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Critical Bodywork Advice for Massage Practitioners

by Gerry Pyves(more info)

listed in massage, originally published in issue 103 - September 2004

In the four years since Gerry Pyves launched his revolutionary approach to massage in this very magazine, NO HANDS® Massage has become the fastest growing Bodywork approach in the UK. Positive Health asked him to write a follow up piece on his discoveries since that article.

Personal Story

When I wrote my first ever article about NO HANDS Massage (Positive Health, 2000) I had only my own personal experiences and the experiences of a handful of practitioners to go on.

The response from Positive Health readers, however, was overwhelming. I was inundated with letters confirming that my experiences of injury were far from unique. As a result, I realized that I would need to shift the balance of my life away from my own cosy clinical life towards giving something back to the massage profession that I so loved.

From having a full time clinical practice of 15 years, I now consider myself lucky to find time for even five clinical days a month. Yet these clinical days (I am writing at 4.00am following such a day) are where my massage soul truly lives… I savour every client and every stroke like a good wine. It is somewhat ironic that having discovered a way to work endlessly and effortlessly, I am the only NO HANDS practitioner who is no longer free to use that skill!

Now don't get me wrong – I gave hundreds of massages a month for many years, and I still manage to 'sneak in' hundreds of massages a month to massage therapists on courses. The point is this: my whole approach emanates from my work with clients and it is from giving bodywork that I get all my pleasure. Those who have attended my courses know my commitment and joy in putting bent bodies straight and bringing gentle touch to traumatized tissues. In truth, I now believe I was born to massage…

Whistle Blower

I also believe that I was born to blow the whistle on practitioner injury. Over the last four years I have presented to all the major UK associations and personally met thousands of massage therapists. My schedule is gruelling – in the last year alone I travelled 20,000 miles in the UK bringing my message to therapists. I regularly burn out (yes, I confess it!), I miss my family often and I miss the simplicity of my past life as a full time clinician here in the beautiful Pennines of West Yorkshire. I wouldn't recommend my current lifestyle to my worst enemy! So why do I keep going?

The truth is this: there is something so addictive about being of service to others, isn't there? And I am proud to report that since my last article, I have become personally responsible for hundreds of practitioners massaging their clients with zero-strain, and for resurrecting the broken and destroyed careers of massage therapists throughout the UK. What really gets me out of bed in the morning and recharges me daily is the thought of all that great touch going on and on and on and on…

The demand for touch is massive and growing daily. Nor is this just my subjective opinion. In a report by the University of Exeter, it was conservatively estimated that in the year 2000 alone over 10 million people paid visits to touch therapists.[1]

1. The Extent Of Injury

So how widespread and serious is this injury problem? In America one massage student wrote a book with her brother about the possible dangers of injury, after she failed to even complete her training in Massage.[2] As far as I know the only study into the health of Massage practitioners anywhere in the world was commissioned by myself from a company experienced in carrying out studies across different industries.[3] The results indicated that 78 per cent of Massage therapists had experienced injury to their wrists or hands. Many who filled in the questionnaire had either left the profession because of this or had reduced their workload to a pitiful financial level.

Travelling around the UK I get to talk to audiences of over 100 therapists a time – I have seen over 1,000 in the last year alone. At these seminars I always ask for a show of hands for people who are at each of the different stages of injury outlined below.

It soon became apparent to me that the figures from the Watson study[3] do not appear to be accurate at all. Once practitioners learn how to identify the early signs of injury the figure often seemed to leap to 90 per cent. It is virtually 100 per cent for any practitioner who has been full time in the profession for more than five years. Only one or two of these seem to survive working full time in this profession for more than a few years without injury. Armed with this experience, you can imagine that I am neither tentative nor polite about describing the current extent of injury in our profession.

We are experiencing an injury pandemic that threatens to cripple our Profession.

2. The Mechanism of Injury

During my seminars around the UK I spend over 75 minutes identifying and describing each of the seven stages of injury. The diagram on the next page gives a summation of the essential stages to injury:

Such a depressing picture is best understood through simple Newtonian physics. Newton's third Law of Motion states that: 'For every action there is an equal an opposite reaction'. This means that whenever we apply pressure to our clients, they apply pressure back through our wrists. No matter how 'aware' our movements are, no matter how well we work with energy, no matter how well we were trained in proper stances, every ounce of force that we apply to our clients that goes through our wrists is applied back through our fingers, wrists and thumbs.

And these joints and bones of the hand and wrist are uniquely designed to crumble and tear for evolutionary reasons far too involved to get into here.

So just how much pressure is being transmitted through the practitioners hands and wrists? RSI research showed that a typist puts 20 tonnes of pressure through their hands each day.[4] By the same measure, I calculate that a practitioner who doesn't even touch a client for half the session is likely to be putting 80 tonnes of pressure through the wrists in one hour. That's the weight of one British Challenger tank. Every session. In the light of this mechanism, the reported high incidence of injury to our profession becomes understandable.

The Historical Causes of Injury

Now Massage is not new, you say, so how come there is suddenly such a problem? What could possibly have changed to cause such an upsurge in injury? In terms of western massage, the sort of massage we are now giving to our clients is very different from the massage that Per Henrik Ling gave his clients 200 years ago.

Modern man and woman do not come for the same reasons or for the same sort of touch that Ling dispensed. Massage was actually a very small part of what he did, funnily enough. Much of his Movement Cure was about just that – movement. He wasn't just the father of western massage and physiotherapy but also the precursor of movement approaches to healing like Feldenkreis and the Alexander technique.

The massage techniques that Ling codified were only used for a few minutes in each treatment – within the context of a movement and rehabilitation therapy. The full scope of a typical Swedish Movement Cure session consisted of:

The Swedish Movement Cure

1. Active Movements: These were strengthening, stretching and mobilization exercises performed by the client.

2. Duplicated Movements: These involved the combined work of client and practitioner, both assistive and resistive. This involved, typically, stretches and resisted movements.

3. Passive Movements: These involved movements performed by the practitioner or 'Gymnast'. Typically these involved joint mobilizations, passive stretches and the codified massage strokes.

Of all the techniques used by Ling, it can be seen that massage strokes formed less than one sixth of the Swedish Movement Cure.[5] For this reason, many of the early drawings of Ling's work show mobilization and Range of Motion diagrams, as much as massage strokes.

Nor can it be said that the concerns of modern man and woman resemble the concerns of Ling's clients. The massive impact that rapid social upheaval has had on the fragile human psyche as well as the daily threat of instant nuclear annihilation, is evidenced by the appearance of a veritable panoply of anxieties and neuroses.

The truth of the matter is this: Modern Man and Modern Woman come for massage to take a very different kind of cure. They come for the balm that touch can provide in times that are immensely stressful to the human psyche. They come so that they can re-balance and self-heal. They come to the massage therapist in the same way that a traveller in the desert comes to an oasis. Touch does so much to stimulate the natural re-balancing impulses within the body. That is why it is so hard to get them off the massage table, even when the session is over! They are still drinking thirstily at the waters of recuperation and self-healing…

The result is that we now use techniques originally designed for just a few minutes at a time for 50-60 minutes. QED: Injury.

Assessing Your Stroke Pattern

The beginning of a solution to the problem of injury can be found through assessing your own current stroke pattern. Before reading any further, fill in the chart below by making a 'guestimate' of your last massage. Better still, ask a couple of colleagues around and have a stroke assessment session. Have one of you act as observer and tick the predominant single category for each 30 second unit. In a 50 minute session this will give you a single percentage every 30 secs. You will come out with a good assessment of your stroke pattern.

Assess Your Massage Stroke Pattern!

1. Light Palmar Touch __________%
(whole hand technique, light pressure only)

2. Heavy Palmar Touch __________%
(whole hand technique, lots of body weight)

3. Base of Wrists __________%
(Thenar + Hypo-thenar eminences significant pressure ie kneading)

4. Fingers + Thumb __________%
(pressure applied to specific areas)

5. Forearm ___________%
(any part of)

6. Other ___________%
(Body parts from the elbow up, including torso and legs)

Total 100%

Optimum balance of Strokes

Category   1: 10%   2:  5%   3:  5%   4: 5%   5: 60%   6: 15%

Next to whatever the stroke pattern that you have filled in for yourself, now fill in what I believe is the optimum balance of strokes every practitioner needs to aim for if you wish to survive this work for more than a few years. If you have not done this exercise then do so before looking at the footnote to fill in my recommended stroke pattern.1 Now circle a big minus figure or a big plus figure for each category and you have a personal goal to achieve for yourself in order to protect your career.

Protect Your Career – Properly!

Whilst increasing the use of your forearms sounds simple enough, it is important that you take yourself and your clients seriously enough to do a proper training in this. You would not say to a nurse – "Oh massage is easy! Just put some oil on your hands and move them up and down the body".

Likewise, learning how to adapt your existing knowledge of massage to the use of other body parts requires a complete paradigm shift in your whole body movement if you are to avoid either injuring yourself or your clients. If you start to use your forearms without proper training, I can guarantee that you will hurt your clients and yourself much more than if you carried on using your hands.

In order that I could sleep at night I spent the fifteen years following injury to both my wrists making sure this approach worked for 20 practitioners and their clients in over a quarter of a million sessions. Only then did I begin to show it to a profession I respect too deeply to suggest changes without good reason. In general, the profession should be very wary of self-styled 'experts' in any new approach that has not undergone such a long, rigorous and dedicated clinical development.

References

1. Mills S & Budd S. Professional Organisation of Complementary and Alternative medicine in the UK 2000. A second report to the Dept of Health. University of Exeter. 2000.
2. Greene L. Save Your Hands. Gilded Age Press. 1995.
3. Watson D. A report into the demographic incidence of wrist and finger damage to bodywork practitioners. Shi'Zen publications. 2000. www.shizen.co.uk
4. Adams A. Degenerative Masseurs Syndrome. Workshop presentation. 2000.
5. Pyves G. No Hands Massage – squaring the circle of practitioner injury. Journal of Bodywork + Movement Therapies. July. 2001.

Bibliography

Pyves G. The principles and practise of No-Hands Massage – Zero Strain Bodywork. Shi'Zen Publications. 2000. www.shizen.co.uk

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About Gerry Pyves

Gerry Pyves MA (Oxon) TAP(ITA) Dip TM(CHM)  PGCE is a qualified transactional analysis psychotherapist and the founder and originator of NO HANDS® Massage. Gerry has been a freelance bodyworker for over 25 years during which time he has developed NO HANDS Massage, an advanced bodywork approach that not only helps practitioners overcome injuries but provides a deeper, more powerful experience for the client. He has also developed The Fairy Tale Process™ which provides training in personal and life  transformation as well as writing a number of books including the world’s first novel about Massage, Mavis and I… Gerry travels internationally giving live treatments and explaining the principles behind his work. Gerry may be contacted on enquiries@nohandsmassage.com or more information can be found about NO HANDS Massage at  www.nohandsmassage.com

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