In the four-in-hand technique, the ringer hold two bells in one hand with the clappers at right angles to each other. This allows the ringer to either move the hand normally ("ring" – primary bell) or ring knuckles-first ("knock" – secondary bell) to ring two bells independently with the same hand (for a total of four bells when ringing with both hands). The two bells can also be played simultaneously by holding the wrist at a 45° angle. In large ensembles, four-in-hand is typically used to ring multiple positions or pick up accidentals.