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Learn more about Rehab, Sports Medicine & Performance

mobility

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Our June issue brings information on preventing neck pain by strengthening your neck.  Mike O’Hara describes and demonstrates in a video exercises that will help strengthen the muscles of your neck.  In another article, Mike tells how grip strength can be a predictor of early death in some patients.  Be sure to read Jeff Tirrell’s article on performance based training.

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You Have A Social Media Disease

There Is No App for Thumb Pain

Your thumb is made up of an intricate system of tendons that enable very precise movement.  The joints of a thumb are fairly small and yet we are able to produce an amazing amount of force with this single digit.  In this age of all things digital, the modern American thumb has been subjected to greater workloads.  Problems with thumb pain, numbness, and limited function are becoming more common complaints in physical therapy.  I have some suggestions on how to manage pain and limit the damage and embarrassment of excessive social media thumb exposures.

Thumb Tendon Troubles

Dr. De Quervain was the first to clinically described thumb tendonopathy, and we call thumb tedonosis De Quervain Syndrome.   The test for De Quervain Syndrome was created by a clinician with an equally odd name and it is called the Finkelstein test.  Place your thumb in the palm of your hand.  Make a fist with the finger around the thumb.  Hold the wrist in neutral and then deviate the wrist toward the pinkie finger.  If you feel pain it is a positive Finkelstein test.

Resolution of thumb tendonopathy pain happens quickly when you give in to the symptoms of pain and modify your activities.  Rest the thumb tendons by using your fingers instead of your thumb on that smart phone.  Avoid fitness activities that put stress on the thumb.  Lifting in front of the body with the palms facing inward is often the lift that new mothers perform and develop painful thumb tendons.  Early on in the pain onset, icing is often helpful.  In physical therapy, we are successful with soft tissue mobilization, ultrasound, and manual therapy.  A gauntlet type thumb splint you wear at night is an unattractive but provides aviable position of rest for severely aggravated thumb tendons.

The Numb Thumb

Irritation of the median nerve in the carpal tunnel of the wrist will create thumb, second, and third finger numbness and pain.  An injury of the recurrent median nerve in the front of the palm will produce numbness in the thumb and limited strength during thumb opposition–thumb to pinkie finger.  Patients with neural irritation often develop numbness, weakness, and then pain.  The pain often wakes them from sleep and disrupts hand function.

Once again, you will resolve a numb thumb with rest.  Once neural irritation gets fired up, it takes longer to resolve than an aggravated tendon.  Giving in to the numbness and resting the hands will produce better results if you start early.  Two weeks of avoiding the aggravating hand activity produces good results.  Night splints for the wrist and thumb are often helpful.  A carpal tunnel release is a common surgical alternative that takes pressure off the median nerve.

Gumbie Thumb Beware

Every joint has a certain degree of stability and certain degree of mobility.  Our spine, knees, hips, shoulders, and elbows must move enough to produce motion but not so much that they fall apart.  The amount of movement in our joints is largely an inherited characteristic–you can blame Mom and Dad.  The person at the extreme end of the scale (“double jointed”) needs to take certain precautions with their thumbs.

The Beighton Score is a popular screening technique for joint hypermobility.  It has been around for thirty years and is used in research all around the world.  The scoring is based on eight passive range of motion assessments and one active range of motion assessment.  One point is assigned for each of the following.

A pinkie finger that can be passively bent backward more than 90 degrees.

A thumb that can be pulled down to the front of the forearm.

Elbows that passively hyperextend to 10 degrees.

Knees that passively hyperextend to 10 degrees.

The subject can place the palms on the floor during a straight leg, forward bend.

Researchers disagree on the score that should be a threshold for concern about systemic joint hypermobility.  I have found that fitness clients and physical therapy patients that score a 5/9 or higher require modification of their training programs.  It is not uncommon to encounter physical therapy patients that have a Beighton Score of 9/9.  Hypermobile individuals need to take more precautions when they perform repetitive tasks such as texting on a smart phone.

Kimberly Salt wrote an excellent article on social media induced thumb pain in the May 19, 2018 issue of the New York Times.  Take a minute and read, Me and My Numb Thumb: A Tale of Tech, Texts and Tendons.

Michael S. O’Hara, PT, OCS, CSCS

In our May issue, Mike O’Hara discusses the importance of walking.  If you have pain or difficulty with walking, there are things that help.  Mike demonstrates some exercises to get you ready.  Be sure to read Jeff Tirrell’s article on squatting, and read about Afterburn–a new class at Fenton Fitness that uses heart rate monitors while training.

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In the April 2018 issue, Mike O’Hara discusses the benefits of the farmer’s walk exercise. Jeff Tirrell tells you how to reduce injury to your ligaments and tendons, and tips are given for getting back out into the garden.

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In the February issue of our newsletter, Mike O’Hara discusses ways to improve hip mobility and strength.  Read Jeff Tirrell’s article on why dairy products may actually be good for you.  Having back pain doesn’t mean you can’t have a fitness program.

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PDFRead about keeping your hip flexors healthy and working well in Mike’s article, Nobody Names Their Child Iliacus.  Video instruction of the exercises in the article is available.  Jeff Tirrell gives five nutrition rules than can be broke.  Find out the correct way to set up your dual action air assault bike.

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PDFFind out if you scalenes are causing problems in Mike’s article, Scalene Salvation.  Read the inspirational stories of some Fenton Fitness members who conquered osteoporosis.

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Discover the difference between muscle soreness following exercise activity and pain you should be concerned about in “Do I Have A Problem?”.  Jeff Tirrell gives advice for women on optimizing performance  and Mike O’Hara discusses training priorities for those over forty.

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Keep your shoulders and spine happy and strong by following Mike O’Hara’s advice in “Pushing Up Performance”.  Video explanation and performance of pushups and their variations included.  Jeff Tirrell discusses the proper performance of pull ups in his article. “Movement You Should Master”. Is your mobility limited?  Try massage sticks or foam rollers with the information provided in “Pain, Pressure, and Pliability”.

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Train your hip adductors and bulletproof your legs by following the advice in Mike O’Hara’s article Adductors Galore.  Video demonstration and explanation included.  Mobilize your upper body by foam rolling.  In Foam Roll T W I, Mike explains the importance of adding foam rolling to your exercise program.

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