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Idiopathic Wrist Pain
327 Plays14 days ago
Miranda and Josh talk about idiopathic wrist pain including evaluating and treatment this complex issue.
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Transcript
Introduction and Focus on Home Exercises
00:00:05
josh MacDonald
Hi, I'm Josh McDonald.
00:00:06
Miranda Materi
And I'm Miranda Materia, and we are Hand Therapy Academy.
00:00:10
josh MacDonald
Let's talk today about some of our favorite home program exercises, some of our favorite things to do to get patients moving at home. Randall, what are some of your kind of go to's? What do you like to do?
00:00:21
Miranda Materi
Oh gosh, I think I say this all the time. It's usually functional tasks. But if I had to pick like a specific exercise for i don't like a stiff PIP joint or even a flexor tendon that's further out, it's probably to be tendon glides. I feel like that's like a staple in hand therapy. It's something we usually show them on day one.
00:00:39
Miranda Materi
And it's something that they'll do, you know, they memorize and they do throughout their day. So if it's like a specific exercise thing, it's probably tendon glides or we call them tendon glides or six pack.
00:00:50
Miranda Materi
depending upon where you were trained and what you were taught.
00:00:53
josh MacDonald
Yeah.
00:00:54
Miranda Materi
That would be my favorite. And then of course, functional things. I'm like, just use your hand.
00:00:59
josh MacDonald
Yeah. Yeah. And I think you're right wherere where there's maybe a difference between what do we give out the most and what's our favorite.
Specific Techniques for Hand Therapy
00:01:06
josh MacDonald
So for me, if, if it's not tendon glides, it's maybe median nerve glides.
00:01:06
Miranda Materi
Yeah.
00:01:10
josh MacDonald
Cause we have a high volume of carpal tunnel and peripheral neuropathy patients right now. um And I feel like and know there's different nerve glides for radial and ulnar and median nerve. I feel like the median nerve glide that we give out, I feel like it works well for a large percentage of them.
00:01:26
josh MacDonald
And, and so the ulnar nerve glides, the whole like, finger upside down, masking on your face.
00:01:31
Miranda Materi
That was
00:01:31
josh MacDonald
I can't do it. I don't have the region for it. And so I feel like some of my patients, they look at me like, that's just weird. What am I doing that for? So the median nerve glides, I give out a ton for that. Um, and then joint blocking.
00:01:42
josh MacDonald
I give a ton of joint blocking for those stiff PIP joints, um, for, um, pull through on scar tissue, on flexor tendons, all that stuff.
00:01:43
Miranda Materi
good one.
00:01:50
josh MacDonald
I like to, like, you can obviously teach it just using the contralateral side. They hold their finger and they're just doing normal, um, um uh, joint blocking. I also like to make for them to take home. It's, I take eighth inch material and it's maybe like nine to 10 inches long and and and an inch and a half wide and I fold it in a half and it's this double thickness. And I do a little like u shape out of one end. So it's almost like a guillotine thing. They hold over P1 or P2 with their hand back of their hand flat on the table.
00:02:17
josh MacDonald
I feel like it both increases a little bit of leverage, but it's also something concrete for them to take home. And our patients, when I give them like, all right, just do this little thing. It's super important. It doesn't maybe carry as much weight with some of the patients. If I give them this, this like gift, like it's just like, I'm trusting you with this. Don't lose it. I crafted it just for you. It took me three minutes total, but you know, it's something that gives them a little bit more concrete nature to it. So I like giving that out. If I'm going to ask them to really hone in on joint blocking, that's something I'll say, throw it in your purse, keep it in your pocket, put it your center console, whatever the case is just to, um,
00:02:52
josh MacDonald
make it more real.
00:02:53
Miranda Materi
So it's basically a homemade joint blocking tool. A great way to use caps.
00:02:56
josh MacDonald
yeah The finger platter. Yeah.
00:02:58
Miranda Materi
ah Yeah, a great way to, something to give you your patients to take and then something that's theirs. Yeah, that's a good one.
00:03:02
josh MacDonald
Yeah. Yeah. Just makes it a little bit more concrete for them.
00:03:06
Miranda Materi
Yeah,
Upper Quarter Exercises for Mobility
00:03:07
Miranda Materi
definitely.
00:03:07
josh MacDonald
Yeah. Yeah.
00:03:07
Miranda Materi
a As you were talking, I thought of something I do give most patients and that's what we call the upper quarter exercises. So it's this whole like proximal stretching in the shoulder.
00:03:15
josh MacDonald
Yes. Yes.
00:03:18
Miranda Materi
And I feel like these are for anybody and everybody, you know, as long as you don't have something, you know, like a nerve transfer something that is restricting you from these, but these are great exercises to stretch your pecs, you know, all of those things that I think everyone really can benefit from because most of us are you know, doing exercises at a desk or a computer.
00:03:38
Miranda Materi
um So giving them the upper quarter exercises are really key. Okay.
00:03:43
josh MacDonald
Yeah, it's scaling stretches and scapular retractions and chin tucks and um ah thoracic stretch over the back of a chair. No, I agree. I have in our clinic with the older population, we have patients that never reach over over their head.
00:03:58
josh MacDonald
Like the highest they reach is either to wash their hair or to get something out of a cupboard and they're not getting past 90 degree shoulder flexion. And so when I ask them, they come in with like, oh, my hands are tingly. Can you reach up in the air? And they can only get to 80 degree shoulder flexion. i'm like, let's work on that whole scapula thoracic. And just that can make a difference because they just don't need to reach up overhead in their daily life.
00:04:20
josh MacDonald
They've lost that skill. So I agree. That's a, that's a favorite one for me, for anyone with neuropathy or, like tennis elbow stuff or like, let's just get you moving big. Like I'm here for my thumb.
00:04:31
josh MacDonald
Yeah, but you can't reach overhead. And it's kind of this cascade downstream.
00:04:34
Miranda Materi
Right, and your radial nerve is irritated. and Yeah, it's usually, yeah, I feel like everybody can be in it for some proximal
00:04:37
josh MacDonald
Yeah.
Research and Recommendation on Exercise Adherence
00:04:40
Miranda Materi
time.
00:04:40
Miranda Materi
With that being said, though, we know the research shows that people will not do over four exercises. Of course, there's outliers where people will, but if you're giving too many exercises, they're not going to do it.
00:04:52
Miranda Materi
so
00:04:53
josh MacDonald
Yeah. Yeah. So that's interesting. You say that in the back of my head, I always knew not to give people 52 exercises, but you found an article that says no more than four. That's interesting.
00:05:02
Miranda Materi
Yes. yeah yeah
00:05:03
josh MacDonald
Okay. Okay. And, and I feel like if you give them eight, they're not only going to, it's not that they're just going to do four. They're going to do zero.
00:05:12
Miranda Materi
yes
00:05:12
josh MacDonald
So I'll tell them like, we have this sheet that has the upper quarter and I'll get it. Like if they, if they don't like chin tucks, I got one lady that says like, I just don't feel like I'm doing that. I said, big X, don't do it. Cross it off.
00:05:23
josh MacDonald
Cause she's not going to understand it and she's going to ditch the whole page. So yeah, making sure your home program is like realistic.
00:05:29
Miranda Materi
Yeah. Or it's just like, okay, I want you to just integrate, you know, like where you, sorry, over the back of the chair, where you put your elbows out and you stretch your pecs.
00:05:35
josh MacDonald
Thank you.
00:05:36
Miranda Materi
Like, I just want you to do that a few times per day, you know, every time you sit down for dinner. So it's giving these like cues of where they can integrate it in, in a functional manner, instead of like sitting down for 20 minutes and doing your exercises. Cause that's usually when people don't do it. Right. But if you can integrate it through like, okay, when you're brushing your teeth, I want you to, to fix, you know, try to grab the toothbrush and hook grasp or I don't know, something.
00:05:59
josh MacDonald
Yeah, yeah, yeah, yeah.
00:05:59
Miranda Materi
like that.
Dynamic Tasks for Improved Function
00:06:01
josh MacDonald
um And I one of the exercises that we've taken to in our clinic for those neuropathy patients, ah we do it for shoulder mobility is a version of we pull out the cones, which is a bad word in some people's world, but we pull out cones and we do call reverse cone stacking.
00:06:14
Miranda Materi
the thousand
00:06:16
josh MacDonald
So I take the stack and you grab the top one with your thumb down and you use big rotation and stack it with your thumb down. So you're doing a full rotation from pronation to full supination, but it gets nerf flossing and gliding distally. It gets shoulder working. It's this whole big functional thing. And so I'll tell patients, I just want you to do that at home with solo cups or your movie cups or Ikea something, just find some nesting cups or something. and do this big movement rotational component. It can be for nerve gliding or wrist range of motion, soup pro. It's just something where they can like have a task to do at home.
00:06:51
josh MacDonald
Yeah.
00:06:51
Miranda Materi
Right. It's like these more dynamic tasks.
00:06:53
josh MacDonald
Yes.
00:06:53
Miranda Materi
I think the same with doing the apple pickers, you know, where tell them to reach for the apple, pull the apple down and look at it.
00:06:57
josh MacDonald
Yeah. Yeah.
00:07:00
Miranda Materi
That's great because you're moving your shoulder, your elbow, you know, you're doing some fisting with your hand. So doing more dynamic exercises.
00:07:07
josh MacDonald
yeah Depending on the patient, that's always a good exercise for the right patient, but depending on the patient's personality type, they may need to be sold on the value of something that doesn't make them hurt.
00:07:19
Miranda Materi
Yes, that's true.
00:07:20
josh MacDonald
Like if it's if it's like, i don't really feel like this is doing anything. Trust me, you're range of motion, you're working edema, this is going help pump the fluid out. I may have to do a bit of a sales job to get them to understand why this little
Ensuring Exercise Adherence and Patient Communication
00:07:32
josh MacDonald
task that may not feel all that challenging is really good for you.
00:07:36
Miranda Materi
Yeah, it's kind of like the L&B, right? That spring-loaded split where you're like, trust me, you're not going to feel it, you know, the first five minutes.
00:07:45
josh MacDonald
Yeah.
00:07:46
Miranda Materi
They'll really want to crank it up and feel it. And you're like, no, no, you just got to wait.
00:07:49
josh MacDonald
Yep. Yep. Everybody I give a dynamic splint to or static progressive, I tell them do not wear this when you go to bed. Cause I've had a couple of patients do it and it destroys them. So yeah, the accumulation of time may be the benefit, not the first five seconds of the repetitions.
00:08:06
Miranda Materi
Yeah, the education part is really important.
00:08:06
josh MacDonald
Yeah. Yeah. Yeah. I'll also like our first visit with any patient is really trying to get them set up with something they can do at home so they get better by the next time they come in.
00:08:18
josh MacDonald
If all I do is pull things off the shelf that they can't do at home and that I send them on their way, they're not going to get better between today and the next time I see them. So I try to give them that stuff. And then I need to revisit that home program.
00:08:31
josh MacDonald
If they ask me six weeks in, hey, should I still be doing tendon glides? on a distal radius fracture, I've missed the boat and I have not progressed them. um But at the same point, that may still be it a good exercise to be doing.
00:08:43
josh MacDonald
We don't always have to give them something new and shiny every week for home program. That list of four exercises is going to last you for three weeks. And then we'll give you new ones or we'll upgrade one or two of them as we go.
00:08:54
Miranda Materi
Yeah, I think that's a key point. And it's remembering what exercises you gave them and what you told them to do, and then checking in with them, right? So how many times do you you see people give their patients something and then they never come back to it or check in?
00:09:07
Miranda Materi
And then you're like, then that patient's kind of like, well, what the heck, right? You gave me all this stuff. You don't even remember what it is.
00:09:11
josh MacDonald
Yeah.
00:09:12
Miranda Materi
So...
00:09:12
josh MacDonald
yeah
00:09:13
Miranda Materi
I know for our clinics, we you know have like a folder where they can put their exercise in it and they can take that folder home and they say, bring that folder back with you so we can take a look at your home program and make sure you're doing it correctly.
00:09:26
josh MacDonald
That's great. That's fantastic. i I definitely have it happen more often than I'd like to admit where a patient comes in and we're working on higher level stuff and they're asking me, do I still need to do those things you gave me on day one? like, ooh, I have not upgraded a home program recently enough, have I?
00:09:39
josh MacDonald
Let's sit all of those things. Yeah, just today. Today we're going to graduate you out of those things. Yeah, yeah. It happens more often.
00:09:45
Miranda Materi
Yeah, you almost see them. Yeah, when they come in, like, how are you doing? Are you better, worse, no change? And how did the stuff for you that you're doing at home go?
00:09:54
josh MacDonald
Yeah, yeah.
00:09:54
Miranda Materi
Right. And it's not asking the question, did you do your exercises? Because when you ask that, people will always want to say yes, even if they didn't. Right. So it's using those motivational interviewing saying and saying, how did the exercises go as opposed to did you do them?
00:10:08
josh MacDonald
Yeah. Yeah. Asking different questions that will give you the same information, but then they don't feel trapped to lie about it or, or change reality a little bit for you to help. to They want to please us.
00:10:19
josh MacDonald
They want to give us the answer they think we want.
00:10:20
Miranda Materi
It's not that the patient wants to lie, but they want to make us happy and say they did their home program,
00:10:22
josh MacDonald
Yeah. Yeah.
Exploring Patient Adherence and Study Potential
00:10:27
josh MacDonald
Yeah, yeah. i It would be interesting to see a study for any given clinic's caseload. What percentage of your patients are doing at least a reasonable portion of their home program?
00:10:28
Miranda Materi
you know.
00:10:38
josh MacDonald
um I think the percentage is probably much lower than we would like.
00:10:42
Miranda Materi
Yeah, that would be interesting. wish That would be a simple.
00:10:44
josh MacDonald
Yeah, yeah. And hard to get a real answer to that. Maybe not everyone would give the most reliable answer. Unless you just did a paper anonymous survey, what percentage of your home...
00:10:53
Miranda Materi
I think you'd have to do it blind.
00:10:54
josh MacDonald
Yeah, yeah. That'd I'm not sure I want to know the answer to that.
00:10:56
Miranda Materi
Yeah.
00:10:58
Miranda Materi
I think that'd be really good though. And then why didn't they do it?
00:11:00
josh MacDonald
Yeah. Yeah, yeah.
00:11:03
Miranda Materi
Too many was it there was no value in it you know?
00:11:08
josh MacDonald
Yeah, yeah. That would be interesting. Huh. That feels like ah ah a capstone project for your graduate program.
00:11:14
Miranda Materi
it does feel like a capstone problem.
00:11:16
josh MacDonald
Yeah.
00:11:17
Miranda Materi
Add that to our list.
00:11:17
josh MacDonald
Yeah.
00:11:18
Miranda Materi
That would be good though.
00:11:18
josh MacDonald
Yeah. Yeah. Get another one of those.
00:11:21
Miranda Materi
Yeah.
00:11:21
josh MacDonald
Yeah.
Conclusion and Contact Information
00:11:22
josh MacDonald
All right. Well, um we seem to be going longer on these podcasts lately, but hopefully that's good information. You got some ideas out of it for your practice and your patients in their home program. If you have any questions or comments, reach out to us on social media at Hand Therapy Academy, or you can reach us on email info at handtherapyacademy.com.