Issue link: https://www.massageandbodyworkdigital.com/i/1488451
Angling the Palm Contact One of the major advantages of the full- f lat palm is that it is broad (Image 5A). However, this can also be a disadvantage because the contact may be too broad to allow work in certain areas and/or contours of the client's body—for example, when performing a long deep stroke up the client's back along the paraspinal musculature. In the low back, there is plenty of room for the palm to be fully f lat. But as we reach the interscapular region (between the scapulae) in the thoracic spine, there is often not enough room between the medial border of the scapula and the spine. Instead of switching to another contact, we can simply supinate the forearm to orient the palm so that we are pressing more on the hypothenar side of the palm instead of the full-f lat palm (Image 5B). This narrows the contact, allowing seamless passage of this stroke through this area to continue to the top of the client's trunk. We still have a strong contact, but one that fits between the scapula and spine. We also can even focus 50 m a s s a g e & b o d y wo r k j a n u a r y/ fe b r u a r y 2 0 2 3 5A: Full-flat palm. 5B: Hypothenar contact. 5C: Hypothenar contact with focus on the pisiform as the contact. 5D: Ulnar-side knife-edge contact. Pisiform for Joint Mobilization Learning to use the pisiform (or trapezium/scaphoid tubercles) as a contact can be especially valuable when performing joint mobilization. It allows for a very specific contact on the bone of the client's body, but also is a strong and stable contact. And it is a comfortable contact because of the cushioning of the surrounding myofascial tissue. Author's note: In the world of massage therapy, Grade IV, slow-oscillation joint mobilization is legal and ethical in most states of the US. No fast thrust should be added to the mobilization. Fast- thrust Grade V joint mobilization is not legal or ethical for massage therapists. the force of our stroke through the pisiform of the hypothenar eminence (Image 5C). There is an art to learning to use the pisiform, and it can take time to master, but it is well worth it. The pisiform is a small bone, so it is very specific in its contact, but it is a round bone, so it is not pokey for the client. Further, because it is surrounded by the myofascial tissue of the hypothenar eminence, it is padded and even more comfortable for the client and the therapist. We can even transition our contact to be fully on the ulnar side of our hand (Image 5D). The ulnar-side contact is often referred to in manual and movement therapy as the knife-edge contact. 5A 5C 5B 5D Pisiform