Preventing thumb pain in Physiotherapists?

[eire]

I am a Physio working in predominantly Musculoskeletal outpatients at the moment. I have already started having pain in my thumb MCP joints after only 4.5 years working, with just over 2 years of that in Musculoskeletal therapy. Does anybody have any tips for preventing/ reducing the damage caused to thumb joints with manual therapy work (massage, trigger point release, mobilisations). I try to support my thumbs with my other thumb or fingers, but don't find it effective. Are there any splints/ supports that might be helpful? Or any specific techniques (especially for trigger points) that are less stressful on thumbs. I try to use my elbow or pisiform when i can.

Thanks!

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[physiobob]

I am a Physio working in predominantly Musculoskeletal outpatients at the moment. I have already started having pain in my thumb MCP joints after only 4.5 years working, with just over 2 years of that in Musculoskeletal therapy. Does anybody have any tips for preventing/ reducing the damage caused to thumb joints with manual therapy work (massage, trigger point release, mobilisations). I try to support my thumbs with my other thumb or fingers, but don't find it effective. Are there any splints/ supports that might be helpful? Or any specific techniques (especially for trigger points) that are less stressful on thumbs. I try to use my elbow or pisiform when i can.

Thanks!

There is a thumb spint made by an Australian physio that lets you place both thumbs into the splint at the same time. It was mainly developed for the issue you are having an the MCP and PIP joints of the thumb. Unfortunately I don't remember the name of it.

That said usually this problem arises with poor technique, such as pressing to much with the hand and elbow when mobilising. Think about a soft yet sturdy posture and use the gentle movement of your bodyweight to facilitate the mobilisation at the thumbs. Once I learnt to do that my thumb issues resolved - now just have wrist issues

[Fisiomarc]

Keep your thumb as close to your index finger as you can when you massage or press a trigger point(TP). The movement during the massage comes mainly from your shoulder and/or your wrist, and/or the rest of your body (depending on the movement), never from your thumb, that has to be as stiff as possible. I guess all this iwas already obvious to you... You can use dry needleing for TP. It works as well ass massage, even better...Afterwards, you can massage the refered pain area with your knuckles in some muscles (Neuromuscular technic?). In long muscles, you could use only your knuckles, both in the TP and in the refered pain area.

[Judith Mollet]

Trigger points can be treated using rounded wooden things that physios I know seem to find/ get someone to make. It's not the same feeling as your own thumbs and I wouldn't use them for the initial finding of the taught band but it does save thumbs. Couldn't help letting out a weird smile reading your mail, Eire, as I was sitting with a taped right thumb at the time (base of thumb problems) The left one hurts less. Physios have thumbs that take a hammering over years. When we aren't working them to death we ride bikes and do other sports to strain them etc etc. If you start to get severe problems, or rather beforehand, consider other options in terms of full time physio work where you'd be happy. Do CPD enough to change direction to less "thumbs on". Then there are wrists and backs to consider of course.....As we are human beings we are likely to get degenerative changes, Heberdens nodes (mine are wonderful)and all sorts of things sooner or later, like the general population does. It's a schizo profession, we often get our aches and pains while taking away other peoples aches and pains

[BobbySports]

Hey

There is a tool known as a 'thumb saver' which I use and find it quite usefull. Once you have located the trigger point the tool can be used.
Its pretty cheap & and will, atleast to some degree, reduce the amount of strain on the thumb.

[estherderu]

I have been in this profession for 32 years now.


Began to get trouble with my MCP joints and thumbs after 10 years or so.
Changed my technique... and quite radically .....
When I "massage" I steer with my legmuscles and use weightshifting AND most importantly I use very soft techniques, skin deep.
You should all try it.... its amazing what you can do with the skin.......
think dermatomes and not only muscles/joints and you will see that you need not "overburden" you patient or your joints....

good luck.....

Esther

[IceMan]

In addition to the above suggestions, if you don't have a splint, try to avoid hyperextension of your MCP and PIP joints when applying deep pressure. Keep the joints neutral/slightly flexed and use other digits to support the "mobilising digit". Apply pressure with the pad of the tip of the thumb and not the volar surface of the PIP which I think may be a common mistake.

Also change thumbs and/or fingers while mobilising soft tissue. Give those fingers a break.

I don't really have pain in the joints after mob'ing soft tissue but my intrinsic muscles turn to jelly afterwards and my hand-writing (bad at the best of times) becomes attrocious!

[stressclinic@xsinet.co.za]

Hi Eire,
Good advice....... Get yourself another job.
I've been doing massage work for the past 16 years.
Just came back from Ortheopeadic surgeon and there is nothing they can do
for me now. The damage is done. We helped patients while we could, but now we sit with the problems.
Please your hands are precious, and they must last you until you die one day.
As much as I want I cannot even help myself now, so please get out while you still can.
There are other things to do to help those who need you.
You are the only person suffering and the pain gets worse when you get older.
I am now 61 and not looking forward to the next 5 years of pain and suffering.
Please take good care of yourself, you owe it to yourself! Much Love. AMG

[Quickstart]

Anyone got tips for the grossly hypermobile physio? I keep hearing things like: "Don't hyperextend your MCP/ IP joints but what about those of us who are physically incapable of holding our joints into a neutral position? Are thumb spints really the only way to go?

[Jill Wigmore-Welsh]

Also find a Teacher of the Feldenkrais Method of Somatic Education, who will give you some lessons which will help you integrate your movement.

[pudding_bowl]

I don't use too much hands-on as have been mckenzie trained but when it's required i use it. and can certainly get a bad thumb if i don't do it right. I have 2 techniques: put the thumbs back to back straight arms and apply pressure with body weight - and the thumbs support each other. This may not work when the PIP joint drops backwards I guess so the second posture I use is to hold one thumb with the other hand and support it like a splint - again using correct bed height and body position to apply pressure.
As I said earlier I often get away with using exercise therapies and patient generated forces with the same if not better results. I do agree there are times when hands on is required and in those times I try to utilise a good technique but otherwise I do quite well to avoid it.

[msk101]

Just very briefly. i have some seriously funky thumbs which previously almost stopped me practising as a physio but now I pretty much don't use them any more... Look into the Sarah Key treatment using heel of foot (very sensitive for big lumbar stuck joints).

cheers,
msk101

[quorthon]

pudding bowl as i recall Mulligan techniques invlovle 2 thumbs together and they really great as u can compensate and balance the pressure between your two hands...and SNAGs are really usefull as add-ons in McKenzie method...Some times, though