At first, this is not going to sound like a massage injury prevention guide for your thumb and index fingers, but it really is.

Ready?

Your client, Taro, is waiting on the table. When he was changing you had grabbed a quick snack, but then remembered that you nails were like daggers.

You frantically fumble for your nail clippers but know if you don’t get in that room like now, Taro is going to be major grumpy. You decide that you only have time to cut 3 nails per hand. Which 2 nails on each hand are you going to leave uncut?

Let me see if I can guess…

…hmm…

…could it be these two?!

Let’s take this a step further. Here are two hands. The fingers are numbered 1 – 5, starting with the thumbs.

If you taped your 4^th and 5^th fingers to your palm, could you do a massage?

Yeah, no problem, right?

Now imagine that 1, 2 and 3 are taped down to your palm. That massage ain’t happening, is it?

For me, fingers 1 and 2 do the most massage work. Finger number 3, the middle finger, comes in third. Finger 4 gets used some. And finger 5 is basically along for the ride unless I’m squeezing which I rarely do (Trap Release Without Squeezing).

Years of Overuse Can Cause A Massage Injury

Now imagine what happens after 20 or so years of primarily using fingers 1 and 2. It’s a massage injury waiting to happen, right?

Here’s a common sense but under-utilized strategy that will set you on a course to saving your thumb and index finger.

The strategy is: Take the workload off the overworked parts. Also known as use overworked parts less.

How to Prevent a Finger Massage Injury

Experimenting with Fingers 4 and 5

For the longest time, when it came to massage, fingers 4 and 5 were decorations on my hand.

But when fingers 1 and 2 started to feel persistently tight, I started experimenting with offloading some of the work to fingers 4 and 5.

At first, it was like trying to eat with my non-dominant hand. But after a few months, fingers 4 and 5 started to adapt, and fingers 1 and 2 got happy again.

Substituting fingers 4 and 5 for fingers 1 and 2 has its limitations, but the substitutions work particularly well in these situations:

Three Ways to Use Fingers 4 and 5

Supine Occiput Work

This is the best starting point for engaging fingers 4 and 5 more and using fingers 1 and 2 less.

Why?

Because you don’t have to press hard with fingers 4 and 5 to do this technique. The weight of the client’s head resting on your fingers creates the pressure. And slightly pressing up with fingers 4 and 5 is a great way to start to strengthen them.

Temporalis, Masseter, and Pterygoids Work

From a requiring strength standpoint, working jaw muscles is a more advanced move than the supine occiput work. I would start by getting some reps in with fingers 4 and 5 on the body of the temporalis.

Then I’d work in the masseter and pterygoids.

Sinus Work

When you’re ready to fine tune your pressure with your 4^th fingers, try them out on sinus cavities. It’s definitely challenging at first, but like anything else, it gets easier after a few attempts.

Cervical Work (Light to Medium Pressure)

When you resign yourself to learning how to spread the workload out to prevent a massage injury, it’s only natural to experiment. I find that it’s during heavy massage weeks, when body parts get tired, that I experiment the most. This move came about when I had a lot of necks to do in one week.

I’m combining finger 4 and my thumb on the opposite hand. This combination is good for light to medium pressure.

Going to the Next Level

If you want to take spreading the workload out to the next level, try substituting fingers 4 and 5 for other tasks that finger 1 and 2 do.

For instance, when I’m doing a massage, this is how I usually get cream from a massage cup.

Finger #2 working hard.

Here’s what I try to do now.

This is a minuscule task in the grand scheme of overuse. But in this case, it’s not about changing an action to prevent a massage injury. Instead it’s about making you feel more adept using finger 4. When I do things like this, I want to use fingers 4 and 5 more often in daily life. Here’s what I mean.

Spilling Over Into Life

The other day my wife was watching me type, or as she put it “pound the keyboard”.

What can I say, I GET EXCITED WHEN I WRITE!

But she also made another interesting observation. She pointed out that I was only really using 3 fingers on each hand to type.

Guess which ones?

Yep, fingers 1, 2  and 3.

Well, of course, I can’t let this go. So, I’m fixing this by forcing myself to use fingers 4 and 5 about 15%ish of the time when  I type. I hate it because it really makes me slow down. But I know I’ll like the end result.

At this point, I need to talk about obnoxious thumb pain. If you’re in a state where your thumbs are aching all the time, you’re going to want to seriously consider these suggestions.

Other Ways to Save Your Thumbs and Index Fingers

This is my favorite:

1. Use a T-bar or an L-bar.

The T-bar…

…and L-bar

…are my top choices for massage tools. For one, they have a simple design which means you can hold them in a variety of ways. Over-designed tools lock you into one or two holds.

T-bars and L-bars are the ultimate thumb savers because they literally substitute for thumbs. And they don’t stress thumbs because you can hold them in many different ways.

Here’s a quick T-bar and L-bar intro: Save Your Hands: Use a T-bar and L-bar.

2. Use knuckles and fingers in combinations.

Combining body parts is foundational to saving your thumbs. When you combine body parts, you brace and stabilize joints and spread out the workload.

If you want to get started combining body parts, begin here: How to Do Very Precise Pressure

The last thing you need to know is that you have to experiment.

Embrace the Experiment to Prevent a Massage Injury

Experimenting live (on a client) is a little scary because we’re not sure how it feels to the client.

You can lessen the chances of the client saying “Ouch! What the hell are you doing?!” by first working on people who can give you immediate feedback, like friends.

I never use this approach for this reason: I’m a wimp. If something hurts during a massage, I want it to stop hurting. So, automatically, I start experimenting with different techniques until the pain goes away.

Introducing a New Technique

So, when I introduce a new technique, I look for warning signs with the client, like a leg twitch, as an indicator to determine if what I’m doing is okay.

And I don’t spend a lot of time using that new technique at first. Rather I introduce it briefly, look for client reactions, and then reintroduce it in small doses. It slowly becomes a tool in my toolkit when I know clients like the technique and I’m comfortable with it.

Joyriding with Fingers 4 and 5

Ready to take fingers 4 and 5 for a spin?

I’d start with supine occipital work. Then I’d try out jaw work, and when I felt comfortable with that I’d fine-tune my finger 4 touch with sinus work.

If you’re thumbs and index fingers need a serious break, try using a T-bar, L-bar or body part combinations.

Now you have the information that will help you prevent a massage injury to your thumb or index finger. And if you’re currently in pain, experiment. You just need to find the way out.

Get Help With Your Specific Pain Issue

If you need more help with saving your hands (and the rest of your body) when you massage, consider reading my DIY book, The Pain-Free Massage Therapist.

About seven years ago my body was falling apart after 20+ years of massage. I gave myself a year to figure out how to massage pain-free, and if I couldn’t, I’d have to find a new career.

In that year I discovered the things I was doing wrong for my body in the massage room. But the process to becoming a pain-free massage therapist was not as simple as replacing one technique with another. It involved changing my thinking so that I caught trouble before it happened along with knowing how to adjust when I was in pain.

This book is your head start. You don’t have to come up with the strategies and techniques to save your body. You just need to try out the ones I recommend. Keep the ones that work for your body; pass on the ones that don’t.

The book comes with a website link where you can access free how-to-massage-pain-free videos. You can purchase the book on Amazon.

Purchase Book

If you have any questions or want to talk about your specific pain issues, email me mark@makethemostomassage.com 🙂

 

A few winters ago I had dry-skin challenges of winter and I developed a significant skin crack on the knuckle of my right middle finger. This knuckle is a tool that I use when I need to deliver precise, deep pressure.

At first, I thought about cancelling some deep pressure clients, but I didn’t. Instead I worked around the injury—and I’m glad I did. For one, I got better at using my left (non-dominant), middle-finger knuckle to deliver deep pressure. I also “created” and got efficient at using new power tools (two or more tools—fingers, thumbs, knuckles, fists, elbows-forearms—that are used together). In essence, my injury helped me become a more durable and balanced therapist. Here’s my process for working around a hand injury:

Think “Work Around” Not “Work Through”

We’ve all done it–repeat the same mistake over and over. My injury was a perfect example. At first I taped my knuckle and tried to work through the discomfort, like I’ve done in the past, but my knuckle just got angrier. Finally, after my knuckle became sore to the touch, I decided to work around the injury instead of through it. In other words, I would not use, or minimally use, my right, middle-finger knuckle. Instead I would figure out other ways to deliver precise, deep pressure. When I gave that knuckle a rest, it finally had time to heal and within a week, it was good to go again. This time I think (hope) the lesson has stuck.

Think: Opposite Side

Since I wasn’t going to use my right, middle-finger knuckle during a massage and I wasn’t cancelling any clients, the pressure was on. I needed to immediately figure out new ways to deliver precise, deep pressure during the upcoming scheduled massages. The good news was that I was familiar with using my left, middle-finger knuckle to deliver deep pressure, but I just wasn’t good at it. So with my right knuckle out of commission, I put my left knuckle to work. It took some work but to my surprise, within 10 massages I felt competent with my left knuckle. Which begs the question: If my right knuckle wasn’t injured, would I have ever gotten better with my left? My guess is probably not.

Think: T-Bar

I also tried substituting my thumbs and fingers for my right knuckle, but this wasn’t sustainable because I used my thumbs and fingers a lot throughout a massage already. So I started experimenting with my T-bar. The fact is that I also used my T-bar a lot throughout a massage, but the T-bar didn’t overtax my hand muscles and finger joints because I could hold it in a variety of ways. Substituting the T-bar for a knuckle was new to me, but I found it to be an excellent substitute when doing precise, deep pressure in the arches of the feet, on the levator scapulae attachment and in the upper cervical areas.

Think: New Power Tools

Though I had temporarily stopped massaging with my right, middle-finger knuckle, I habitually kept placing my hands down as if I were going to use my injured knuckle. When that happened I found myself experimenting with using other knuckles on my right hand. Because I never experimented with these knuckles individually, it felt comfortable to support them with another tool. Soon I had more power tools (two or more tools—fingers, thumbs, knuckles, fists, elbows-forearms—that are used together) at my disposal. My new power tools were right, pinky-knuckle braced with left thumb and right, index-finger knuckle braced with left thumb. These combinations were great for detail work in the back and upper shoulders.

In this video I demonstrate some combinations:

The Rewards

There’s no doubt that it can be scary when you get injured. But if you can work around an injury there’s potential for multiple payoffs. For one, you’ll become more versatile with under-used tools. You’ll also begin to “create” and use new power tools in ways you never imagined before. Lastly, you’ll feel more confident in your ability to succeed in massage because despite being injured you will have gotten the job done without compromising the quality of your work.

Can you massage pain-free?

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If you struggle with pain around the neck and upper traps when doing massage, here’s one simple massage strategy that could help you out: sit down when you can.

Pain in the Trap Area

When the orthopedist diagnosed me with an unstable shoulder and cervical radiculopathy a while back, I knew I needed to change some things around or I would have to find a new career. At the time, pain symptoms kicked up in trap/levator scapulae area when I was doing detailed work and having to stand in one position for a long time.

Then one day I sat down to work the neck of a client who was prone. I rested my forearms on my knees and the pain in the trap/levator scapulae area practically went away. But as I pressed, the pain returned.

To me, this pain could be associated with muscular contraction of my neck and upper shoulders and/or a change in my shoulder/neck positioning. I wondered how I could take “contracting my shoulder and neck muscles” out of the equation when doing seated massage.

Over the course of the next year, I discovered the other piece of the puzzle: leaning.

Seated Leaning

I had become efficient with leaning to generate pressure when standing, but it didn’t cross my mind to lean when I was sitting and working. When I eventually did, the trap/levator scapulae area stopped acting up.

The hinge for leaning when seated is the waist. When you’re leaning from the waist, the weight of your torso will sustain the pressure. If you’re not leaning, your shoulder and arm muscles will be working hard to sustain the pressure.

Seated massage is ideal for doing prone cervical work. In this video, I break down the process into 3 steps: sit, support arms, and lean: Seated Massage Body Mechanics Video.

Sit and Work Using a Massage Tool

I would strongly recommend experimenting with a massage tool in the seated position. Specifically, I would choose to work with an L-bar because it has a longer shaft than the T-bar. The longer shaft will allow you to get into the cervical erectors easier.

When you use a massage tool like the L-bar while seated, you’ll be able to really focus your pressure because the end of the L-bar has a small surface area. This means that you’ll barely have to lean to generate appropriate pressure. I hardly feel like I’m working when I’m seated and leaning with my L-bar.

In this video–L-Bar Seated Massage Body Mechanics Video–I show how to sit, support, and lean when working the neck with an L-bar.

Create Your Own

There are many other ways that you could incorporate seated massage into your massage routine. Here I’m working the plantar side of the foot with my arms supported on my legs. From this position, I can easily get my pressure up to medium.

If I need deeper pressure, I would stand and support my arm and hand with my leg.

If you want to give your hands a break, try the same standing supported-arm technique with a T-bar.

It’s Not Hard

There is only one way to change how your body feels when doing massage and that is to experiment. If you’re having trap area problems, try doing some of your work seated.

In my book, the three most important steps for seated massage are:

1. Sit
2. Support
3. Lean

Once you get those down, think about adding “looking straight ahead”and you’ll put even less strain on your traps/neck.

Watch a Video Before You Start Your Next Client

For quick reference, here are the videos. They are short so that you can watch them during the time you allot for your client to get on the table.

Seated Massage Body Mechanics Video

L-Bar Seated Body Mechanics Video

Massage doesn’t have to hurt you. Keep experimenting. And if you need some help, let me know.

Can You Massage Pain-Free?

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