A massage therapist’s hands are their most important asset, and the thumbs are vital to their versatility of use. Although other joints of the wrists and fingers can suffer injury, the thumbs lead the pack in this department. Seasoned and new massage therapists can benefit from reviewing their body mechanics in this department so their thumbs stay healthy throughout their massage careers and beyond.        Â
Key Takeaways
- The CMC joint, a highly movable saddle joint, is most likely to be injured. It should be kept in flexion (thumb toward pinkie) during massage strokes to protect it.
- Keeping the thumb joints in straight alignment (from elbow to thumb) is essential to prevent injury. This creates a solid support structure of bone and joint for applying pressure.
- While the CMC joint allows for circular motion, using it this way under pressure increases injury risk. Instead, therapists should engage their whole arm while keeping the CMC joint stationary.
- Bracing the thumb with other fingers or the opposite thumb during strokes disperses pressure and reduces strain. If thumbs become fatigued, switching to other tools like elbows or fists can prevent overuse.
Thumbs are one of a massage therapist’s most used tools. They are versatile and have loads of sensory receptors, making them a favorite while getting results during a session. However, they are the most commonly injured joint for massage therapists. With awareness of how to best use this tool, these thumb joints can hold up throughout a massage therapist’s career.
Thumb Joints
Carpometacarpal Joint (CMC)
This joint has the greatest likelihood of becoming injured. Due to the nature of this highly moveable saddle joint, massage therapists need to be mindful of its proper use during massage. This joint is most protected when pulled into flexion and then used for a stroke. Using your right hand, touch your thumb to your pinkie. That movement requires CMC flexion. Moving the CMC joint in this way is desired while using the thumb during massage.
Metacarpophalangeal Joint (MCP)
This joint can become stressed when the joint is allowed to flex, creating a knuckle you can see. This resembles the picture above, where the arrow points and the first knuckle are visible. In massage work, the metacarpophalangeal joint should be extended (so no knuckle is visible) and then used as a tool to deliver the massage stroke. Allowing the joint to flex puts strain on the joint and can lead to injury.Â
Interphalangeal Joint (IP)
The interphalangeal joint is least likely to become injured, but those with a natural hyperextension of this joint must be careful. This hypermobile joint is commonly called a hitchhiker’s thumb, and when massage therapists with this thumb apply pressure for a stroke they must bring the joint into alignment with the rest of the thumb joints to avoid injury. I’ve seen varying degrees of hypermobility of this joint in many massage students. While this trait gives those who own it another step to take, it can always be mastered and used as a tool safely.   Â
Rules of Thumb Use
Keep Straight Alignment
The number one rule to prevent injury is to keep a straight alignment of the tool you’re using. In this case, the thumb. To have proper alignment, think of shaking a person’s hand. As you extend your hand towards theirs, look at the alignment of the bones from your elbow to your thumb. Your radius leads directly into your carpometacarpal joint, which leads straight to the metacarpophalangeal joint and interphalangeal joint. This is how these joints should be stacked to use the thumbs at the massage table. Bone supporting bone, joints straight, all leading into your tool. When this setup is used before applying pressure with the thumbs during a massage stroke, the chance of injury is greatly lessened.
Thumb set up
No Circles
The movements available when using the thumb joint make it a great tool. Even though the saddle joint of the CMC can move in a circular motion, it doesn’t mean it should be used that way. When force is applied while circling the thumbs, too much pressure is put on the CMC joint, which leads to injury. A safer way to circle is with the whole arm using a stationary CMC joint.Â
Brace When Possible
Even when the thumb is used in straight alignment, and the CMC joint is stationary, it’s a good idea to brace the thumb whenever possible. This bracing can come from other fingers or, my favorite, the other thumb. Instead of the full force of a stroke on one thumb when using braced thumbs, the force is dispersed between both thumbs and therefore, keeps the joint safer. Trigger point work or cross-fiber friction is a place where the use of one thumb may be more desirable, but bracing may still work.
When thumbs begin to feel tired, change tools. Find another way to get the result you’re looking for. It may be difficult initially, but get creative and save your thumbs. For specific work in dense muscles, this is most difficult. Hamstrings, for example can have minute adhesions or problem areas that need fingertip sensory to find. Of the fingers, the thumb is best suited for pressure. However, pressure deep into a hamstring belly or cross-fiber friction at the ischial tuberosity is too much for a thumb alone. An alternative is using the thumb to search and assess, then changing tools to the elbow or fist for pressure. I know, the elbow or fist often isn’t specific enough for a tiny adhesion in which case there are two options. One, use the thumb with less pressure applied, or two, try a thumb-saver tool. These tools have a brace-like cover that slips over the thumb. The tool hinders your ability to feel what is happening under your thumb but is worth trying.
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.
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