your center. The basic Pilates and yoga mind/body exercises described below are perfect for developing the core. In mountain pose, for example, the energy flows up from the earth and through the crown of the head. Done correctly, you are lifted, light yet strong, with the muscles of the core stabilizing you in that position.

There are four basic Pilates floor exercises that effectively work the core muscles. They are –

The hundred prep - Lie supine, heels on the floor, neutral spine. Inhale slowly and stretch the arms (shoulder width, touching the sides of the body, palms down). Slide the scapulae toward the feet. Exhale slowly, engage the core muscles and peel the head, upper spine and arms off the floor. Deepen the lower rib cage into the floor and round the spine up over the floating ribs. Maintain a neutral pelvic position, checking that the abdominal wall is hollowing and deepening, not tensing and pressing upwards. Inhale and lift the arms 6 inches from the floor, exhale and return the arms to 2 inches above the floor. Continue for five to ten breaths. Lengthen the body back to floor and relax completely. This exercise strengthens the core and scapular stabilizers and improves thoracic flexion.

Swimming prep - Lie prone; rest your forehead on your hands, fingertips touching and palms to the floor. Exhale deeply to draw the lower belly off the floor, using the transverse abdominals to maintain the length of the lumbar spine. Inhale to depress the scapulae and lift the upper spine and legs 2 to 4 inches off the ground. Keep the hands pressed to the forehead and the navel lifting up into the body. Visualize lengthening the spine; reaching the crown of the head across the room and stretching the thighbones out of the hip sockets. Keep the legs very straight and release all unnecessary tension. Exhale to stretch the entire body back to the floor. Relax completely. Note that the low back should remain fairly relaxed. If you feel it engaging, release the buttocks and focus on the length of the body rather than the height. This exercise develops thoracic extension, stretches hip flexors, strengthens the scapular retractors and depressors, the erector spinae, and the hamstrings.

Saw - This movement incorporates rotation with flexion. Start seated with legs extended and spread to a comfortable width, shoulders over the pelvis. Flex the feet and extend the arms. Inhale, lengthen the spine and expand the floating ribs towards the back wall. Exhale to rotate the spine, and stretch forward and downward. The ischial bones remain anchored to the floor. Reach the right little finger toward the left little toe. The back arm medially rotates and reaches back with the palm pressing up toward the ceiling. Look at the back hand. Spiral the spine and exhale completely. Inhale to fill the lungs and articulate the spine to the upright starting position. Exhale to repeat on the other side. This is a wonderful spine stretch and overall trunk strengthener and lengthener. It develops support for movements involving rotation. Modifications include slightly bending the knees or sitting on folded towels to ensure a fully erect spine and differentiation between the femurs and the pelvis.

Mermaid - Sit cross-legged or in a chair with both feet on the floor (if hip flexors are too tight to sit tall comfortably). Raise the right arm up to the ceiling, resisting scapular elevation. Inhale deeply to bend the spine and reach the arm to the left, palm down. Turn head to left and look down. Maintain length on left side. Both ischial tuberosities should remain bolted to the seat/floor while the right side of the body stretches, ribs spreading and underarm lengthening. Exhale slowly and focus your intentions on the right internal obliques lifting the spine back to straight. Repeat on other side. The benefits of this exercise include spinal flexibility and increased lung capacity. It stretches the obliques, quadratus lumborum, latissimus and scapular depressors, and develops support in side bending movements.

In addition to the Pilates movements above, combining the five yoga positions described below makes for a perfect set of core strengthening exercises. The five yoga exercises are –

Downward facing dog - Root your feet with the heels down and root the hands, palms down and with the fingers wide creating an inverted V with your body. Distribute your weight equally front to back and side to side. Spiral the shoulder blades down and move the chest toward the thighs. Allow your head to release toward the earth. Engage your core to keep yourself stable. This posture opens the hips and shoulders, stretches the back and strengthens the core.

Warrior one - Place one foot forward, bend the knee about 90 degrees and align it over the big toe. The other foot is about 3 feet back on a 30-degree angle. Keep both feet flat on the floor. Adjust your legs shoulder-width apart so that you can balance onto both feet equally. The pelvis is level and facing forward and the femur is spiraling forward. Press into the back leg while you push energetically forward. Lift up through the pelvis and spiral through it. Avoid squeezing the buttock muscles; roll the hips underneath you, which lift the core engaging the lower abdominals. Lift the arms above the head with the shoulder blades pulled down through the scapula. Hold the position through three to five breath cycles and then switch sides. This pose explores the use of oppositional energies and develops core strength.

Warrior two - Place one foot forward, bend the knee about 90 degrees and align it over the big toe. The other foot is about 3 feet back on a 30-degree angle. Keep both feet flat on the floor. Adjust your legs shoulder-width apart so that you can balance onto both feet equally. The pelvis is level. Press into the back leg. Avoid squeezing the buttock muscles; roll the hips underneath you, which lift the core engaging the lower abdominals. Extend the arms horizontally from the shoulders, palms face down. Avoid lifting the shoulders so you are not creating tension in the cervical spine. Stay connected to your center while you reach your fingers out beyond the limits of your skin. Hold the position through three to five breaths; switch sides. This pose develops endurance, steadies the mind, and opens the pelvis to enable more breath into the belly.

Mountain pose - Stand with your feet hip width apart. Neither lock your knees nor grip your toes. Expand the space of your feet so you are standing directly in the center. A good way to practice is to rock forward and back on your feet to find your center of balance. Lift up through the pelvic floor and keep the natural curve of your spine. Lift through the thighs. Extend through the pelvic area. Drop your shoulders away from your ears. The upper body is effortless. Focus on your breath. As you inhale through your nose the breath moves from the earth up your spine; as you exhale through your mouth your breath is moving back down into the earth. On the exhale, feel the energy move through your body and out of your hands. This practice develops the consciousness that your hands are an extension of your whole body. Hold this position through three to five breath cycles. For massage therapists, grounding from the earth is as important as the breath.

Child’s pose - A good ending position is the child’s pose. It is all about relaxation and breathing deep. Seated on your knees, fold your body forward as your head touches the floor. Arms may be extended gently forward with the palms down or placed behind you with palms face up. Let yourself melt into the earth, releasing any muscular effort. Breathe deeply and feel the air fill your back. Relax in this position through three to five breaths cycles. This pose enables deep relaxation and breathing into the back of the body. It also releases the lumbar spine.

There are many other types of exercises that work the core muscles, including those using stability balls and/or foam bolsters as well as other equipment like free weights and static equipment. However, these nine exercises work the torso sufficiently to strengthen it to meet the requirements of performing most types of massage therapy.

My Favorite Massage Strokes

My favorite massage strokes include effleurage, petrissage and compression. In reading the textbook by Mosby, compression is listed as a separate type of stroke, though the author acknowledges this is controversial. I use effleurage to relax the client’s body, but also to achieve compressive force over a broad area.

When massaging a person’s back, for example, I use effleurage strokes utilizing the whole hand. I start at the top of the shoulders and go down, in one long fluid motion, through to the lower back. Putting a hand on either side of the spine, with my thumbs in the laminar trough, and making a slow, compressive movement I am able to affect the trapezius, rhomboids, teres major and minor, erector spinae, external abdominal oblique, and the iliac crest. This stroking movement is one of my favorites, as I am able to use my body weight as leverage to lean on the client in order to cover a wide area. Many clients have expressed how good the stroke feels to them. I believe having the thumbs into the laminar trough and the whole hand pushing down and forward of the stroke is very therapeutic as it both follows the fiber direction of some muscles and in a cross-fiber direction on others.

A second stroke I enjoy using is petrissage, especially when working on the clients’ calf and thigh. I utilize kneading, rhythmic rolling, lifting and wringing of the muscles as I massage these two areas. Standing perpendicular to the client and grasping their calf/thigh with both hands, I move my hands in a figure eight pattern. I keep tension on my fingers gently squeezing the muscles while grasping with whole hands to get the lifting and wringing movements in with the rolling and kneading. I also move my body in rhythm with my hands, in effect, incorporating my whole body into the stroke. I can adjust the amount of pressure I use by leaning my body more or less, as I perform the stroking motion.

Compression is a third stroke I enjoy. I like to work on trigger points in the supraspinatus, infraspinatus and levator scapulae areas of the body by pressing down with finger and thumb tips, single index finger knuckles, palm heels, and elbows. Now that I can fairly easily identify trigger points by feel in those areas, I am working to learn to identify trigger points in other areas of the body as I perform the massage. Because, I think, most people carry their tension in their neck, shoulders, and upper back, the trigger points are easier to find there. I also use a compression stroke and a scooping motion when doing the pushaway technique in the laminar trough. Using the heel of my palm, I am able to push down into the laminar trough, the amount of compression determined by body leverage, and work that area of the spine.

These three strokes are my favorite ones. I am able to incorporate them into many of the techniques I use while giving a massage.