The human body has a number of “weak links”, areas that are more susceptible to injury than most. They are the thumbs, hands/wrists, shoulder, neck/upper back and lower back. All should be on your radar if you practice manual therapy; the most often-injured body part – the thumb – is of major concern if you are a reflexologist.
The thumbs are our strongest and most useful digits for applying pressure. They are short, and unlike the fingers, have muscles at their base that help to stabilize and support them. The thumb and the hands are the most unique structures of our body; (Read Language of Touch to read why.) however, their remarkable and uncommon abilities are also what make them so vulnerable to injury.
We use our thumbs a lot: gripping, texting, hitch-hiking (Yeah, some of us still do that!), in addition to thumb-walking and working on points, if you are a reflexologist.
When we apply pressure through our thumbs, the force is concentrated at the first carpometacarpal (CMC) joint, the joint that makes the thumb opposable and we as humans stand out. The CMC joint is created from the articulation of the proximal end of the first metacarpal and the trapezium bone.
For every pound of pressure applied with the thumb, there can be 10 to 12 pounds of pressure concentrated in the CMC joint. This becomes problematic if performed with:
- little or no awareness
- exclusive repetition
- poor body mechanics
- no ergonomic principles in play
- static loading
- tired or pained hands
The muscles that provide most of the hand’s mobility actually originate in the forearm. Strong flexor and extensor muscles start at the elbow and continue as tendons from the med-forearm into the fingers.
The tendons pass through the carpal tunnel, a small passageway running between the wrist bones and the transverse carpal ligament. Nine forearm flexor tendons and the median nerve, the nerve that supplies sensation to the thumb and the first three digits, all occupy this tight 10 mm. in diameter corridor. The carpal tunnel walls are rigid, so if any inflammation or fluid buildup develops the irritation is contained causing pressure on the median nerve. That can lead to carpal tunnel syndrome (CTS), a degenerative condition characterized by numbness, pain, swelling and an inability to even use the hand for the simplest of tasks.
Even if CTS does not result, painful conditions such as wrist tendonitis (inflammation of the tendons), tendonosis (degenerative changes to tendons without inflammation) or tenosynovitis (inflammation of tendon sheaths) can ensue.
If pressure is rendered through the fingers while the wrist is extended, the carpal tunnel is narrowed, creating friction and irritation to the tendons and sheaths protecting the tendons. The inflammation that ensues causes degenerative changes to tendons and damage to the median nerve.
There are five primary factors that increase your risk of hurting your hands when doing reflexology. They are:
- Repetitive motions. You have two thumbs and eight fingers. Use them all. There are dozens of techniques available to offer in a reflexology session, not just thumb or finger-walking with your dominant hand. Use them. Mix it up.
- Static loading – maintaining grip/force for a long time, especially in an awkward posture. When you work points, is your hand relaxed, are your joints extended or are you applying pressures with a “death-grip”?
- Working when you shouldn’t be. Are you distracted? Distraught? Tired? Hands hurting? Are you doing more back-to-back sessions than your body is ready for?
- Ignoring the importance of ergonomics in the workplace. (Ergonomics is adapting the work environment to fit your work.) Adjust your stool so that you maintain a 90° angle at your forearm/elbow junction and your wrist and digits remain straight when you are working. NEVER apply pressure with thumbs, fingers or wrists extended.
- Awkward body mechanics (Body mechanics is adapting your body to fit the work.) Sit straight; spine erect. Feet flat on the floor. Head up. Develop the practice of keeping your eyes on your client’s face and chest to monitor facial expressions and breathing, not on your hands (they know what they’re doing). If you must look at your hands, keep your head up; look down with your eyes. Are your shoulders relaxed or are they about to touch your ears? Stand, sit, stand, sit to avoid low back pain.
Awareness is the first step in protecting the hands from injury when offering reflexology. Hopefully, the above information will provide you with insight into how you are working and how that might be affecting the health of your hands.
The second step in preventing injury actually begins before you enter your clinical space. Watch for the next post outlining the primary ways to avoid injuries to your hands.