Massage & Bodywork

March/April 2012

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education PATHOLOGY PERSPECTIVES | BODY AWARENESS | FUNCTIONAL ANATOMY | SOMATIC RESEARCH Avoid Using the Heel of the Hand By Barb Frye The heel of the hand is a favorite among manual therapists for applying compression strokes. But, like the wrist joint, the heel of the hand can sustain serious injury when overused, often disabling a therapist from practicing. Many massage therapists use the yes One of the most disabling injuries to MTs is when the median nerve is compressed through overuse. The symptoms— dysfunction, numbness, pain, and tingling— may result in carpal tunnel syndrome. no heel of the hand rather than the entire palm of the hand when, for example, applying long friction strokes down the back. Although it seems like a strong and useful tool, and many therapists regularly use it to apply compression strokes, the anatomy of the heel of the hand is not ideally suited to bearing weight. Following are some reasons why. • Eight small carpal bones comprise the heel of the hand. When under strain, they are susceptible to tenderness. For manual therapists, the pisiform— the hook of the hamate, scaphoid, and trapezium—can become tender if overused for pressure strokes. • The ulnar nerve and ulnar artery pass through a small tunnel called Guyon's canal that lies between the hamate and pisiform bones. Sustained weight bearing, as with compression strokes, can push the ulnar nerve into the walls of this canal, causing nerve damage. Celebrate ABMP's 25th anniversary and you may win a refund on your membership. 43

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