Hitch Hikers Guide to the Saddle Joint

By Laura Gordon

Continuing with the theme of ergonomics, we’re going from external environmental factors to the internal workings of the human body.  In this blog we’ll study the saddle joint of the thumb.

In anatomy we learn the movement of synovial joints. These are freely moving joints and include saddle, hinge, pivot, ball and socket, ellipsoidal, and gliding.  In massage the thumb is in constant use and therefore can be the strongest or weakest link in our work. Let’s take a closer look at the saddle joint:

This biaxial, carpometacarpal joint is made of one concave bone and one convex bone. These two saddle–shaped bones fit together at right angles. The structure and placement of this opposing finger gives full range of motion (flexion, extension, abduction, adduction and circumduction) excluding rotation. Because of its placement on the hand, as body workers, we are inclined to use it like a tool which, if improperly used, can be over worked and hyperextended – a habit, if not changed, is the fastest way to “blow out” our thumbs ending our massage career dreams.

Let’s look further into the structure of this joint:

Holding the saddle joint in place is a complex system of ligaments, tendons, and muscles. Here are some helpful descriptions found on the internet:

“Ligaments, tough bands of fibrous tissue, join bones together. Six major ligaments give stability to the wrist. These ligaments join with others to link the wrist to the hand.

Tendons, white, flexible fibrous cords at the ends of muscles, attach muscles to the radius, ulna, carpals, metacarpals and phalanges. When the muscles contract, they pull on the tendons to move the bone. Some tendons also serve as stabilizers.”

“Most of the small muscles that work the thumb and pinky finger start on the carpal bones. These muscles connect in ways that allow the hand to grip and hold.

The smallest muscles that originate in the wrist and hand are called the intrinsic muscles. The intrinsic muscles guide the fine motions of the fingers by getting the fingers positioned and holding them steady during hand activities.”

Take a moment to open and close your hand right now, observe the movement under the surface skin, and consider all that your ligaments, tendons and muscles do to perform this simple act. Pretty amazing, isn’t it?

One way to keep our massage work a lifetime career is to take care of our thumbs using ergonomics.

To protect our thumbs in massage we talk about “stacking the thumb”. This protects from hyperextending the thumb while doing deep tissue work. Keeping the wrist straight, the thumb becomes an extension of the forearm (see image). Another way we protect our thumbs is keeping them close to the palms while making long excursions on the body such as effleurage on the back and legs.

Your challenge this week is to observe how you use your thumbs in your everyday life or in a massage. Tell us where and how often you catch yourself overworking and/or over extending your thumbs. Comments about what habit changes you feel you should make to protect your thumbs.

Ergonomics Body Mechanics and Self Care for Bodyworkers, 1st edition, Diane Redman & ArdathLunbeck, 2012
Massage Therapy Principles and Practice 3rd edition, Susan G. Salvo, W.B. Saunders, 2007

24 thoughts on “Hitch Hikers Guide to the Saddle Joint”

  1. I simply never use my thumbs if I can use something else. It is fairly necessary for petrissage at times, but I rarely use my thumbs for anything else, and never for trigger point.

  2. I got to go to Clary Sage today after the Bixby High School event and the client I worked on wanted deep tissue. I’m a level 3 and wasn’t too familiar with deep tissue yet but I have read about trigger points and worked on areas the client had knots. What’s amazing to me is how many time the body knows how to protect itself because holding the thumb in the way the picture shows, is exactly how I did the deep tissue work for the simple fact it was more comfortable. I’m looking forward to learning more deep tissue tricks that save the body.

  3. Over the weekend I have notice that when I pick up a glass, for a drink, I really use my thumbs, but more so than any other finger. It is like the death grip with my thumb. I have been typing a lot and notice that my thumb strikes the space bar way to many times and it explains the cramp I get. I also noticed that when watching t.v., my thumb is the one that push the buttons and that I do not keep it straight, but I bend it improperly. There are so many more things I caught myself doing that over worked my thumb. I do notice that I bend it wrong when giving a chair massage, but I am working on that. Good lesson! Thanks for making me fix, “the cramp in my style”, my thumb use.

  4. I have on more then one occasion overworked my thumbs. I am a avid computer game player and i play with a special gaming mouse that has buttons on the side of the mouse. I use my thumb to press these buttons and after a gaming session I feel my thumb to cramp and difficult to move. I feel that the best way for me to protect me thumb is to cut down on computer gaming and exercise my hand and thumb. I will start by playing more thumb wrestling with my wife.

  5. I find when I do a massage I tend to over extend my thumb and it’s a habit I am trying to break. I also find that when I wash my dishes I do the same thing. It can wear my thumb out, but because I do it so often I find that i don’t even notice I am doing it.

  6. I over extend my thumbs naturally. This is something I am going to have to really focus on not doing during a massage. Occasionally being reminded of the downfalls of doing this, is really important. Thanks for re reminding me.

  7. I used to overextend my thumbs quite often during massage but now that I am about done I have learned several ways to adjust. Like mentioned above, I always stack my thumbs now when I decide to use them but I try not to use them unless I absolutely have to. Your elbow is a great tool to use instead of your thumbs when working trigger points.

  8. During the Tai Chi massage I noticed that using my thumb for the pressure points was harder than I thought. I had to be more careful pay more attention to my thumb, something that I never gave too much thought. After reading the blog I started noticing how I use my thumb and it makes a difference.

  9. When doing chair massage I tend to use my thumbs too much. I can tell the difference when I do. I try to not use my thumbs at all when doing chair massage and when I keep to that it saves my whole hand from a lot of pain.

  10. I used to overwork my thumbs all the time before I learned the ‘correct’ way to massage and proper body mechanics. I’m alot more careful now that I know. I still do it sometimes but I’ve gotten much better at taking care of my thumbs.

  11. I use my thumbs alot as well and am trying to cut back on it when i realize it. Since i try to pay attention to over using thumbs i try to stack when i can. Chair massages are the worst for me since there is no slip on the body just cotton.

  12. I have classic “hitchhiker” thumbs as it is so I feel that makes me even more susceptible to thumb injuries when it comes to opposing pressure. I have already hyper-extended my left thumb and I have tendonitis in my right thumb that I have received 3 cortisone shots for. I know the biggest thing that I do that HAS to stop is popping my knuckles, including my thumbs. It is a terrible habit and I know it does more damage than it does good. Another thing would of course be texting on my cellphone. I will have to make sure to use support when doing massages so that I do not further damage my thumbs.

  13. An ongoing challenge for me is in the way I hold a pen. When writing, I put a massive amount of pressure on my thumb, often leading to cramping or discomfort. I change pen positions at times to alleviate pressure and, at times, accept sloppier handwriting and simply loosen my grip. When doing massage I make an active effort to not overuse my thumbs. Though I have never experienced any pain, cramping or discomfort, at times I do catch myself putting unnecessary pressure on my thumbs before realizing it. I am excited to practice alternative hand positioning and learning new ways to save my thumbs!!!

  14. After giving a massage or working on trigger points, I always notice my thumbs hurting. Last night in lab my classmate worked on my trigger points with her elbow. It really felt good, and it saved her thumbs, too! I have got to concentrate more on body mechanics. Thanks for the pics and advice.


  15. I tend to use my thumbs a lot. For work, for massage, and for texting. What I need to be cautious of now as a massage therapist is to protect my thumbs so I can use them throughout my career as a Massage Therapist. Before I knew I could damage or injure my thumb joints, I used them regularly and probably not properly while massaging. So this information is good to know!

  16. I have been a nurse aide for the last ten years or so, so I have already heard the never ending story of body mechanics. Massage therapy is very different, but already learning the importance of body mechanics no matter the career, I have taken note since day one of how our instructors stress body mechanics to us. I want to make my body last as long as possible, because I want to be able to work as long as I choose too, not my body.

  17. This week I have noticed that my thumbs have been more sore than usual but mainly because we have been learning shiatsu, but there have been a few times were my thumbs weren’t right, but thanks to Ross for showing us the thumb exercises.

  18. I have noticed that I use my thumbs a lot and sometimes hyper extend it so I am going to break that habit and have started by trying to use my knuckles on trigger points or crunchies. I am extremely glad we covered this subject this week as I do need to use my thumbs less so I don’t ‘blow them out’. That would be devastating as massage is my passion.

  19. I just started with massage and I notice I use my thumbs a lot. This blog has excellent points on how to not strain or over use your thumbs. My goal is to start off with good habits and correct body stance so later on I won’t need to relearn it or get injured. Reading this makes me think how lost I would be without being able to use my thumbs. I’ve noticed that I use my thumbs a lot at my current job picking up luggage by the straps. This will help me notice and try to change the way I pick up some items. I like the examples of how to use your thumbs safely during massage and this will help me start on the right track.

  20. Really really need to stack thumbs guys! I have clients coming int always with upper back pain and lower, you will want to stack your thumbs always. Switch between thumbs and your forearm/elbow. Helps thumbs relax while using elbows.

  21. I realized last night that I am not thumb friendly. I am working on to use proper body mechanics and not to use my thumbs so much. Reading this blog will definitely help me out not just in doing massage but also in everyday using my thumbs.

  22. The first week in massage I blew out my thumbs! very painful, worse when you cant bend them without pain shooting up through them… No Bueno!!! I have learned alot since day 1! and I still have more to learn. I find when I’m on chair events that I overuse my thumbs alot but have gotten wise and started using my elbows or more pressure with my palm.