Thumb and wrist pain from over use in massage and acupressure

Back MassageI received this email asking for help with a common issue for massage therapists and acupressure practitioners.
Hi there,  I’m Alex and I’ve been a massage therapist for 13 yrs now, and my question is this – 
I tend to use my thumbs a lot for pressure it’s a bad habit I know, I should use better mechanics and body weight but after doing it for so long my thumbs kill me and my hands cramp quickly when grilling anything now. Even a pencil. What can I do to reverse this?
Dear Alex,
The first step in reversing this is to care for yourself in everything you do.  I understand having a habit of over-use that is painful to myself while I am in service to another person.  That pattern has to stop. Hurting ourselves in order to help another relieve pain or stress is not the best equation for anyone.  It makes no sense, yet many of us do exactly that – strange but true!
And as you said, you need to shift your body mechanics in order to protect your thumbs. Our work comes through our hands, but really, where does it come from? Your thumbs are a part of you, and it is all of you that comes through your thumbs and hands to another person – your body, mind Thumb pressureand spirit together are the source of your work.
Qi Gong has been a great practice for me to learn how to move in a more coordinated way that creates more ease and less tension in my whole body. Any mindful practice – Qi Gong, Taichi, yoga will be helpful to get your whole body re-connected.  When your integrated and flowing from your entire body, your pressure is coming from all of you (rather than straining your shoulder, elbow, wrist, thumb). Now your energy is allowed to pass through your joints, through your thumbs, and to another person.
It sounds like you have been working hard from your shoulder or perhaps just your elbow down to your thumbs – this will eventually create the issues you are having.  It is for this reason that we have to have a practice that supports the integration of all of our joints, our whole body, mind and spirit, in order to keep the meridians and joints open so that energy can flow. We have to care for ourselves in the same way that we care for others.
The nerves that serve the arm, wrist, and hand all come from the neck and they pass through the thoracic outlet. Impingement in the thoracic outlet can create many issues in the wrist, hand, and thumbs – so, in addition to the above (#1 being the most important action to take) get massage for your own neck, shoulders and thoracic outlet.

Wrist extension exercise

Use a very light weight. You should not experience any pain with this exercise. If you have pain, lighten the weight.

For wrist strengthening, it is actually the wrist extensors that need strengthening as they are weaker than the flexors.  The strength imbalance between the flexors and extensors leads to strain and pain. So do not focus on strengthening the wrist flexors. I am sure they are already strong enough.
Use a 1lb weight to start with. (This is a humbling exercise I know!) Rest your forearm on a table with your hand/wrist hanging off of the edge of the table, palm down.  You hold the weight in your hand, with the palm side facing down.  Now, extend upward. The muscles you use to perform this action are the wrist extensors. These are the extension exercises that you need to strengthen this muscle group.  There should be NO PAIN.
Do about 8 repetitions, pause and then repeat one more time.  You should experience no pain at all while doing this exercise.  If there is pain, reduce the reps or the weight. If it feels too light, go up a half pound.  Increase weight slowly and by small amounts over time. Only do the exercises every other day because you need to give a day off for the muscle fibers to repair after the weight lifting.
Also, contrast baths of heat and cold are great for the forearm, wrist, thumb and hand. Get 2 big buckets – one with hot water,  and the other with cold. Place your forearm and hand in the hot, then the cold, then back to the hot, and back to the cold- go back and forth at least two times. Do this two or three times a day.
I hope this helps you find ways to take better care of yourself and return to health, vitality, and ease in your life and work.
Cindy Black

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Cindy Black

Cindy Black is the Founder of Big Tree School of Natural Healing and the author of Meridian Massage, Pathways to Vitality. She is appreciated for her ability to make the complex accessible, fun, and practical.


  1. Jane Walsh on September 23, 2019 at 8:39 am

    Hi Cindy, I used to be a massage therapist and I enjoyed it, but I sustained a severe sports injury to my right wrist that ended my career. It caused severe tendonitis. However, I would like to return to massage, but only doing a minimal amount in order not to injure myself again. Do you think this is feasible. I had physio on it and two steroid injections into the wrist, but two is my limit. They worked, but I don’t want steroids in my body again. Do you have any advice for me please? Kind regards, Jane.

    • Cindy Black on September 24, 2019 at 6:40 pm

      Hi Jane,

      I think it is possible for you to return to massage therapy, but you will need to adjust the way you work to your reality in the present moment. For me, learning about meridians and Qi (energy) opened up a whole new way of working without creating strain and pain for myself.
      Learning how to collaborate with Qi means that I use much less physical effort and get even better results. I call my work “Meridian Massage,” perhaps this form of work may help you to keep doing the work that you love so much.
      – Cindy

  2. Margot Brand on April 23, 2016 at 4:09 pm

    Yep! Good advise. Been an M.T. For 25 years and need to be reminded. Thanks.

  3. Sharon Gingell on March 10, 2015 at 3:55 pm

    Great tip. I am also feeling the strain on thumbs .

    • Cindy Black, L.Ac., LMT on March 10, 2015 at 5:44 pm

      Hi Sharon,
      Go easy with your thumbs.

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