Thumb Injuries: How Massage Helps

Friction therapy is the primary treatment I use for tendon and ligament injuries in the thumb. It breaks up adhesive scar tissue and stimulates the production of new collagen fibers. When performing friction therapy on tendons and ligaments, you move across the structure at a 90-degree angle for 4 or 5 minutes, rest, and then do it again. No lubricant is used and the skin moves with you as you strum over the tendon or ligament. The treatment should not be painful, just slightly uncomfortable. The client is sometimes a bit sore for up to 48 hours after treatment, so be sure to inform your client about that possibility.

If the ulnar or radial collateral ligament of either the MP or IP joint is sprained, friction therapy is a very effective treatment. You hold one side of the joint steady with your middle or index finger, and then apply friction with the thumb of the same hand. Continue for 4 to 5 minutes, take a rest, and then do it again. If working with your thumb isn’t good for you, use your fingers for the friction treatment instead.

For clients with de Quervain’s tenosynovitis, be sure to include a stretching regimen as part of the treatment sessions and as daily homework for the client. If the client’s pain or limitation increases after one or two sessions, or if the condition doesn’t improve within 8 to 10 sessions, discontinue the treatment and have the person see a physician who specializes in hand and wrist conditions. Frequently an anti-inflammatory injection within the tendon sheath helps a person to recover more quickly.

Sometimes, too, there are myofascial adhesions near the surface of the tendon or ligament that are easily treated with some myofascial work prior to the friction therapy. In addition, massage therapy of the entire hand and arm at the end of the treatment is very useful in promoting a healing environment.

The one major category of thumb injuries that does not respond to manual therapy is damage to the joints. Hands- on work may also be inappropriate if the client has a complete tendon rupture, bone fracture, or other serious condition that requires medical intervention.

Active Assisted Stretch for Joint Inflammation

In mild, relatively recent cases of joint inflammation, active assisted stretching followed by strengthening exercises is effective in restoring pain-free joint mobility, which allows strength to be rebuilt. In addition to stretching and strengthening the thumb, work with the forearm, fingers and hand as well, since all of these muscles and joints work so closely with one another.

If the injury is very painful or has been present for more than a few months, I recommend working with a physician preceding the stretching and strengthening to get an anti-inflammatory injection.

One final, important part of the treatment process is teaching the client a series of active assisted stretching movements and simple concentric and eccentric strength exercises for their thumbs and fingers. These exercises are essential for effective collagen production and tissue alignment. The client must do them on a daily basis in order to heal completely and be less vulnerable to re-injury.

To perform an active isolated stretch, first you have the person actively move into the stretched position as far as they can, and then you gently move them a little bit further—always staying within a pain-free range of motion. After two seconds of gently slow stretching, the person moves back to the neutral starting position. Then you repeat the full motion multiple times.

Additional Content

Active Assisted Stretching and Strengthening Exercises

There are two supplementary videos teaching active assisted stretching and strengthening for the forearms, wrists, and hands that I encourage you to try and share with your clients.

Additional Ideas on Keeping Hands Healthy

Go to massagetoday.com for more content from Ben.

Self-Care for Massage Therapists: Protecting Your Hands

Massage practitioners are particularly vulnerable to thumb injuries. This is especially true if the joints of the fingers and thumbs are very flexible. If you have hypermobile joints, be very careful about the use of your thumbs. Whenever possible, find alternative ways of working—for example, using your forearms and elbows instead of your thumbs for many of the deeper movements. You can also protect the thumbs by strengthening them through exercise and making sure they’re in good alignment (never hyperextending). If you’re not overly flexible, you should stretch your thumbs and fingers, in addition to doing strengthening exercises, on a regular basis.

I have been in practice for over 50 years now, and there was a time about 25 years ago when I overused and strained my thumbs. I received some treatment for them, got well, and then adjusted my techniques so that I never strained my thumbs again. I have seen a number of therapists’ careers ended by thumb injuries. Be careful—your hands are your future.