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Proper elbow techniques

This is an excerpt from Deep Tissue Massage by Jane Johnson.

Elbows

Elbows are commonly used as part of a deep tissue massage routine. They can be used in two ways. First, they can provide localized static pressure to relatively small muscles that require deep pressure (such as the tensor fascia latae or levator scapulae) or to a small, specific area of a large muscle (such as the origins of the hamstrings). Second, they can apply what is sometimes called stripping—that is, the slow, continuous application of pressure with oil along a narrow band of tissue.

Covering a smaller surface area, the pressure facilitated by the use of elbows is deeper than when using forearms or fists—and might even be as deep as when using a massage tool. For this reason, it is best to use elbows for deep pressure only after tissues are thoroughly warmed. (Of course all deep tissue techniques have a more profound effect and are safer to apply after tissues have been warmed using regular massage techniques.)

Using Your Elbows to Apply Static Compression

Use your hand to practice this technique on yourself before trying it on a client.

1. Identify the spot you wish to treat and touch it with your elbow, keeping your elbow flexed (a).
2. Extend your elbow slightly, while still touching the spot, but do not add any pressure yet (b).
3. With your elbow on this same spot, still extended, lean onto the client (c).
4. Maintaining the pressure, slowly flex your elbow (d).
5. Ease up, reducing your pressure, and soothe the area.
6. Repeat.

Using Your Elbows to Apply Stripping

To use your elbow to apply a stripping technique, follow these steps: Starting at the distal end of a thoroughly warmed muscle, identify the line of tissue along which you wish to strip (e.g., the centre of the calf muscle).

1. Starting at the distal end of a thoroughly warmed muscle, identify the line of tissue along which you wish to strip (e.g., the centre of the calf muscle).
2. Place your elbow at the distal end of this line, supporting your elbow with the web of your other hand.
3. Lean onto your client with your elbow and, using the guide hand, slowly move from the distal end of the muscle to the proximal end.
4. Soothe the area with strokes such as effleurage or petrissage.
5. Repeat.

Safety Guidelines for the Use of Elbows

Additional safety guidelines for using the elbows relate to the fact that the pressure applied is so localized. When using the elbows, you must never compress main vascular structures, lymph nodes or nerves. You need to take extra care in controlling this technique. Be especially careful when using oil—you must guide your elbow to prevent it from slipping, keeping the elbow in the correct position on the muscle.

When using elbows to treat trigger spots, be sure to remove the pressure if the sensation of slight discomfort at the spot does not dissipate within 60 to 90 seconds. If the discomfort does not dissipate, this could indicate you are pressing into a spot other than a trigger spot.

Finally, remember that elbows should be used only after tissues have been thoroughly warmed. That said, with practice, many therapists become expert at applying just the right amount of pressure with the elbows, using this very pressure as part of the warm-up. Using elbows certainly facilitates the application of deep pressure, but such pressure doesn't have to be deep.

Advantages, Disadvantages and Uses of Elbows

After practicing compressive techniques using your elbows, tick the statements with which you agree in the following three lists:

Advantages

• Facilitates the application of very deep pressure
• Can be localized to a very specific spot
• Avoids strain on the therapist's wrist
• Easily links to compressive techniques using forearms
• Can be used with oil or as a dry technique
• Can be used through a towel or through clothing

Disadvantages

• Cannot be used on all muscles
• Can take time for therapists to learn to lean onto their clients when using elbows

When Is the Use of Elbows Indicated?

• When you need to apply very deep, localized pressure and do not have massage tools available and do not wish to use your fingers and thumbs
• For the treatment of trigger spots
• When your wrists and elbows are at risk of damage through overuse or if you are hypermobile in these joints
• When you wish to incorporate a compressive technique into a chair massage routine
• When you need to provide massage through clothing, such as at a sporting event

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