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Massage Therapist Thumb from a Neuromuscular Therapy Perspective

Our most valuable tools are our hands. When we get hurt, our hands are often forgotten how important they are. Then, even the most simple tasks like buttoning a shirt, opening containers, pouring coffee or turning a knob can be difficult. Mobile massage therapist in Orange County need to be aware of how frequently they use their thumbs in their work. Injury is the main reason why Therapists leave the profession. We will be discussing De Quervain’s Tenosynovitis (or “Massage Therapist Thumb”) and ways to prevent this injury from happening in our profession.

What is De Quervain’s Tenosynovitis and how can it be treated?

Although the exact cause of De Quervain’s Tenosynovitis remains unknown, repetitive hand and wrist movements often exacerbate the symptoms.

De Quervain’s Tenosynovitis refers to swelling of the tendons running along the radial wrist and attaching to the base the thumb. This includes the synovial sheath covering the long tendons, the Extensor Pollicis Longus as well as the Abductor Pollicis Longus.

These structures form the “anatomical stool box.” You can find it by abducting the thumb and extending your thumb, while also observing the dorsal side of the hand.

How can I tell if I might have De Quervain’s Tenosynovitis

These symptoms are typically caused by pain along the radial side and tenderness on the wrist. They can be particularly aggrieved by:

  • Move the thumb
  • Forging a fist
  • Gripping and grasping
  • Turning the wrist
  • With your arms extended in front and your thumbs pointed toward the ceiling, lift something.

How Massage Therapists Should Not Use Their Hands

This is a common condition in the massage profession, considering how much work Massage Therapists do with their thumbs unsupported. These images show an unsupported thumb position.

The downward force exerted on the thumb or finger will cause it to retract and extend. Not only is the thumb no longer supported but the force line would also cause the shoulder medially to rotate, causing a lot muscle recruitment and possible injury to the elbow and shoulder.

With both hand positions, it is clear that the line of force is more appropriate than the above image. However, the right hand will feel a lot of tension as the thumb is being taken and pushed into the upper trapezius.

While some may argue that the stacked thumbs offer support, observe the hyper-extension and flexion of both the left and right thumbs. Both thumbs are also taken from the hand. This false sense security can cause Therapists to believe that they are able to use more force, which could lead to further injury.

This image is making us shiver. We are concerned about the formation of “Massage Therapist Thumbs” due to hyperextension of thumbs. The positioning of the hands, and hyperextensions of the metacarpophalangeal joints make this image even more distressing.

Proper use of hands during massage therapy

Now that we have identified the wrong position for massage therapy hands, what should they be? Let’s first examine the neutral position of the wrist and hand. The functional hand position is described in medical texts. It is where the wrist extends 20deg to 35deg. A normal transverse arch is maintained. While the thumb is abducted and aligned the pads of the four finger, the thumb is lowered and moved with the fingers. The proximal interphalangeal joints can be flexed at 45deg-60deg

The hand should be placed flat on the surface, palm down. We will see slight wrist extension. The pads of the four fingers touch and the thumb rests on the lateral surface. The thumb pad points inward. The wrist extends the radius. All force generated by the hand is dispersed to the elbow and shoulder.

Numerous hand positions are possible while performing Neuromuscular therapy. Although it looks like the thumb is being used in this image, the thumb and hand are still in neutral positions. The “second thumb” technique is used by the right hand. This involves holding the index and rings finger tips side-by-side and arching the middle finger.

This gives you a wider touch surface for areas that might be hypersensitive. It also makes it easy to pin ropey tissue. Combining hand positions with the sensitive skin of the foot’s dorsum creates a diffused pressure that covers the tendinous structures above the tarsals.

In the image to the right, it is easy to misinterpret a thumb acting only on the plantar side of the foot. Notice that both the thumb and hand are in their natural resting positions.

The wrist is slightly extended, so the force flowing into the foot flows unimpeded down the shoulder, past the elbow and to the wrist and out to the thumb. Micro-movements created by the hip and feet create micro-movements in the thumb, eliminating the need to extend and flex the interphalangeal joint.

Here is an example of using finger tips side by side. While both hands and wrists remain in neutral and relaxed positions, deep transverse friction applies to the medial longitudinal ar and the attachment of Tibialis Anterior.

This hand position is very effective in introducing touch, palpate and applying acceptable force to the tissue. It’s a useful tool for Neuromuscular Therapy. Many Therapists are limited in their intake and evaluation time. Combining palpation with a massage stroke can help reduce tissue warming time and softening time.

These activations and perpetuating factors need to be taken into consideration when deciding the best treatment for De Quervain’s Tenosynovitis. When using any modality, it is important that Massage Therapists maintain a neutral thumb and wrist position. The muscles that are overused by Therapists when they leave their thumbs unsupported are the Abductor Pollicis Longus or the Extensor Pollicis Longus.

What Muscles Are Involved?

The Abductor Pollicis Longus can be found on the radius and interosseous membranes. It travels to the base and first metacarpal. It is the thumb abductor, as its name suggests. This muscle extends to the posterior side of the wrist, just below the superficial finger extensors.

The Extensor Pollicis Longus can be found on the posterior ulna or interosseous membrane. It extends beyond the Abductor Pollicis Longus attachment at the base of your thumb’s distal phalanx. The name of the Extensor Pollicis longus is similar to Abductor Pollicis. It will extend the thumb at interphalangeal joints and the thumb at metacarpophalangeal joints.

Daniel S. Williams

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