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MYOFASCIAL TECHNIQUES When working with people who use their hands a lot, you'll often find one or two areas that are particularly immobile. Use a firm "scrubbing" movement to check and release anterior/posterior (volar/dorsal) movement of each carpal articulation. "SCRUBBING" TECHNIQUE Our first step will be to check the mobility of the carpal bones. With a firm grip on the carpals as shown in Image 3, move the carpal bones against one another in an anterior/ posterior (A/P) direction (in the hand, this is referred to as dorsal/ volar motion). Firmly but gently, "scrub" all the carpal bones against one another, much like you would if you were scrubbing a stain in a piece of clothing. Be thorough, moving each of the carpal articulations in turn. Feel specifically for the bones— instead of working only with soft tissue in this technique, we are feeling for the mobility of the carpal bones themselves. There isn't any kneading, petrissage, traction, or wrist stretching in this technique—focus instead on encouraging carpal movement in the A/P dimension. Be slow, full, and sensitive, but you can be quite firm (as long as it is comfortable for your client and he or she isn't recovering from an injury or instability issue). Lean into it and wait for a release at the end-range in each direction. Be sure to keep your own hands as soft and adaptable as possible. When working with people who use their hands a lot, you'll often find one or two areas that are particularly immobile, as if two or three of the carpal bones had fixed themselves into a non-moving "coalition." Often these coalitions involve the central carpals (particularly the trapezoid, scaphoid, and/or the capitate). As mentioned, the capitate is in a position to be particularly troublesome to the carpal tunnel, so be sure it is as mobile as possible, especially in a posterior or dorsal direction (Image 2). For a variation on this technique, you can passively flex, extend, and sidebend your client's wrist as you monitor his or her A/P carpal motion. Because the carpal tunnel tends to close with wrist extension, checking carpal mobility together with various movements can reveal restrictions that are easy to miss in a neutral wrist position. Incidentally, the proximal row of carpal bones generally has more inter-carpal movement than the distal row, in order to allow the adaptability needed for movement between the hand and arm. The greater stability of the distal row plays a role in maintaining the carpal tunnel's space, but as a result, is more prone to being fixed and hypomobile. Once you've thoroughly checked and released A/P carpal mobility, you can use the next technique to make sure the carpal tunnel itself is open. visit massageandbodywork.com to access your digital magazine 125