Athletes Treating Athletes

This is part seventeen in the Self Muscle Massage Series. In the introduction post to this series we introduced and demonstrated the three muscle release techniques that will be used in this post. If you would like to review them, click here. If you would like to see any other parts of the series, click here.

In this installment of the series we’re going to be moving from the forearm down into the hand. Typically, as you move further away from the core of the body, the muscles get smaller and become more prone to injury through repetitive overuse situations. It is also why bony injuries such as fractures and joint dislocations become more common where the muscles are unable to counteract the full load of the body in a fall situation onto the arm. In this area, the most common muscular injuries are in the form of compartment overloads such as carpal tunnel syndrome (where nerves get pinched by tight muscles causing pain and numbness in the hand) and tendon injuries (i.e. trigger fingers, etc).

Anatomy

Bony Landmarks

Instead of rambling on about all of the tiny bones that make up the hand and wrist, I’m going to stick with a simple overview. Just below the radius and ulna are the carpal bones. There are eight of them and they are arranged like little rocks between the long bones of  the forearm and those of the fingers and thumb. These small bones allow for wrist movement while the long finger bones allow for grip, pinch, etc. The bones of the fingers and thumb are arranged in segments to allow for increased mobility. In order they are- 1) from the wrist to your knuckles are the metacarpals and 2) from your knuckles to your finger tips are the phalanges. As you look at your fingers, there is a little bone on either side of the creases (where the finger bends). Your index finger for example has two creases and therefore three phalanges while your thumb only as one crease and two phalanges.

Muscles

When it comes to the wrist and hand, an easy way to think of the muscles is to think about what fingers of the hand they control (they are traditionally referred to as digits 1-5 with 1 being the thumb and 5 being the pinky or little finger). With this in mind, the muscles will either control the thumb (digit #1), little finger (digit #5), or the three fingers in between (index, middle, ring or digits 2-4).

There are two muscle groups that provide the “bulk” in your hand- the thenar and hypothenar muscles. Together these two groups provide the padding for activities where you put weight on your hands (ie push up position. The remaining power muscles are tendons with the true muscles located up in the forearm.

Thenar Group + Adductor Pollicus (aka the thumb muscles). The thumb is essential to grip strength and activities and as such, has it’s own little army of muscles to perform these functions. The thenar group actually contains three separate muscles, all of which work to bend the thumb at the first phalange (crease) and move the thumb in relation to the palm of your hand. The adductor pollicus is the largest of the thumb muscles and opposes the thumb (brings it across the palm of your hand towards your pinky). These muscles are easy to find because they are visible. When you look at the palm of your hand you will see all of the normal creases where the hand bends. There is a large semicircle crease that runs from below the index finger all the way around the thumb. Inside that crease are your thumb muscles.

Hypothenar Group. The hypothenar muscles control the small, pinky finger. There are three muscles and together they work to bend the pinky finger and move the finger towards/away from the other fingers. Together with the thenar muscles, these muscles allow you to touch your pinky to your thumb for strong grip tasks. Like the thenar muscles, these muscles are also easy to find by following the creases in your palm. There is a semicircle that runs from below the knuckle of the pinky down to the wrist.

Finger and Long Thumb Flexors. These muscles are visible in the hand only as tendons. The Flexor Digitorum muscle originates in the forearm and splits into four tendons just before the transverse carpal ligament. From there the tendons travel down the carpal bones to the tips of the finger. The Flexor Pollicus Longus also originates in the forearm and travels to the tip of the thumb as a tendon. The reason for including these muscles in this post is to point out that the forearm cannot be overlooked when trying to improve mobility in your fingers and thumb.

Transverse Carpal Ligament. While this is not a muscle, it is important to note. The TCL runs over the carpal bones inserting onto either side. Beneath it run the median nerve and vascular structures to the hand. This is where carpal tunnel can occurr. If the soft tissue structures around the ligament begin to push on it, the nerve and artery/vein can be pinched causing pain and numbness.

Soft Tissue Release

What you’ll need: stick/foam roller and tennis ball

The techniques: click here for an introduction to the techniques and a video demonstration

1) Lengthening/elongation with the foam roller or stick.
2) Cross friction with your hand or tennis ball.
3) Sustained pressure or trigger point release with the tennis ball.

Key Areas to Work On

#1 Foam Roller. To best work on the hand, start off with a foam roller in the forearm and work both sides from mid-forearm down to your wrist. Rotate your hand as you go to cover more area. From there, switch to the tennis ball and work on the palm itself from following the carpal bones. See the video for further details.

#2 Tennis Ball- Cross Friction. The key with cross friction is to remember that you are working perpendicular to the muscle fibers. This means that you will be working in a side to side (horizontal) direction when working on the hypothenar and finger muscles and up and down (vertical) direction when working on the thumb/thenar muscles. The movement itself is very small (maybe 1-2 inches). Sink the tennis ball in deep, relax and then maintain that depth as you work. If you feel like the ball or your fingers are rolling or sliding, you’re moving too much. When working on the hand, the primary locations for cross friction will be at the common origin of the thenar and hypothenar groups (aka on either side of the transverse ligament). You can also use this technique on individual long flexor tendons. See the video for further details. If you’re still unsure of the cross friction technique and how to properly do it, click here for a review

#3 Tennis Ball- Trigger Point. When moving onto trigger point areas, remember, let the tennis ball sink in nice and deep and just sit on it. If after 2-3 minutes it hasn’t released, move onto the next spot!

Video

Here is a video demonstration for self muscle release for the hand using a foam roller and tennis ball.

References

1) Hammer, Warren. (2007). Functional Soft-Tissue Examination and Treatment by Manual Methods, 3rd edition. Jones and Bartlett Publishers, Inc, Sudbury, MA.

2) Hyde, Thomas and Gengenbach, Marianne. (2007). Conservative Management of Sports Injuries, 2nd edition. Jones and Bartlett Publishers, Inc, Sudbury, MA.

3) Moore, Keith and Dalley, Arthur. (1999). Clinically Oriented Anatomy, 4th edition. Lippincott Williams and Wilkins, Baltimore, MD.

4) Muscolino, Joseph. (2009). The Muscle and Bone Palpation Manual. Mosby, Inc, St. Louis, MO.