Here are some thoughts about arms and hands for those of us who work with our arms and hands.
Our work shapes our hands, for sure. When I was young, I had slim hands with long, thin piano fingers, as someone called them. While studying under Ida Rolf, PhD, I soon built shorter, thicker, and stronger fingers from all the heavy fascial work we did back then. (I am more delicate with my hands now, yet I get more done. But my increasingly elderly hands are still very much shaped by my 45 years in bodywork, sure enough.)
Just as surely, though, our hands have shaped our brain. We are not the only animal to use tools or to vocalize—birds and whales rival Mozart and Brahms. But our sophisticated use of symbol-rich language developed in tandem with our uniquely human hand.
How your brain makes sense of your universe is dependent on your language structures, and our language takes much of its shape from how our hands interact with the world.
“Jim gave Gloria the bracelet to look at.” Would dolphins—highly intelligent but with flippers instead of hands—construct their grammar in this way—noun, verb, object? I very much doubt it. What our hands do and how our minds think are inextricably entwined. Only an octopus tentacle or an elephant’s trunk can come close to a hand, and both of these sensitive limbs have helped shape the awesome intelligence of those creatures, as our hand has shaped ours.
About 6 million years back, according to anthropology, we reared up on hind legs. When we took the weight off our forefeet, we created a limb no longer used for weight-bearing—neither on the ground nor swinging through the trees
Tyrannosaurus Rex similarly swung himself up on his hindquarters—but ended up with tiny forelimbs of little apparent utility.
We humans, however, took another evolutionary path that turned our upper limb toward multiple uses that have in turn shaped our human experience.
Human forelimbs, taking the same basic bone configuration as the leg, adapted themselves away from being either a weight-bearer or a mover to being almost exclusively for interacting with external objects (including, for instance, our clients).
It was a gradual change—a squirrel, a raccoon, or even a dog will use its ‘hands’ for digging or holding food when it is not covering ground. Baboons have been observed throwing rocks at their predators. Our unique shoulder and hand, however, have made us such masters at throwing that we regularly throw things all the way to other planets with stunning accuracy.
We will look at the shoulder’s uniqueness briefly here, but it is our hand that makes the miracles of juggling, surgery, cello playing and wrenches on lug nuts possible.
Get a Grip
Specifically, the human hand is capable of several kinds of grip unknown to elephants, octopi, or even our closest relatives. Most of these are variations of two types of grip.
The opposable thumb allowed us to form a chuck between the thumb , index and middle finger (sometimes supported by four and five) to hold objects at a specific spot and angle—this is the precision grip. We use the precision grip when we thread a needle or write, or hold a nail.
The power grip (the hand that holds the hammer) is also dependent on the thumb to provide the opposing pressure to press the handle into the palm. Gripping most tools with only the four fingers is a frustrating experience.
Get that thumb in there, however, and the human hand is an incredibly versatile instrument. From using a club to plucking out a thorn, our hands have made us at once the most delicate, capable, and most dangerous of primates.
Consider for a moment what your hand gets up to before you even go to work. It might be a general swipe to get the covers back, but then a precise finger comes over to hit the snooze button. Watch the next time you put on your underwear—what complicated choreography goes on in your fingers! By the time you’ve brushed your teeth, turned on the stove, hooked the handle of your cup and tied your trainers, your hands have adapted a hundred different ways to adjust your environment in your favor.
And when you get to your studio, of course, your hands are your eyes into the body. A rich and complex wash of heat, fluidity, texture and vibration comes through our hand and up our arms, which we in turn shape into subtle shifts in our own pressure, speed and angle to release restrictions.
We are back to the beginning: You shape your hands and your hands shape you.
As an example of how your hand lives in your mind, consider your signature on a check. Up until just a few decades ago, we believed that when a hand moves to write a signature, what we call muscle memory is your brain and spinal cord reassembling in order all the kinesthetic signals from those muscle spindles and Golgi Tendon Organs. When a signature is needed, the brain dials up that same signal series as a musical score that runs out through the muscles again when our signature is required.
It turns out to be more complicated than that. Imagine writing your signature on a big blackboard— you would not use the same muscles to do a large signature that you would on a check, but it will be recognizably your signature just the same. So your signature exists as an independent pattern in your head.
Hmmm … so even though your signature started from the small play of muscles, it becomes its own thing and can be played out over other muscles and still keep the pattern. Imagine tromping out your signature on the beach—can you feel it? It’s still your signature. This is one example of the way your brain learns throwing from your hand and then extrapolates to throw things at Mars.
An Arm and a Leg
As bodyworkers, we all work other people’s shoulders a lot. But sometimes (in my experience as a client) we are bit more pro forma when we leave the shoulder for the lower arm and hand. Let us work our way down, then, between the shoulder and the hand, considering how both we and our clients use it, and how we might work it to our and their advantage.
First, it is useful to compare the arm and the leg. They are constructed on similar lines, but the leg pulls the design toward stability, while the arm leans toward mobility. They both begin with an assembly to attach a ball-and-socket joint to the axial (fish) skeleton.
The hip attaches to the spine at the sacroiliac joint, and from the top of the foot it is a straight shot from tibia to femur to ilium to spine. The shoulder, by contrast, has a more complicated journey: It attaches to the sternum via the collarbone and then dances around back through the scapula to get to the humerus. We’ll talk about another dance in the lower arm before it gets to the wrist to support the hand.
It’s worthwhile noting that both your arm and your leg has a 1, 2, 3, 4, 5 arrangement in the bones:
|Scaphoid, Lunate, Triquetrum*
|Talus, Calcaneus, Navicular
|Trapezium, Trapezoid, Hamate, Capitate
|Cuneiforms 1, 2, 3, Cuboid
Each tier of movement leads into and supports the next tier. Both start with a ball-and-socket joint before the one bone, both have a hinge joint in the middle.
Both the leg and the arm are a miracle of design, but the subtle differences make for radically different function. The two bones in the lower arm rotate over each other, the leg bones will not do that. The wrist is mobile in several dimensions; while the ankle is much more constrained.
The Mobile Shoulder
Our shoulder has undergone unique evolutionary development since our ancestors swung gracefully through the trees. These changes allow the shoulder to throw with great force and accuracy.
Since our shoulder is so mobile and hangs off our spine similarly to a pub sign, it requires many muscles to strap it down.
Chief among these are the rhomboid-serratus anterior sling, and the cinching over the top of the trapezius—pectoralis minor sling (We have written extensively on the shoulder elsewhere—see Anatomy Trains, 4th ed., Elsevier 2020—here we want to concentrate on the upper and lower arm.)
The Arm Takes Wing
If we look at the muscles and fascia that arrange themselves around these 15 bones in the arm, it is easiest to see them arranged from core to extremity, with four lines of myofascia corresponding to the four sides of a bird’s wing:
The top of the wing is called the Superficial Back Arm Line, and this myofascial continuity starts with the trapezius and deltoid, running down the outside of the arm and the back of the forearm to the fingernails.
The bottom of the wing is the Superficial Front Arm Line, which travels from the powerful pectoralis major and latissimus dorsi down the front of the arm to the palm and fingers.
The front of the wing is the Deep Front Arm Line, running from the pectoralis minor via the biceps to the thumb.
The trailing edge of the wing parallels the Deep Back Arm Line, which includes the rhomboids, rotator cuff, and triceps, ending up at the little finger side.
Generally speaking, the two superficial lines provide the power to the arm in throwing, swimming, etc., and the two deep arm lines provide stability and refinement to the movement.
Understanding the lines offers insights into mobility and stability in our arms—and performance issues as well as shoulder and neck pain. Individual muscles are at work within the myofascial continuities of course, so let us examine some of the most salient to massage work.
Explore more about the arm lines at Anatomy Trains.
A Call to Arms
Leaving aside the rotator cuff and the scapular stability/mobility equation for another discussion, we turn our attention to the upper arm. Our clients mostly concern themselves with the size of their guns on the flexor side, or lament the floppiness of their triceps on the underside.
The floppy triceps needs exercise, no doubt about it—planks or push-ups or moving iron overhead is required. Loosening up the triceps is not often what is needed by our clients. As bodyworkers, though, we can assist the client in readying the triceps for the loading work by easing the fascia close to the humerus deep to the triceps.
Place the client’s hand near their head as if they were about to push up into a wheel, a backbend. Ideally, the palm is face down and the thumb near the ear, with their fingers pointing to the feet. (Stiff Rolfer that I am, I am unable to get my hands comfortably into this position, so with people like me, get as close as you can—maybe the fingers point out, maybe the heel of the hand is not fully grounded—no worries.)
Now stand at the table’s head and get your six fingertips into the insertion of triceps at the elbow. Sink through the layers (often not difficult) close to the bone—you will feel a dense layer in these folks close to the humerus. Ease, melt, scrape, hydrate this layer near the bone, moving toward the armpit (but not getting that far) as they move their elbow into your pressure. Then send them off to the gym or vinyasa and they will build their triceps more easily and consistently.
On the other side are the flexors, notably the biceps, but also the two underlying muscles—coracobrachialis and brachialis. You would never know it from all the curls the gym rats are doing, but the upper arm is primarily concerned with elbow stability. Curls may make it look great on a bodybuilder, but how often do you lift your groceries or a child to your chest in this way? A curl is not how our biceps generally function.
Watch your arms while you are doing massage, doing yoga inversions, or using almost any tool. Are your elbows bending in and out? No. There might be a little flexion and extension in the elbow as you work, but the power comes through the elbow, not from the elbow.
Your upper arm muscles, while certainly capable of curls and triceps extensions, tense mostly for stability, not power or range, as curl training implies. A boxing jab punch is an exception, relying on the triceps for power.
So while I work with both heads (and both feet as well) of the biceps, especially if it has been injured, my upper arm work more often reaches beneath to the brachialis and coracobrachialis.
Release the Brachialis
The brachialis is likewise close to the bone and likes to be scraped off of it before a workout. It can then expand and push the biceps up, a happy result for the body builder.
For those with chronically flexed elbows, releasing the brachialis is often more effective than anything you can do with the biceps.
• With the client supine and the palm up, have them flex the elbow and then you press finger or thumb-tips into the brachialis near the elbow on either side of the biceps tendon (Fig 7).
• With full but comfortable pressure, have them straighten the elbow back to the table, stretching the brachialis out from under your fingertips.
The coracobrachialis is particularly active in those where—observed in standing—the elbow is closer to the body than the wrist. This is a defensive and weak position, and the coracobrachialis—the adductor magnus of the arm—is nearly solely responsible.
Can the following technique improve confidence in the client? I believe so, but whether that is right or not, you can definitely help resolve the body portion of a somato-emotional pattern.
Release the Coracobrachialis
With the client seated at the edge of the table so the arm hangs free, put your hand palm out into the armpit. Have them press their elbow against their side to pop the coracobrachialis under your fingers—just anterior to the nerves of the brachial plexus (Fig 8).
Having located it, you can release the muscle down, toward the elbow, as the client rotates the shoulder in and abducts the elbow a bit. Repeat as necessary.
Open the Fascial Walls
The biceps and triceps are part of the Deep Front and Deep Back Arm Lines respectively. Interestingly, the Superficial Front and Back Arm Lines have no muscles in the upper arm, and are instead represented fascially by the two walls (septa) that separate the biceps and triceps.
• Palpate just proximal to the two epicondyles of your humerus and you might be able feel these fascial walls. On the outside/backside it is sometimes hard to discern, but on the inside you can often feel it as a guitar string just north of the epicondyle between the biceps and triceps tendons.
This fascial string can sometimes inhibit shoulder extension and abduction, and is worth opening in those cases.
• Turning to the forearm, below these epicondyles the muscles open up into the numerous flexors and extensors that control the wrists and fingers. Just distal to the bone, many muscles are seeking attachment, and in those with complex hand movements like musicians, these attachment sites need a ton of combing out—both extensors and flexors, or sometimes I do them both at once—while the client takes the hand in a circle to move the muscles below my hand and give me an ‘eye’ into what I am doing.
The V in the Forearm
An important spot is where the biceps attaches into the radius. Hold one hand against your belly, and trace down the biceps tendon—you will follow it in toward its attachment on the radial tuberosity. Pronate and supinate to feel it move.
Now swing your lower arm away from you, into lateral humeral rotation, and track that tendon again. The bicipital aponeurosis (sometimes called the tendon of Lacertus) will surprise you by leading you into the flexor group in the lower arm. This tendon is seldom shown accurately, and often not shown at all. People who regularly carry heavy loads will often need easing work here.
Now bring your arm medially, and again put your finger down the ‘hole’ where the biceps tendon goes. There are muscles on either side of the V-shaped opening. Now turn your thumb in and out (pronate and supinate) strongly, to the ends of the movement. You will feel one and then the other of the two muscles on either side, the pronator teres and supinator, forming a V that reaches halfway down the radius.
So if someone is strongly pronated or supinated in the relaxed position, one of these might draw your attention.
Going back to the whole grip idea, these muscles are a big help with aim. As you can see and feel, these muscles are controlling the angle of your thumb. Play with it—this has a lot to do with your accuracy and spin with a spear, ball, rock, or even a bow and arrow.
Untangling the Forearm
Returning to the flexors and extensors outside these muscles, the ones all coming off the attachment at the epicondyles, it is confusing to the beginner to wtry to parse these muscles out. Allow me to help.
One concept from Anatomy Trains is the idea of expresses and locals—expresses being myofascial units (muscles) that cross multiple joints, and locals being muscles that cross fewer or only one joint.
For instance, we just looked at the upper arm. The biceps is an express muscle, crossing both shoulder and elbow (and the radio-ulnar joint too, for that matter; the biceps helps the supinator).
The coracobrachialis is deep under the biceps, and crosses only the shoulder joint. Brachialis is also a one-joint muscle, a local crossing only the elbow joint. The triceps is the only muscle on the back of the arm, and two of its heads are locals, crossing only the elbow, while the long head crosses the shoulder as well.
The more surface express muscles are designed to coordinate joint movement across multiple joints seamlessly, while the underlying locals are more joint stabilisers, and thus more responsible for our resting posture. This statement generally holds true for the spine, shoulder, hip, upper arm and thigh.
Interestingly, it reverses in the lower arm and lower leg. In the leg, the muscles that control the ankle are more superficial while the ones that control the toes are the deepest. Same in your lower arm: The muscles controlling the wrist are on the surface, and those that reach to the fingers are very deep.
This allows us to reach into the lower arm in three ways.
First, working around the epicondyles themselves, both the flexors and extensors that come in to either one. Teasing, melting, combing, releasing—whatever word you want to use, the tissue near the condyles almost always benefits from our slow and careful attention—especially on the extensor side, I found to my surprise. For those with lower arm achiness or dysfunction, detailed and picky work around the epicondyles is often called for.
Once the picky work is done, finish with an integrating move:
• With the client supine and arm palm down on the table, put one loose fist on the anterior deltoid, and the other right at or just distal to the lateral epicondyle.
• Begin moving (sorry, but plowing works) the tissue down the arm. Because the upper and lower arm are about the same length, your upper hand will meet the elbow as the lower hand gets to the wrist.
• The client moves their elbow a couple of inches in and out as you make the pass.
This is a great technique for integrating the arm, and people will often comment on the way the arm rests on the ground.
Second, pay attention to the angle of the wrist. It is capable of going from flexion to hyperextension, but where does it rest? As a relaxed extension of the forearm, or held curled in flexion or anxiously in extension?
The wrist is also capable of radial and ulnar deviation, as in waving bye-‘bye. You can increase range of motion, but the other question is where it rests. Few rest in radial deviation, but ulnar deviation is more common, especially among massage therapists, because that is the way the hands naturally approach the curved surfaces of the body.
Now, these superficial muscles in the forearm that control wrist position all come from these epicondyles, and are conveniently attached to the four corners of the wrist.
Obviously, release the flexors if the wrist is flexed and vice versa.
Ulnar or radial deviation can be dealt with by easing tissue of either the two inside (radial) muscles or, because ulnar deviation is way more common, the two outside (ulnar) muscles.
• Make a loose fist and put one knuckle on either side of the ulna near the elbow.
• Work the tissue deeply and slowly toward the wrist, easing the tissue near the bone and dissolving all the “pop” you feel.
• As you go, the client brings their hand in sideways toward the thumb, away from your work, repeating as necessary.
Third, for those who use their fingers in very complex ways—musicians and machinists—you can delve down into the deep muscles that control the fingers.
On to the Hands
It is amazing, given their complexity, that we do not have more troubles in the arm and hand. There are two related reasons for this:
1) There are more nerves, and therefore more feedback, than in most places in the body and;
2) we use our hands so much every day that they stay organized. What you don’t use is what you lose.
Nevertheless, even more felt sense and coordination can come from unearthing these muscles deep in the forearm close to the interosseous membrane. These are the finger flexors and extensors that head through the carpal tunnel. They are the very eyes of the hand, and can awaken new feelings in those who use their hands for art.
For the same reasons, the hand has fewer problems, and you have likely been taught how to spread open the flexor retinaculum over the carpal tunnel, and to open the palm via the thenar and hypothenar muscles that sit at the base of the thumb and little finger.
It is also worthwhile checking out the position of their capitate bone, which is the pelvis of the hand. Often this bone will pop to good effect when you open the palm or wrist.
Even though our arms work so well, we cannot afford to just wave at them as we go by in our sessions.
I hope this discussion of some of the issues you will encounter is helpful. It is those suffering clients with odd and inexplicable symptoms that lead to yet more study of the intricate detail and wonderful invention hidden in the uniquely human arm and hand.
About the Author:
Thomas Myers is the author of “Anatomy Trains”(Elsevier 4th ed 2020) and co-author of “Fascial Release for Structural Balance” (North Atlantic Books, 2nd ed 2017). A frequent speaker, Tom has penned many articles and online learning programs on structural anatomy, assessing the fascial network, and applying manual therapy. Myers and his faculty offer continuing education for a variety of manual therapists worldwide, and professional certification in Anatomy Trains Structural Integration.