Avoid Using the Heel of the Hand

By Barb Frye
[Body Awareness]

The heel of the hand is a favorite among manual therapists for applying compression strokes. But, like the wrist joint, the heel of the hand can sustain serious injury when overused, often disabling a therapist from practicing. 

Many massage therapists use the heel of the hand rather than the entire palm of the hand when, for example, applying long friction strokes down the back. Although it seems like a strong and useful tool, and many therapists regularly use it to apply compression strokes, the anatomy of the heel of the hand is not ideally suited to bearing weight. Following are some reasons why.

• Eight small carpal bones comprise the heel of the hand. When under strain, they are susceptible to tenderness. For manual therapists, the pisiform—the hook of the hamate, scaphoid, and trapezium—can become tender if overused for pressure strokes.

• The ulnar nerve and ulnar artery pass through a small tunnel called Guyon’s canal that lies between the hamate and pisiform bones. Sustained weight bearing, as with compression strokes, can push the ulnar nerve into the walls of this canal, causing nerve damage.

• The carpals are anteriorly arranged in a shallow bowl shape. Covering this concavity is the flexor retinaculum. Together, these structures form the carpal tunnel, through which pass nine flexor tendons, as well as the median nerve. When you overuse the hand, specifically the fingers, heel, and/or wrist joint, the structures within the carpal tunnel, such as the flexor tendons, can swell, compressing the median nerve. This can cause a cluster of symptoms, including dysfunction, numbness, pain, and tingling, that together are called carpal tunnel syndrome. This is one of the most prevalent and disabling injuries among manual therapists.

• Using the heel of your hand for deep-tissue work forces you to hyperextend your wrist joint. When you use a hand position that includes both compression of the wrist and hyperextension of the wrist joint, you are at risk for serious injury.


Guarding the Heel

Although its shape appears functional, the heel of the hand should not be used for applying pressure. To relieve the stress placed on the heel of the hand, integrate the entire palmar surface of your hand into your touch.

Functionally, the palmar surface is an effective tool for superficial and deep strokes, and for palpating the contours of the body. In addition, techniques such as Therapeutic Touch and reiki use the palm of the hand with great sensitivity to increase the flow of energy throughout the body. Another advantage of using your palm is the automatic decrease of extension that occurs at the wrist joint when you naturally flatten your hand to bring your palm in contact with the body. You can add to this advantage by maintaining proper alignment and by keeping your fingers and thumb relaxed at all times.

Barb Frye has been a massage educator and therapist since 1990. She coordinated IBM’s body mechanics program and authored Body Mechanics for Manual Therapists: A Functional Approach to Self-Care (Lippincott Williams & Wilkins, 2010), now in its third edition. She has a massage and Feldenkrais practice at the Pluspunkt Center for Therapy and Advanced Studies near Zurich, Switzerland. Contact her at barbfrye@hotmail.com.



Smart Practice Tip

Become more familiar with the carpal bones by palpating the heel of your hand. Try locating as many carpals as possible, noticing whether or not any are sore. This kind of exploration will give you insight as to why it is prudent to use extreme caution when using the heel of your hand for applying pressure. If you are unfamiliar with the anatomy of the palmar side of the hand, check out Trail Guide to the Body by Andrew Biel (www.booksofdiscovery.com).