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neural

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

PDFIn this issue, Mike O’Hara, PT gives ten reasons to love lunges.  Video of lunge exercises/progressions are included.  In Going Grizzly, Mike presents the exercise combination of Crawls and Sandbag Carries; a combination that helps you train more efficiently and move better.  Watch the video for instruction on these exercises.

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Getting up and down off theKnee_To_Hip_Skips ground is a movement skill we need to maintain. It is the functional exercise activity that keeps us safe and independent for a lifetime. Developing proficiency in getting up and down off the ground has multiple benefits. It takes away fear, builds confidence, and increases activity in other areas of life. Your fitness training should involve activity that makes you better at moving gracefully in and out of the positions necessary to get up and down off the ground.

Getting up and down off the ground is largely a neural activity. Nearly everyone has enough strength, range of motion, and balance—you just need some practice. Physiologically, we know that movement practice makes transmission of neural signals more efficient. Research on motor learning has taught us that repetition, ascending challenge levels, and coaching produces the best results. The knee to hip skips exercise will improve from the groundup movement skills.

Knee to Hip Skip Performance
The knee to hip skip teaches the neural system to link your opposite arm to opposite hip. All you need is some open space. If you have knees that are sensitive to pressure, a mat will make the exercise easier. Assume a half kneeling position (the left knee down and the right leg forward). Rotate the left hip open and keep the right foot firmly planted. Slide the left hand down the left leg to the ground and move the left hand about one foot length away from the thigh. The left hand will be on the ground and the body tilted to the left. Slide the left leg under the right leg. Reach the left leg straight out and lower the left hip down to the floor. Keep the right shoulder blade down the back and the neck long. Return to the starting position by reversing the movement. Perform five repetitions on each side.

Every workday I find physical therapy patients who struggle to get up and down off the ground. This is a drill that nearly everyone needs to practice. It is often the most difficult phase of the Turkish Get Up, the ultimate ground based movement exercise.

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