This is an excerpt from Deep Tissue Massage by Jane Johnson.
Using Your Body
Assuming you are in good health and feel rested and energized, there is little you need do differently to prepare yourself to apply deep tissue massage. However, you will be using your body in a way different from when you apply Swedish massage techniques, so you might find it useful to read through these guidelines relating to the use of forearms, fists and elbows.
Using your forearms to massage means you need to get closer to your client, and it is tempting to flex at the waist to do this. You will be working with your treatment couch set at a fairly low height because this facilitates leverage. Prolonged unsupported flexion of the trunk strains the ligaments of the back, results in pain and could lead to problems later. Instead, when using your forearms, ensure you are either in a good, wide stance or that you are supporting yourself by resting your other arm on the treatment couch (or on the forearm you are using to massage). An alternative is to sit on the treatment couch, as in the example shown on page 97 under Using Your Forearm on Trapezius (With Arm Abducted). The disadvantage of sitting in this way is that you need to twist slightly at the waist to apply the stroke, and some therapists find this position uncomfortable.
Something else to consider when using your forearms is that pressure will be more concentrated to the glenohumeral joint of your own shoulder. When working statically, such as when applying compression (see, for example, p. 118, Using Your Forearm on Gluteals), this is not normally a problem. Problems occur when you start to apply forearm effleurage from a static position and do not move along the treatment couch. With the application of lighter massage this is fine, but with deeper pressure you start to both compress and move your own joint, grinding it as you pivot from the shoulder. The simple solution is to try to always move alongside the treatment couch as you effleurage, sustaining pressure through your glenohumeral joint yet minimizing its movement.
To make a fist we must flex the metacarpophalangeal joints that form the knuckles (where the hand meets the fingers) and the interphalangeal joints of the fingers (figure 2.1). When using your fists to apply strokes in deep tissue massage it is best to avoid applying pressure while these joints are unsupported. This prevents directing pressure through the joint in such a way that compromises its stability. Pressure is best directed through the bones of a joint when those bones are end to end, rather than angled with respect to each other. But to work with the bones of the hands and fingers end to end means you have your fingers straight, in the extended position, not in the shape of a fist. The most preferable way to use your fists safely is either to keep your fingers fairly loose, cup your hands together (e.g., the therapist's right fist on p. 112 under Fisting the Medial Calf) and press through the relatively flat surface provided by your metacarpals, or you can form a tight fist and press through your proximal interphalangeal joints, which should be firmly supported and unmovable in this position (e.g., p. 122, Fisting Hamstrings).
As with other joints, it is safer to keep your wrist joint in a neutral position when using fisting to apply deep tissue massage strokes. One reason therapists suffer overuse injuries is that they frequently apply constant pressure through an extended wrist joint. Wrist extension is, after all, inherent to the stroke of effleurage. Radial and ulnar deviations also occur in our wrists as we massage. Therapists risk injury to this joint when using repetitive rotary-type movements with pressure, such as when using fists to knuckle the upper trapezius. With light massage, overuse injuries of the wrist are not likely to be a problem, but as the pressure and frequency of your treatment increases you risk sustaining pain. You might also develop laxity in this joint if it is not protected.
As when using your forearms, when using elbows it is necessary to lean onto the client, so you again need to guard your own posture to prevent injury to your back. In addition, remember that the ulnar nerve runs close to the surface of your elbow. If you experience pain, numbness or tingling in your arm when using your elbow, you might be compressing the ulnar nerve. You should stop using the technique or apply pressure with a different part of your elbow.