How To Protect Your Hands When Working With Stiff Patients
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[00:00:00] If you're working with patients and they are stiff and you are already starting to feel pain in your own hands and arms, you're not going to want to miss this video. This video is from one of my courses that I taught, uh, my two day manual therapy workshop. And one of the things that's really important to me for the longevity of my career is to make sure that my hands Stay pain-free and that I don't get injured and that I don't need surgery.
And at any time, you know, God, knock on wood because of repetitive type of strain or working with really, really stiff, um, people, uh, post-surgical. So if that's really important to you, uh, watch this video. It's all about. positioning, body mechanics. I think this is a clip on how I normally may assess somebody with a wrist problem and it just allows me to easily move them around.
So take a look and then let me know what you think. So [00:01:00] When we're working with the small, working with the small, um, carpal bones, they don't always have to be across from you. Because if you're short, um, sometimes it's not as advantageous and it puts a lot of pressure on my shoulders, right, to work. So a lot of times I like to work with someone side by side, or I like to have them lay down because I understand that the flexors start over here, come through, and then the extensors start up here and come across.
Um, so a lot of times I try to, when I work with a wrist, I try not to overuse my hand and actually open up and use a lot of my, between my, my, um, thumb web space, right? To get some wrist extension. Um, so a lot of times you'll see that your wrist extensors are hard to get, but flexion actually hurts, right?
So if you're following and doing the yummy and yucky, then you'll go and do a lot more [00:02:00] wrist extension, right? So you have a lot. So, but it's, if I just do your wrist alone, it's not too bad. It's your wrist and your fingers together that are really, really tight. So she's got extrinsic, a lot of extrinsic, uh, flexor tightness, uh, which is causing a lot of wrist pain, right?
And then, of course, your forearm. So a lot of times we're thinking, oh, let's just stretch them, right? Just manually stretch them. But one thing I want to challenge you to think about is how can we shorten them? And work on the tissue while they're in a shortened position to get the, to get the movement and the reduction in pain that we want.
Right? And hand placement in manual is really important. You might be able to find it, but in order to protect yourself and your joint, I want to encourage you, because I see a lot of people doing a lot of this, right? Using the tips of your thumb, but I really want to encourage you sometimes to use the flatness of your thumb.
[00:03:00] to be able to get. And then a lot of times I'll use my whole hand or palm if I'm working with big tissue, right? So here I'm gonna have sort of my back to you. But if I want to, if I want to shorten the flexors, I actually want to put someone in in a little bit of supination and then, um, inflection to shorten those flexors.
And then I could work that tissue, right? You feel that so I can use the side of my Use the side of my thumb, and I'm using the weight of my body, alright? This allows me to get very ulnarly, right? And a lot of the muscles don't just end here, they actually, if you get just proximal to that medial epicondyle, you can affect a lot of your wrist flexors, right?
And if you work that tissue, you can get better. [00:04:00] Um, risk sensors, you can have reduction in pain. Right? So that's specifically working with muscles. Muscles and tendons. And if I do that, and then I go relax. Is that better? A little bit. So what I'm feeling here is, I can isolate, it's your MPs that are real tight.
Your MPs are really tight. So if your MPs are really tight, is it the joint or is it the intrinsics? So, a lot of times I'll do, and I'll find that pisciform, which is why it's so important, because your wrists fall, you're actually good ulnarly, but radially deviated, she's real tight. Do you feel that? So, one of the things I'll do if I find that they're radially real tight, I'll, I'll inter, uh, sorry.
Sorry. It's okay. It's alright. I'm trying to help you. Relax, relax. Yeah, I'll actually, [00:05:00] instead of going more pisiform, I'll hook my finger around the radius and I'll push her more radially. So there can be a little bit, she's so tight, I can do a little joint distraction and then I could push it more radially.
Do you feel that? Yeah. Does that feel good? Yeah. What joint are you distracting? The second metacarpal to the carpals, so I'm distracting. I'm pulling on the second metacarpal and then I'm wrapping my index finger around the carpals and I'm mobilizing against that
and I can just hold.
I just go home. Yeah, I'd rather go. Oh, that got looser with me. That got looser. Miami is better than Iowa. [00:06:00] Weather wise, you know, it's hot now, right? So you can go. So as long as whatever, wherever you find that tightness, If you go back to the anatomy of okay, so even if it's not supposed to move that much, it is supposed to move something, right?
It's supposed to move a little bit. So try that move out, right? Try the shortening the muscles, right? If you're trying to affect the, the forearm, Flexors, you can work towards, from distal to proximal. How does that feel? Or you can work proximal to distal. That doesn't feel that good, right? I usually, when I do this, I use a little bit of cream.
I'm gonna borrow your cream.
Alright, so I'll put a little bit of cream. It just allows me to relax. So I can use the side of my thumb, and I can use my body pressure. Do you feel that? Mm hmm. Does that feel good? Mm hmm. Alright. Now, I could do that [00:07:00] same thing on the extensor side, right, and I'd do the same thing. So, to shorten the extensors, you go into, um, pronation, and you could put them into flexion, right, and you can go with the muscle, right, with the muscle, and I could shorten it all the way, relax, and shorten it all the way, and my thumb is doing cross friction.
Right. So I can do cross friction. I'm putting her into pronation. You feel it? Mm-hmm . Right? That's, does that feel good? Yeah. It's all right. You're like, uh, that just hurts. No, I can feel that moving. So, I'm, I'm working on muscle right now. Not fat. Not fat. . I.[00:08:00]
Um, well, a lot of times if we're trying to get more motion or we're trying to reduce pain muscles only get long and only get short. So when you shorten it, you just have a chance to work with it in a different tension. So a lot of times we just put it into tension and we work into more tension, right?
But we can actually shorten it and we could get faster. You potentially get faster results with it, right? So just shortening it allows you to work with it in a different way. in a different, uh, phase. Right? And you can feel it. If you feel her forearm, owner wise, she's got a lot of tension right here.
Don't pull. Right? And relax. And one of the things I like to do is, the forearm muscles, because of supination and pronation, um, one of the things I like to do is, you know, remember when you were younger, you had that Indian burn? Like someone would twist your arm? So, that's actually a really, it could be a great move, because it [00:09:00] allows you to move the tissue.
It allows you to move the muscle, the fascia, and the skin. So if I roll you like this, how does that feel? Good. If I roll you like this, how does this feel? A little more painful. Okay, so this direction feels better, right? The yummy side. This is the yummy direction, and you can actually, so here, when you're doing this, this is really great for anyone with ulnar sided pain, right?
Because a lot of the ulnaris sit really, really ulnarly. If you have anyone who has a lot of muscle tension and tightness with supination and pronation, this can really help with it. So one way that I'll do this, So then if I do, now when I turn to the other direction, Better. It's better, it's looser, right?
You can do this with, um, really stiff people. You can do this with really painful [00:10:00] people. If you have someone who, um, is CRPS and they're real tight in their hand, if you work a little bit more proximal to them, it could really help them to have less tension, less pain. That way you can get to the more painful spot.
All right. So try the twisting. Um, so this is from, um, just a purely manual on moving the skin fascia, right? So how do we pair it up with some motion? So I can twist the arm like this. Now I'm going to have you turn your palm up. Turn, turn, turn, turn, turn, turn, turn, turn, turn, turn, turn, turn, right? You're going to twist in the other direction.
Turn your palm down. Which direction feels good? Pronation. All right. So now relax. I'm going to turn your palm up. And I'm going to twist you, go ahead, turn your palm down, turn, turn, turn, turn. So you're kind of turning, and you're turning them, you have a certain amount of pressure, but you're letting them have some give to actually turn, [00:11:00] alright?
Turn. So you can do it one hand, you can do it two hands, you can do it interlocked, alright? And that's mobilization with movement, but there's also that contract relax, so it's very pump receptive. Neuromuscular type of thing. Is that looser? Much looser, right? And we only did like five reps, right? If you're a therapist, an occupational therapist, physical therapist, assistant, if you're interested in developing your clinical skills in manual therapy for hand and upper extremity injuries, you're not going to want to miss this two day workshop.
I go over heavy anatomy, But not the boring shit the applied stuff so you can take the skills that you learn in those two days Take it to your patients on monday and really be able to use these techniques right away You're going to know what's safe to do. It's not safe to do And really at the end of day protect yourself and your hands for the longevity of your career.[00:12:00]
The links are below Um, and I hope to see you there
