Hand Tools

By Rebecca Jones
[Ten for Today]

Some roll. Some cup. Some vibrate. Some compress. And nearly all of them, used properly, save wear and tear on a massage therapist’s thumbs, fingers, hands, and wrists. Yet many therapists still avoid using hand tools on their clients. The very nature of massage is skin on skin, and many therapists reject anything that comes between their fingertips and a client.

“They feel they’re cheating, like they’ve done something wrong, haven’t been using proper mechanics, if they have to use a hand tool,” says Greg Polins, a North Carolina massage therapist and the inventor of Thumbsavers, one of a bevy of devices on the market aimed at ergonomically-minded bodyworkers. “But at the end of a full day doing thumb work, that joint is going to fail no matter how good your mechanics.”

Indeed, with more than three out of four massage therapists reporting pain or other musculoskeletal symptoms related to their massage work over a two-year period, and with many choosing to leave the profession within five years, all too often because of work-related injuries, the pragmatists may win this debate by default.

Here’s a look at some issues surrounding hand tools, their pros and cons, and how to evaluate which, if any, hand tool may be right for you.

1. How can a hand tool help save my hands?

One of the greatest causes of injury among massage therapists is overuse of muscles. “Massage therapists tend to use their thumbs and fingertips quite a bit to apply pressure, especially sustained or deep pressure,” says Lauriann Greene, coauthor of Save Your Hands! (Gilded Age Press, 2000). “They do that because thumbs and fingertips are very sensitive, with a lot of nerve endings at the tip. But that’s exactly the reason there’s a risk of injury, because the nerves are so close to the surface.”

Sustained pressure on the fingertips can lead to compression of the nerves and blood vessels, which can lead to reduced circulation and loss of sensitivity. Over time, this can lead to permanent reduction in sensitivity. Likewise, for every pound of pressure exerted by the thumb, 10 pounds of pressure is placed on the carpometacarpal joint. All this increases the likelihood of damage to the median nerve.

“It isn’t an all-or-nothing thing, but any amount of time that you can give your thumbs and fingertips a rest is that much gained,” Greene says. “Using a hand tool offers another option, a different way of using your upper extremities to avoid the overuse that’s so much a problem in injury.”

2. Should I use a hand tool throughout a session?

Hand tools will never replace good palpation skills. You need to use your hands to find the target muscles and trigger points. Tools can be used to deliver extra pressure for compression, but use them in moderation. In fact, Greene suggests that when you’re not actually using the tool, you shouldn’t even have it in your hands. “It’s like using a computer mouse,” she says. “People have a tendency to keep their hand on the mouse even when they’re not using it, and that’s one of the ways people get injured from computer use. They’re gripping the mouse without realizing it. Tools are the same. When you’re not actually using it, put it down, because the gripping itself can be a risk factor.”

3. What do I look for in a hand tool?

Above everything, it has to feel good in your hand. It needs to mimic as closely as possible the stroke you would apply with your bare hand.

“The idea, with any type of pressure tool, is that it should feel just like your thumb and forefinger,” says Jen Tracy, a massage therapist and co-owner of the Colorado-based Neuromuscular Solution, makers of the NMT-Bar.

Beyond that, consider the ergonomics of the tool and how you will put it into practice. “Does it allow you to keep your wrist straight?” asks Renee Gladieux, director of sales at the Pennsylvania-based Pressure Positive Company, makers of such popular hand tools as the Jacknobber, Index Knobbers, and the Knobble. “Does it allow the therapist’s body to maintain good mechanics? Is it durable? Does it clean easily?”

Greene recommends finding a tool that you can grip comfortably with your whole hand, not just your fingertips.

4. Are there any bad tools on the market?

Bad is usually in the eye of the beholder. What works well for one person may be a disaster for someone else. Greene recalls seeing one especially poorly designed tool that had a long handle that would rest at the base of the user’s palm—an ergonomically dangerous choice. Also be wary of bad tools that aren’t on the market—things rigged by amateur inventors that really could do more harm than good.

“We have a whole closet jammed from floor to ceiling with prototypes that people from all over the world have sent us,” Gladieux says. “Some you may see in a catalog some day, and others you will never see. They’re in our closet because the factors didn’t come together to manufacture them in a way that would be cost-effective.”

“Some are too complicated,” says Bernard Gladieux Jr., Renee’s father and president of Pressure Positive. “Some are too hard to use. And some just don’t have the market potential.”

Polins says he experimented with more than 100 prototypes of Thumbsaver before he came up with the model that’s now on the market.

5. Should I tell my client when I’m using a tool?

Experts are split on this. Done properly, a client won’t realize when you’ve stopped palpating with your hands and begun using a tool. If the object is simply relaxation, there may be no need to interrupt a client’s reverie.

Of course with more aggressive modalities, client feedback is important. “Some deep muscle techniques are pretty rough, and you want to get feedback from clients as to how much is too much,” says Bernard Gladieux. “That tipping point is critical.” Renee Gladieux says she always alerts clients when she is switching to a hand tool. “In trigger point therapy, particularly, you often will search around for the sweet spot that represents the hyper-irritable node, and there’s no way the therapist can find that spot without feedback from the client.”

6. Is there a chance I may injure a client?

Yes, that’s why you want to practice—both on yourself and on another therapist—before you ever attempt to use a hand tool on a client.

“Usually, tools allow you to use your larger proximal muscles instead of the smaller distal muscles. So you can apply more force with less effort,” Greene says. “Because of that, it takes time to get used to how much force you’re using. The tendency will be to go deeper and use more force than you would with thumb and fingertips. So practice, or you’ll wail away on a client without being aware of it.”

7. Are there times tools should not be used?

Absolutely. Hand tools typically are used for deep massage. Therefore, any time that deep massage is not appropriate, hand tools typically are not either. “If you’re just interested in light relaxation massage, you don’t need tools,” Tracy says.

Use common sense. Hand tools may not be appropriate on elderly clients, who tend to have more fragile skin. They also should not be used in bony areas. In addition, percussive tools should never be used over any organ. “The kidneys are not very deep from the skin, and if you’re pounding them, you could damage them,” Greene says. “Using them over the ribs, you could break someone’s rib. They’re meant for large muscles, not viscera or bones.”

8. Should a new massage therapist begin using tools right away?

There’s nothing wrong with using tools early in your career, but many experts advise waiting a while.

“Wisely, a lot of massage schools want their students to learn how to use their hands first,” says John Louis, founder and CEO of Acuforce International, the Illinois-based firm that makes a number of hand tools, including the Massage Star and the Acuforce. “I would say it’s a good idea for new graduates to spend a little time getting their feet wet, learning the trade with their own hands. Maybe after the first year, incorporating tools are a good idea, because you do run the risk of hurting your hands after a while.”

9. How many tools should I own?

Most hand tools are generally affordable. You can invest in several and see which ones suit you best. Some tools are more versatile than others, and some can be held in different ways, so consider that when testing a tool.

10. Are there some common mistakes I can avoid?

Beware of saving your thumbs and fingers only to develop wrist and arm pain through improperly gripping a hand tool. “The hand tool will do no good if you’re tightening your hand while using it,” says Michael Takatsuno, founder of PUSH (Power Under Soft Hands) Therapy and director of the PUSH Therapy Center near San Francisco. PUSH Therapy uses flexible thumb-like and finger-like tools called Shemala Finger Tools, which Takatsuno imports from China for resale.

“Using tools correctly can be tricky. It takes training to learn to keep your body soft so you can keep your hand soft,” Takatsuno says. “It’s a chain reaction. If my back and thighs get tight, the tension will work its way into my forearms and hands. So learning to use your hands correctly requires you to not have tension in your forearms and shoulders and back and core.”

Vibrating tools can pose special risks. “The length of time that you use them can be problematic,” Greene says. “Vibration is a risk factor for injury, so prolonged use of a vibrating tool can be harmful.”


Rebecca Jones is a Denver-based freelance writer. Contact her at killarneyrose@comcast.net.