Massage & Bodywork

March/April 2010

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ten for today BY REBECCA JONES HAND TOOLS Some roll. Some cup. Some vibrate. Some compress. And nearly all of them, used properly, save wear and tear on a massage therapist's thumbs, fingers, hands, and wrists. Yet many therapists still avoid using hand tools on their clients. The very nature of massage is skin on skin, and many therapists reject anything that comes between their fingertips and a client. "They feel they're cheating, like they've done something wrong, haven't been using proper mechanics, if they have to use a hand tool," says Greg Polins, a North Carolina massage therapist and the inventor of Thumbsavers, one of a bevy of devices on the market aimed at ergonomically-minded bodyworkers. "But at the end of a full day doing thumb work, that joint is going to fail no matter how good your mechanics." Indeed, with more than three out of four massage therapists reporting pain or other musculoskeletal symptoms related to their massage work over a two-year period, and with many choosing to leave the profession within five years, all too often because of work-related injuries, the pragmatists may win this debate by default. Here's a look at some issues surrounding hand tools, their pros and cons, and how to evaluate which, if any, hand tool may be right for you. 1. HOW CAN A HAND TOOL HELP SAVE MY HANDS? One of the greatest causes of injury among massage therapists is overuse of muscles. "Massage therapists tend to use their thumbs and fingertips quite a bit to apply pressure, especially sustained or deep pressure," says Lauriann Greene, coauthor of Save Your Hands! (Gilded Age Press, 2000). "They do that because thumbs and fingertips are very sensitive, with a lot of nerve endings at the tip. But that's exactly the reason there's a risk of injury, because the nerves are so close to the surface." Sustained pressure on the fingertips can lead to compression of the nerves and blood vessels, which can lead to reduced circulation and loss of sensitivity. Over time, this can lead to permanent reduction in sensitivity. Likewise, for every pound of pressure exerted by the thumb, 10 pounds of pressure is placed on the carpometacarpal joint. All this increases the likelihood of damage to the median nerve. "It isn't an all-or-nothing thing, but any amount of time that you can give your thumbs and fingertips a rest is that much gained," Greene says. "Using a hand tool offers another option, a different way of using your upper extremities to avoid the overuse that's so much a problem in injury." 78 massage & bodywork march/april 2010 2. JACKNOBBER II SHOULD I USE A HAND TOOL THROUGHOUT A SESSION? Hand tools will never replace good palpation skills. You need to use your hands to find the target muscles and trigger points. Tools can be used to deliver extra pressure for compression, but use them in moderation. In fact, Greene suggests that when you're not actually using the tool, you shouldn't even have it in your hands. "It's like using a computer mouse," she says. "People have a tendency to keep their hand on the mouse even when they're not using it, and that's one of the ways people get injured from computer use. They're gripping the mouse without realizing it. Tools are the same. When you're not actually using it, put it down, because the gripping itself can be a risk factor."

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