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Massage Today
February, 2012, Vol. 12, Issue 02

Giving a Big Thumbs Up for Healthy Thumbs

By Judith DeLany, LMT

The thumb is one of the most practical and necessary implements of the body. It is the first self-comforting tool to be used, often seen thrust into the mouth of a fetus in the womb. Throughout life, the thumb is constantly used without conscious thought, making it easy to forget just how vital the thumb is in daily life. That is, until it is injured.

Imagine holding a glass of water without a thumb, or pulling up your pants, writing with a pencil or using a paintbrush. Although those who are thumb-challenged can usually improvise, one can readily experience the difficulties by simply duct-taping the thumbs to the palms for a day.

The thumb pad is richly endowed with sensory receptors and is associated with more brain receptors for receiving information than most other body parts. This makes the thumb a particularly useful palpation tool. While articles abound excluding the use of the thumb in massage, this article offers insights as to how to protect the thumb in order to use it for a lifetime.

Anatomy of the Thumb

The osteo-articular column of the thumb is comprised of five bones – scaphoid, trapezium, first metacarpal and two phalanges. The four joints within the column allow for flexion–extension, abduction–adduction, rotation and circumduction of the thumb. Only a ball and socket joint offers more range than the saddle joint of the thumb, which permits angular motion in almost any plane. Because the thumb is attached more proximally than the fingers, it also offers the hand an inherent architectural advantage, particularly in grasping, opposition and apposition.

In contrast to its profound mobility, the thumb can also be used as a solid structure for compression of myofascial tissues. As a solo instrument, the columnar thumb can statically compress muscle fibers into underlying tissues. In conjunction with the other digits (particularly the index and ring fingers), it can be used to grasp the tissues and to apply pincer compression (like a C-clamp), flat compression (like a clothes pin) and manipulation (the international hand signal for money). Each of these techniques offers ample opportunity to assess the tissues and also a standing opportunity for injury, repetitive strain and subsequent dysfunction of the thumb joints.

While the thumb is undoubtedly a useful tool in massage therapy, it can be misused and abused by poor mechanical habits. Gliding strokes applied with thumbs placed side-by-side (ulnar surfaces touching) project pressure through the osteo-articular column and onto the joint surfaces in a manner that is protective of the ligaments. However, gliding strokes applied with the thumbs touching tip-to-tip produce valgus forces on the thumb joints and can lead to a slow, insidious stretching of the thumb's ulnar ligaments.

Skier's thumb (also known as gamekeeper's thumb) develops due to a sprain or strain of the (usually strong) ulnar collateral ligament of the metacarpophalangeal joint. This may result in instability and weakness of the thumb, painful joints and, ultimately, arthritis and joint deterioration. This type of injury can happen abruptly, such as when falling onto the outstretched hand (particularly if gripping something, like a ski pole), or it can occur over time due to chronic repetitive stretching of the ligament, as occurs with poor biomechanics when performing massage.

Following an abrupt injury, the thumb may swell and be bruised, however, sometimes pain may not occur until a day or two later, or even over a period of weeks. When ligaments are torn, surgical repair may be necessary or treatment might consist of splinting or casting and rest. Exercises might be required to regain range of motion, although it may take weeks or even months for complete range and strength to be restored. This type of injury is usually more tangible than the similar results that occur with a repetitive overstretching of the ligaments through poor habits of use. Nevertheless, their outcomes may be similar, with painful loss of function being the ultimate consequence.

Besides sprains associated with falls and poor thumb mechanics, thumb dysfunction can also stem from hitting with clenched fist, bowling (which can also produce neural damage to the digital nerve from the edge of the hole of the ball) and chronic strains associated with excessive use when texting and playing video games. The following tips may be useful in preventing injury.

  1. When applying static pressure with the thumb, make sure that the pressure goes through the column. To achieve this, the tip of the thumb (not the pad) contacts the surface. The column, including the contributing radius, is maintained as a straight line, from the tip of the elbow to the tip of the thumb.
  2. When gliding, the tip of the thumb, NOT the ulnar surface, leads the glide.
  3. When both thumbs are gliding together, their shafts should lie side-by-side. Avoid tip-to-tip positions, which project valgus forces into the thumb joints.
  4. When it is appropriate to use another tool (elbow, pressure bar, stone, etc.), use the tool and save the thumbs for when a higher degree of proprioception is needed.
  5. Limit video games and texting. Learn to use voice-to-text features.
  6. When biking, skating or performing other sports, wear wrist guards (hand pads).
  7. And, most importantly, when the thumb is chronically painful or if an injury has occurred, seek professional help before damage progresses.

Judith DeLany serves as director of NMT Center, writes textbooks for Elsevier Health Sciences, and lectures internationally in the field of neuromuscular therapy. For more information regarding her work, visit www.nmtcenter.com or call toll-free at (866) 571-7942.

 

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