This sounds like a random combination of good and bad advice, with the potential to hurt someone. And you seem to be proud that you didn't learn from others (e.g. about the risks).
Luckily, someone already told you that you shouldn't press pregnant women's abdomens with more pressure than you think (you seriously needed to be told that?), so perhaps if you keep doing this, people will gradually teach you the other safety precautions, too.
In the last year I’ve taught ~50 people how to massage, too. More recently I’ve been teaching people how to massage others:
Please tell them to get second opinion from someone who actually knows what they are doing.
*
OK, this is rude, and I should probably instead write the specific things that you missed. But I am concerned about you overconfidently doing what you are already doing (and teaching others to do that!), and it feels like giving you more information will only increase your overconfidence (now that you know this last detail, you certainly already know everything important). Anyway, off the top of my head:
- you should make sure the muscles are warm before you start massaging them
- hands and legs are always massaged in proximal direction
- don't massage people with varicose veins, you might literally kill them
- larger muscles can be massaged with greater strength, but smaller muscles gently
...probably a few more things I forgot.
Viliam, can you recommend any resources for massage safety? I've been doing self-massage for years, it's saved my career from multiple chronic pain conditions. I try to read about safety when I can, but I don't know of any good central resource, and this is actually the first time I learned about the varicose veins thing...
I had a university course and some supervised practice 20 years ago. Sorry, I don't have notes, and I probably forgot a lot. Also, we never did self-massage, it was always other-massage.
The risk with varicose veins, if I remember correctly, is also knocking some plaque off and giving someone a stroke. (I suppose that could happen spontaneously, too. But perhaps with your "help" it would happen sooner, and maybe with a larger piece? No idea.)
Hands and legs massaged in the proximal direction, otherwise you could damage venous valves by basically pressing the blood through them in the opposite direction. (No idea whether that hurts or how much. We were taught not to do that, and I followed the advice, so I didn't find out.)
With muscles, you progress through warming up, friction, smaller pressure, greater pressure. Warming up, because otherwise the muscle is not relaxed.
Don't push on skin if there is a bone below it, you would be damaging whatever is between your finger and the bone. Don't push on spine. (Though you can massage around the spine, making a "V" shape with your fingers, each fingertip on one side of the spine, moving in cranial direction.)
We only did the massage of back, arms, legs, neck, and face. I do not remember whether there was an actual reason mentioned for avoiding the front part of the body. (I remember from a different source that massaging the belly in a wrong direction could tangle your colon. Not sure if that's true. The correct direction is clockwise for most people, but... there are a few people who have it the other way round.) Pushing on entrails is an obviously bad idea. Pushing on boobs is also bad, not sure why exactly (whether actually harmful, or just because massage sometimes encourages fat cells to release some fat, and women usually want to keep their boobs).
(And the idea of pushing on a pregnant woman's abdomen is just... how the fuck could any sane person even consider this? Can you imagine how fragile are the organs of a fetus? Also, you get the feedback from the woman whether it hurts her, but you do not get the feedback from the fetus; it's not like it can yell at you or move out of the way of your iron grip. This part just horrifies me; if a person needs to be explicitly told this -- and quotes the advice with a question mark, as if there is some doubt to it -- what else do they need to be told explicitly that you or me would just consider too obvious to mention? Don't stab your fingers in other people's eyes? Don't crush their windpipe? Don't punch their heart?)
Returning to the original topic, massage is taught at medical schools and sport schools, you could probably attend a lecture if you care about this. Or you could pay a professional masseur to show you how to massage your friend. That way you could also get some tacit knowledge, such as "when you do this, put your hands in this angle" etc. (If you know an experienced doctor, you could ask them whether they had patients who were hurt by massage, and what exactly happened.)
From my perspective, unlike the OP, you seem to generally know what you are doing.
1Thanks a lot for the reply, this is valuable info.
From my perspective, unlike the OP, you seem to generally know what you are doing.
I appreciate the kind words, but I've made no systematic effort to acquire knowledge -- everything I posted in this thread is just bits and pieces I picked up over the years.
As you can see from elsewhere in this thread, I suspect I might have given myself an internal injury about a month ago from doing deep tissue massage, likely due to being on a low dose of an anticoagulant supplement (nattokinase).
However, I do think this sort of injury is generally rare. And my health would be in far worse shape if it wasn't for massage.
Yeah maybe I am callous about massage safety. Please recommend resources.
I think the crux is that I have the assumption that any harmful motion will hurt before it does significant damage. But if you’re not paying close attention to pain, yeah I think you could easily hurt yourself and others.
I would be wary of deep massage in the abdominal region. You don't want to damage organs or tear open someone's abdominal aorta (or even weaken the wall of their aorta). Internal bleeding can be life-threatening. Important organs like the kidneys aren't always well protected. You could cause organ bruising or worse. EDIT: Risks of internal bleeding or bruising are especially severe if someone is on an anticoagulant like warfarin. Avoiding acupressure could also be wise in that case.
I'm currently recovering from what I believe is an internal injury I gave myself from doing a super intense deep back massage [edit: while on a low dose of an anticoagulant supplement -- likely just a bruise]. Prior to that I did many years of massage with ~no issues, although I did try to follow safety tips from massage books.
If you have tense muscles in your abdomen, I think finding creative ways to lie (or even wall sit) using a mat like this is a much safer option than doing massage:
https://www.amazon.com/ProSource-Acupressure-Pillow-Relief-Relaxation/dp/B00I1QCPIK/
It costs negative time to use an acupressure mat if it helps you fall asleep ;-) I've tried a lot of things for sleep, and the acupressure mat has been one of my most powerful tools.
The pillow that comes with the mat is a good tool for the back of your neck, another sensitive region I'm wary of massaging. Lots of people have tension there. I sometimes notice my cognition improving after I release the muscles in the back of my neck and the back of my head. I think it's due to increased blood flow to my brain. The release from the pillow will be most intense if you shave your head first, for full contact.
Please recommend resources.
PainScience has lots of great content about massage. The author is a former massage therapist and has excellent epistemics IMO.
Ty. rhabdomyolysis is interesting.
But after poking around on that website I'm like "Yep, I only massage healthy people. Don't push anything that hurts a lot. Don't do anything obviously bad like massaging weak areas around injuries. Also the neck is sensitive (I already avoided this intuitively)".
I expected more of an update. Do you think I missing anything specific & significant? (Other than our likely crux about priors.)
It's not just a matter of the neck being sensitive, it's also the arteries that go through the neck. You don't want to massage an artery in that area, because you could knock some plaque off of the inside of the artery and give someone a stroke. Rule of thumb is never massage a pulse, and know where the arteries in the neck go.
For example, this book advises against deep massage in the suboccipital triangle area in the back of your head -- the author claims you could give someone a stroke that way. (BTW, I would suggest you probably not do the "quick vertebral artery test" described in that book, I remember finding some stuff online about how it is inaccurate and/or dangerous.)
Similarly, you might not necessarily think of the area behind your jaw and below your ear as part of the neck, but it's a sensitive area because there's an artery right around there, and there is a small stalactite shaped bone you could break right off. That artery goes down the front of your neck and beneath your collarbone. Definitely read a guide for safety before attempting to treat that area -- there's one in the book I linked.
The temple is also not a place to apply heavy pressure. The book I linked recommends just letting your head rest on your fingertips if you want to massage that area. (Or you could make creative use of the acupressure mat I linked elsewhere in this thread, especially if you shave your head first.)
In general, light pressure is safer than heavy pressure, and can be more effective if you go about it right. I like to to experiment with sustained pinches and pokes (like, over 2-3 minutes even, if I find a good spot) as I very gradually move inwards in response to tiny, barely perceptible sub-millimeter release sensations in the muscle. This can work as a very slow massage stroke too. (I know I'm not describing this very well, I'm just trying to give people ideas for experiments to try.) Careful not to overdo it though, this sort of approach is very hard on the small muscles in your forearm. Actually, learning forearm massage is a great place to start, because then you have a shot at repairing RSI or other overuse injuries (including from massage!) in your forearm. [EDIT: Note, RSI is often just the tip of the iceberg, you probably have lots of upper body tension if you get RSI, and that's quite likely the root cause.] Buying massage hand tools online is another good way to save your forearm muscles. And the book I linked has great ergonomics advice.
No prob.
As a general rule, I think pinching is safer than poking, because you can be more certain that you are just massaging muscle rather than artery or bone. And it seems more effective too, especially if you create slack in the muscle you're treating. However, pinching is rather hard on your fingers and forearms, so you're liable to give yourself RSI if you overdo it (which in theory should be treatable with massage, I guess, but you might need to get a friend to do it if you're no longer able to massage yourself!)
Another thing massage books mention is that you're technically supposed to always treat a muscle and its antagonist (roughly, the muscle which performs the opposite motion, I believe?) in the same session. If you don't do this, the antagonist is liable to tense up in response to its complement being released? However, the risk here is more like "annoying, hard-to-diagnose chronic pain" as opposed to the sort of injury that could send you to the ER.
I think there is a lot of alpha in massage therapy. I've been doing it for years, and it's helped with a surprising variety of problems (e.g. had migraines at one point, massaging deep in my shoulder and use of the acupressure pillow I mentioned elsewhere seemed to help a lot). It'd be cool if there were people on LW who were true experts at it, including safety expertise obviously (I don't consider myself an expert there).
One of the best massage therapists I ever visited was a practitioner of what he called "neuromuscular therapy". He told me about this site called somasimple.com, made it sound like LessWrong but for discussing the science of chronic pain. That was many years ago though. I think maybe he got his training from the National Association of Myofascial Trigger Point Therapists. IIRC, there are a number of groups like that which are endorsed by the Trigger Point Therapy Workbook that I linked elsewhere in this thread.
I think massage therapist could be a good career for those concerned about AI-driven automation, because some people will always be willing to pay a premium for a human therapist. I believe licensing is done on a state-by-state basis in the US. Perhaps best to check for a state which has licensing reciprocity agreements with other states, if you want some flexibility in your living situation.
I expected more of an update. Do you think I missing anything specific & significant? (Other than our likely crux about priors.)
It's hard for me to say since I don't know much about massage, but my guess is probably not too much.
Unlike the other commenters, I am not too worried about the safety risks here. People in romantic relationships massage each other all of the time without training, and that seems to be pretty safe. I suppose certain health conditions might put people at risk, but if so they've probably been informed of this by their doctor as something to look out for.
That said, as you scale up, things get more risky. Like suppose you trained 5,000 people and happened to miss something important regarding safety. That would be bad. The badness of the miss gets multiplied by 5,000 (roughly).
I downvoted this post because I think it is low quality. For various reasons. A big one is that the author hasn't attempted to stand on the shoulders of others by researching what is currently known about massage, and so the material in the post I see as quite unreliable.
But I wish there were a way to upvote this topic. Massage has always seemed like a really great thing for people to do for each other. It feels great. It plausibly helps with things like stress, anxiety, and pain. It probably doesn't take too long to learn. Then once you do learn it, you can spend a half hour a day or whatever massaging your romantic partner (or whoever else) and they can do the same in return. Seems pretty win-win.
1author hasn't attempted to stand on the shoulders of others by researching what is currently known about massage
this sounds like you're against first-principles reasoning and (re)discovery, which seems odd to me on LW
No, I'm definitely not against either of those things. I just think that it would make sense to begin by understanding what is currently known about a topic.
The post The Neglected Virtue of Scholarship elaborates on this idea. An excerpt:
The lesson I take from these and a hundred other examples is to employ the rationality virtue of scholarship. Stand on the shoulders of giants. We don't each need to cut our own path into a subject right from the point of near-total ignorance. That's silly. Just catch the bus on the road of knowledge paved by hundreds of diligent workers before you, and get off somewhere near where the road finally fades into fresh jungle. Study enough to have a view of the current state of the debate so you don't waste your time on paths that have already dead-ended, or on arguments that have already been refuted. Catch up before you speak up.
In the context of massage, here's how I imagine this looking. Before trying to figure things out on your own, spend a few months reading some textbooks on massage therapy and adjacent fields like human physiology. Talk to people in the field and ask to be pointed in the right direction. Stuff like that.
To be clear, this can be done in combination with first-principles reasoning. I think it's a great exercise to try to think from first principles about something, and then do some investigation into what the academic/professional community currently knows, and how what they currently know compares to what you've found. I think it's a great way to develop an understanding that is Truly Part of You.
First principles thinking could also lead to genuine insights. In a somewhat mature field, as many researchers will tell you, such insights are not easy to find. But hey, that doesn't mean it's not worth trying. It's just worth knowing what sort of level of difficulty it is you're dealing with.
Hey, I am trying to rediscover medicine from the first principles, would you like to try my pill?
Massage might cause problems, idk.
Practicing without a license is a crime in many jurisdictions. There's a reason massage therapists need 1000 hours of training, certification, and regular continuing education. It's a field susceptible to pseudoscience, so an understanding of anatomy and the medicinal risks is important to make sure you don't screw anything up.
It is irresponsible that you are teaching others without ever being taught yourself.
One safety-related thing I've seen mentioned in multiple other places but not here, is that you can damage venous valves (especially in limbs) by massaging incorrectly. Especially if you're massaging with force just short of inducing physical pain.
There's a reason massage therapists need 1000 hours of training, certification, and regular continuing education
That reason is "rent seeking behavior".
1000 hours is too much.
But, let's say, 10 hours would be reasonable (part of that safety advice, part of that supervised practice) if you are doing to do something with a potential to hurt others. And if you are going to teach people to do as you do. At least you are aware that you didn't learn from any expert, but those poor people think they did.
Should there be a 10 hour training minimum for taco creation, or sharing recipes online? There's a wide variance in the quality of tacos. A very poorly made taco can even make you sick!
Currently I would say no.
But I worry that maybe one day I will read an article on Less Wrong like this:
I’m sure there are a bazillion youtube videos about nutrition and food safety, but I haven’t watched any of them. I just started putting random ingredients together...
If you want to cook for other people, my main advice is that you cook for yourself. Then you understand how it tastes and can offer that to others.
Just explore, be curious, and try random things.
Someone once told me that putting arsenic in a meal can cause poisoning?
And by the end of the article, my answer might change to yes. :(
1Practicing without a license is a crime in many jurisdictions.
Good call out. I think this is worth keeping in mind. Although it sounds like the author isn't practicing or proposing anything that is for-profit, in which case I doubt there are any legal things to worry about.
It's a field susceptible to pseudoscience, so an understanding of anatomy and the medicinal risks is important to make sure you don't screw anything up.
I disagree here. People in romantic relationships massage each other all the time and that isn't considered risky.
I think the pseudoscience stuff is relevant when there is a financial transaction taking place. You don't want the buyer to think they're getting a peach when in reality they're getting a lemon.
It is irresponsible that you are teaching others without ever being taught yourself.
Agreed. The Neglected Virtue of Scholarship comes to mind. There's reason to believe that it's a field that's been studied enough such that you can start off standing on the shoulders of giants to a moderate extent.
You can just massage yourself. Then once you learn to massage yourself massaging other people, dogs, and cats is almost the same.
I’m sure there are a bazillion youtube videos about how to massage yourself, but I haven’t watched any of them. I just started squeezing my muscles and did more of what feels nice.
In the last year I’ve taught ~50 people how to massage, too. More recently I’ve been teaching people how to massage others:
It’s super easy:
Complexities:
Massaging others:
Getting acquainted with your body:
Warnings?
cross-posted to my blog