Let’s assume you’re sitting down. Reach your hands forward and press your palms together until your elbows are straight. Now, separate your arms out to the sides into a “T” shape and turn your thumbs down. Finally, reach both arms overhead and bring your palms together again.
Ideally, these movements feel easy and pain free. But for some readers, even thinking about this motion brings discomfort. Tight muscles, old injuries, nerve compression, arthritis, and more can limit not only the hands but everything between them and the spine.
Maybe it’s because my own journey with Rolfing® started with hand and neck issues, or maybe it’s just that the fascial and musculoskeletal systems of the arms are so fascinating, but I truly enjoy helping clients regain functional, pain free use of their hands. Many come in with common diagnoses like carpal tunnel syndrome, tennis elbow, or golfer’s elbow, but the story is usually deeper than a single label.
Identifying the Source
I was introduced to Rolfing® Structural Integration while recovering from a neck injury in graduate school. The pain felt localized to my neck, but in many ways it was about my hand. I was rock climbing at the time, pushing my body to grab and hold difficult positions. “Move your right hand two feet higher, rotate your wrist, lock in tight.” My intent was focused on what my hand needed to do. My neck, shoulders, and spine had the job of getting it there, and they couldn’t keep up.
It might sound odd, but many of the issues we think of as neck or shoulder problems are really about how our structure supports or fails to support hand use. You had better believe that your shoulder is listening to your hand during your golf swing. Your trapezius muscle knows what your little finger is doing while you sip your morning coffee.
Critical Anatomical Zones
Let’s focus our attention on the structures of the elbow, forearm, wrist, and hand. This includes twenty-seven bones of the hand, the ulna and radius of the forearm, and the lower third of the humerus, the long bone of the arm.
Muscles here are grouped into flexors (which close the fingers and bend the wrist inward) and extensors (which open the fingers and bend the wrist outward). These muscles are innervated by three major nerves: median, ulnar, and radial, which carry both motor and sensory information.
It’s common to see imbalance. Typically, the flexor group is overdeveloped relative to the extensors. These imbalances become more obvious and limiting as you move closer to the hand. Clients often don’t realize how little functional movement their fingers and wrists can perform until pain forces the issue.
Assessment and Intervention
A diagnosis is just the beginning. My work starts by asking: How did we get here? What movement patterns led to this issue? What habits, activities, or compensations are maintaining it?
For example, a client came to see me with carpal tunnel symptoms in their left hand made worse by computer use, but they also play guitar regularly. The position of the arm in each of those activities is very different. I’ll start asking: How is the hand being positioned? What strain does that place on the tissues up the arm, even into the shoulder and neck?
One key area of focus is creating space within the forearm. Through Rolfing, we work to differentiate the fascial layers so that the flexors and extensors can move independently, rather than tugging on each other like tangled ropes. We also want to restore glide to the nerves so they can move freely without creating pain points or tension.
Once we’ve done some work to free up the myofascial system, the layers of connective tissue surrounding the individual muscle groups and specific muscles within the arm, I find it very helpful to address the neurofascial components, which surround and protect the three critical nerves mentioned earlier. Each of these nerves must be able to glide and slide throughout their pathways, which begin at the spine and terminate in the hand.
Gliding action refers to the movement of the nerve through a tissue layer. You can envision the action of flossing, where the floss glides through your teeth. Sliding action is a lateral movement found around joints, where the nerve shifts side to side as the surrounding surfaces move. Both movements are essential to ensure nerve health and overall comfort
Clients can learn and perform simple nerve glide and slide stretches on their own to further aid recovery. The key to this maneuver is maintaining a gentle (1 or 2 out of 10) level of stretch on the nerve while allowing the rest of the body to make natural adjustments. I’ve put together a short video demonstrating the technique for you.Moving Forward
If you’ve been struggling with arm pain, I invite you to consider what story your hands have to tell. There’s often more to the picture than a single diagnosis. With Rolfing® Structural Integration and Integrative Bodywork, we aim to address the whole system, restoring ease, balance, and confidence in movement.
Let’s work together to get you back to doing what you love, freely and without pain.
Be well, Eric Maklan