6 Top Exercises to Teach Your Patients in Hand Therapy
The prescription of exercise therapy is the mainstay of the treatment of a huge number of musculoskeletal pathologies (low back pain, cervical pain, chronic pain, carpal instability, radius fractures, etc.). The evidence is conclusive regarding the direct local and indirect systemic benefits of exercise therapy.
However, we often encounter some limitations when using exercise programmes, and that is lack of adherence. We have previously discussed how we can improve adherence to an exercise programme through 14 points that you can apply with your patients to improve adherence.
Among all the information we can provide to our patient, it is essential that they UNDERSTAND the exercises we provide them at home. Sometimes, and more so in Hand Therapy, some exercises that may be simple for the hand therapist, are complex and difficult for the patient to apply correctly. That is why we need to take advantage of all the material or visual, auditory, etc. aids that we have at our disposal.
Among the various existing systems to support learning, today we talk about the “VARK” tool.
Do you know what it is? Discover examples for 6 TOP Exercises for injuries or pathology of the hand, wrist or fingers? This is of interest to you!
VARK | Visual, Aural, Read/Write, Kinesthetic
The VARK tool is a working system used in education to help students learn complex concepts by dividing them into different styles. In this way, the aim is “faster and better learning”. Each initial corresponds to individual sensory preferences:
a) Visual: preference for graphic and visual ways of representing information.
b) Aural (Auditory): preference for listening to information.
c) Reading/Writing: preference for written information.
d) Kinaesthetic: preference related to experience and practice.
In this way, by applying the VARK working system, we can apply its aids to teach hand, wrist and/or finger patients to understand somewhat more complex exercises, so that their practice at home is a success.
Here are some suggestions based on Daniel Harte & Leanne Law’s 2017 paper, published in the Journal of Hand Therapy:
1. Radial Abduction of the thumb in Osteoarthritis
One of the most commonly prescribed exercises for patients with thumb base osteoarthritis is radial abduction of the thumb. This movement activates certain muscles responsible for realigning and providing stability to the thumb, which counteracts the situation of metacarpophalangeal hyperextension that so often appears in these patients.
Why does thumb abduction improve base osteoarthritis?
Thanks to the work carried out by authors such as Kristin Valdes, we condense in a blog post, ALL the biomechanical explanation of this situation, and how specific exercise is key.
Giving a nickname to an exercise such as thumb abduction (Auditory) is a simple method of instructing the patient to perform the exercise correctly. An example might be to move the thumb like “the hands of a clock“. The therapist can use a marker pen to demonstrate how the interphalangeal and metacarpophalangeal joints of the thumb should be kept straight. At the same time, emphasise that, while respecting this, the thumb should be spread apart (or create as wide an angle as possible).
The hands emerge from Lister’s tubercle (dorsal prominence of the distal radius) and are directed one towards the interphalangeal joint of the thumb, and the other to the tip of the middle finger.
2. Stable Thumb Position for the pinch
In order to achieve a stable thumb, correct muscle activity of specific thumb musculature is required: First Dorsal Interosseous, extrinsic and intrinsic muscles. The objective in this type of patient will be to achieve and relearn the “O” sign of the thumb, which gives great stability to the load in functional gestures such as the Pinch.
To get the patient to relearn this position, we can add a visual drawing at the level of the first interdigital space. In this case, the authors selected the drawing of an “emoticon” or “emoji” of shock or even the image of “Scream of Edvard Munch”. We can choose the one that the patient prefers and that facilitates learning:
We leave you 8 Recommendations for treating a patient with Osteoarthritis of the Hand or thumb base, made by the ReHand teammate, Pablo Rodriguez, and published in the networks of lafisioterapia.net.
3. Tear Colditz Test
This functional goal-oriented technique seeks to assess how many times a patient can tear layers of paper before the thumb collapses. That is, how many times can the patient perform this task until the stable “O” position of the thumb disappears. It is important to highlight to the patient that he/she should NOT lose thumb posture by trying to achieve a higher number of folds or tears.
Harte D, Law L. Incorporating different learning styles into a home exercise program. J Hand Ther [Internet]. 2019;32(1):128–32. Available from: https://doi.org/10.1016/j.jht.2017.08.008
In this way, by associating functional and occupational tasks such as this one with VARK learning strategies, we can enrich the whole rehabilitation process.
4. Tenodesis Effect for Tendon Injuries of the Fingers of the Hand
The tenodesis effect is a complex muscle coordination movement between the flexor and extensor muscles of the fingers, often used as a coordination exercise, or to promote tendon gliding of the tendons after injury or damage to the finger tendons.
The gesture usually goes from wrist extension to wrist flexion, with the fingers relaxed. Thus, in wrist extension, due to tendon tension, the fingers flex passively, while in wrist flexion, the fingers extend.
In this case, to get the patient to internalise the exercise, and to include functional and/or occupational strategies, a basin of water is used. The patient is asked to wet the tips of the fingers, and then to try to dry and shake the drops off the fingers. Through this movement, the patient internalises the tenodesis gesture described above.
5. Composite Fist or Progressive Finger Flexion Exercise
In order to achieve and encourage progression at the level of flexion of the interphalangeal joints of the fingers, marks can be used and drawn on the palm of the hand, so that the patient can visualise targets.
The therapist will draw several marks on the palm of the hand in order to mark and record progress. This simple detail will allow us to monitor and guide the patient’s progression in cases of digital flexion deficit.
6. Lumbrical Muscle Exercise with ReHand
Another exercise that is sometimes complex is the work of the intrinsic muscles of the hand such as the Lumbricals. These muscles are so important in rehabilitation work for hand disorders such as thumb osteoarthritis or carpal tunnel syndrome. Do you know why this is important?
To achieve correct activation of the lumbricals, the patient is asked to perform interphalangeal extension of the fingers, associated with metacarpophalangeal flexion, seeking the Intrinsic Plus Hand Position gesture.
This gesture is easily applicable in Pinch exercises available within the ReHand telerehabilitation system. We must ensure that, during the thumb and index finger pinch exercise, the patient maintains the interphalangeal extension of the index finger, and the movement is at the level of the metacarpophalangeal joint. In this way, we can redraw two lines as they appear in the image, so that the patient internalises the gesture.
ReHand in Hand Therapy and Exercise Therapy
ReHand is a digital rehabilitation system for the wrist, hand and finger segment. Developed by a large multidisciplinary team of Physiotherapists, Hand Therapists and Hand Surgeons, it seeks to provide a solution to clinical needs and update the hand approach to the latest scientific evidence.
ReHand incorporates three systems:
1) A system for prescribing exercise programmes adapted to pathologies such as Thumb osteoarthritis, Radius Fractures, Tendon Injuries, Carpal Tunnel Syndrome, etc.
2) A treatment system for the patient in a Tablet application, which allows for individualised exercises adapted to the patient, and the sending of validated scales such as QuickDASH, among many others.
3) A monitoring system for therapists and professionals in charge, receiving information on clinical evolution and adherence data.
Pablo Rodríguez Sánchez-Laulhé
PhD Candidate | MSc, PT & eHealth Researcher