Self-care for hands

LOOKING AFTER YOUR

HANDS

They say a bad workman always blames his tools. For many holistic therapists, our hands are our tools and failure to take good care of them can result in career-ending injuries. We look at some of the most common problems….

WHILE some forms of bodywork involve other parts of the body, such as forearms and elbows in Shiatsu, and most bodyworkers use their hands and fingers to apply pressure to their clients’ bodies. A great deal of movement and force goes through what are comparatively complicated and delicate constructions. The human hand contains 27 bones including the phalanges of the fingers, metacarpals and the eight bones which make up the carpus at the wrist. Add in the tendons, ligaments, many of which pass through the carpal tunnel and a host of nerve endings which make our fingertips so sensitive, and the range of movement our wrists, hands and fingers are capable of and it’s clear why a lot can go wrong.

While we use our hands while treating clients, it’s fair to say that we also spend more time on our computers and keyboards and increasingly spend our leisure time using our phones, tablets or gaming. Where previously they might have been rested in the evening while watching TV, now scrolling through a phone, shopping online or reading on a kindle all add to the wear and tear our hands experience.

Up to date statistics are hard to come by as musculoskeletal injuries are generally bundled together. According to a TUC report 1 in 50 (half a million) of all workers in the UK have reported an RSI condition and six people a day have to give up their jobs because of the impact the condition has on their work. If hand strain, joint pains or RSI are impacting your ability to work, then it makes sense to start with reviewing the ergonomics of your workspace and the way you physically interact with clients.

Using a massage tool can be a career saver. It’s probably best to buy a few different tools and find which is most effective for your clients and most comfortable for you. Massage guns are becoming increasingly popular and there are many ergonomically shaped wooden and plastic tools to choose from. Similarly, there are keyboards designed to minimise the occurrence of RSI as well as ergonomic computer mice, wrist wrests and similar tools which could make your work day easier. Leaving extra time between clients or leaning techniques that don’t involve the hands can also mean you can keep working. There are a number of UK course providers. You may want to check that any training you undertake is acceptable to both your membership body and insurer.

Overuse and misuse

Broadly speaking, the problems that bodyworkers experience stem from either the overuse or misuse of the hand and wrist.

Tenosynovitis

Tenosynovitis is an inflammatory condition that affects the sheath (synovium) that surrounds the tendons. While it generally results from repetitive motion, it can also be the result of a bacterial infection through a cut or wound.

There are variations of tenosynovitis such as De Quervain’s tenosynovitis which affects the thumb and stenosing tenosynovitis (sometimes called Trigger Finger) which usually affects either the middle finger, fourth finger or the thumb). Symptoms are synonymous across the different types of tenosynovitis in that the sufferer will usually feel pain, stiffness, aching, swelling and a dysfunction of the area which includes the inability to straighten the affected area or a loss of grip or strength.

Treatment options include anti-inflammatory pain killers, rest, ice, shockwave therapy and injections of autologous blood taken from elsewhere in the body and injected into the tendons. This is an experimental treatment.

Tenosynovitis is more common amongst the middle aged and affects women more often than men. The tendons are often slow to recover, which can mean time off and clients switching to another therapist, so self-care is essential.

Saddle Joint injury

One of the commonest problems that body workers experience is pain and swelling in the thumb. It’s not surprising as so many massage therapists think of the thumb as their primary tool for applying pressure or working to unknot areas of held tension. The muscles which stabilise the thumb can mislead us into assuming that they are stronger than they really are. Generally, the carpometacarpal joint is the focus of the pressures on the thumb when we use this in massage. This is the saddle joint at the radial end of the carpal bones. It allows the thumb to be opposable. When pressure is put on the thumb tip, the thumb base muscles contract, stabilising the joint by pulling the metacarpal bone down into the CMC joints, creating 10-12 times the amount of pressure experienced at the thumb tip in this joint. It’s not unknown for a therapist dealing with a trigger point to apply 10 pounds of thumb pressure to the client’s skin, resulting in 100-120 pressure on the base of their own thumb.

This can easily lead to a saddle joint injury. The saddle shape of the joint allows the thumb a great deal of rotation. Saddle Joint Injury can manifest as a dull ache or a throbbing pain. When a therapist uses a gliding motion, but leaves the thumb out to the side and pulls back away from the rest of the hand, puts a the joint under excessive strain. Working mindfully and monitoring the position of the hands can help prevent this happening. If an injury occurs, anti-inflammatories and rest are the best options for recovery, but such injuries can reoccur if technique is at fault.

Another common type of misuse is massaging with a bent wrist. While this can be tempting where minor discomfort is being experienced, it stretches the muscles and tendons, creating alignment issues which exacerbate existing problems. This is why ongoing training and monitoring your own movements is so important. It’s easy to fall into bad habits or take shortcuts, but these can often be damaging in the long run.

The type of massage or bodywork performed can influence the probability of developing a hand or wrist problem. Those who specialise in treating trigger points, deep disuse massage or neuromuscular massage all use more forceful movements and this, combined with inattention to correct alignment and posture increase the risk of injury.

Self-care

Fortunately, there are a few simple self-care preventative techniques that can be used to lessen the chances of developing hand or wrist issues.

n Using the correct alignment and considered movements when working with clients should be at the forefront of your mind during an appointment.

n Before your first session of the day, make time for some stretches. Rotate your wrists and open and close your hands for a minute or two, then stretch warmed-up tissues.

n Use tools that make your life easier. This might mean using an electric table to position and move clients without straining yourself, or exploring the use of massage guns and hand tools.

n If possible, space out your treatment sessions or limit the number of higher risk treatments each day.

n Ice, heat and paraffin hand baths can all provide some relief.

Your hands are one of your most important tools, so take good care of them. n