A changes the angle of our wrist joints. For example, if we have the contact-side hand generate all the force, then if we want to meet the contour of the client’ s body perpendicularly( which allows for maximal pressure with minimal effort), the angle of the forearms would need to be vertical, which would then require the posture of our wrist joint to be in full or near-full extension( Figure 8A). This could be injurious to the wrist.
If instead, we share the force of the stroke 50 / 50 between the contact and brace hands, then we can change the angle of our forearms to be less vertical, allowing our wrist joints to be in less extension( Figure 8B). But the resultant force is still vertically downward and perpendicular to the contour of the client’ s body. We maximize the efficiency of our force, and with a healthier posture to our wrist joints. Of course, we don’ t want to angle our forearms too horizontally, or we lose the ability to transfer force from our core into the client( Figure 8C).
Pisiform for Joint Mobilization
B
C
Figure 8.( A) Wrist joint in full extension,( B) Forearms angle so that the wrist joints are in less extension,( C) Excessive change
in angle of the forearms. Light green arrows represent the force transmitted through the forearm. Dark green arrows represent the resultant force into the client.
Learning to use the pisiform( or trapezium / scaphoid tubercles) as a contact can be especially valuable when performing joint mobilization. It allows for a very specific contact on the bone of the client’ s body, but also is a strong and stable contact. And it is a comfortable contact because of the cushioning of the surrounding myofascial tissue.
Author’ s note: In the world of massage therapy, Grade IV, slow-oscillation joint mobilization is legal and ethical in most states of the US and in Australia. However, no fast thrust should be added to the mobilization. Fast-thrust Grade V joint mobilization is not legal or ethical for massage therapists.
Quantity of Strength, Quality of Feel
There are many choices for contact when performing manual therapy. Each contact has advantages and disadvantages. When deciding between smaller and larger contacts, I hope you consider the palm as perhaps the ideal middle-size contact because of the advantages it shares with both smaller and larger contacts. And beyond the consideration of the size of the palm contact, there is also the quality of the feel of the palm as a contact. Its strength and stability are matched by its comfort because of the surrounding myofascial tissue. And when you learn how to change the orientation of the palm to focus toward the hypothenar eminence and its pisiform, or the thenar eminence with its trapezium / scaphoid tubercles, the specificity and efficiency of your work increases multifold. So, consider the palm for its quantity of strength and its quality of feel.
Dr Joe Muscolino has been a manual and movement therapy educator for more than 40 years. He is the author of extensive online streaming video content on anatomy, physiology, and kinesiology, as well as assessment and treatment skillsets for manual therapists and movement professionals. He has created a Master Online Curriculum( MOC) for massage and other manual and movement therapy educational institutions. He is the author of multiple textbooks and he teaches continuing education workshops around the world, including a certification in Clinical Orthopedic Manual Therapy( COMT). Visit www. learnmuscules. com for more information, or you can reach him directly at josephe. e. muscolino @ gmail. com.
This advertisement is available only to ATMS Accredited Members in accordance with the Therapeutic Goods Advertising Code.