As a hands-on practitioner, your thumbs are precious, powerful and worth preserving.
Here are few principles of sustainable thumb use, gleaned from working with the more than 7,500 hands-on practitioners who have taken our Advanced Myofascial Techniques trainings.
The best way to use your thumbs is usually to use something else instead. The most sustainable thumb alternatives are bony projections such as your forearm, soft fist or knuckle. With practice and creative positioning, any of these tools can be as sensitive and as specific as your thumb.
Avoid thumb joint hyperextension at any of your thumb joints. If you’re already accustomed to it, thumb hyperextension may feel stable, but this stability relies on stretching your articular ligaments and joint capsules to their maximum length, which will cause them to slacken or become sensitized over time. This leads to less stability and eventual pain.
A neutral, aligned joint position is good; even better is to keep a small amount of flexion at each thumb joint. Engaging the powerful flexor muscles of your palm will support your thumb joints and ligaments.
If this positioning is not familiar, you may need to practice it gradually as you develop the necessary flexor strength. You do not actually need much strength, but you do need a little, and if you are not accustomed to working with slightly flexed thumb joints, the muscles involved may be weak at first.
Pain or discomfort in your own thumbs in not something to ignore. If your thumb or hand hurts when doing a technique, do it in a different way. This sounds obvious, but many of us forget about our own comfort when we are focused on that of our clients.
Some practitioners have found hand-held tools or thumb splints useful. I have not, but you might.
When using a hand-held tool, be sure that you are closely attuned to your client’s verbal and non-verbal signals, since you have less direct tactile feedback with a tool.
Save your thumbs for the few places where they excel and are truly irreplaceable. After several thumb injuries unrelated to bodywork, and after 35 years of manual therapy practice, I still use my thumbs quite comfortably (knock on wood) in a few areas.
In addition to the Thenar Eminence technique I use my thumbs for working the 1) iliolumbar ligaments; 2) knee (meniscal ligaments, infrapatellar fat pad, and patellar tendon); and 3) sacrotuberous ligaments—but hardly anywhere else. (See “Thumb Pain and the Therapist: Advanced Myofascial Techniques,” MASSAGE Magazine, August 2018; and “The Sacrotuberous Ligaments,” Chapter 12 in Advanced Myofascial Techniques.)
Use alternatives to your thumbs; avoid straining them—especially hyperextension—and save them for the times they’re most needed. Those are the best ways I have found to make thumbs last.
Excepted with permission from Advanced Myofascial Techniques, Volume 1, Chapter 12: The Thenar Eminence. Handspring Publishers, 2015.
Til Luchau is the author of the Advanced Myofascial Techniques DVDs and books (Handspring Publishing, 2016), a Certified Advanced Rolfer and lead instructor in the Advanced-Trainings.com faculty, which offers online learning and in-person seminars throughout the U.S. and abroad. Luchau is also a MASSAGE Magazine All Star, one of a group of body-therapy masters who have dedicated their lives to empowering and informing massage professionals. These innovative therapists and teachers are lined up to educate MASSAGE Magazine’s community of massage therapists by sharing their expertise in our print magazine, on our social media channels and on massagemag.com.