Health Maintenance for Therapists' Hands

Massage Magazine, Apr/May 1989, Issue 19, 20-24

Care, development, and protection of the hands is crucial for effectiveness and career longevity, no matter what massage specialty one practices. The massage therapist’s hands perceive the needs of the tissue beneath. They perform fine, delicate movements as they direct energy and apply appropriate technique. They sustain the weight of the therapist’s body as compressions, stroking, or kneading procedures are applied. They are the most important tools of the trade.

Health maintenance for the practitioner’s hands includes:

1. Balanced alignment of the entire body and appropriate weight shifts to apply pressure.
2. Extra bracing and specific alignment of the shoulder, elbow, wrist and finger joints.
3. Appropriate choice and variety of tools to be used, i.e. fingertips, knuckles, elbow, etc.
4. Increasing dexterity and strength in the hands.
5. Regular cleansing and maintenance for the hands.

Body Alignment

Strength, focus, endurance, relaxation, and receptivity in the hands reflect usage throughout the entire body. Proper usage is impossible without correct table height and width. Individual therapists need to experiment to find the measurements which allow them to work with efficient, stress-free body alignment. When next to a massage table, the feet should be firmly planted on the floor and spread, usually to a shoulder’s width apart. The knees should be flexed; however, too deep a stance is tiring to maintain while too shallow a stance does not allow for proper weight shift or maneuverability. Body weight can be shifted directly into the working tool of the therapist if the torso is facing the area where pressure is to be applied. Alignment of the spine (by avoiding twisting, rotation, and excessive curvature, especially of the lumbar and cervical areas) minimizes stress and helps prevent injury.

All unnecessary contraction of the pectoral girdle muscles should be released so the shoulders remain down and relaxed. Hunching and rounding the shoulders while doing techniques such as petrissage should be avoided. The deltoids, pectoralis major, biceps, triceps, latissimus dorsi and trapezius will not be overused if body weight is used efficiently. Of course, the shoulder joint must be stabilized as the practitioner’s body weight is shifted through it into the client’s body. This stability is achieved through balanced function of the serratus anterior/rhomboids, the latissimus dorsilupper trapezius, and the humeral stabilizers (i.e., teres minor, infraspinatus, and subscapularis). Proper care of the shoulder joint while working prevents structural deviations (such as kyphosis) and helps eliminate injuries (such as rotator cuff syndrome, shoulder bursitis, and muscular strain).

Shifting Weight

Momentum for an effleurage, a knead, a compression into a tsubo, a slow melting deep tissue release, or a passive joint movement should usually be initiated and maintained by pushing into the ground. This weight shift is accomplished when the therapist stands with the leg nearest the table one to two foot-lengths behind the other foot. With each technique applied, the therapist’s body weight is pushed from the back leg into the area being compressed or stroked. Movements away from the client’s body, such as traction stretches and return effleurage, are accomplished as the therapist shifts weight from front foot to back foot.

When standing with the torso facing the table, the therapist’s feet should be at least a shoulder’s width apart, (again, with the knees flexed). Weight shifts between the feet should power the arms for techniques such as petrissage, and for some passive joint movements. The feet should also be firmly planted on the floor when the practitioner is seated. The actual weight shifts need occur, when seated, as the ischial tuberosities function as the feet and are pressed into the stool or chair used. Of course, spinal alignment (with the head erect) should always be maintained as well.

When the forearm or elbow is used (as in deep tissue bodywork), only the contraction of the elbow flexors is necessary; the forearm, wrist, and hand should be relaxed. The shoulder joint should be stabilized in an open, balanced position, avoiding excessive adduction or abduction of the humerus. The shifted body weight should be the source of pressure. No pressure should be applied from the other hand, or the shoulder and back muscles. This will avoid strain to the upper extremity and pectoral girdle. Other possible injuries (such as cervical strain and misalignment, bursitis, rotator cuff syndrome, tennis elbow, and neuritis) will also be prevented.

Joint Protection

The joints of the fingers, wrist and elbow also need to be protected. Whatever technique is applied, it should be performed with as much opened, balanced alignment of these joints as possible. If the wrist joint is hyperextended during effleurage and deep palmar and hypothenar strokings, carpal tunnel syndrome, tendonitis, and/or ligament strain in the wrist can result. Excessive pressure on the fingertips, particularly the thumb, can cause hyperextension or flexion of the metacarpal-phalangeal joint, resulting in ligament strain and stretching with resultant pain, swelling, and instability in the affected joints. By bracing or supporting the hand being used, additional protection from strain of the joints sustaining the greatest pressures can often be avoided. For example, the fisted hand can brace the thumb, or the other hand can act as a splint for the phalangeal joints when fingertip pressure is required.

Exclusive and improper use of any tool (especially the thumbs, the heel of the hand and the fingertips) can result in damage to the joint structure. Practitioners of all forms of deep tissue techniques in particular should reserve these tools for small areas or for thinner, less tense muscles and for specific, definition-type work. Alternative tools, such as the knuckles and elbows, can be sensitized to as fine a receptivity as fingertips. Since the structure of the elbow is more capable of sustaining deep pressure without threat to joint integrity, it should be used for deepest pressures when possible. Irritation and inflammation of the joint capsule, strained ligaments, osteoarthritis, and carpal tunnel syndrome are all probable results of using one tool more than others or attempting to release large masses of muscle with smaller tools, such as thumbs or fingertips.

Developing Strength

Strength and dexterity in the hands can be increased through activities such as typing, weed-pulling, and playing piano, guitar or rhythm instruments. Other more structured exercises include squeezing a firm ball, such as a tennis ball or a product (available in athletic stores) called “Iron Hand.” Touching each fingertip to thumbtip in a smooth, increasingly brisk rhythm can also increase dexterity. Both strength and dexterity can be developed by fisting the hand, then rhythmically squeezing it tighter, moving from little finger, to ring finger, and so on, through the thumb. The sequence should be repeated, increasing speed and repetitions as the hand develops. Pushing the finger-tips of one hand against those of the other (either simultaneously or again from little finger through thumb in a rhythmic sequence) is also effective, as is the rhythmic rolling of three marbles in the palm. Both left and right sides of the body need to be worked so that one hand and arm will not be less strong or dextrous than the other.

Tai Chi Exercise for Energy

Protect and strengthen the hands by increasing overall body energy and learning to direct that energy through the hands. Traditional Oriental disciplines (such as T’ai-chi ch’uan and Chi Gung) are notable for their effect on the development of the body’s vital energy (the Chi). If experienced instruction in these arts is unavailable, the following basic exercise from T’ai-chi, done daily, may be helpful:
1. Stand with the feet shoulder’s width apart, with the feet directly under the shoulders. Distribute the weight evenly between the feet and throughout each foot.
2. Achieve a relaxed, bipolar extension of the spine by imagining that a string attaches to the crown of the head extending the spine upward toward the sky. At the same time time, imagine a weight at the coccyx extending the spine downward. Arms should hang loosely at the sides. Maintain this upright and extended alignment of the spine throughout the exercise.
3. Gradually bend into the knees. Step straight forward with the left foot, leaving a space of two foot lengths between the feet with toes pointing straight ahead. Shift about 70% of the weight forward into the left foot. Turn the toes of the right foot to a 45 degree angle to the right. The torso should face ahead. (This position is called the “bow stance” in T’ai-chi, and is recommended above as a tableside stance.)
4. Bend the arms at the elbows to a 90 degree angle allowing the palms to face each other (as if holding a beach ball) in front of the abdomen.
5. As the weight is gradually shifted 100% back into the right leg, make a circle in front of the abdomen by moving the arms down and back. Inhale gently and fully from the lower abdomen.
6. As the weight is shifted gradually forward approximately 70% into the left leg, continue the circular movement of the arms up and forward. Exhale gently and fully from the lower abdomen. The full circle of the arms will also be about beach ball size.
7. Continue the slow, coordinated movement of the weight and torso with the circular movement of the arms for 2 to 5 minutes.
8. Repeat the exercise with the right foot forward.

Regular Maintenance

Regularly clip and file nails and keep the hands clean, smooth, and free of calluses and rough spots. Protect hands with gloves when gardening, using harsh cleaners and doing manual labor. In addition, self-massage of the hands is invaluable for keeping them tension free. Perform deep, melting compression of the muscles down to the bone; wring and strip out accumulated tension. Post-event sport massage techniques can also be applied to any stressed areas of the pectoral girdle, arms, or hands.

Fingernail Chua K’a Exercise

Increase and clarify energy flow by regularly and systematically working each finger in the following manner:

1. Press the edge of the nail until the nail is bent to a 45 degree angle. Go over the entire edge of the nail.
2. Press the sides of the nail inward.
3. Press down on the surface of the nail with the nail of the opposite thumb. Move from nail root to the tip, covering the entire surface of the nail.
4. Use deep pressure to massage the tip of the finger by grasping the fingertip between the index finger and knuckle of the opposite thumb. Attentive care of the hands is as crucial for effectiveness and vitality of the therapist’s trade as advanced or specialized skill enhancement. Many injuries and discomforts can be avoided by proper body alignment, extra support for the joints, increasing hand strength, using a variety of tools, and regularly maintaining one’s hands.

Editor’s note: See also Dr. Stephen T. Chang’s, Internal Exercises from TAO Publishing and George Downing’s, Massage and Medita- tion for more on health maintenance of the therapists’ hands.

Carole Osborne-Sheets is in private practice in the San Diego area as a licensed holistic health practitioner specializing in integrative body therapies. She is co-founder of the Institute of Psycho-Structural Balancing, where she continues to teach.