Additional Contacts
There are a few other contacts that can be used with clients. Two of these are the knuckles and fists. Albeit very stable contacts, knuckles and fists are hard and bony, and if used, they should only be used in areas of the client’ s body that are fleshy. Using a bony contact over a bony area of the client’ s body can be extremely uncomfortable for the client. Speaking as a regular client of massage therapy, one of my pet peeves is when a therapist uses a bony contact over a bony area. Ouch!
Feet are another contact used, especially in Asian massage practice. The feet are strong contacts, especially since body weight is also being employed in this practice. The feet are also broad and cushioned, making them comfortable contacts for the client.
When massage therapy tools are considered, although they may be employed to decrease stress to the practitioner’ s thumb / finger joints, the trade-off is that they, like bony contacts, tend to be hard, so the choice of where to use them should be strategically integrated into our work. A note of caution: Because we are not directly contacting the client’ s body when we use massage tools, our ability to sense the response of the client’ s tissues to our work is diminished.
Figure 2. Full-flat palm contact( with no brace).
Bracing / Supporting the Palm
There are two easy ways to brace a fullflat palm. Figure 3A shows what is likely the most common brace used: the palm of the other hand. This brace works very well when the palm is fully flat. However, it’ s not as versatile a brace for when we want to orient away from the full-flat palm and angle it to use more of the hypothenar eminence or the thenar eminence.
A
For full versatility of the palm, I recommend using the thumb-web brace shown in Figure 3B. For the thumb-web brace to be used effectively, the actual web of the thumb needs to be placed directly over the carpal region at the base of the palm where the pressure of the contact hand is contacting the client. Often, therapists will instead brace the contact hand / forearm as seen in Figure 3C, with the ulnar side of the support hand on the dorsum of the contact hand, and the thumb web up high on the distal forearm. This leaves no support to the actual contact region at the base of the palm that meets the client’ s body.
Full-Flat Palm
When the palm is used in massage, most therapists use the full-flat palm( Figure 2). The full-flat palm is a wonderful contact because, as stated, it is broad, strong, and stable, and covers a large amount of surface area of the client’ s body; but it’ s not hard or pokey. And it can be easily braced / supported. Bracing a contact is extremely valuable for good body mechanics that allow for longevity of career. By bracing a contact, we support the structure of the joint, which preserves the fascial tissue of the ligamentous / joint capsule complex, preventing overstretching and injury of the joint. We also decrease compression forces through the contact joint because bracing allows for the physical stress of the stroke to be spread across both upper extremities. In other words, the braceside upper extremity does not just protect the contact, it also contributes to the force of the stroke.
B
C
Figure 3. Full-flat palm contact with brace –( A) Palm brace,( B) Thumb-web brace,( C) Thumb-web brace incorrectly placed
One way to learn how to effectively employ the thumb-web brace for the full-flat palm is to first place the palm as a contact on the client but exaggerate the ability to see the contact by extending the hand at the wrist joint( Figure 4A). Then, place the thumb-web support directly over the base-of-the-palm contact but exaggerate the position of the supportside upper extremity by pronating the forearm( Figure 4B) so you can better visualize where the thumb web supports the contact hand.
This positioning shown in Figures 4A and 4B is not comfortable or relaxed for the therapist, it is just done to help us better understand the positioning of our hands. So, now let both hands relax as seen in Figure 4C. Comparing this thumb-web brace with the opposite-side palm brace( see Figure 3A), you can see the disadvantage of the thumb-web brace is that the elbow of the brace-side upper extremity is out a bit, which means the brace-side glenohumeral joint is slightly
JATMS | Spring 2025 | 151