Body Part - Hands - Techniques

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Hi.

I envision a sticky for this thread in the future (and the other body part threads I'll start!), if this goes well.

We could utilize this sort of like the "Massage Pearls" thread. Anything you find interesting within the MassagePlanetL forums regarding a specific part body and the work surrounding it, could be parked in this thread. Obviously we may end up with some thoughts duplicated from the Massage Pearls, but who cares!!!! The more, the merrier!

In addition, if you'd just be interested in posting some neat techniques you do for this particular body part, that would be wonderful too!

Consider items like:

• Amount of time you generally spend on this body part.
• Amount of time you can spend on this body part.
• Techniques you may use to stretch out a massage while working this body part (example: you need to pass a few minutes to get back on track -- swedish therapists may really appreciate this info).
• How you incorporate other bodyparts at the same time when you are working this area (example: long strokes in working the hip with one hand and the posterior calf with the other -- in unison).
• Techniques for specific problems or patterns.
• Draping/loose draping/non-draping information - the why & why-nots associated with this area.
• Tell us something that just feels good!
• Types of lotions/oils you would use for the technique and why.
• How to perform deeper work or lighter work in the region.
• Case Study Examples from your practice.
• Bonus thoughts that you may have that would be helpful to new and old therapists alike!

Without further ado .... it's all about the hands!!!!

 

[michele_cat_cyprus]

I see some clients that have a variety of hand problems, arthritis and thumb injuries being the most common complaints. Some clients have asked me to spend the entire session working only on their hands, and I am happy to do so.

With thumb pain, the obvious thing is to work adductor pollicis, particularly the meaty part found in the "web" between the thumb and index finger. But I rarely find this to be the most productive place to work. I get better results from working very close to the saddle joint, with pressure directed to the lateral aspect of the 2nd metacarpal. Sometimes it is necessary to move the position of the thumb to apply pressure at different angles to the bone. Working multiple angles is often more effective than just one.

This basic approach applies to working all of the interossei of the hand. Many cases of hand/wrist pain have been alleviated by working the interossei. Relative tightness can be assessed simply by shifting the metacarpals and noting which have "play" and which do not. I often find the most tenderness at the proximal attachments.

The techniques I employ most frequently for these muscles are NMT-style trigger point work, some cross fiber friction, positional release, compression, and some active isolated stretching. If I am being thorough, it's easy to spend 15-30 minutes per hand and still feel like there's more to be done.

Arthritis is a trickier problem. I haven't found much good material on bodywork for arthritis of the hands, and what I have found is usually little more than gentle Swedish (I am searching for anatomy and physiology-based approaches). I am studying the problem and have been developing a completely different approach that seems to provide some lasting benefits. Several of my clients have osteoarthritis of the hands at different seforum.xxxes of severity, and they've been open to letting me try out some ideas.

The first practical problem with my new approach to manual treatment of arthritis is that it is time-intensive. It takes at least 20 minutes per hand, more if the condition is severe or in a flareup. I've been comparing notes with some PTs and chiros, and so far they've all told me it's probably always going to be slow work.

The second (and biggest) practical problem with my approach to manual treatment of arthritis is that it requires serious grip endurance on the part of the therapist. Not so much strength, but endurance. This is due to the very specific grips that seem to be most effective while also being the most comfortable for the client. I have some ideas about how to overcome these problems later, but for now I am focusing on refining application of the method.

Regular clients that have received this arthritis work all report:

• improved circulation with better color throughout the hand
  increased ROM
  decreased pain
  more grip strength and endurance
  better sleep at night (not waking up with arthritis pain)
  fewer and less intense flareups
  better hand coordination for daily tasks

But the results could be better. I don't yet know the limits of what may be accomplished.

I am curious to learn more about existing approaches to manual treatment of arthritis of the hands. My method still needs a lot of refinement and testing, and I hope to learn some things that will make it more efficient and effective.

 

[Bittersweet]

Here are a few ideas.

Take a minute to brush up on the anatomy (not only the hand, but the writst and forearm). I found this Human Anatomy Learning Web Site - Dartmouth Medical School
that may be of interest to you.

The neat thing about these particular models is that they are "drawn muscular threads", instead of "the" muscles, so you can get a really good pic of where things are going to in the extremity. I think you'll like it.

So, when you get into your massage, since you have a full 60 mins. That is 30 mins for each hand/wrist/arm. I would think you could address everything below the elbow specifically, but since she's more interested in hand, keep the majority of the time to the hand, working up toward the elbowintermittently, but when finishing, sweep the entire arm up into the shoulder/neck with one long move, to "pull it together". Of course, that is unless she only wants hand and no extra. The nice thing about addressing her hands in this fashion (in case she wants a "why"), would be that the extremity can be looked at as an entire entity coming off of the body, it will only take 10 seconds to do the long sweep, and also that the forearm muscles actually end up attached in the hand.

For more specific moves: you could try slow, moderate/firm to deep work for each individual muscle, and don't fortget those fingers. I work the fingers individually each between my thumb and 2nd & 3rd digit. However, I had a friend show me a nice little move that feels good in which you bend your 2nd & 3rd digit (index and middle finger) at the PIP joints and then wrap these two fingers around one of the clients fingers and pull from the inside out to the tip of the finger very slowly. At the end of the move you let your fingers pull off of the clients finger rapidly. Sometimes it makes a little "air popping" sound as your fingers come off of the clients. That may be something you'd like!

If this isn't what your looking for, I'll try to give some more ideas.

I think you could easily do twenty mins per hand/wrist/arm, along with about 5-10 mins of parrafin dip for each hand if you move slow. And thirty per should work out just fine if you stay very specific. Being specific will also hopefully *winks* keep you from getting bored.

 

[John F]

Client with "safe zone" being her hands:

I like to push the edge a bit and incorporate different elements of massage as well as visual, textures, sounds specific to what I'm trying to bring about in the session. For her, this is all about relaxation and her safe zone is her hands so I'm working a special treatment designed for her needs.

maybe you could put a hot stone in the palms of her hands while she is laying face down. also, i like to work the hands and forearms while the client is both prone and supine. it's a totally different sensation working both ways. in fact, i mostly enjoy the work while laying prone and most therapists do not work the arms/hands this way. also, maybe when you turn her supine towards the end of her massage you could use some cold marble stones to finish up.

If it is textures you are looking for, something like this may also be helpful, to run up and down each finger and into the palms and wrists. Small and simple, but you never know:
Thumb - Ease Massager

And here is a "figit":
Figit for your digit - Finger Massager

I also found this site, that may be of help (has pictures):
Giving and receiving a simple hand massage

A few tips off another google search.... pretty simplified, but it may have something in it that you don't do, or that spark a thought:

Hands:
Massage Steps:
1.Sandwich your partners hand between your own for a few seconds.Using your thumbs, massage the palm of the hand.
2.Massage the back of the hand, working in between the bones to help release any tension.Do not press too hard.
3.Massage each ofthe fingers and the thumb in turn, squeezing, rotating, and pulling them gently.
4.Using light strokes, draw your hands down your partner's arm, down the hand, and off at the fingertips.This finishes the hand massage.
5.Move round to the opposite side of your partner.Now repeat every seforum.xxxe of the arm and hand sequence for this side of the body.

Another site offers these ideas:

Hand Massage

Gently press and massage the back of the right hand with the fingers of the left hand, placing the left thumb on the right palm and massaging between the tendons of all the fingers. Don't forget the area between each finger. Also massage the soft area on the palm below the thumb and below each knuckle.

Press and massage the tips of the thumb and each finger. Then work on the first joint of the thumb and each finger by pressing on the bottom with the thumb and on the top with the first finger and gently pull forward for a few seconds. Then massage along the sides of the thumb and each finger.

The wrists also require care. Place fingers on top of the wrist with thumb below and gently press and massage. The sides of the wrist should be attended to.

This information is from a pdf I found:

Hand Massage
from Trauma Healing and Transformation, Chapter 4, p. 150-151
—Patricia Mathes Cane, Ph.D.

Hand Massage and Reflexology

The hands, wrists, and arms can hold much tension and pain, especially if a person works a lot with their hands. With five to ten minutes of hand massage you can relax a person and relieve pain in the body. There are many acupressure and reflexology points that affect internal organs and different parts of the body. Massaging hands, fingers, and joints can
relieve many problems, including poor circulation and arthritis. If a person feels anguish or stress, you can give them healing care without any words. Hand massage can be done with people of all ages and conditions—children, teens, adults, the elderly, the sick or dying—
anywhere and with or without lotion. Soft music may be used during the massage. Often when I work with large groups we will do hand massage in silence so that participants can learn quality of presence and how to communicate without words. In some bi-lingual workshops
where people don’t know each other’s language, the hand massage is a wonderful way to get to know someone without words.

Directions for a Hand Massage
• Place one hand of the person between your hands to create a connection and to peacefully center yourself. At this point you can apply lotion to the first hand, if desired.
• Open the palm of the person’s hand, gently pressing the palm and stretching the muscles of the hand. Press the reflexology points covering the entire palm.
• Massage the muscles and tendons between the bones of the hand. Support the wrist with your palm. Work from the wrists toward the fingertips. Massage the upper part of the hand.
• Massage each finger and each joint visualizing the tension pouring out of the fingertips.
• Massage the muscles around the wrist and forearm.
• Massage the upper part of the arm moving towards the elbows.
• Brush off any static energy that remains in the hand and arm.
• To finish, place the person’s hand between your hands and visualize warm light and energy entering the person, giving them what they need at the moment.
• Do the same procedure with the other hand.


Resources for Further Study

Books
Byers, D. Better Health With Reflexology. Ingham Publishing, 1983.
Davis, Eshelman, McKay. The Relaxation and Stress Reduction Workbook. Oakland,CA: New Harbinger, 1988.

Kirsta, A. The Book of Stress Survival. NY: Simon and Shuster, 1986.

Krieger, D. Accepting Your Power to Heal. New Mexico: Bear & Co. 1993.
Kunz, The Complete Guide to Reflexology. Reflexology Research Project, 1981.

Lidell, L. The Book of Massage. NY: Simon and Shuster, 1984.
Moneforum.xxxue, A. Touching. NY: Harper and Row, 1987.

Rick, S. The Reflexology Workout. NY: Harmony Books, 1986.

Massage Magazine

American Massage Therapy Journal

Music: For Massage
Baroque at Bathtime, Phillips.
Celtic Quilt, Kobialka, Lisem.
Streams of Dreams, Michael Maxwell, Dan Gibson, Solitudes, Inc.
Path of the Heart, Max Highstein, Desert Heart Recordings.
Reiki, Merlin’s Magic,
The Poet, Michael Hoppé, Martin Tilman, Teldec Classics International.
Afterglow, Michael Hoppé, Martin Tilman, Tim Wheater, Hearts of Space.
When It’s Time for Letting Go: Music to Heal the Heart, Serenity.
Inner Light, Anjali Quartet, Sri Rama Publishers.
Drums, Geoff Johns, Sounds True Recordings.

Contacts:
American Massage Therapy Association, 820 Davis St, Suite 100. Evanston, IL 60201 708-864-0123

Associated Bodywork & Massage Professionals, PO Box 1869, Evergreen, C) 80439 1-800-862-7724

American Reflexology Certification Board & Information Center, PO Box 246654, Sacramento, CA 95824 916-455-5381

And one last site which is for a special glove (not something you'll probably need, but who knows!), but it does have some nice "exercises" on the page, that you may be able to incorporate into the "sensation" portion of the massage. It has pictures, if you scroll down. Exercises/Movement: Clench and Fan; Thumb Stretch; Wrist Stretch and Wrist Circles.


If you are into "singing bowls", you may want to have her do something like that during the session. I found this site about them while searching for something else.

Quartz crystal singing bowls work on the same principle. With the bowls, you use a suede-covered mallet, instead of your finger. You circle this mallet around the outside rim of the bowl, and an enchanting sound begins almost immediately. This tone continues to resonate long after you stop circling with the mallet.

Can you do dry brushing with a natural bristle brush or exfoliating gloves? It's too bad you can't do a scrub, but this might be an alternative. I think an exfoliating treatment would be lovely then paraffin and a massage.

I had one other idea in the middle of the night that may be a nice "finisher" for the hand massage.

If you have a choclatier or nice bakery around that makes individual items - something like this (I looked up Wisconsin for you *winks*):

Candinas Chocolates

- or a pastry shop (I coldn't find one with pictures). You could place a box of 2 candies or an individually wrapped tart into her hand when you are done and leave the room.

Or, if you have fresh flowers, maybe snip off the stem of a gerber daisy or carnation and slip it between two fingers, closest to the knuckles where the fingers meet, as a different sensation.

Last, and I know this is starting to get out on a limb... I wonder what you could do creatively with a scarf, maybe twisting it and sliding it betweeen the fingers. Just a few more tactile thoughts there.

I was sort of thinking essential oils which are good for boosting the circulation...

I love to incorporate texture and I already have a really soft fluffy piece of material to gently cuddle each hand as I finish it.

I think it helps us grow as therapists to "think outside the massage routine" to send people to new heights and give them a very customized beautiful treatment. I always use scarves or very soft satin or fur type material in massage sessions. It deeply relaxes them, makes them feel secure and cared for in a nurturing professional way. I explain before hand how I'll be using different textures just for the joy and feel of it. My clients love it!

I was thinking two different tracks actually as far as aromatherapy goes... the first one being circulation... and perhaps using something like cypress, sandalwood, lemon or lime. The second being a prelude to your work with the flower... thus being floral based... perhaps using geranium, patchouli, ylang ylang or rose essential oils. Of course what you use will depend on what you have available or have access to.
When I worked at the salon I always carried a geranium/patchouli massage oil blend for my female clients with dry skin in the winter... it always made their skin velvety soft! And of course, they smelled great too.

Sometimes having a theme can really inspire you I think... I am sure that you'll come up with lots of cool things to do.

You said you couldn't use soaks, scrubs or masks, but you could perhaps lightly buff her dry skin with a dry washcloth or hand towel... it gently exfoliates and gets her circulation going and would prepare your client for the next step.

I guess I think a hot stone massage for her arms and hands would be great. It would warm everything up and allow for your deeper more detailed work.

When we did the hot stone massage work on the forearm at the Gaia's Touch course I took we used iced stones as well... yep we put them in a bowl of ice water - you could stick a flower in there too! And you take a iced stone in one hand and a hot stone in the other and use them to do contrast work on the forearm. You can then park the cold stone on areas where there is soreness... and you can park the warm stone in the palm of her hand... and you can tuck small stones between each finger and swaddle the whole hand in that soft fabric you have to allow the heat to sink deep into the joints of her fingers. Don't forget you can place stones under her forearms to support and warm them as well while you work on the other arm...

When you mix in the aromatherapy is up to you of course, I think there are many places where you could add it in. A drop or two of lemon in the water of the cold stones? A couple more essential oils could be used with carrier oil to do your actual massage...

Honestly this sounds like it could be a really great idea lovely_day, sure you could use this hand massage idea for holidays like V-day and Mother's Day... but just think of all the secretaries, musicians and people who work on computers all day who have fears of getting CTS... this could be a lovely treat for them as well!

Don't forget to pick out special music that "enhances" this massage as well for you... be it something classical and romantic or relaxing and new age... but I'd use it to create a "total package"... (They're not going to hear that same CD every time they come to get a massage from you...)

I think I understand where you are coming from lovely_day, you want to do your best to engage all the client's senses... and to truely create a healing "experience" for them. It sounds delightful!