How to lengthen the life of your thumb

First published in the Shiatsu Society UK Journal

Thumbs are our business! After all Shiatsu means thumb (or finger) pressure, so our shortest digits are at the very core of our work, arguably our most important assets. How often do we look after them? Do they hurt when we give sessions? Do we ignore that pain? How can we maintain their health for as long as we want to be giving Shiatsu? And, if we have discomfort, does that mean we have to stop?

Measurements from Veet Allan’s Ocean of Streams

One cun from Veet Allan’s Ocean of Streams

Use of the thumb in Shiatsu

I am a Zen practitioner and teacher and so cannot write about how Namikoshi therapists deal with the matter of using varying pounds or kilos of weight through their thumbs.

I have commonly used the pad of my thumb when I work along a Meridian or activate Tsubos. I aim to keep my thumb joints straight, in line with my arm (often with an equally straight elbow as in diagonal back stretches), and I notice if the blood leaves the tip and turns white.

I am interested in the journey the Ki takes from my Hara to the point of contact, and in relaxing the muscles of my shoulders, wrists and of course thumbs as much as possible to promote flow. I use the image of pouring cream into the narrow-necked, spherical-bottomed, client’s Tsubo as I transfer my weight gradually from my centre. This way I can sense the amount needed for that place at that time, and safeguard the health of my thumb.

I often imagine that my thumb is a tube. This tube is strong and soft which enables me to make a very sensitive contact with the receiver, and maintain ‘open’ joints. I do not think of the bends of my thumb, around which the Ki must travel up and down, in and out between us, but of supported, continuous sides.

This way of working has all sorts of knock-on benefits such as keeping enough distance from the client physically and psychologically to enable a spaciousness; maintaining open awareness and enough objectivity.

I do not have overly flexible thumb joints, so they stand upright if I take this type of care and move rhythmically forwards and backwards as I work. They rarely cave in or give way and for 26 years I experienced almost no pain. If I remember correctly there were two spring times when there was generalised pain in my hands and I once visited the doctor who tested their flexibility and deduced that they were normal given my initial dance career and latter Shiatsu practice. So I took up yoga and T’ai Chi, ensured I included sour tastes in my daily diet, meditated for anger and frustration management, checked my alcohol intake, and carried on working hard.

It was in 2016 that my thumbs started to give me gyp as I worked. The trouble coincided with the end of the peri-menopausal stage (it is common to have joint pain then), with my kids leaving home, and I was tired. I had been preparing for a change and to take a break, but was finding it very hard to let go. The pain in my thumbs helped persuade me of the need, useful as pain always is in directing us to something which requires attention.

Thumbs in the movies: If you want to see how very frightening thumbs can be, watch the film, Spy Kids and beware of the Thumb Thumbs in their red knitted costumes!

I embarked on a sabbatical that October, offered 2 - 4 sessions a week when I was away (a huge reduction), and returned with the assumption that they would be fine. However, when I got home I found I was very keen to continue travelling and my thumbs were not fine. As a result, not only have I carried on walking and visiting, but I have changed the way I work.

In the same way that I adapted my practice when I was heavily pregnant, I knew there must be a way of continuing to give Shiatsu but it meant letting go (again!) of old rules and habits. Now I use my fingers and palms much more, the sides and knuckles of my thumbs, my knees, elbows, feet, forearms, sometimes even my forehead, and have found a greater variety of touch as a result. Other parts of my body are useful where my thumbs used to bear the brunt, and sometimes I take my hands off altogether, although I aim for constant Ki contact. (This is something I could not have done previously but is okay now I have more experience.)

Most importantly I have acknowledged that thumb (in fact, any) joint pain means I am trying too hard and putting in too much effort. This is a personal pattern, one I have been addressing since my childhood in one way or another, so it was not surprising that it came through my Shiatsu. I am grateful for that pain because I am once again thoroughly enjoying giving and am sure that my treatments are more effective.

Finally, any thumb discomfort alerts me to the state of my clients. Unsurprisingly I attract those from whom I can learn and with whom I share some similarities, so when I notice it, I ask myself whether this person has a tendency to try very hard or over focus (LV correspondences). I realise that if I engage with the kinder, more self-respectful way of doing things I have been experimenting with, I can create a Ki-field which stimulates awareness of this energy, and from that place the client often starts to reveal something underlying or debate alternatives.

Anatomy of a thumb

We all have different thumbs - different thicknesses, varying lengths and joints and sinews which are not the same.

Interesting fact: The motions (of the thumb) are crucial to the overall function of the hand, with amputation of the thumb resulting in 40% impairment. Amputation has also been cited as causing 22% disability of the whole person. (m)

The thumb consists of three rather than four bones, as in the fingers: the metacarpal which is connected to the trapezium (a carpal bone), and two phalanges – proximal (nearer to the central line of the body) and distal (at a distance). The princeps pollicis (Latin: of the thumb) artery supplies oxygenated blood. It can flex, extend, adduct, abduct and move in opposition (touching the tip of the thumb to the tips of the fingers across the palm). (b)

There are three main joints: between the two blue phalanges is the interphalangeal (IP) joint; between the blue and the green is the metacarpophalangeal (MCP) joint; and between the green and the pink trapezium carpal bone is the carpometacarpal (CM… — There are three main joints: between the two blue phalanges is the interphalangeal (IP) joint; between the blue and the green is the metacarpophalangeal (MCP) joint; and between the green and the pink trapezium carpal bone is the carpometacarpal (CMC) joint.

Adducton (towards the index finger) and abduction (away from), occur mainly at the CMC joint and in two planes: forwards / backwards, and side-to-side (when the hand is held up in front of your face, palm away from you). Flexion and extension can also happen at the IP joints as well of course, and could be the thumbs’ downfall.

Diagram 2 Anatomy Colouring Book Thumb joints.jpg

The average flexion at the MCP joint is 50%. Flexion there is unusual but our work can strain that joint considerably if we allow overextension (see the dimple at the top of the joint in photo 3) and are not careful to hold it steady when working.

Flexion at the IP joint is normally approximately 80 degrees but we who work with hand pressure are likely to be nearer 100. Extension is 5 degrees but if you compare the two photos below you can see the possible range.

This is my thumb and you can observe that I have a very small IP extension

This is my nephew’s thumb and his is quite different. If he wanted to become a Shiatsu practitioner, he might struggle with IP pain until he learns to strengthen the muscles around the joint to support it for upright working

Dimple at the CMC joint from over extending

The more potential for flexion and extension Shiatsu practitioners have, the more likely we could develop arthritis – true or false? The jury is out on this one.

Tendons of two arm muscles extend to the thumb: adductor pollicis and abductor pollicis longus and they move the thumb towards and away from the other fingers. The 1st dorsal interosseous muscle, the flexor, abductor and extensor pollicis brevis plus the flexor and extensor pollicis longus (which bend and straighten the thumb by activating the distal phalange) are all involved in moving the bones. (i)

Why is my thumb hurting or feeling weak?

Wear and tear is a phrase which sends my composure right off-kilter, but you could simply be doing too many sessions. It is hard to say no, and most of us need to earn a living, but have a think about the sensible number for you. Making an appointment with a supervisor and spending some time looking at the underlying reasons why your thumbs are hurting can be most beneficial.

Perhaps you are doing other things which stress your thumbs: texting (g), knitting and crochet for example. You could measure the time you spend doing each and choose which is the most important.

Interesting fact: If you text with your thumb as well as do Shiatsu you are putting significant strain on that joint.

The muscles can become strained. Falling over while skiing or skating is bad for thumbs – ow! Carpal Tunnel Syndrome is common (when the median nerve gets pinched or compressed). Trigger Thumb (h) is where it becomes hard or impossible to uncurl the thumb (the flexor tendon sheath narrows and the tendon gets inflamed trying to move through too-small a space). On top of all that, because the thumb is attached to your hand is attached to your arm… there are any manner of other causes, never mind the connection to your big toes or chest.

I have a regular client, KH, who habitually suffers pain in the thumb joint (as well in other parts of her body) with heat and inflammation. I use micro-movements using the proximal-distal joint actions I learned from Bill Palmer and have adapted in my practice, and using my mind to Smooth the Ki through the joint. It does not cause her pain during, and afterwards she reports an improvement. In the same way as I would use a distal point such as BL 67 for itchy eyes, I use LU 1 for the thumb.

The palmar base of the thumb, in the middle of which LU 10 can be found, resembles the shape of a lung (right thumb right lung etc). If it is purple in appearance or puffy with excess fluid, look out for a LU condition.

LU 10 is a Ying-Spring point which clears Heat from the channel and body, and might therefore aid thumb joint inflammation.

The Lung Meridian runs through the thumb as we all know, and this brings with it associations with grief, intake of Ki, and respiratory connections.

What can I do to prevent and help my thumbs?

The most important piece of advice I can give is not to continue what you are doing if it hurts. Stop!

Ask yourself, Must I do it that way? Can I use less pressure? Am I using brute force / muscular effort instead of projecting my Ki? Can I use a different body part? Is it possible to do what I want another way? Am I using my bodyweight? Is my thumb straight?

Perhaps you are doing what you always do and your thumb is prompting you to change, so examine your habits. It is good to change sometimes, it keeps your Ki moving to avoid stagnation which can cause pain. It is also good for the client as you are paying them attention. As you care for yourself, you are simultaneously caring for them.

Watch this Manaka Hammer and Peg video from Carola Beresford-Cooks for the times when your hands are tired or thumbs sore and you want to disperse Stagnant or Excess Ki around the body. Make sure you heed her advice on when and when not to use it! (f)

Medically, there are treatments such as cortisone injections and surgical procedures which are not usually things that Shiatsu practitioners are very keen on, what with possible side-effects and so on.

In order to avoid this, warm up and strengthen your thumb (and the rest of the hand) before you start work, just as you would before going for a run. Here are a selection of exercises you could do. They take 5 minutes but may mean that your thumbs last a Shiatsu lifetime.

Hypermobility (loose jointed or double jointed) is defined as a joint that easily moves beyond the normal range. Although it tends to decrease with age, as we get stiffer, that is not necessarily the case with Shiatsu practitioners who are using their thumbs day in and day out, keeping them limber and flexible.

Know why you are doing it:

· Get to know your thumbs

· Heighten awareness

· Strengthen the bones and muscles

· Delay joint deterioration

· Improve thumb fatigue

· Increase movement

· Aid joint stability

· Manage pain (d)

Isometric exercise:

Touch thumb pad to thumb pad and push without pain, keeping the thumbs as straight as possible. Hold for 5 seconds, focusing on the parts which feel beneficial, and then release. Rest for 5 seconds and repeat 5 times. Build up to 16-21 seconds of both activity and rest. (e)

Stretching:

Top tip: For effectiveness, only extend until you feel a good stretch but not beyond.

1. Make a fist then spread the thumbs and fingers out. Repeat 21 times.

2. Squash two squeeze or gel balls slowly and carefully as if you are getting every last drop of water from them, making sure you use your thumbs as well as fingers. Release equally gradually to full relaxation between each action.

3. With palm down make a fist. Open the thumb, and then the other fingers consecutively whilst simultaneously twisting the wrist so that by the end the palm is upwards and all five digits are spread and open. Fold them in in reverse order, starting with the little pinkie finger and twisting the wrist until you are back at the starting position. Repeat 11 times on each hand. This is the ‘making a lotus blossom’ mudra in Indian Kathak dance. Many of the other mudras are equally beneficial for the thumbs.

4. Flamenco hand gestures are also fantastic for thumb health (although holding castanets over a long period of time will cause strain if care is not taken). Hold the arms in front of the body, palms towards the solar plexus and fingertips facing each other. Move the middle fingers towards the inner wrists (the other fingers and thumbs will follow along behind). At the point of maximum (but not painful) flexion, continue moving the hands in the same direction rotating the wrists and as the palms start to turn away from you and upwards, allow the pinkies and others fingers to fan outwards in a fully extended position with thumbs stretched in the same direction as the forefingers. Slowly soften the joints as you turn the wrists back in the opposite direction, relaxing the digits, as if stroking around a circular object until you are back to the starting position.

“‘Hold stretches for 30 seconds without bouncing or jerking. It should feel good. Remember: keep it gentle, not intense.’ (e)”

5. Play thumb war (j), but make sure it is in the spirit of fun.

6. Shaking. Some people love shaking the hands as if trying to get something sticky off them. Do not do it if it hurts.

Massage:

With the palm facing the body and the elbow bent, stroke the left thumb with the right hand from the wrist to the tip, quite quickly, suspending the movement briefly at the tip before continuing to brush off. This benefits the active as well as the passive hand. Repeat 11 times and then do the same on the other side. You can use oil or cream if you like.

Make a hole with your right hand by curling over your fingers and hooking around with your thumb. Insert your left thumb. Using both hands twist the right around the left with gentle friction. You will be twisting both wrists as you do this.

Self-Shiatsu is useful and if you practice regularly on clients then making it part of your daily routine will maintain your overall health (makko-ho, Tsubos, meridian work).

True or false? That satisfying pop comes from tiny bubbles bursting in the fluid around your joints. Or from ligaments snapping against bone. Despite what annoyed adults might have warned you, it doesn’t cause arthritis. Still, it might be smart to stop. One study showed that this habit may cause your hands to swell and weaken your grip.

Exercise:

Swimming is good because the water exercises a gentle pressure on the joint as you hold it steady while moving.

Yoga positions such as downward dog and cat/cow on all fours, can benefit. They may cause some pain to start with but will strengthen over time. Make sure you work with a well-qualified instructor so you do not cause increased damage.

“In Hatha Yoga, the thumb is considered symbolic of the cosmos (k)”

We know that moving one joint can benefit the others, and that doing something enjoyable is really important. So, walking, dancing, practicing chi gung and Tai Chi, anything which mobilises the joints, will help the thumbs too.

A thumb splint or immobiliser may help if you are training to be a Shiatsu practitioner and needing to strengthen, or if you are going through a period of pain, to reduce the strain.

If acute then test with heat and ice to find which helps, or alternate between the two. You can also place your hand in warm water several times throughout the day to relax the tendons and muscles.

Rest cannot be overemphasised. Most people need to rest more.

Treatment is recommended if you have throbbing or pain on a regular basis and to prevent damage. Try Shiatsu - I have heard it is very effective!

Look after your thumbs! They are small but vital and so deserve extra special attention.

There is a video of these exercises and various thumb massage techniques on YouTube and elsewhere. https://www.youtube.com/watch?v=nsFi-KucBwg&ab_channel=TamsinGrainger