Massage tools
As massage therapists you dedicate your lives to easing tension, relieving pain and rebalancing the bodies and emotions of your clients. Nurturing and caring for others comes naturally to you, often at the expense of your own well-being. Putting others first may seem like a good idea, until suddenly your own body suffers and your most precious tools, your hands, stop working the way they should. Hours of performing massage therapy can really take its toll on your body, resulting in injury or weakness.
Investing in massage tools and equipment is a great idea, but only if you are investing in your most precious tools first – your hands and your body. Taking care of them, along with your own general health and well-being, will allow you to do what you love for years to come.
Injury happens when your push your body beyond its limits, and repetitive motion such as massage is a major factor as the body is not designed for constant repetitive motion. Tissue damage starts to occur once the body part in question has reached the limit as to how many times it can move in a certain way. 
For example, your thumb has small muscles with limited strength, not designed to withstand constant repetitive motion. Add to that the pressure needed to perform massage, as well as the hard work your thumbs are doing to remain stable while they work, and you soon have a recipe for tissue damage, and pain. Proper technique can help, such as keeping thumbs aligned with the hand and arm, which allows more of the pressure needed for massage to come from the larger muscles of your arms and upper body. 
Bruce Baltz of Massage Daily recommends strengthening your fingers, focusing on extension, abduction and adduction to stretch the flexor muscles. He offers the following techniques:
When starting the stretching movement, it is essential that you move each finger by contracting the opposing muscle. This way, your body will be communicating with itself on what you want to accomplish. Assist yourself with light pressure to increase your range of motion, holding for only two seconds. Let each finger come back into a resting position. This is when new oxygen and blood will enter the tissue. Repeat this process 10 times for each joint.
Isolating finger extension
A simple hand exerciser also can assist in strengthening the muscles we take for granted and most often neglect. This type of device allows you to strengthen all those neglected hand muscles, and you can incorporate the healing power of warm and cool temperatures to help bring more blood and oxygen into our hands and, at the same time, help release trapped toxins.
After a long shift, your hands will feel tired, if not sore, so a cool application will be a welcome antidote. A hand exerciser that has been cooled in the refrigerator does wonders to sooth your overworked hands. When working with hydrotherapy principles, I have found that combining them with muscle contraction or manipulation enhances the soft-tissue results. Most of us will find that increasing circulation in our hands presents significant challenges, but by using both warm and cool temperatures, you will assist your body in flushing the tissue through vasoconstriction and vasodilation.
Finger abduction
To assist in vasodilation, use heat to benefit from the temperature exchange. When working with warmer temperatures, safety guidelines must be followed to prevent injury. Therefore, if you are utilising any type of hand exerciser, I recommend heating it in the microwave for no longer than 10 seconds. For cool application, place the hand exerciser in the refrigerator for an hour and a half to two hours. Always end with cold; your body will naturally warm itself back up.
In order for our bodies to function at an optimal level, we must find a balance between strength and flexibility. As massage therapists, this is particularly true for our hands, which are used constantly in our work. If this is achieved, we can work more efficiently, longer and with fewer injuries.
As well as caring for the hands, there are a number of other factors to consider.
Give yourself time
There are a number of time factors that can have a negative effect on your well-being as a massage therapist. Suddenly or drastically increasing the number of massages you perform in one day increases your risk of injury, as does skipping straight from one client to the next without a few minutes to stretch out and relax between.
Client positioning
Many massages take place with the client lying face down on a massage bed, which means that you must bend over the client for long periods of time. Not only is this tiring, over time it can lead to back problems.
Raising the bed will help reduce the angle at which you bend over your client, but it’s not the only option. Try massaging your client while they lie on their side (this is particularly effective for heavily pregnant clients, propped up and made comfortable with cushions of course), or sitting in a chair in front of you.
Your positioning
Standing at the client’s head allows you a longer reach down their back, but it also puts a lot of strain on your back as you bend further and longer. Vary your positioning so that you massage from the side as well as the head.
Massaging in a cramped room or with your table at the wrong height will likely cause you to adopt awkward or stressful postures and positions as you massage, distorting your body mechanics.
Technique, technique, technique
Keeping wrists straight as you massage will help prevent carpal tunnel syndrome and loss of sensation in your hands, which could potentially lead to long-term nerve damage, 
Rather than only using your hands to apply pressure, engage your shoulders and back too.
Stretch it out
Gently stretch and massage your own fingers, hands, wrists, shoulders and neck before and after every massage client. Don’t wait until the end of the day or until you have noticeable tension in one or more of those areas. Prevention is key.
Nourish yourself
When you have back to back massage clients it can be easy to forget about lunch, afternoon tea and even drinking fluids. Staying hydrated and nourished throughout the day is essential to avoiding a mid-afternoon crash in energy levels, or reaching for an unhealthy snack on the way home. 
Treat yourself too
Your clients aren’t the only ones who benefit from receiving a massage. Investing in regular sessions with a massage therapist will not only relieve your own tension and muscle fatigue, it nurtures your own well-being so that you have more to give. 
If it hurts, don’t do it
If massaging a certain way or using a certain technique causes you discomfort, stop. Re-evaluate your technique, or ask someone you trust to look at what you are doing and offer advice. If discomfort continues, get it looked at by a doctor.
Common injuries sustained by massage therapists
Soft tissue injuries common to massage therapists fall into two categories: muscle/tendon injuries and nerve impingement injuries. The primary cause of these disorders is thought to be overuse, or using a part of the body beyond the point where it can function normally and remain healthy. These injuries are collectively referred to as repetitive strain or stress injuries (RSIs), cumulative trauma disorders (CTDs) or simply overuse syndromes. Left untreated or allowed to become chronic, these injuries can lead to osteoarthritis, and temporary or even permanent disability and the loss of function of the hands and/or arms.
The most common muscle/tendon injury among massage practitioners is overuse syndrome. The most common injury sites are the thumb, the wrist, and the forearm. This chronic injury is characterised by gradual onset. Appearance of symptoms often occurs with a sudden and/or substantial increase in workload, or a sudden decrease in time spent between massages. Changing technique, trying new techniques, or even emotional stress can cause an onset of symptoms. The primary symptom of overuse syndrome is diffuse achiness, tightness and/or soreness in one part of the upper extremity rather than a sharp pain in one specific spot. 
Other symptoms include loss of function and paraesthesia. Classic signs of inflammation like swelling, redness and heat are generally not present in overuse syndrome. Overuse syndrome usually takes quite a while to resolve completely, often a number of years.
Tendinitis and tenosynovitis are inflammatory conditions (of the tendon and tendon sheath respectively) that have a more sudden onset. These injuries are caused by tearing (strain) of tendon fibres or irritation to the tendon sheath. The clear presence of inflammation distinguishes these injuries from overuse syndrome. Among massage therapists, tendinitis and tenosynovitis are less frequent complaints than overuse syndrome. The main symptom is localised pain. The affected area is often swollen and hot. With proper treatment, and careful avoidance of re-injury, tendinitis and tenosynovitis tend to heal in a shorter period of time than overuse syndrome.
Muscle/tendon injury as a result of doing massage is more common among massage therapists than nerve impingement injury. The two most common nerve impingement injuries sustained by massage practitioners are carpal tunnel syndrome (CTS) and thoracic outlet syndrome (TOS). CTS involves impingement of the median nerve at the carpal tunnel of the wrist. TOS refers to impingement of nerves C8-T1 at area of the base of the neck where the brachial plexus descends through the space between the first rib and the clavicle. Massaging in unnatural postures or with unaligned joints is often the cause of CTS or TOS. Like overuse syndrome, these injuries tend to develop slowly and can be triggered by a sudden increase in workload or decrease in time between massages.
Excerpt from ‘Save Your Hands! Injury Prevention for Massage Therapists’ by Lauriann Greene.
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