Move a Stiff Wrist with These Manual Therapy Techniques
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[00:00:00] If you're struggling to move a really stiff wrist, my name is Wong. I'm an occupational therapist and certified hand therapist, and I teach a two day manual therapy workshop all for the hand and upper extremity. I'm going to share with you a clip from this course that I taught in my clinic in Miami, where we are right now.
I'm going to share with you some concepts about the wrist that are really important to understand as it pertains to like how to get it moving. Cause you have to understand what happens in order to get it moving. So please enjoy the clip. If you have a distal radius fracture, or you have someone with a stiff wrist, then what you could do is you can actually mobilize the carpal bones to get better wrist motion, right?
That's it. It's so simple. So a lot of times we tend to, like, do this stretch where we're just stretching, right, the tendons and the muscle and trying to get better, um, wrist extension and wrist flexion. [00:01:00] But if you could go and you could mobilize the carpals a little bit, then you might be able to get better wrist extension.
So the rule of thumb with the wrist is, wrist extension is, um, harder to get and more important, right? Um, but wrist flexion tends to be painful. Right? So when you move into, ah, like, ah, it hurts me right there, right? So, I'm not trying to make fun of people, it's just what happens, right? Um, so if you were using the strategy of working into ease versus restriction, then working into extension is actually easier, and when you get better wrist extension, you will get better, less painful.
wrist flexion, right? So here's the thing. You can work just flexion extension, or you can do where you find the pisiform, [00:02:00] right? If you find the pisiform, you can push the pisiform radially while you move the wrist ulnarly. Not only does it help to move the carpal rows against each other, right? But you're also loosening up some of the wrists.
Uh, flexors and extensors. Okay? And a lot of times this alone can give me really great wrist flexion extension. Right? But the manual aspect, right? So you can push them more ulnarly, right? But you can also push them more radially. So for example, a distal radius fracture on the distal side is The, the scalpoid, the first metacarpal, second metacarpal, third metacarpal, they all get real stiff, right?
And didn't I say that the second and third metacarpals have a [00:03:00] lot of tight, short fat ligaments that hold it together? And because it's so it's so strong, it tends to be real stiff, right? So when you work into, it's not that you're trying to do radial deviation, ulnar deviation, it's actually kind of a form of that dart throwers motion.
So you're going into radial deviation, but wrist extension. So a lot of times when I work it with my wrist. I will make my hand so it's, uh, stationary, but I would kind of put it right at the crease of the wrist using my C space, right? So I can push the carpal bones in one direction, and then I will push the metacarpals, like the hand, into that radial deviation wrist extension move.
You feel that? So first of all, it's less work on my hands. [00:04:00] right? Because I'm using my whole, and this is the movement. So it's all like chess, right? Right? So you can do that. And then you could do moving it more ulnarly. And then once you get some of that, you can work on some wrist extension. So again, I might put my hands around the thumb, and the metacarpals, so then when I push, I'm going to push down on the carpals, the radius, and ulna, but I'm pulling up on all the metacarpals.
You see that? So you could do that next to someone, you could do that, um, at the table where you're in front of them, right? But that's going to help me get some wrist extension. Right? And then, if I'm, if someone's really stiff, what happens is when you go really stiff, and then you let them [00:05:00] go, what happens?
It hurts, so don't do it. So, one of the things that takes, doesn't always take the pain completely away, but it takes the bite of the pain off. Right? So the sharpness of it. So if I'm gonna push someone into, into a sustained wrist extension. When you go into flexion, just push down against me, push me down, push me, push me, push me, push me.
So it's a little bit of an isometric, um, unloading, right? So when they use their muscles to pull down, It's going to hurt less, right? So if I'm using this and um, they're coming into extension, I'm pushing them into extension, extension, extension. Okay, so now you're going to bring your wrist all the way down for me.
Pull it down. Pull, pull, pull, pull, pull. And I just slowly let it go. So it's like an isometric pull, right? And that you could do that move with everything from the fingers to the elbow to the shoulder. All right. [00:06:00] So what I say before, I'm going to show you things that anything that I show on one area, you might be able to apply to another area.
You know what I mean? I've done that with fingers and it really does. It really does help. Yep. Mm hmm. Um, so that's what I do for, you know, the wrist, um, flexion, extension, ulnar deviation, and stuff like that. Another thing is, if you're trying to get end range, remember the second and third metacarpal?
They're really attached to, um, these carpal rows, and what you can do is you can do some joint distraction as well. So all you do is you grab. the metacarpal, and then you have to grab, kind of like the carpals, and you just distract, right? And you can even push on it a little bit to get that end range of motion.
Distract, end range of motion. The thing is, I can hold here, and then I can hold here. Does that make sense? Because it's your weight bearing bone, [00:07:00] and you want to be able to put and get end range of motion. This is not going to hurt your radius, because it's, it's not necessarily pushing. It's your carpals.
Does that make sense? Right? No, it's okay. I forgot what I said. Uh, honestly, um, oh, that, that you can distract, right? So you can distract, you can distract at any joint. You just have to know like, why am I distracting here? Right? The carpals, the metacarpals to the carpals. Those are tight, so you can distract it, and then you could do some end range, um, stretching to get that end range part from the second and also from the third, right?
You can even do it, um, sometimes I'll do it from a standing position, so come here, I'll show you. In a standing position, straight. So, if I'm trying to get end range extension, I want to be [00:08:00] mindful of the elbow, right? I'm going to be mindful of the elbow, and I can put my fingers underneath here, and I can, um, get some, if you lean forward, and just rock back and forth.
Right? I can get some end range on the radial side. I can put a little bit of lift underneath here. Lifting up the metacarpal? Up the metacarpal, and then I could, I could work this right here. If you're finding your, your ulna, your people are tight on this side, then you lift up from here. Oh, yeah. This is really great for anyone with a Like an ulnar sided wrist pain, your, your, your, um, FCUs, your ECUs, right?
This right there. No, it's not traction. It's just end range, it's just end range, um, you know, [00:09:00] trying to get end range motion. Understanding where the metacarpals sit with the carpals, right? And then you can even control someone's elbow. So, I want you to, she doesn't have that much supination, or pronation really, but you could lock here, and you could have them get end range motion, right?
Cause your fingers, you're getting to that carpal junction, against the radius ulna and the metacarpals, when it comes to wrists, right? So, you feel that one? When you had, when you were lifting up on it? Yeah, yeah, so I tend to, I was, uh, in my other class, I had a, Uh, OT that she had a distal radius fracture and all I did was I taught her cause she, she wasn't getting end range.
So I teach her. So all you have to do is, again, it's your thumb. So you come in here and you're pulling your thumb out and up, out and up. And then you rock over. [00:10:00] You rock over to get that end range here, you can put it underneath here, and you're rocking forward, and then you could do it on this side, and you, you have to, you have to do a lift, like a roll out, like a roll out and lift up, and then you're using your body weight.
to get end range. Does that make sense, everyone? If you want to develop your clinical skills as it pertains to manual therapy techniques for working with any kind of hand and upper extremity case, I've got two options for you. I've got my two day manual therapy workshop and I'll include the links below so you can see where I'm going to be, my locations and dates and stuff like that.
I also have my on demand versions of the whole course. You could buy it in segments of it. You need more hand or wrist or elbow or shoulder. You can buy. Each one individually or you can bundle them up and save. Key thing here is to develop your clinical skills. The links are below.
