For deep pressure massage to the neck, align your core with your stroke by laterally (externally) rotating your arm at the shoulder joint so that your elbow is positioned in front of your core. Now lock your elbow into your core just inside (and usually slight above) your anterior superior iliac spine.
Even perfect body mechanics cannot eliminate all physical stress to your body when doing massage. Ideal body mechanics merely minimize the stress. For this reason, when doing massage, especially deep pressure massage, it is wise to alternate which treatment hand contact you use during a session.
When performing deep pressure massage for the neck with the client supine, it is typical for the therapist to sit, centered at the head of the table. However, this does not allow for efficient body mechanics because it is difficult or impossible to position your core in line with the stroke.
The science of performing deep tissue work to the neck follows the laws of physics and, whenever possible, involves the use of body weight and the contraction of larger muscles instead of smaller ones. The art of performing deep tissue work lies in exactly how these guidelines are carried out and applied.
Side-lying position for deep pressure massage into the neck can be very effective and can allow for effective longitudinal as well as transverse cross-fiber strokes; however, it is important to avoid exerting deep pressure too far anteriorly onto the transverse processes of the client’s neck.
Being able to feel tissue tension barriers is the one most important hands-on skill that an orthopedic manual therapist needs. Clinical orthopedic manual therapy (massage and stretching) only effects change if we reach tissue tension and then apply slightly more force beyond it.
When working the low back, a good strategy is to begin with a smaller treatment contact such as thumb or finger pads to assess and begin treatment of the lumbar region, and then switch to a larger contact such as the palm or elbow to deliver deeper pressure.
Make sure that the feet are not too far apart. A wide stance may feel more stable but creates a static position that makes it difficult to transfer weight from one foot to the other. With a narrower stance, it is easier to shift the center of weight of the body from one foot to the other as a stroke is done.
A common body mechanics error is for the therapist to stand above the face cradle at the head end of the table. Standing here only distances you from the client, causing you to lean over the client to reach the low back; this compromises body mechanics and does not allow for the efficient use of body weight.
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