Job and Life

Muscles in the forearm flex and extend the wrist and are the activators of the fingers and many of the movements of the thumb. The tendons of these muscles are held in place by retinacula as they pass over the wrist. If the flexor muscles are consistently overused, their tendons can swell up, pressing on and affecting the nerves and blood vessels which pass with them under the flexor retinaculum. Tenosynovitis is inflammation of the inner lining of the tendon sheath which is generally caused by overuse, especially when working awkwardly and/or repetitively. It is most common in the tendons of the wrist and hand, where it can cause tenderness or pain in the tendon, often gives rise to swelling, and can lead to restricted movement. It can also lead to carpal tunnel syndrome, in which pressure on the median nerve as it passes through the carpal tunnel causes numbness, tingling and/or pain in the thumb, index and middle fingers. In the worst situation it can also lead to loss of control in parts of the hard. Wrist problems are not unique to a masseuse. Any activity which involves the hands in constant, regular or repetitive activity can lead to problems.

Tenosynovitis at the wrist and carpal tunnel syndrome are common occupational problems for hairdressers and musicians, for people doing regular computer work (which is very widespread these days) or involved in building work or factory work (particularly on production lines). If you are a masseuse and also using your hands consistently for other activities, such as typing, gardening, DIY or playing musical instruments, you need to be especially careful of your wrists.

Wrist problems in massage

It is primarily the cumulative effect of techniques that involve pushing or pressing that cause problems, especially if you are doing them with your wrist bent. Pulling techniques, which put much less pressure through the wrists, generally only lead to problems if they are done with the wrist consistently bent. However, even with the best positioning of your wrist, there is still quite a pressure passing through it, so learning to use your forearm and elbow is also very helpful, particularly if you have small hands or slender wrists. Bear in mind that if you are straining your wrists and/or hands, you are also likely to be tensing your shoulders as part of an instinctive body reaction. You may also be holding your breath and stiffening your back. In fact you could be unconsciously tensing throughout your body, which is likely to cause more strain and thus feed back into this cycle of pain and tensing. Therefore, if you are changing the way that you use your wrists, you need to consciously relax the rest of your body (particularly your arms, shoulders and upper back) to ensure that these associated tensions don’t draw you back into your old habits. Do not continue doing strokes that strain your wrists. Find alternatives. Rest them and If you have persistent pain, especially if it persists when you’re not working, seek specialist help. Regular massage can help, preferably as a preventative measure but also by giving some relief from the pain/tensing cycle if there are already problems. Many people find that acupuncture and osteopathy/chiropractic/ physiotherapy can reduce an established problem and sometimes relieve it totally. A reminder here – it’s always useful to prepare for doing massages, and to release any accumulated tensions afterwards, by doing simple exercises to mobilise your shoulders and arms, exercise your wrists, move your thumbs and curl and uncurl your fingers.

Having the wrist bent – Many techniques involve varying the angle of your wrists within the stroke.

This is fine for light strokes such as brushing across the tissues. And if you are doing percussion strokes, it’s important that you keep your wrists supple and able to move. However, the greatest strain on your wrist in massage comes from having it consistently bent when you are applying pressure. Even when you are only applying light pressure, it’s good to cultivate the habit of keeping it relatively straight. And, when you are applying sustained pressure, it’s crucial to minimise the bending of your wrist, which is not shaped to work powerfully at an angle.

So the angle of the wrist and support for it are important. It’s also crucial to keep your hands as relaxed as possible. Monitor your wrist use carefully, so that adapting to any discomforts becomes an integral and automatic part of doing massages. And remember to vary your massage techniques. Even with best practice – a straight, supported wrist – there is still pressure on your wrist. So it’s wise to include pulling, lifting and stretching techniques in your massage treatments, whenever possible, to lessen the compressive forces that are going through your wrist. And to save your wrist entirely, whenever you can, by learning to use your forearm and elbow skillfully.

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