It’s great that therapists are trying new ways to do massage. In online forums and social media, we see therapists talking about, for example, how using the knuckles instead of the fingertips is the most risk-free way to do massage. Another swears by the forearms, and yet another by avoiding the upper extremity altogether and using the feet to do massage.
The reality is that each “tool” we use to do massage, be it hands, thumbs, knuckles, forearms, etc., has its own set of risk factors. Some have fewer risks than others. Thumbs and fingertips are inherently unstable and therefore carry the most risk for most people: first, because their structures are inherently unstable, and their delicate ligaments, tendons and cartilage can be easily damaged; second, because the instability forces you to contract the forearm flexors and extensors quite a bit to keep them from buckling, and this increases pressure in the carpal tunnel (which can lead to CTS) and can cause tendonosis in the forearm muscles.
But there are risks associated with use of any part of the body to apply pressure. To use the knuckles (which aren’t all that stable, either, if you use only 2-3 of them), you have to stabilize with the forearm flexors and extensors, too, and if you’re not stabilizing your scapulae at the same time and using the larger muscles of the shoulders and back to create the force, your shoulders can be at risk for injury. In our 2006 study of injury among massage therapists, shoulders were the body part most often injured. Same goes for use of the forearms – the shoulders are still vulnerable, although certainly the large, flat surface of the forearm offers much more stability than the fingers, thumbs or knuckles. No matter what body part you use, transferring pressure through the bones of that body part causes wear and tear to the joints which can lead to osteoarthritis over time.
And as for using the feet: not only do they also have small bones and other soft tissues that can get injured, but you have to hang on with your hands and arms to overhead bars as you massage. We recently had a CIPI candidate tell us that she was starting to have shoulder symptoms from hanging on to the bars, and I have heard of another therapist who injured her feet by massaging with them.
So am I saying that it’s not good to look for alternatives to using the hands to do massage? No, it’s actually a really good idea to do that. Just bear in mind that there is no one part of the body that is magically free of risk factors for injury. Being aware of the risks of using a particular body part to do massage is very important. For choosing which body parts to use for your massage techniques, the approach that seems to work best involves frequently changing the part of the hand or arm (or even feet) you use to do massage, so that no one part becomes overused. Using real tools (IndexKnobber, Massage Star, etc.) when possible can also be very helpful. Do you use a certain part of the body to do massage more than another? Share your experiences with us here.
Lauriann Greene post “Knuckles, Forearms...Which Body Part is Best to Use to Do Massage? Thanks to Lauriann for her thought on this issue. I'd like to add some thoughts here. Having had an active massage practice for 21 years and having taught massage therapy for 14 years with my own pre-existing conditions and risk factors, I am unrelenting in making sure our students use their bodies in ways that minimize their risk of injury over time. I aim to make sure that they develop sound and habitual optimal patterns of body use from the very beginning of their programs. It's absolutely true that use of any part of the body can result in injury if used to long, too hard and with less than optimal body mechanics.
We start all classes with yoga and other movement arts activities to establish increased strength, aerobic fitness, and strong muscles of scapular stabilization. Even with this students come in with all manner of hand, arm and shoulder anomalies that could result in injury; so far we have a pretty good record of finding ways to accommodate those so they can have long, fulfilling and comfortable careers.
That said, I dislike the use of "knuckles," which many students are inclined toward, and which has a feel that is aggressive and unpleasant for many clients. "Soft fist" is a little better, but "dorsal fingers" or "backs of the fingers" both expresses and describes what I believe is a softer and more reasoned approach. With knuckles or dorsal fingers many students want to lead with the knuckles, and for those with weak extensors the metacarpal-phalangeal joint "folds" way too much, a serious risk to wrist and hand health. Making sure not to exceed a 90 degree angle at that joint and leading with the radial (ie: indicis) side of the fingers while maintaining the body in a position that facilitates neutrality of the wrist and elbow seems to be a good solution.
Massaging from the whole body, for instance, in a wide lunge with weight in the back heel grounded for stability, with a lifted sternum helps eliminate some of the hazards of forearm use. Not all use of feet on the client's body requires supporting one's weight with bars. There are numerous ways of working on clients on the table or on the mat that require little or no use of the hands, and are especially suitable for work on large, dense, tight-muscled clients in particular.
In the past I thought that tools were artificial and hindered sensitivity. I've come to believe that certain tools used in ways that facilitate sensitivity can be a great boon to the busy massage therapist. I personally dislike any tool made of plastic, but have enjoyed (as my clients have!) the use of hot stones as hand-held tools and placed stones. Holding the stones can still create some strain on the hands, but when balanced with other techniques, creates a balanced repertoire of upper extremity actions. More recently I have begun using rosewood and bamboo tools (Mu-Xing therapy) and they create yet another set of "holds" that helps balance the musculature. So, part of the key to healthy massage practice is variety, and clients appreciate it.
Another key element in injury prevention is avoiding overuse. I know it can be difficult in uncertain times to limit the number of massages one gives in a week, all MTs should find a limit that their bodies tell them is reasonable and stick to it. We should never be so hungry for clients that we work on people who demand intense pressure (not the same at all as intense depth, which may not require undue pressure) or who are simply too large, dense, and athletic for our own frames. Maintaining a regular yoga or other movement art practice that keeps the therapist in touch with her body and it's conversation with her is a key element to assessing the body parts, tools and techniques that will allow her to have a long and healthy career.
Victoria Jordan Stone, MA, NCMT
Author - The World's Best Massage Techniques (2010) Fairwinds Press Partner -
Blue Ridge School of Massage & Yoga, Blacksburg, VA
From Massage Magazine Blog http://massagemag.com/massage-blog/injury-prevention-ergonomics-manual-therapists/2011/10/24/knuckles-forearms-which-body-part-is-best-to-use-to-do-massage/
