Elbows are one of the best sensory motor tools we have to apply deep tissue massage and bodywork. Some practitioners will use their elbow the same way, all the time, which is not best use of an elbow.

Elbows are one of the best sensory motor tools we have to apply deep tissue massage and bodywork. Some practitioners will use their elbow the same way, all the time, which is not best use of an elbow.

Elbows should be used when a practitioner is tempted to use their thumbs or fingers to apply direct pressure into a client’s soft tissue. Thumbs and fingers were made for holding and oppositional squeezing and grasping. Using your thumbs and fingers to apply direct pressure into a client’s soft tissue is an inefficient and possibly damaging use of your digits.

Elbows can be used at various angles, entry points and applications to provide an enhanced deep tissue treatment. The two most common and extreme opposites of elbow insertion points are the dull and pointy elbow.

The Pointy Elbow

To apply a pointy elbow, simply flex your elbow to around 150 degrees, so that your knuckles are facing your head. When you flex your elbow to 150 degrees, you will create a sharp point with your elbow’s olecranon process. We call this a pointy elbow, and sometimes we call it sharpening your elbow or tool.

You can use a pointy elbow to break down scar tissue, strip muscles and apply direct static compression bodywork for modalities such as acupressure and trigger point therapy. Your pointy elbow can be applied to a specific and small area of fascia or muscle fibers to pull, stretch, compress or cross fiber soft tissue adhesions and more.

The Dull Elbow

Dull elbows are flexed at around a 90-degree angle and they’re great for general muscle tension relief. Dull elbow application usually achieves greater amounts of applied pressure than a pointy elbow. Dull elbows are a great tool for working larger areas, such as the glutes or thoracolumbar fascia, without causing the discomfort a pointy elbow might achieve because it is dull.

Dull elbows are a great alternative when clients say it feels like too much pressure with a pointy elbow. The fact is, it might not be the pressure that is causing the discomfort. It might simply be that the client does not like the feeling of a pointy elbow, but they might enjoy or tolerate greater pressure with a dull elbow.

Muscles can be stripped with a dull elbow similar to a pointy elbow. We consider stripping strokes to be when a practitioner applies traveling parallel pressure alongside or on top of a muscle. Stripping muscles with a dull elbow usually feels less intensive to the client, so a greater amount of pressure or a broader stretch may be achieved with a dull elbow.

Dull elbows can do almost anything that a pointy elbow can. But, a dull elbow cannot always articulate the precise pinpoint pressure that a pointy elbow delivers given the practitioner’s ulna is usually engaged and starts to contact the client’s soft tissue when greater pressure is applied.

Using Dull and Pointy Elbows in Deep Tissue Massage

Changing elbow dullness or pointiness simply creates different insertion points and application tools for deep tissue techniques. It is important to be able to use your elbow in various applications and methods to achieve specific goals.

Providing deep tissue application to a first-time client may see better and quicker success by introducing a dull elbow first. A dull elbow can feel less invasive than a pointy elbow. Once the client becomes acclimated to the deep pressure that can be achieved with a dull elbow, the practitioner can then vary their treatment between a dull or pointy elbow as needed with each new treatment area and technique.

Practitioners might start stripping a muscle first with a dull elbow, and once the intensity has diminished, they can strip the same muscle again with a pointy elbow to generate a whole new level of intensity.

When applying static pressure with a dull or pointy elbow, a practitioner can also flex and extend their arm or supinate and pronate their hand while maintaining their pressure and placement. This slow back-and-forth hand rotation and arm flexion/extension can create a distracting, grinding feeling that might be effective when working in a small and specific area.

The #1 & #2 Blunders When Using Elbows in Deep Tissue Application

Believe it or not, one of the biggest problems a practitioner encounters when using their elbows is in their hands! When using a dull or pointy elbow, observe your hands.

Blunder #1: Your Hand!

Are you making a fist atop of the elbow that is applying pressure? Some therapists make a fist in the air and squeeze it as hard as they can while applying elbow pressure into a client’s tissue. Relax your hand and allow your wrist to flex and flop when applying pressure with your elbow.

A practitioner should use proper body mechanics with their body weight to lean their elbow into a client’s soft tissue. Squeezing a fist or straining your wrist is improper use of your arm and does not help anything, but it’s the number one dysfunction that happens when using elbows, especially given most practitioners do not realize they are doing it.

Blunder #2: Your Other Hand!

The practitioner’s second hand is also often misplaced. Some practitioners will use their second hand to hold up the massage table, or place it behind their back like a restaurant waiter and sometimes they will even use it to scroll through their phone or text during the appointment. We consider all of these to be incorrect applications of your second hand.

We prefer practitioners to use their second hand as a “mother hand.” Place your second hand next to your elbow to guide the application. Practitioners will be more perceptive to tissue changes when the second hand is next to the elbow sensing soft tissue changes. If you are unable to place your hand next to your elbow, then place your second hand somewhere on the client’s body so that they can feel and receive your full presence.

Special note: There are some maneuvers and applications that involve using two elbows at the same time. Hand position requirements can change when providing dual elbow application.

Improving Deep Tissue Elbow Application

Keep your upper arm close to your trunk when using elbows for better stability and pressure. Do not allow your clothing to touch the client while keeping your elbow close to you. If your clothing touches the client then it is contaminated and the contaminated clothing should be changed prior to working on the next client.

Elbow pressure should start off slow and continue to slowly increase with deliberate intention until the client’s wishes are satisfied, or unless further pressure could be harmful . Applying too much pressure too quickly will often overstimulate the nervous system which could result in ticklish, painful or other undesirable feelings to the client.

It is not advised to apply elbow pressure into client’s bone or a joint. This could be misuse of your elbow and an inappropriate or painful application to the client.

Summary for Using Your Elbows for Deeper Bodywork

Some practitioners and instructors may have different names for the dull and pointy elbow which is all okay–as long as the concepts remain the same. Practitioners should start experimenting with various elbow flexion angles for greater uses and applications beyond the dull and pointy elbow. These two specific dull and pointy elbow positions are just a start.

Learning how to apply your elbow with various angles and entry points will help improve the technical ability and quality of your deep tissue treatments. It is critical to further establish an effective communication system with the client to do no harm and make sure you’re on the same page with how much pressure should be applied in the work. There are many tricks of the trade to help improve deep tissue techniques. These are just a few.

Applying deep tissue techniques should be an enjoyable experience for both the practitioner and client. Increasing the practitioner’s deep tissue skill level will provide a better experience and result for all.

Selena Belisle

About the Author

Selena Belisle is the founder of CE Institute LLC in Miami, Florida, where they teach massage, nursing and cosmetology industry CE courses. She has been practicing massage therapy and bodywork for over 30 years. She is approved as a continuing education provider by many industry state boards and the National Certification Board for Therapeutic Massage & Bodywork.