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Work Smart! Not hard! Body Mechanics: The Wrist

Massage therapy can be physically demanding. Many massage therapists end up needing to leave the profession due to injury.

I am fortunate to be able to say that I have been doing massage and bodywork for 27 years. But it wasn’t always smooth sailing. I had some struggles on and off for the first years of my career until I figured out what I was doing wrong, how and where I was compromising myself and how to use my body more efficiently.

Just as your car runs more smoothly and uses less gas when it is tuned up and the wheels are in alignment, you will perform better and for longer if your body is in alignment.

In 2006 the ABMP surveyed 600 massage therapists. They inquired about musculoskeletal symptoms and injuries among massage therapists and bodyworkers. Go to the end of this article to see their frightening statistics.

I am sometimes flabbergasted at the lack of alignment that I see when some of my students enter my classes. Massage therapists sometimes do some crazy things with their hands. So I am on a mission…. I want to help you stay in the profession as long as you want. My students hear me say over  and over, “Work smart. Not hard”.

I highly recommend that at all times, you use proper alignment of your thumbs, fingers, wrists, arm, shoulders as well as your upper and lower back, pelvis, hips, knees, ankles and feet. That is a lot to be mindful of.  Let’s start with the wrist.

Image #1

Image #1 Using the fist is a common tool used is massage therapy. This is an effective tool. You can achieve deeper pressure with a soft fist than with the thumb. It gives a much broader base of contact than the thumb. We always want to work with the wrist in a neutral position. Look at the image #1 to the right. This is neutral. In a neutral position, the bones are aligned and the muscles, tendons, ligaments and joint capsule are toned but not overworking.

Image #2

Image #2 Now look at image #2. In #2 the flexor side of the wrist is compressed which means the bones are compressed, the ligaments and joint capsule are compressed. The extensor side of the wrist is elongated which means the ligaments and joint capsule is stretched open. The therapist has to work hard to stabilize the wrist so they are using extra effort to do the stroke. If you currently have this in your massage repertoire, take it out.

Image #3

Image #3 In image #3, the wrist is ulnar deviated which compresses the medial wrist bones into the ulna. If you currently have this in your massage repertoire, take it out.

Image #4 - Don't ever do this!

Image #4 Look at image #4. Well… that is just plain awful. Please don’t EVER do that.

Look back to Image #1. Make a soft fist. Tone your hand but don’t squeeze it. I find lightly pressing my finger pads into the proximal thumb and pinkie pad to be helpful with the maintaining of this tone. Pretend you have a roll of dimes in your hand so that you are not squishing the metacarpalphalangeal joints.

When you perform a “soft fist” stroke, stack you bones. Align your softy flexed elbow over your wrist. This eliminates any deviation. Look at it to make sure you are aligned. After 27 years in the profession, I still look to make sure I am aligned. Always align the thumb in the direction you are stroking. Don’t use your upper arm/shoulder (biceps, coracobrachialis, anterior deltoid) to push the stroke forward. Use your legs. Stack you bones, feel the vector forces lining up through the bones and then move from your legs. It is better to push the stroke than pull.

I have many tools in my toolbox. I set it on a table next to my massage table. Every couple of minutes I pull out a different tool. Sometimes I use my thumb, then I will switch to my fist, then an elbow, sometimes the flat of my hand. This way no tool ever gets overused.

General principles to pay attention to:

  • Use a variety of tools.

  • If you feel like you are working too hard… you are! Stop! Reevaluate how you are doing the stroke. Look at the alignment of all of your joints.

  • If you are experiencing pain doing a particular stroke, STOP! Ask yourself “How long do I want to remain in this profession?” Then choose another tool out of the tool bag.

  • If you don’t know if you are in or out of alignment, seek out a teacher or colleague that can watch you work and guide you to greater ease in your body.

  • Learn  how to move from your center by familiarizing yourself with Tai Chi principles.

ABMP Stats:

  • 77 percent experienced pain or other musculoskeletal symptoms related to massage work.

  • 64 percent sought medical treatment for symptoms.

  • 41 percent were diagnosed with an injury.

  • Shoulders, thumbs and lower back were the most common injury locations.

  • “Applying pressure” was listed as the most common cause of work-related symptoms.

  • 67 percent had ongoing symptoms.

Think about this…. If you leave this career (a career that I assume that you love), due to injury from poor body mechanics, think of all the people that will never get to experience your unique loving touch.

May you have a long and flourishing career!

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