Originally published in Massage & Bodywork magazine, February/March 2006. Copyright 2006. Associated Bodywork and Massage Professionals. All rights reserved.
Chair massage is a versatile method of galvanizing a massage practice. Many therapists use chair work to advertise what they do best. So why does it have to be so hard on the body? As a massage therapist for 10 years, I have a wealth of experience in both doing the work and getting injured. With an ongoing thumb issue, I had to modify my work to not use them in treatment, whether doing full-body table work or short duration chair massage sessions. The techniques I'll describe here illustrate a way to do chair massage without using the thumbs at all, and the hands only minimally. The forearms, elbows, and fists are the primary tools I use today, effective especially when combined with a focus on excellent body mechanics.
I founded a massage practice at Harvard University's Health Services in 1995 and started by doing chair massage sessions. A recent graduate at the time, I was excited about starting my new career and subsequently did too much, too soon. Even though I had excellent training from the Muscular Therapy Institute, then in Cambridge, Mass., I did not heed my body's calls to stop and rest.
Consequently, being in high demand to do chair massage in various university departments left me with an injured thumb that was not healing properly. I had learned hand-saving techniques in massage school, and I worked on adapting the moves to chair work. The "experiment" worked out well, and my clients were satisfied with the pressure I was able to give. (Note: I did not work while I was injured, and in no way would I suggest any other practitioner do so.)
These modifications can help prevent injuries. It is a way to work with ease and comfort while giving deeper pressure. In doing these modifications, I wasn't working harder; I was working more gently with my body. My clients were feeling a broader surface of my arm and the bony edges of knuckles and elbows, so it felt like I was using more pressure. As the years have progressed, I've honed the techniques to a flow for the whole body. My hope is to see more therapists using their bodies correctly and have long injury-free careers.Proper Positioning
The crux of mechanical success in chair massage is how to use your body weight correctly when in a lunge position; it begins with knowing where to put your feet behind your client in the chair. These moves are designed to be done with a client in an upright-style massage chair. The cantilevering chairs are not recommended for hands-free work.
To get in position, put the leg that's closest to the client in the back, as close to being in line with the client's spine as possible. Begin with one foot directly behind the client and with the other foot parallel, but a hip's width wide. Imagine that a small, fat dog has the space to run between your legs; now maintain the space for this imaginary dog at all times. Take a step forward (a little longer than the length of one of your feet) and position your front foot in line with the leg pad of the massage chair. This foot positioning gives you plenty of "dance space" to bend your knees properly. Too many times I have observed practitioners standing directly behind the client, bending at the waist, feet parallel, and not using any body momentum.
When doing chair massage, at no time should your body be static, with only your arms or hands moving. With every lunge position technique, your knees bend, your back foot elevates, and your whole torso goes with the flow of the lunge, either forward or backward. At no time should you bend at the waist, either forward or laterally. All height differences of your clients should be accommodated by adjusting the seat height of the chair (if you can) and/or bending your knees. For the taller massage therapist, I would recommend focusing your work on the client's upper body and the kneeling lunge for lower body work. Try this exercise with a practice partner in the chair: With your feet in proper lunge position, position yourself to the right of your client. With your right foot in front, and left foot behind your client, bend your right knee to propel your body forward. Lean your left forearm onto your partner's trapezius. Rest here a moment and feel how only the weight of your arm is the pressure into your partner's shoulder. Now lift your back left heel. Notice how this simple heel lift heightens the pressure applied to your client's tissue.
In a lunge position, the heel lift and the subsequent front knee bend creates a forward leaning position of the body. For a Kneeling Lunge, you can use a small towel, a gardener's foam kneeling board, or a pillow for your back knee that's on the ground. The front leg is bent and your hips are propelling the momentum, rather than your feet. By pressing your hips forward, your front knee bends and your upper torso will lean forward and backward. You may want to make sure your psoas is stretched and warmed up before trying the Kneeling Lunge. A kneeling position can sometimes put pressure on your ankles -- the back ankle from having the foot extended and the front foot from the weight of your body. If kneeling doesn't feel comfortable to you, use good judgement in taking care of yourself and knowing your body's limits. Even in a kneeling position, your legs are doing all the work. By leaning forward, pressure is applied by allowing your body weight to sink into the client, rather than implementing brute force. These two positions are the primary sources of giving pressure in seated massage, not arm or hand strength.Observations to Apply
Now a few notes are in order about relaxing the rest of your body while doing this work. Keeping your chest open, and your shoulders down will ensure that your upper body is not hunched and that your muscle strength is reserved. Keep a mental eye on the position of your shoulders: Are they over your hips? Are your ears in line with your shoulders? I frequently say when teaching the hands-free course, "You don't own a waist, and you don't own wrists." In not "owning" them, they don't bend; you keep them in a natural, relaxed state.
Chair massage is quite sociable work, unlike the one-on-one session in your office. Frequently chair massage is done in a public place. Keeping your head up and your body relaxed allows for smile marketing, eye contact with prospective clients, and a welcoming to those who might be unfamiliar with massage.Maximizing the Forearm
Your forearm contains a myriad of tools: the broad base of the flexor muscles (flexor carpi ulnaris, flexor carpi radialis), the ulnar ridge and more medial muscles (extensor carpi ulnaris primarily), the flat of the elbow at the humeroulnar joint, and the elbow point. When using the lateral epicondyle elbow point, it is important not to flex your arm too much so as not to expose the ulnar nerve. I also use my knuckles and elbows in ways that most therapists use their thumbs. The core technique used with all the arm positions is compression. This may be achieved by rocking the arm back and forth, pulsing by bending your knees or a compression, and then a fascial stretch. For those who have had myofascial release training, that stretch will come easily. For those who have not done fascial work, the technique should only move the "slack" of the skin or muscle. There are other techniques that go deeper in the tissue, and the variety of light and deep moves works well in providing a range of techniques with which to work.
The moves are grouped together so that one can flow into the next. I have focused this particular discussion on a full back flow, with one of the moves traversing the entire lateral side of your client's body, including the legs. You will be using forearms, elbows, and knuckles. At no time are you using fingers, palms, or thumbs. There are hands-free techniques that go all over the body. I have organized the techniques by similar arm and hand positions to make it easy to learn and transition from one move to the next. The names are indicative to either the position ("Knuckles in the Knotty Parts") or by the major contributing technique ("Forearm Fascial Stretch"). Feel free to find your own flow. Interspersing one or two of these techniques into an existing routine can be worthwhile in saving energy and also becoming familiar with a new way of moving while working. Contraindications follow standard massage practice, taking special care with the lower back moves. Avoid any or all of the deeper pressure elbow-centric moves, or even fascial stretches, if the client has any disc issues. If your client is sore in any part of the body, modify the pressure given for that specific location.Forearm L to I
Working muscles large to small, start with the trapezius working either side of the spine. Start on the left side of the body with your left arm bent into an "L" shape. Use your forearm horizontally to press into the left side of the client's trapezius. With any of the forearm moves, remember not to clench your hand. Let your hands feel loose and relaxed while your forearm does the work. Get yourself into the properly positioned lunge position. Start at mid-back, just below the inferior point of the client's scapula. Start as low as can comfortably be managed by bending your front knee deeply so that the most surface area can be covered. Be safe with this bend; don't put undue pressure on your knee by bending it over your toe. You can lengthen the lunge a bit by moving the foot behind you further back. Lift your back heel and use compressions with your forearm in a superior direction (still holding an "L" position). When your arm reaches the client's inferior scapula, rotate the arm vertically, so that your forearm's ulnar ridge fits between the client's scapula and spine ("I" position). In the client's "knotty" areas, your elbow can dig in a bit.
When the superior angle of the client's scapula is reached, rotate your arm back to an "L" and dig your elbow laterally along the superior trapezius/supraspinatus muscles. The dig should not be an arm-focused move, but a lift of the back heel; this gives you leverage and momentum versus body/muscle strength. You can do forearm L to I from the head of the chair facing the client, working the trapezius superiorly to inferiorly. Try doing one of each on either side of the back. With one move, the entire trapezius has been spanned. For the tall practitioner, it's best to start around T-4 or T-5 of the client's mid-back, where the arm goes into an I position. In this way, taller practitioners won't be tempted to bend their waist.
This Forearm L to I can be done over the whole back and down the side of the body (in L position). When working the Forearm L to I in the legs, position yourself to the side of the chair facing the lateral side of the client's body and be in a kneeling lunge position. This side positioning will give more momentum to the technique and allow room to lunge forward and apply more pressure to the client's legs. Be sure not to push too hard or the client will rock out of the chair. Make sure your chair is stable enough to withstand this lateral rocking pressure. When working the client's iliotibial band, the forearm can be positioned in L or I. Using L, the broad surface of your forearm can give the compression; when positioned in I, your elbow can dig into tight areas.Forearms/Elbows in the Trapezius
Working from the head of the chair, a deep superior trapezius focus can be a popular option. Even now your body is positioned side by side with your client. Position your body in a lunge, and rest your forearm into the trapezius (as if the trapezius is an armrest) by bending the knees and bringing all of the body weight down into the feet. Rock forward and back by bending the front knee and then feeling the weight ground back into the back leg. This rocking motion can give added pressure into your client's superior trapezius. Try using all parts of the forearm, such as the multilayered muscular anterior (or underside), your ulnar ridge, or elbow. Each part of your forearm application will have a different sense of depth to your client. As most massage therapists can attest, the trapezius is a frequent area of tension for clients. This is a restful move where you can catch your breath if the Forearm L to I was vigorous. If the client can tolerate deeper pressure, use the elbow point and bend the knees a bit further. Be sure to not let your shoulder rise while doing either of these movements. Let your knees bend, and lift the back heel when you want to give pressure.Knuckles in the Knotty Parts and Rolling Knuckles
For Knuckles in the Knotty Parts, you are directly in front of the chair versus being beside the client as you were for Forearm/Elbow Trapezius. The face cradle should be in line with your breastbone. Your feet are still in lunge position, but a shorter distance apart lengthwise. Your hip-width stance should be maintained at all times (remember the fat dog). Hold your hands in loose fists. With your hands positioned so that the palms face each other, place your knuckles on either side of the client's trapezius. Lift your back heel, and allow yourself to rock forward, sinking your knuckles into the client's tense trapezius tissue. A small rotation of the hands (Rolling Knuckles) can make the move feel deeper without adding any muscle force.
Your hands can continue Rolling Knuckles up your client's lateral neck muscles (scalenes, sternocleidomastoid) rotating either clockwise or counterclockwise. Once the client's occiput has been reached, feel the edge of the skull's ridge into the first or second phalangeal joint of your fingers and give a small pull upward, leaning your lunge into your back leg. Rolling Knuckles gives extra pressure into the tight muscular attachments at the base of the client's skull and can continue (at the client's tolerance) superiorly up and around the client's head or inferiorly to the trapezius. Be wise not to tighten your fingers or palms during this loose fist move, but keep your hands at ease so as not to cause too much tension in your body.Forearm Fascial Stretch
After these deeper techniques, a follow-up "softer" fascial stretch can give your client a chance to breathe and rest. For those old enough to remember the television show I Dream of Jeannie, before Jeannie blinked her eyes to perform some magic, she stacked her forearms on top of each other in front of her, fingertips to elbows. In this position, start at the lowest place that can be reached comfortably on your client's back. Forearm Fascial Stretch can be either a lower or upper back move depending on your knee-bending comfort. Your lower arm can be at the quadratus lumborum or anywhere on the trapezius for a greater upper-back stretch. With the bottom forearm taking up the slack of skin and back muscles, gently stretch the tissue with your top arm in a superior direction. Work one side of the spine at a time. If you can comfortably reach the lower back without bending at your waist and by lunging deeply, or positioning yourself in a Kneeling Lunge, your top arm can stretch all the way up to your client's superior trapezius. Your bottom arm rests and stays stationary either at the lower or mid-trapezius, giving a full back stretch to your client. Lower Back Fascial Stretch, Fists, and Elbows into Glutes
The Lower Back Fascial Stretch can be helpful for clients who sit for long periods. Transition your way down the back with a familiar technique, or Forearm L to I in a superior to inferior direction. When the lower back is reached, you should be in a Kneeling Lunge (with a knee support if needed), facing the back of the client. Your forearms are positioned in I Dream of Jeannie. Span the quadratus lumborum just above the iliac crest with your forearms. You can separate your arms a bit laterally if needed for a larger client. Rest your forearms and feel for the slight play of the client's tissue, moving the hips down at the belt line. Let the weight of your forearms power this move; don't push in any way. This is also another restful move. For deeper pressure, curl your hands into soft fists and use your knuckles into the inferior iliac crest, on either side of the sacrum. If your client asks for even more pressure, you can use your elbows here too.
These are only a few of the moves that are included in the hands-free protocol. This flow can be condensed or expanded to fit the time frame of chair massage sessions set by your client. By using forearms, elbows, and knuckles, your thumbs and hands are preserved. I have found that I'm able to do more hours, with less effort, and still be able to see full-body massage clients within the same day of a chair massage event. Body mechanics are the most difficult aspect to master with this technique. Take the time to work with these moves separately, in front of a mirror if that's helpful. By focusing more on your body's natural momentum, you can give a deep and satisfying chair session without compromising the comfort of your own body. Lisa Santoro has been a massage therapist for 10
years and has a practice at Harvard University's Health Services. She is also an instructor at the Muscular Therapy Institute in Watertown, Mass. She can be reached at
email@example.com or 617/312-2302.