A in medial / internal rotation, which is not the ideal posture for the shoulder joint. However, where the thumb-web brace really shines is how it allows for the versatility of the orientation of the palm as a contact.
A
B
C
region( between the scapulae) in the thoracic spine, there is often not enough room between the medial border of the scapula and the spine. Instead of switching to another contact, we can simply supinate the forearm to orient the palm so that we are pressing more on the hypothenar side of the palm instead of the full-flat palm( Figure 5B). This narrows the contact, allowing seamless passage of this stroke through the area to continue to the top of the client’ s trunk. We still have a strong contact, but one that fits between the scapula and spine. We also can focus the force of our stroke through the pisiform of the hypothenar eminence( Figure 5C).
There is an art to learning to use the pisiform, and it can take time to master, but it is well worth it. The pisiform is a small bone, so it is very specific in its contact and as a round bone it is not pokey for the client. Also, because it is surrounded by the myofascial tissue of the hypothenar eminence, it is padded and even more comfortable for the client and the therapist. We can even transition our contact to be fully on the ulnar side of our hand( Figure 5D). The ulnar-side contact is often referred to in manual and movement therapy as the knife-edge contact.
B
Figure 6.( A) Thenar contact,( B) Thenar contact with trapezium / scaphoid-tubercle focus
An alternative orientation of the palm is to instead pronate the forearm to orient the palm toward the thenar eminence( Figure 6A). This also allows for a strong but smaller contact than the full-flat palm. To focus the force of the stroke, we can orient the palm such that we place our force through the tubercles of the trapezium and scaphoid( Figure 6B). Whether it is best to orient toward the thenar eminence or the hypothenar eminence depends on the contour of the client’ s body we are trying to meet. Most often, the hypothenar side is most advantageous. But the flexibility of being able to seamlessly switch from full-flat palm toward thenar or hypothenar eminence and back, allows for a much greater efficiency of our work.
Figure 4.( A) Exaggeration of base-ofthe-palm contact for full-flat palm,( B) Exaggeration of thumb-web support of base-of-the-palm contact for full-flat palm,( C) Relaxed posture of hands with thumbweb brace for full-flat palm
A C
Angling the Palm Contact
One of the major advantages of the fullflat palm is that it is broad( Figure 5A). However, this can also be a disadvantage because the contact may be too broad to allow work in certain areas and / or contours of the client’ s body. An example would be performing a long deep stroke up the client’ s back along the paraspinal musculature. In the low back, there is plenty of room for the palm to be fully flat. But as we reach the interscapular
B
D
Figure 5.( A) Full-flat palm,( B) Hypothenar contact,( C) Hypothenar contact with focus on the pisiform as the contact,( D) Ulnar-side knife-edge contact
152 | vol31 | no3 | JATMS