The Ultimate Workout Routine for Massage Therapists

The importance of physical health and well-being can never be overstated for massage and manual therapists alike. Whether you're fighting fatigue in your hands and forearms, struggling to perform multiple manipulations throughout the day, or finding it difficult to demonstrate movements and exercises for clients seeking self-care routines, your physical condition is key. 

As a massage therapy instructor, I see many of my students struggle with wrist and back pain during the early stages of their training. Typically, reinforcing proper body mechanics resolves these issues. However, the sheer volume of work they face after graduation can exceed what their current stamina can handle. Much like training for a sport or event, we must condition our tissues to meet the physical demands of our profession. 

While the importance of proper body mechanics—such as stacking joints, using body weight efficiently, and maintaining a low center of gravity near the client—is undeniable, building muscular and joint endurance is a separate, equally important challenge. 

In this article, we’ll outline a progressive workout routine designed to help you build strength and endurance to support your body and extend your career in hands-on therapy. 

Tissue Tolerance  

Tissue tolerance is a rehabilitation concept that refers to the body's ability to withstand external forces, movements, and stressors without resulting in injury or pain. This concept applies in a variety of contexts. Initially, we might think of being able to perform an exercise without experiencing delayed onset muscle soreness (DOMS), but it also includes adaptations like developing calluses from repetitive motion. Many factors influence the body’s ability to develop tolerance—such as age and underlying health conditions—but primarily, it's about the frequency and intensity of exposure to the stressor. 

This is why workout regimens and rehabilitation programs are designed to progress gradually. Injuries, pain, and tissue damage often occur when we perform activities too much, too fast. The value of preparing your body extends far beyond simply being able to perform a sport, job, or exercise. For example, sedentary individuals or older adults may experience pain while performing tasks that seem simple to others. While many people view building tissue tolerance to gain the ability to perform tasks, others see it to prevent losing that ability. For massage therapists, this might mean being able to complete a full day’s work without experiencing hand, wrist, or elbow pain. Although massage and manual therapy techniques should always incorporate proper body mechanics, it’s unrealistic to think that stamina and tissue tolerance don’t also play a role in staying pain-free during long workdays. 

Warmups to begin your sessions  

Often therapist will do simple hand and wrist static stretches a few moments prior to a session. While static stretching often feels good and suffice, there are a slew of warm up activities to better your performance in your therapy sessions. Beginning with dynamic movements and stretches!  

Refer to this article for more info on the mechanism and effectiveness of stretching methods https://www.gcmedicalmassage.com/post/stretching-before-physical-activity-the-benefits-risk-and-best-practices-by-gavin-crump-omt-mmt-lm 

• Hand spreads – A dynamic movement to warm up the fingers in all directions. Start with a firm fist, squeezing tightly with elbows straight, then slowly extend fingers as far back as possible, reaching your end range at both ends and holding for 2 seconds then switch. Repeat 8 times.  

• Wrist circles – With hands in a light fist with thumbs out begin figure 8 movements of the wrist in a slow controlled fashion with arms outstretched. Smooth transition between supination and pronation. Repeat for 10 cycles then again counterclockwise.  

• Isometric triceps behind the back grip – Reaching one hand behind your back from over top and another reaching behind from below. Interlock your hands behind your back and pulling them apart in an isometric fashion to warm up triceps. Hold for 20 seconds and then switch hands. If this technique is too difficult then performing a simple plank with elbow tucked close to the body for 30 seconds.  

• Arm circles – Great for activation all the muscles of the rotator cuff and warming up the shoulder. Begin with small concentric circles both clockwise and counterclockwise. Then, finishing with full range of motion circles both directions. Aim for 30s in each direction.  

• Toe touches with AIS – Active Isolated Stretching was developed by Aaron Mattes. Preformed by stretching a particular muscle for no longer than 2 seconds as to avoid stretch reflex mechanism and antagonistic muscle contraction to optimally length muscle tissue. AIS stretching is optimal as a warmup because of its dynamic nature and how quickly it yields results in increasing range of motion compared to that of static stretching - This stretch will begin by standing straight up feet shoulder width apart then reaching down to touch your toes until you feel resistance in your hamstrings. Hold the stretch for no longer than 2 seconds then return to standing and repeat this process until you've reached a preestablished flexibility goal or roughly 10-15 repeats.  

• Depth squats – Theses squats will begin in horse stance followed by a very slow controlled squat remaining on heels all the way down then returning up to horse stance at that same slow and controlled pace to warm up glutes and quads for proper body mechanics. Repeat for 4-6 reps.  

• Tippy toe walks – Wake up the calves with walking on tip toes without the heels striking the ground. This aids in gastrocnemius and soleus activation and helps stir up lower body circulation.  25 steps or down and back in a room. 

• Heels walks – The opposite activity will be performed this time without the toes touching the ground only walking on the heels to help activate tibialis anterior for a strong stable surface in archer stance. 25 steps or down and back in a room. 

  
  

Lastly, close out your warmup routine with a mindfulness activity of your choosing to calm your mind and get prepared for to provide your type of therapy. This could be meditation practices, mantras or affirmations of any nature to help you be your best.  

The purpose of this routine is not to tax your cardiovascular system as going into a therapy session sweaty and out of breath is not ideal. But having an active body and mind is great to keep you doing the best therapy that you can.  

Full Body Workout 

Progressive Overload 

• The gradual increase in intensity, resistance, duration or volume of workouts over time to stimulate muscle adaptation. 

Rate of Perceived Exertion (RPE) 

• A subjective one to ten scale that aids in gauging the intensity of exercise. 

Compound Lift 

• An exercise or movement that engages and affects multiple muscles groups and joints. 

Accessory Lift 

• An exercise that accompanies a primary movement, often used to target weaknesses, muscle imbalance, and structural stability. 

  
  

The exercises provided below are meant to be performed together in one session around 3 to 4 times a week, with sessions lasting approximately 90min. The movements provided are chosen to strengthen, condition and prepare the body for movements and stances that are often performed by massage therapists. Proper implementation of progressive overload will assist with muscle stimulation as the body adapts to resistance, volume, duration, and intensity overtime.  

The workout plan will start with three compound lifts accompanied by an accessory movement for full body resistance training, a separate exercise focusing on wrist flexors and extensors, a carry and walk movement that works core stability, cardiovascular health and grip strength and ending with 15 to 30 min of low or medium intensity cardiovascular work. Some sections will also include alternative options allowing for movement diversity. Each movement can be progressively overloaded with weight increases allowing for other factors to stay consistent. Form and execution of movements are not provided as anatomical deviations can affect movement patterns.  

• Barbell Pause Squat — 6–7 sets, increasing in weight as needed to match RPE with rep range. The goal is to train the body through a deep squat with a pause at the bottom, translating into strength and stamina for the horse stance. 

  • Set 1: 12+ reps at an RPE of 1–2; perform without weight on the bar as a warm-up. 

  • Sets 2–3: 8–10 reps at an RPE of 3–4. 

  • Sets 4–5: 6–8 reps at an RPE of 5–6. 

  • Sets 6–7: 4–6 reps at an RPE of 7–8. 

• Bulgarian Split Squat — 4–5 sets, increasing in weight as needed to match RPE with rep range. This movement builds stability and stamina that translate well into the archer stance. Focus on maintaining balance rather than adding maximum weight. Lunges can be substituted as an alternative. 

  • Set 1: 10 reps at an RPE of 2. 

  • Sets 2–3: 10 reps at an RPE of 3–4. 

  • Sets 4–5: 8–10 reps at an RPE of 4–5. 

• Incline Smith Press — 6–7 sets, increasing in weight as needed to match RPE with rep range. A pressing movement useful for functional strength. 

  • Set 1: 12+ reps at an RPE of 1–2; perform without weight as a warm-up. 

  • Sets 2–3: 8–10 reps at an RPE of 3–4. 

  • Sets 4–5: 6–8 reps at an RPE of 5–6. 

  • Sets 6–7: 4–6 reps at an RPE of 7–8. 

• Push-Ups — 4–5 sets, adding weight as needed to match RPE Focus on a slow eccentric and full range of motion. This accessory movement promotes shoulder health and stability. Alternatives include Standing Cable Flys or Triceps Pushdowns.

  • All sets: 10–20 reps at a consistent RPE of 5. 

• Barbell Rows — 6–7 sets, increasing in weight as needed to match RPE with rep range A staple back movement for building strength. Alternatives include assisted, unassisted, or weighted pull-ups. 

  • Set 1: 12+ reps at an RPE of 1–2; warm-up with no weight. 

  • Sets 2–3: 8–10 reps at an RPE of 3–4. 

  • Sets 4–5: 6–8 reps at an RPE of 5–6. 

  • Sets 6–7: 4–6 reps at an RPE of 7–8. 

• Hyperextensions — 4–5 sets, adding weight as needed to match RPE This exercise supports spinal stability and health. A Kettlebell Swing is a suitable alternative. 

  • All sets: 10–20 reps at a consistent RPE of 5. 

• Dowel Wrist Flexion & Extension with Weight — 4–5 sets, adding weight as needed to match RPE Strengthens wrist flexors and extensors. Use a dowel or rod with a rope tied at the center and a weight at the bottom. 

  • All sets: 2 slow, controlled reps (one full roll-up and unroll = 1 rep) at an RPE of 4–6. 

• Farmer’s Walks — 4 sets, adding weight as needed to match RPE Trains core stability and strength. Suitcase Carries can be used as an alternative. Choose two points for a set walking distance—completing the walk is one rep. 

  • Set 1: 2 reps at an RPE of 4. 

  • Sets 2–3: 3 reps at an RPE of 5. 

  • Set 4: 3 reps at an RPE of 6. 

• Low to Medium Intensity Cardiovascular Work — 15–30 minutes No specific movement is designated; this section is left to your discretion. 

Conclusion  

As massage and manual therapists, we dedicate ourselves to the care and well-being of others—but that work starts with taking care of our own bodies. Building tissue tolerance, strength, and endurance isn't just about making it through a long day—it's about creating a sustainable, pain-free career that allows you to show up fully for your clients, day after day. 

The exercises outlined in this guide are more than just a fitness routine—they're an investment in your future as a practitioner. Progress may feel slow at times, but consistency will lead to resilience, reduced pain, and greater confidence in your practice. Treat your body with the same respect and intentionality you offer your clients—it’s your most valuable tool. 

Written by Gavin Crump OMT MMT LMT  

Co-authored by Jackie Tian LMT