Key Point

• With about 30 muscles supporting the hand’s ability to grip and grab, treating forearm issues can be a challenge.  

Popeye the Sailor was a regular part of my Saturday morning cartoons and Sunday comic strips when I was growing up. For those of you who have no idea who Popeye is, you might recognize him by his rusty dialect, missing eye, sailor’s cap, and permanently affixed pipe in his mouth. But he’s probably best remembered for his exaggerated forearm size and strength. As a kid, I gathered that his shenanigans were fueled by his handy access to endless amounts of canned spinach. As an adult and a massage therapist, his forearms raise all sorts of questions.

What’s with the hypertoned flexors and extensors, Popeye? A typical bodybuilder (or any incredibly strong human) will most likely have broad shoulders, six-pack abs, and bulging biceps. Not Popeye. His forearm size, relative to the rest of his body, makes me wonder how he gets his shirt on in the morning. This, as I have come to deduce (also I might have learned about it online), is because the strength required to handle the tensioned ropes of a ship is largely about the hands. And the hands do not act on their own.

Forearm Findings

While the hands have a lot of cool little muscles that are great at cool little movements, they are just that: little. This means when more demanding tasks are asked of them, like hoisting sails, they call in reinforcements. Enter the forearms—the house of strength behind a hand’s ability. The more intrinsic muscles in the hand are great for positioning our fingers to grip. And the extrinsic muscles that live in the forearm batten down the hatches. Popeye’s forearms suddenly make a lot of sense.

But it doesn’t always work out this way. As MTs, we don’t find ourselves with overblown forearms, even with our extensive hand use. There are, as you have most likely experienced, many instances where the function of a muscle is overused, underused, or misused. The instances of this happening in the forearm are more common than we probably like to admit. The hand’s ability to grip and grab is a collaboration of about 30 muscles—that’s a lot of room for error.

Anyone who’s had tennis elbow, golfer’s elbow, or carpal tunnel syndrome can attest to this. These dysfunctions don’t necessarily indicate you play tennis or golf every weekend. They just mean that some combination of the 30 movers and shakers in this region are malfunctioning. It would be lovely if we just got stronger. But I have a feeling that if Popeye existed in the real world, his forearms would be riddled with sprains, strains, and all the -itises. 

Treatment

Really good, detailed work in the forearm requires understanding this premise. Figuring out what is overfiring, underfiring, or stuck in a misfiring pattern is often the first step in helping a client through their issue. And one of the best ways to do this is not necessarily about memorizing all 30 muscles that live here—although that would be helpful. Until you’ve got these down, though, slow your work, be methodical, and ask the right questions.

With your client supine, have them rest their hands at their sides, palms down. This slight, internally rotated position helps neutralize the shoulder and keeps any shoulder issues out of the spotlight. Place a small bolster (a rolled-up hand towel will do) under their wrist if there is any residual discomfort. Starting off with a steady forearm (yours), steamroll up the forearm (theirs). Moving from wrist to elbow, sink in with the anterior aspect of your forearm into the posterior aspect of theirs. As you do this, have them wiggle their fingers and thumb around just enough to create a little engagement.

Once things are warmed up, begin the specific work. Stand near your client’s shoulder, facing their hand, and gently grab the upper forearm. With your fingers supporting your work between their arm and the table, place a thumb into the bundle of extensors near the elbow. Support your thumb with your other thumb—because thumbs need a lot of help—and begin to sink in. As you do this, ask your client to wiggle their fingers again—this will give you good information. 

If you and your client are ready, you can take it one step further. The forearm powerhouses are exactly that. They engage more when you ask them to do more. Sinking in again, have your client squeeze their hand into a fist. This extra request for energy pulls those larger muscles out of the shadows and offers a lot more perspective on how things are operating under the skin. Repeat this technique in various positions throughout the forearm and have your client report what they feel. From here, follow the pattern of contraction, listen to the lines of communication, and ease the dysfunction back into function.