Case Discussion - Preventing Your Own Hand Pain as a Hand Therapist
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[00:00:00] Hey there, are you new to hand therapy and you're kind of struggling a little bit and your hands are starting to feel really tired and painful? Stay tuned. This is a video for you. My name is Wong. I'm an OTCHC and inside the mentorship program, I talked to a lot of therapists who are trying to get into hand therapy, they're getting into hand therapy and they're kind of struggling a little bit because hand therapy, everyone thinks it's easy and it's actually, it can be very challenging.
Especially if you're working with really stiff hands, um, and, or you're just not used to it, right? Or you're just not used to it. I'm going to share with you one of my student's questions. Let me put it up here for you. So one of my students, she's new to hand therapy, and she's struggling a little bit with keeping her hands pain free.
Do you have any suggestions to build up my endurance strength eventually? Where do I begin to get stronger? Would stretches be good for me, or is just range of motion? So she wants to improve on mobility and flexibility. So, [00:01:00] if you're looking to improve your strength in your hands, it actually starts in the shoulder.
So one of the things that, um, I tell my students, and I'll share with you too, actually I do this with my, I do this with my, um, I do this with my patients as well. I always look at someone's body type before I start recommending do you stretch or do you strengthen because there's a lot of people who feel very tight all the time but they're actually not limited in mobility.
They're actually very mobile and they're lacking strength which is what causes them to feel tight all the time. Hear me out. I have two types of people. I have a loosey goosey person or a stiff as a board person, right? A stiff as a board person, joints are like you can't bend them past zero. They usually, if you try to [00:02:00] bend them past there, they're just, they don't have pain.
They just are not very, very flexible by nature. By their nature, their ligaments tend to be very taut, holding their joints together. And those people who are very stiff as a board people, when they have an injury, they tend to be very stiff, very fast, and they, you'll struggle to get them to gain their motion fast, right?
That's just the way their body is built. And I want you to look at someone's body type beyond their hands, right? My loosey goosey person is someone who Their ligaments hold them together, but their ligaments are very loose. And so they tend to be very what we call hypermobile, right? So they tend to have their MPs go beyond zero, you'll see their, uh, their MP, their PIPs, their DIPs might go beyond [00:03:00] zero.
So their hypermobility tends to be in their whole body, not just in their hands. So the way I look at someone's body to determine are they loosey goosey or are they stiff as a board is I look at their MP motion. I look at their elbow and I look at their knees, right? So people who tend to be hypermobile are hypermobile throughout their whole body.
Someone who tends to be stiff as board, they tend to be stiff as board through their whole body, right? And of course, it's like a bell curve, right? That's. This is your hypermobile, hyper, and then this is your hypomobile people, and then majority of the time, the people sit in the middle, right? They're all mid.
But for the most part, we have varying degrees of hypermobility. If you're a therapist and you're working with patients, Look at your own mobility. I've been teaching manual [00:04:00] therapy and I've been teaching orthosis for over five years now. And I guarantee you that majority of the patients, sorry, guarantee you that majority of the students that I teach, majority of them are hypermobile, right?
Majority of them are hypermobile. They will complain of how stiff they are. Stiff they feel. But they stretch. And they stretch and it doesn't seem to help because they're constantly needing to stretch. If that's you, that's me, right? So I used to be told, stretch, stretch all the time, and it never really would help me get rid of my pain.
It would help in that temporary moment and then. I had to keep doing it to get like that sensation of feeling better. Um, and so stretching really isn't the thing to help you, but strengthening is. And strengthening with, um, smaller ranges of [00:05:00] motion can be more helpful than getting big ranges of motion.
So for example, I'll show you. When you're doing external rotation, look at my external rotation. Look, I can be out here. My, my forward flexion, I'm past my ear. I don't need to, to go through that whole motion because now it's going to stretch my already loose ligaments, right? I actually need to strengthen in a very particular way.
And I would encourage you if you're a therapist and you're new to hands, you're a therapist and you're, um, been in hands and you're having hand pain. Number one, number one, you may not be strengthening in a way that kind of helps you to hold everything together. Right. And that's going to be core and it's going to be proximal strengthening.
It's going to be shoulder strengthening. Um, number two, you're probably demonstrating poor body mechanics as you [00:06:00] provide therapy. Right. I see it all the time. People are, you know, if you're working, if your thumbs Are painful you're working too hard and you're feeling really tired Then it might be your body mechanics, right?
So let me give you some tips on that so if it's body mechanics Right, or is it your? strength right There's something for you to do, right? I like solving problems. There's always something for you to do if it comes down to your strength. I love planking
There's a lot of planking There's the regular planking. There's the side planking and there's the reverse planking, right? I'm not here to demonstrate it. [00:07:00] I'm sure you'll find it in some other videos that I have, but planking is really, really good to get your core. It's really good for your shoulders and then, um, rotation, right?
So if you're doing internal and external rotation, but you're doing it too fast or you're doing it, um, too light, then you're not going to feel really strong. But I like internal rotation. I like external rotation. And I think that there's a lot of different ways to go about doing it. You can do it with bands.
You can do it with weights. I have particular ways that I do it. I show my students. Um, so if you're interested in learning more about these types of exercises, it's inside the mentorship program. It's not really just for you, but it's for your patients and you're just learning from that. And then you apply it to yourself as well, but rotations for your shoulder is going to be really key.
And it just depends on where you're [00:08:00] at, right? I definitely have an unstable right shoulder just because I'm very right hand dominant. So I use everything. So I have a lot of strength, um, on like certain things, but then I, I still have to, I still have to, um, do some exercises to kind of hold those, you know, use my muscles to hold my joints together.
Cause my ligaments don't do enough work. Like that's just how I was made. And so I do certain things to ensure the strength of my hands. Um, so that I can live and work in a pain free way. It's very important to me. It's probably why I teach it so much and what I provide in my clinic. But my goal as I'm approaching 50 is to be pain free as I age and to be strong as I age, right?
So I don't know what your goals are, but here are some starters that you can start with in terms of body mechanics. Hello. I have a lot to say about this, but you'll find that inside the manual therapy [00:09:00] workshops that I have. And there's also an online program, but two of the biggest things that I could tell you, um, Oh, two, let's two of the things I can tell you is going to be your hand placement, right?
Your hand placement. It's just so huge. Um, and then hand placement is supported by or arm positioning. Like, um, how do you call it? You know? Yeah. Positioning, positioning. So I'll give you an example because I was teaching my, um, I'm teaching my new therapist. I have a new therapist in clinic and I'm teaching them because we have, we have some really like, Very stiff patients and the thing is, if you're holding and you're twisting like this, you're going to use your hands so much.
Your thumb does 50 percent of the work of your, of your hand. And so can you imagine constantly having to pinch, hold, or [00:10:00] do something for patient after patient after patient, you're going to, you're going to wear down your thumb like nobody's business. So one of the biggest things that I encourage my students and also I'm teaching my therapists Is to make sure that when you're working on something that you have your arm propped up on the table if you can Right, so that's that's positioning so you can prop your arm up on the table if you're working with someone who's bigger let's say you're working with an elbow or Or a shoulder hand placement is going to be key but positioning your body So I when you know when I teach my classes and I'm trying to move something I'm I can't show you because It's only showing this part.
But if you were to be able to look at my feet, I'm rocking on my feet to move my body so that I'm using my big muscles. I'm using my leg to help my arm. So then I'm bracing [00:11:00] my arm close to my body. And let's say I'm moving a shoulder, right? So then now my knees are bending. Or if I'm trying to move someone's arm, I can rock from heel to toe.
And that's all about positioning. You'll see me like I'll use my, I'll pop my elbow into my side to do something if they're, if I can, if I know that they're like a bigger person or they're stiffer, but that really comes down to positioning and hand placement. And you want to really pay attention to your body mechanics as you're working.
If you want longevity in hand therapy, you're going to have to pay attention to biomechanics and your own strength. Everyone moves into hand therapy from skilled nursing, acute care. home health, pediatrics, you know, whatever your past setting is. A lot of people tend to move into hand therapy because they think hand therapy is going to be [00:12:00] easier on them.
It's not necessarily easier. Hand therapy is very technical by its nature. There's a lot of, um, different injuries and you have to know biomechanics and kinematics a lot more than you have to know in other settings. In other settings, you might be using your back more. You might be using your body more.
In hand therapy, you're using your hands and your brain a lot more and it's going to wear down your hands. So you have to be really careful about that and you want to be able to work in a way that's going to help you. So yes, cardio is great. You want to walk or whatever. Um, but your own strength is going to be key in order to Be able to have the effect that you want for the patients that you're working with.
Every single patient, every time I, um, every time I train a therapist at my clinic or when I go and teach, like I'm, I'm short in nature, like I'm, I'm sure I'm a little tiny, you know, not tiny, but I'm not tiny. But [00:13:00] for my size, people are usually surprised at how strong my hands are. It's not that my hands are so strong, it's that they feel strong to the person I'm working with because I maintain a certain amount of strength and then pay attention to my body mechanics 100 percent of the time.
All the time I'm paying attention to my body mechanics. If I need to move you so that I protect my body, you're getting moved because if I hurt you, if I hurt myself, I can't help you. Um, so that's the way I see it. And my patients really love that. They, they don't mind shifting. They don't mind moving around.
Um, and it's because they know that what I'm doing is I'm thinking about them. So let me know if this video helps. If you're new in hand therapy, uh, grab the link below, come check out the mentorship program. All right. Any questions or comments leave them below. Thanks.
