Welcome, massage therapists, to this group focusing on self-care for your precious hands. Your feedback and comments are welcome.
I just received an e-mail from my friend Rebecca Zupo in Austin. She works for a doctor who specializes in rehabilitating hand injuries. She suggested a Meetup focusing on the hands. I thought, that's a GREAT idea, and why not take it to a different level by creating a Massage and Bodywork Group focusing on hand care. So, here we are!
My favorite hand care book is by Lauriann Greene, "Save Your Hands!" If you haven't read her book yet, I hope you will soon. She'll probably join the group and contribute actively. http://www.saveyourhands.com
I love and appreciate my hands; they are so precious to me. I hope this massage community of kindred spirits brings you what you desire in terms of hand care - giving and receiving.
What a wonderful idea for a new group - about a very important topic too. I look forward to interacting with fellow members and helping wherever I can.
Great idea, Ariana, my pleasure to join, and thank you for the kind words about Save Your Hands!
The same strategies apply to saving your hands as apply to saving your neck, back, and shoulders (which are also commonly injured as a result of massage work, and which we also address in our book): a multifaceted, holistic approach involving awareness of risk factors, reducing risk factor exposures through ergonomics (fitting the work to the worker), using good body mechanics (fitting the worker to the work), taking care of general physical and emotional health, and treating symptoms/injury early and effectively.
However, there are special challenges involved in taking care of the hands, particularly since many therapists use them almost exclusively to deliver treatment (i.e., those who don't do massage with their forearms/elbows or their feet), using hand force, repetitive movement and sometimes awkward postures (the "big 3" risk factors for MSDs). The muscles, bones and other structures of the hands are among the most delicate in the body, and it takes special attention to keep them healthy. I'm looking forward to reading the comments in this forum and participating as much as I can, so we can all help massage therapists and bodyworkers save their hands!
The forearms can suffer even more because the skin is much thinner. Gradual, not sudden application of pressure greatly reduces force and injury to hands and forearms (and clients)
I would disagree that gradual application of pressure greatly reduces force and injury. I would also disagree that the forearms suffer more than the hands - since you're applying pressure (force) over a much larger surface area with the forearm, the force is distributed over that entire surface. When you apply force with the hand (or particularly with the thumb or fingertips), you're using a much smaller surface area, so the force is more concentrated. I have never seen a study that showed that forearms were more frequently injured among massage therapists than hands.
The type of injuries that massage therapists and bodyworkers get are gradual onset from the cumulative effects of the work they do, so it isn't a question of how suddenly you apply pressure, but how often, with what intensity, and for how long at a time (frequency, intensity and duration).
After 10 years of practice I have just begun to feel the pain of both long term use. I always prided myself in the fact that I never injured myself as I enjoyed working for myself and my ERGONOMICS were flawless. However in my foolish and desperate need to make up for a financial loose I took on a full time gig where quantity outweighed quality and now I'm paying for it. I had to leave that job and now I'm wearing cool thumb/wrist guards when I'm not doing massage. I have gone back to just my private practice. I had a therapist working on them for a period of time but the base of my thumb and wrist ( carpel?) are not happy.
Any insights or suggestions would be grateful. I can't imagine doing anything drastic like surgery, but I do almost feel the need to see an orthopedic hand specialist.... Ouch and Help please. Left elbow joint hurts too.. Perhaps a long vacation on the Ocean somewhere warm w/o clients !!!!!
In my experience (22 years helping people with upper body repetitive strain injuries), pain in the wrists and thumbs often begins because tissue is adhered higher up the chain (towards the thorax). In many cases I see, adhesions have formed in the armpits, upper arms and forearms. This prevents the normal sliding and gliding of the connective tissues down into the hands and wrists and leads to pain, weakness and disability. When hands and thumbs are as symptomatic as you describe, I first work to release the armpits and upper arms to begin to create some "slack" in the tissues as they enter the hands and wrists. You can do this through stretching or with sessions from someone skilled in myofascial release. My background is in Hellerwork, which is excellent for this type of release.
Check out my contact page for more information on things that can help you. Let me know if I can be of further assistance!
Patrice, I'm sorry to hear that you're in pain. You mentioned that you "almost" feel the need to see an orthopedic hand specialist. I would encourage you to do just that, or another healthcare practitioner who is licensed to diagnose. When ongoing symptoms are bad enough to interfere with functioning, it's time to get a diagnosis. Hand and wrist pain can come from any number of conditions, and only a healthcare practitioner licensed to diagnose can do the differential diagnosis necessary before you can receive appropriate treatment. Massage can certainly be part of your treatment plan once you know if you do indeed have carpal tunnel syndrome, or whatever syndrome or condition you are experiencing.
You mentioned that you had great "ergonomics" - I think you mean body mechanics. Ergonomics is the science of fitting the work to the worker and how work affects the worker, while body mechanics involves using our own bodies more efficiently and effectively as we work. It's an important distinction to make. Since your body mechanics were good, it would be helpful for you to look at the ergonomics of your situation: perhaps something in your work environment, be it table height, lack of enough time for breaks, an overcrowded schedule, or stress at work, could be contributing to your injury. Your story shows us once again that you can have great body mechanics and still get injured - this is why only a multifaceted, holistic approach has been proven to prevent injury. I hope that once you have a diagnosis, you'll be able to get effective treatment to get you back to work pain-free.
Great topic. I am a massage therapist and a reflexologist. I've been doing reflexology for 11 years and massage for 6. I have a lot of trouble with tension and tightness in my neck, shoulders, arms and upper back. My clients often ask me, "Don't your hands get tired or sore?" I say, "No, not really, but my neck and shoulders do". But now lately my thumbs are giving me troubles as I work, and I'm having to modify my techniques. I love my work and certainly don't want to have to cut back or quit because of work related injuries. I just ordered Lauriann's book Save Your Hands. I'm looking forward to reading it. Thank you.
Hello. Sometimes when the neck and shoulders hold a lot of tension after doing massage, it can be caused from using solely upper body strength and not stabilizing the scapulae. Make sure when doing massage keep the head to heart to pelvis connection and slide the scapulae down the back with using the lower trapezius muscles. Also, think about your base of support. While sitting your base of support is the ischial tuberosities and the feet and while standing it is the feet. Let the energy be transferred through the feet and up the body to the hands. This happens with proper weight transference and correct stabilization throughout the body.
Sometimes,with reflexology, it is challenging because you are seated and it can be hard to put your whole body weight behind it. Lining up the bones and joints is very important. The thumb joint is subject to wear and tear with overuse but with cryotherapy you can help the inflammation and healing. Best of luck in your practices!
Stay Healthy!
Karina Braun, Author, Creating Peace with Your Hands
Thank, Karina, for the pointers. I do understand what you are saying, but I know I don't always pay attention to my body mechanics like I ought to when I'm working. Also, a lot of this tension is from using my arms when I'm belly dancing. I need to be doing more stretching. And I know getting back into a regular yoga practice would help too.
Sue, in addition to some of the other comments that have already been mentioned, you should be careful about keeping your work close to you, and make sure you're not reaching out as you work (which can cause the kind of tightness you're describing). The tension in your neck and upper back can come from something as simple as looking down at your client all day (something many therapists do) - try to just glance down with your eyes, rather than hanging your head down. If you're using too much effort to create your strokes, that can cause overall tension - ease up, you may not need to use as much hand force as you think to be effective, and make sure you're not holding your breath as you work. Also take a look at what you do outside of work that may be adding to the overuse of your upper extremities, neck and shoulders - remember, your body doesn't care whether you're overusing your body at work or off work during hobbies or sports, the overall effect is cumulative. Definitely doing physical conditioning of some kind to counteract the tension and build more strength and flexibility is important. Remember that many factors contribute to causing musculoskeletal symptoms, so it usually takes a multifaceted strategy to address the symptoms. I hope you find Save Your Hands! 2nd. Ed. to be helpful, thanks for that!
This is an interesting thread. I would like to discuss some of the posture links involved in the neck and shoulder tension. As mentioned the lower trapezius should be holding the scapula down to support your work. The link from there is the psoas minor which links to the pubic bone and gives you stability to the pelvis.
Often bending and twisting causes disruption of the enervation at T11/12 to the psoas minor. An abrupt kyphosis or scoliosis at that level will also cause the Lovett's reciprocal rotation at C6/7 to mirror the condition. I personally have damage to this area from my youth so I have studied it very carefully during the last 15 years.
This is the most common source of posture distortion I find in my practice.
For the Reflexoligest I recommend working the reflex point lateral to the first meta tarsal/tarsal joint while supine with upper lumbar and lower cervical bolstered. The best access to the foot is to pass it under the bent knee of the opposite leg. This engages the lower trapezius psoas minor chain diagonally. The reflex point does not need to be worked but held firmly for feedback while you arch the low back and neck and release several times.
Find out more about protecting your hands, and the rest of your body, from injury as a massage therapist at the Feb. 11-13, 2011 Certified Injury Prevention Instructor workshop in Boca Raton, FL. 2 1/2 days (18 CEUs) with Lauriann Greene, CEAS and Richard W. Goggins, CPE, LMP. LOTS of hands-on instruction - learn how to help your fellow therapists prevent injury, too!
Aside from being careful with my hands in everyday activities, and wearing gloves when gardening and such, I have found the very best care for my hands to be Trager Mentastics. I learned them long ago, around 1980, and have used them ever since. Once you've practiced them and your hands and arms and shoulders have learned what it feels like to relax, you are able to do only a few movements and those few movements serve as a memory trigger for the body/mind. I recall Dr. Milton Trager spending 45 minutes just on feeling and exploring the weight of the thumbs. As the mind sinks into such an amazing exploration a whole new sense of your hands comes through. So try a Trager Mentastics class sometime! It's the opposite of effort- effortless!
Nancy~That sounds wonderful! As a LMT diagnosed with Focal Dystonia (before I became a therapist), I could probably use some of the Trager Mentastics technique. I am pain free during and after a massage, it's writing the SOAP notes where dystonia gets tricky;) Any other thoughts?
Tenee, you would be an interesting case to work with. I wonder if there are any Trager Practitioners in your area who could work with you?
Another thought- for a temporary fix- how about the voice activation computer programs? In fact I think the new Windows 7 comes with it. You have to train the program to your voice, but they do work. In fact you could just record and not even bother with written notes. If they were needed for a court case or such, you could have them transcribed.
Yeah I'm a case to be studied =D I'll google practitioners in my area! Intriging! On a quest for self healing makes me a compassionate healer myself. Thanks Nancy!
What books and or continuing education are good for carpal tunnel? I have a client that recently had breast cancer and her symptoms began after chemo and radiation. She has been diagnosed and wants massage to help her. She is in need and I want to help her effectively. she can't have surgery because of the demand on the lymph repairing the breast tissue. Ideas?
The pain in carpal tunnel is actually caused by the welling due to inflammation, so anything that helps reduce inflammation will help with the pain of carpal tunnel. Anti-inflammatory diet, lots of vitamin c, lymphatic massage, swedish massage, bindegewebsmassge, actually most massage. Just don't over-do, as it can irritate the tissues in the area and that would increase inflammation. It is important to be gentle.
Ariana Vincent, LMT, MTI, BCTMB
I just received an e-mail from my friend Rebecca Zupo in Austin. She works for a doctor who specializes in rehabilitating hand injuries. She suggested a Meetup focusing on the hands. I thought, that's a GREAT idea, and why not take it to a different level by creating a Massage and Bodywork Group focusing on hand care. So, here we are!
My favorite hand care book is by Lauriann Greene, "Save Your Hands!" If you haven't read her book yet, I hope you will soon. She'll probably join the group and contribute actively. http://www.saveyourhands.com
I love and appreciate my hands; they are so precious to me. I hope this massage community of kindred spirits brings you what you desire in terms of hand care - giving and receiving.
Warmly, Ariana Vincent, Ariana Institute
http://www.arianainstitute.com/online.htm
Dec 2, 2010
Sharon Butler
Dec 2, 2010
Lauriann Greene, CEAS
The same strategies apply to saving your hands as apply to saving your neck, back, and shoulders (which are also commonly injured as a result of massage work, and which we also address in our book): a multifaceted, holistic approach involving awareness of risk factors, reducing risk factor exposures through ergonomics (fitting the work to the worker), using good body mechanics (fitting the worker to the work), taking care of general physical and emotional health, and treating symptoms/injury early and effectively.
However, there are special challenges involved in taking care of the hands, particularly since many therapists use them almost exclusively to deliver treatment (i.e., those who don't do massage with their forearms/elbows or their feet), using hand force, repetitive movement and sometimes awkward postures (the "big 3" risk factors for MSDs). The muscles, bones and other structures of the hands are among the most delicate in the body, and it takes special attention to keep them healthy. I'm looking forward to reading the comments in this forum and participating as much as I can, so we can all help massage therapists and bodyworkers save their hands!
Dec 3, 2010
Robert Thomas Parker
Dec 3, 2010
Lauriann Greene, CEAS
The type of injuries that massage therapists and bodyworkers get are gradual onset from the cumulative effects of the work they do, so it isn't a question of how suddenly you apply pressure, but how often, with what intensity, and for how long at a time (frequency, intensity and duration).
Dec 3, 2010
Patrice Roisman-Carter
Any insights or suggestions would be grateful. I can't imagine doing anything drastic like surgery, but I do almost feel the need to see an orthopedic hand specialist.... Ouch and Help please. Left elbow joint hurts too.. Perhaps a long vacation on the Ocean somewhere warm w/o clients !!!!!
Dec 9, 2010
Sharon Butler
In my experience (22 years helping people with upper body repetitive strain injuries), pain in the wrists and thumbs often begins because tissue is adhered higher up the chain (towards the thorax). In many cases I see, adhesions have formed in the armpits, upper arms and forearms. This prevents the normal sliding and gliding of the connective tissues down into the hands and wrists and leads to pain, weakness and disability. When hands and thumbs are as symptomatic as you describe, I first work to release the armpits and upper arms to begin to create some "slack" in the tissues as they enter the hands and wrists. You can do this through stretching or with sessions from someone skilled in myofascial release. My background is in Hellerwork, which is excellent for this type of release.
Check out my contact page for more information on things that can help you. Let me know if I can be of further assistance!
Dec 9, 2010
Ariana Vincent, LMT, MTI, BCTMB
BREAKDANCING FINGERS - HANDS HAVING FUN!
http://www.youtube.com/watch?v=UH35Lde8nWk&NR=1
Dec 15, 2010
Lauriann Greene, CEAS
Patrice, I'm sorry to hear that you're in pain. You mentioned that you "almost" feel the need to see an orthopedic hand specialist. I would encourage you to do just that, or another healthcare practitioner who is licensed to diagnose. When ongoing symptoms are bad enough to interfere with functioning, it's time to get a diagnosis. Hand and wrist pain can come from any number of conditions, and only a healthcare practitioner licensed to diagnose can do the differential diagnosis necessary before you can receive appropriate treatment. Massage can certainly be part of your treatment plan once you know if you do indeed have carpal tunnel syndrome, or whatever syndrome or condition you are experiencing.
You mentioned that you had great "ergonomics" - I think you mean body mechanics. Ergonomics is the science of fitting the work to the worker and how work affects the worker, while body mechanics involves using our own bodies more efficiently and effectively as we work. It's an important distinction to make. Since your body mechanics were good, it would be helpful for you to look at the ergonomics of your situation: perhaps something in your work environment, be it table height, lack of enough time for breaks, an overcrowded schedule, or stress at work, could be contributing to your injury. Your story shows us once again that you can have great body mechanics and still get injured - this is why only a multifaceted, holistic approach has been proven to prevent injury. I hope that once you have a diagnosis, you'll be able to get effective treatment to get you back to work pain-free.
Dec 15, 2010
Darcy Neibaur
Very talented fingers Ariana. Too Cool
Dec 18, 2010
Karina Braun
Glad you started this group. I am happy to be a part of it. Happy holiday!
Karina Braun
Dec 24, 2010
Lauriann Greene, CEAS
Dec 27, 2010
Kevin Campbell
Dec 29, 2010
Sue Benjamin, NCTMB
Great topic. I am a massage therapist and a reflexologist. I've been doing reflexology for 11 years and massage for 6. I have a lot of trouble with tension and tightness in my neck, shoulders, arms and upper back. My clients often ask me, "Don't your hands get tired or sore?" I say, "No, not really, but my neck and shoulders do". But now lately my thumbs are giving me troubles as I work, and I'm having to modify my techniques. I love my work and certainly don't want to have to cut back or quit because of work related injuries. I just ordered Lauriann's book Save Your Hands. I'm looking forward to reading it. Thank you.
Jan 2, 2011
Karina Braun
Sometimes,with reflexology, it is challenging because you are seated and it can be hard to put your whole body weight behind it. Lining up the bones and joints is very important. The thumb joint is subject to wear and tear with overuse but with cryotherapy you can help the inflammation and healing. Best of luck in your practices!
Stay Healthy!
Karina Braun, Author, Creating Peace with Your Hands
Jan 2, 2011
Sue Benjamin, NCTMB
Jan 2, 2011
Lauriann Greene, CEAS
Jan 2, 2011
Hans Albert Quistorff, LMP
This is an interesting thread. I would like to discuss some of the posture links involved in the neck and shoulder tension. As mentioned the lower trapezius should be holding the scapula down to support your work. The link from there is the psoas minor which links to the pubic bone and gives you stability to the pelvis.
Often bending and twisting causes disruption of the enervation at T11/12 to the psoas minor. An abrupt kyphosis or scoliosis at that level will also cause the Lovett's reciprocal rotation at C6/7 to mirror the condition. I personally have damage to this area from my youth so I have studied it very carefully during the last 15 years.
This is the most common source of posture distortion I find in my practice.
For the Reflexoligest I recommend working the reflex point lateral to the first meta tarsal/tarsal joint while supine with upper lumbar and lower cervical bolstered. The best access to the foot is to pass it under the bent knee of the opposite leg. This engages the lower trapezius psoas minor chain diagonally. The reflex point does not need to be worked but held firmly for feedback while you arch the low back and neck and release several times.
Hans Albert Quistorff, LMP
Antalgic Posture Pain Specialist
http://reflexposturology.weebly.com/
Jan 2, 2011
Lauriann Greene, CEAS
Find out more about protecting your hands, and the rest of your body, from injury as a massage therapist at the Feb. 11-13, 2011 Certified Injury Prevention Instructor workshop in Boca Raton, FL. 2 1/2 days (18 CEUs) with Lauriann Greene, CEAS and Richard W. Goggins, CPE, LMP. LOTS of hands-on instruction - learn how to help your fellow therapists prevent injury, too!
http://www.saveyourhands.com/CIPI/
Jan 11, 2011
Nancy Toner Weinberger
May 25, 2011
Tenee J
Jul 20, 2011
Nancy Toner Weinberger
Tenee, you would be an interesting case to work with. I wonder if there are any Trager Practitioners in your area who could work with you?
Another thought- for a temporary fix- how about the voice activation computer programs? In fact I think the new Windows 7 comes with it. You have to train the program to your voice, but they do work. In fact you could just record and not even bother with written notes. If they were needed for a court case or such, you could have them transcribed.
Jul 20, 2011
Tenee J
Yeah I'm a case to be studied =D I'll google practitioners in my area! Intriging! On a quest for self healing makes me a compassionate healer myself. Thanks Nancy!
Jul 26, 2011
Tenee J
What books and or continuing education are good for carpal tunnel? I have a client that recently had breast cancer and her symptoms began after chemo and radiation. She has been diagnosed and wants massage to help her. She is in need and I want to help her effectively. she can't have surgery because of the demand on the lymph repairing the breast tissue. Ideas?
Jul 26, 2011
Robert Thomas Parker
Jul 26, 2011
Sharon Butler
Jul 26, 2011
Nancy Toner Weinberger
Aug 15, 2011
Karina Braun
I just released a Yoga DVD for Bodyworkers called Create Peace Yoga. It gives a Strength routine, a Renew routine, and a bonus Yoga 4 the Hands.
Stay Healthy!
Karina
Aug 30, 2011
Lauriann Greene, CEAS
Become a better therapist by learning self-care.
Jan 5, 2012