The last few weeks have given many of us the opportunity to pause, reflect and repair. I’ve heard some of our participants say they will take this time to partake in small repairs around the house. I am hoping you will also take advantage of this time to perform routine wellness repairs. Physiotherapy uses exercise to help reduce pain and improve joint strength. That is great and I encourage everyone to get the medical help they need. We all go to the mechanic when our car breaks down. However, we still need to complete routine maintenance and repairs in between visits. The more we can incorporate the right type of exercise into our daily routine, the less chance our body has of breaking down. Today we’re going to take a closer look at our hands.
Do your hands ache at the end of the day when you golf? Have you had to stop in the middle of pulling weeds, knitting, or using a resistance band in class? Perhaps you’ve noticed a dull ache when doing small tasks like writing your grocery list. Today I am here to talk about grip strength. We don’t just use our hands, we overuse our hands.
With 27 bones, 29 joints and 123 ligaments in each hand it’s no wonder that as we age, we sometimes develop hand pain. Holding a paddle, golf club, resistance band, knitting needles or tools requires prolonged grip. Movements where you keep pressure in a clenched position can sometimes be painful. If you notice pain after such endeavors there are two common problems that may be at the root of your pain. They are DeQuervain’s Syndrome and Basal Joint Arthritis. One of the tests for DeQuervain’s is called the Finkelstein test. It’s easy to perform this test. Start by reaching your arm out as if you were going to shake hands, place your thumb in the palm of your hand, and wrap your fingers gently around the thumb. Imagine you have a pitcher of water in your hand and you are pouring the pitcher into a glass by tipping the fist forward. If this movement is painful it may be DeQuervain’s. This syndrome is caused by the inflammation of two major tendons and may be caused by overuse. Tissue that attaches bone to muscle is called a tendon. Overworked tendons get strained and irritated and they swell. Sometimes tendons have to go through small spaces. Swelling prevents tendons from gliding smoothly through this space which can cause pain, popping or a catching feeling.
DeQuervain’s and Basal (thumb) arthritis can have similar symptoms. You
may notice twinges at the base of the thumb or on the thumb side of the
wrist. Pain can gradually onset or can come on quite suddenly and can
travel up the forearm. Symptoms often get worse when forcefully grabbing
an object. Splinting at night to give the hand rest may help. It is important
to keep the hands open as much as possible to allow the muscles to
lengthen and relax.
If you pass the Finkelstein test but still experience symptoms, you may be
dealing with arthritis. Noticing stiffness in your hands in the morning or at
night, loss of strength, aching, a bump or enlarged joint may signify
osteoarthritis. After years of work, repetitive movements, and sports we
can wear away cartilage around the thumb and fingers causing cumulative
trauma at the joint. Cartilage is a smooth, rubbery connective tissue
within a joint that protects the bones. It provides cushioning so bones don’t
rub together. Once cartilage is gone it doesn’t grow back. Exercise can
help stabilize larger joints by strengthening the muscles around them.
Unfortunately, there are no muscles in your fingers or at least, not the type
of muscles that help move your body. The muscles that move your fingers
are in the palm of your hand and up in the mid forearm. They are
connected to the finger bones by tendons which pull and move your fingers
like the strings of a marionette. Hands are more difficult to rehabilitate for
this reason. It is really important to work on dexterity and range of motion
in our fingers to keep them moving properly.
If you struggle with painful hands, you will find larger objects easier to hold
on to. It may help to use larger pens and larger grips on clubs, racquets and
paddles, or perhaps a little extra tape around the handles may help.
If you experience hand pain, ice helps reduce swelling so it can be helpful in
tendonitis type injuries. Warmth can loosen tissue and relax joints. It
sometimes helps to soak hands in warm water when they become painful.
Trust your body and do whatever works best for you. Over-the-counter
anti-inflammatory medications such as ibuprofen are effective and topical
pain relieving gels provide relief. Of course, it’s always important to check
with your physician regarding pain relief.
To reduce the likelihood of hand pain it is important to keep your wrists in
neutral position whenever possible. This will help decompress the median
nerve and provide maximum space for tendons to glide. Taping is a great
tool to increase awareness of how much we bend our wrists during the day.
Start by laying your arm flat on a table palm down. Try placing a small
piece of nonflexible tape such as painters’ tape from your wrist to about an
inch below your knuckle. If you bend your wrist the tape will pop off. If
you try to keep the tape on for a whole day you will quickly realize how
much work your wrists do. Show your wrists and hands a little love and
care with these exercises.
Self-Massage: With a small ball or Tubee between your hands, place your
hands in prayer position. Gently roll the ball or Tubee back and forth
across the palm focusing on the large muscles around the thumb. Next
place the ball or Tubee on a table and roll the muscles around the forearm.
Rubber Band Exercises are great for improving hand strength and
dexterity. We are always closing our hands and seldom do we put energy
into strengthening the muscles that open our hands. A rubber band can be
your ally in fixing that imbalance. Start with a light band and as your hands
get stronger you can add another band.
Spider Push Ups: Place the band over your fingers at your knuckles.
Resist against the band to expand your fingers, stretching them out as far as
you possibly can. Do not, however, stretch them to the point of pain. Hold
this position for three to five seconds, and then slowly control the fingers as
you return to your starting position. Repeat throughout the day.
Thumb Extension: Next thread the rubber band around your pinky
finger and thumb as seen below. Extend and lower the thumb in a slow
controlled manner 10-15x.
Finger Lift: Wrap the rubber band around your hand with your fingers side by side.
Now stretch your fingers away from each other with your hand lying flat on
a table. Next, start by lifting your pinkie finger. Hold the finger in the air
for three to five seconds. Repeat with each finger, including your thumb.
Now go in the opposite direction, beginning with the thumb and working
your way over to your pinkie. Repeat on the opposite hand and then rest
DIP Extension Tendon Gliding: Support your hand so that you can
only flex the last joint of the finger. A flat table will do nicely for this task.
I’ve used a Tubee in the picture below. You may have to use the other hand
to keep the lower joints flat on the table while you straighten and bend the
very end of your finger. Try this exercise with each finger and thumb to help
release trapped tendons.
Our last exercise is independent finger movements which help improve
dexterity. Place your hand up like you are going to wave. First move just
your pinky finger. Next imagine gluing your ring finger and pinky
together. Open and close as shown below. “Live Long and Prosper.”