An image of a woman holding and massaging one hand with her other hand is used to illustrate the concept of massage therapist hand injury.

Savvy massage therapists know caring for their bodies is the key to a long massage career. Today, we will look at some tips to avoid hand injury.

1. Limit Grasping Movements

The hands are helpful in many ways during a massage, but some of their natural movements should be limited. The hand’s grasping or scooping movement makes petrissage possible. Petrissage is a necessary tool in a massage therapist’s tool bag, as kneading a muscle can give results like nothing else.

Be aware of how often you are kneading and with how much pressure. When performing petrissage, the smaller, more intrinsic muscles of the hand contract. These muscles fatigue quickly, and we know pushing past fatigue leads to injury.

During times of deep petrissage, there’s twice as much strain on the hands, which can lead to injury faster.

To avoid hand injury, limit the number of grasping movements during your massage sessions. Use petrissage and kneading where necessary, but realize when another stroke can be substituted and do so.

It’s best to avoid deep petrissage and instead substitute wringing, compression, or another tool like forearms instead of using the hands in grasping movements with pressure.

2. Limit Digit-Intensive Massage

Certain areas of the body require a massage therapist to use more specific tools like fingers. The feet, hands, face, head, and neck are all areas we use our fingers for tools.

Feet, for example, can require a lot of pressure and strange angles depending on whether the client is supine or prone. The digits of the hands are best suited for a foot massage but can also leave them feeling strained.

Whenever the goals for a session will allow, limit the time using fingers and thumbs.

Obviously, if a client is coming to you for plantar fasciitis, your session will include more time on the feet than a client with no specific requests.


1. Be conscious of the length of time using fingers and thumbs

2. Use the tools safely, with the least amount of strain if you need to use them

3. Replace the tools with another tool whenever possible

3. Use the Table as a Fulcrum

Being smart about how we use our hands will keep them healthy for years. Remember the example we discussed where the therapist does neck massage with the client supine?

In that example, the wrists acted as a lever to lift the fingertips into the client’s sub-occipital muscles. Like a wheelbarrow with the fulcrum point at the wheel, your hands will fulcrum at their connection to the table.

Where else during your massage can you use the table as a fulcrum? The padding on the massage table allows an inch or two of downward space if you need to use it.

By getting creative and working smarter, not harder, you can save your hands by letting the table assist you.

4. Use Hands Sparingly

The thought of using hands sparingly has some massage therapists panicking. This panic comes from a need for more education on other tool options for a massage session.

Permit yourself to think outside the box. Play with new ways to deliver strokes.


· What is my desired outcome for the area?

· What stroke gets me that outcome? (effleurage, petrissage, compression, friction, tapotement)

· Is there a tool (other than hands) that will allow me to perform that stroke?

Get in the habit of asking yourself throughout each massage, “What other possible tools could I use right now?”

Idea: What if you used your hands only to warm an area for deeper work? Or as a connection tool, ex. Resting hands or connecting strokes to make them feel fluid. What if you then used other tools for deep work? This idea alone would save your hands and make them last longer.

5. Use Your Other Tools

Knuckles: Knuckles are easy to substitute for many areas where hands and fingers do the work. To give fingers a break, bend and begin using the knuckle instead.

Knuckles can provide pressure to the client’s palms, the bottom of feet, neck, forearms, pecs, and tibialis anterior, to name a few. With the client prone, pressure into the foot’s heel is an excellent place to use knuckles instead of fingers.

Fist: Fists can be used in place of hands for effleurage, compression, and tapotement. Large muscle groups like hamstring, quadriceps, gastrocnemius, and all back muscles are appropriate areas for using fists as a tool.

They work nicely for compression on the upper trapezius, supraspinatus, and neck muscles. From the opposite side of the table, with the client prone, a downward-facing fist can effectively glide medial to lateral across the supraspinatus.

Forearm: Forearms may be the closest tool to hands as far as feeling like a broad, smooth tool. This means the possibilities of forearm usage are vast and are worth exploring. Try using forearms for all areas of back massage.

Forearms are also great for the posterior hip and leg.

Another idea during massage is forearm compression and gliding on the quadriceps, pecs, and forearms. With practice comes the feeling of using your forearm in a way that feels natural.

Elbow: The elbow can be used over any fleshy muscle area and works incredibly well on the client’s back and glutes. Massaging the client’s back often needs a transition from the forearm to the elbow, but the elbow, being more specific, can get deeper for the client.

The erector spinae, around the scapula, and the glutes, including glute medius and piriformis, are all places to use the elbow as a tool.

With the client prone, stand at the head of the table. Begin with an elbow at the top of one side of the spine on the erector spinae group. Decide on the angle of your elbow and sink into the muscle to your desired depth.

Now glide slowly down the erector spinae with the elbow for deeper attention to that muscle group. This specific elbow stroke works best after some effleurage warming the area.

The variety of tools available for massage is plentiful enough to give your hands a break if you are disciplined. With these few tips and the reminder to use alternative tools, you should be ready to massage with healthy hands for years.

Angela Lehman

About the Author

Angela Lehman is a massage therapist of 25 years turned online educator, promoting fitness and nutrition for massage therapists. She runs The Fit MT. With her kinesiology degree specialized in nutrition, she trains therapists in healthy eating, exercise and body mechanics to prolong their careers.