It’s great that therapists are trying new ways to do massage. In online forums and social media, we see therapists talking about, for example, how using the knuckles instead of the fingertips is the most risk-free way to do massage. Another swears by the forearms, and yet another by avoiding the upper extremity altogether and using the feet to do massage.
The reality is that each “tool” we use to do massage, be it hands, thumbs, knuckles, forearms, etc., has its own set of risk factors. Some have fewer risks than others. Thumbs and fingertips are inherently unstable and therefore carry the most risk for most people: first, because their structures are inherently unstable, and their delicate ligaments, tendons and cartilage can be easily damaged; second, because the instability forces you to contract the forearm flexors and extensors quite a bit to keep them from buckling, and this increases pressure in the carpal tunnel (which can lead to CTS) and can cause tendonosis in the forearm muscles.
But there are risks associated with use of any part of the body to apply pressure. To use the knuckles (which aren’t all that stable, either, if you use only 2-3 of them), you have to stablize with the forearm flexors and extensors, too, and if you’re not stabilizing your scapulae at the same time and using the larger muscles of the shoulders and back to create the force, your shoulders can be at risk for injury. In our 2006 study of injury among massage therapists, shoulders were the body part most often injured. Same goes for use of the forearms – the shoulders are still vulnerable, although certainly the large, flat surface of the forearm offers much more stability than the fingers, thumbs or knuckles. No matter what body part you use, transfering pressure through the bones of that body part causes wear and tear to the joints which can lead to osteoarthritis over time.
And as for using the feet: not only do they also have small bones and other soft tissues that can get injured, but you have to hang on with your hands and arms to overhead bars as you massage. We recently had a CIPI candidate tell us that she was starting to have shoulder symptoms from hanging on to the bars, and I have heard of another therapist who injured her feet by massaging with them.
So am I saying that it’s not good to look for alternatives to using the hands to do massage? No, it’s actually a really good idea to do that. Just bear in mind that there is no one part of the body that is magically free of risk factors for injury. Being aware of the risks of using a particular body part to do massage is very important. For choosing which body parts to use for your massage techniques, the approach that seems to work best involves frequently changing the part of the hand or arm (or even feet) you use to do massage, so that no one part becomes overused. Using real tools (IndexKnobber, Massage Star, etc.) when possible can also be very helpful.
Do you use a certain part of the body to do massage more than another? Share your experiences with us here.