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By Ben Benjamin, PhD

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A Common MT Injury: Treating the Thumbs

If a thumb joint injury is fairly mild then rest and gentle stretching followed by strength building is usually effective.  However, if the pain is severe or long standing, injection therapy is the more appropriate treatment to begin with. The injury is severe if it constantly limits the person's life and is frequently or usually painful. Leaving a joint in an inflamed state destroys the integrity of that joint over time so treatment is a good idea.

Stretching and Strength Building

In mild cases an essential part of the treatment process is a series of Aaron Mattes' Active Isolated Stretching (AIS) techniques and simple concentric and eccentric strength exercises for the client's thumbs and fingers. These exercises are essential to effective healing and tissue re-alignment.

Thumb Extension Stretch of the Proximal (CMC) Joint - Copyright – Stock Photo / Register Mark Thumb Extension Stretch of the Proximal (CMC) Joint The client must do them on a daily basis in order to heal completely and not be vulnerable to re-injury.  You begin by doing the stretches on the client regularly and then teaching them to do them by themselves. After they begin to feel better you would add the strengthening component.

To perform an active isolated stretch, first you have the person actively move their thumb into the stretched position as far as they can. Then you take over and gently stretch the joint a little further for two seconds. These AIS stretches look similar to the testing procedures I wrote about in my last article but they are different in how they are performed.

Thumb Flexion Stretch of the Proximal CMC Joint - Copyright – Stock Photo / Register Mark Thumb Flexion Stretch of the Proximal CMC Joint In the stretch you move more slowly, stop before there is any pain and do the stretch four or five times. In the testing you do it once until there is discomfort or pain so that you can make an assessment of what's happening. Let's start with the proximal joint since it's the one that is most often injured.

Thumb Extension Stretch of the Proximal (CMC) Joint

Ask the client to lift the thumb into thumb extension as far as they can and place your middle or index finger in the snuffbox. Now place your thumb of the same hand at the palmar surface of the client's MP joint, and gently move the CMC joint further into extension, always staying within a pain-free range of motion.

Thumb Extension Stretch of the Middle (MP) Joint - Copyright – Stock Photo / Register Mark Thumb Extension Stretch of the Middle (MP) Joint After no more than two seconds of stretching, have the client move the thumb back to the neutral starting position. You will start counting your two seconds when the client cannot move any further actively. Then you repeat the full motion multiple times.

Each time you do the stretch you try to take it one degree further if you can do so without causing any discomfort. If you cannot try a half of a degree. It may take a while so be patient. This principle applies to all of the stretches that follow.

Thumb Flexion Stretch of the Proximal CMC Joint

First show the client what thumb flexion is. Once they bring the thumb into flexion as far as they can, place your thumb pad on the back of the client's MP or middle joint and wrap your fingers of the same hand under the medial or pinky side of the client's hand.

Thumb Flexion Stretch of the Middle (MP) Joint - Copyright – Stock Photo / Register Mark Thumb Flexion Stretch of the Middle (MP) Joint Now gently squeeze your thumb toward your fingers bringing the client's thumb into full flexion. Do this for two seconds then release so that the client can bring their thumb back to the neutral starting position and repeat several times. Go a tiny bit further (like a quarter of an inch) each time you do the stretch and remember there should be no pain.

Thumb Extension Stretch of the Middle (MP) Joint

Place your index finger at the dorsal surface of the MP (or middle joint) of the thumb and your thumb on the palmar surface of the IP joint, and then ask the person to actively straighten their thumb. When the client reaches their maximum of active extension, move their joint slightly further into extension.

Thumb Extension Stretch of the Distal (IP) Joint - Copyright – Stock Photo / Register Mark Thumb Extension Stretch of the Distal (IP) Joint Be sure you stop before there is any discomfort or pain felt. You may need to experiment for a moment first to see where full extension is for that person. Ask the client to help you determine when that moment is about to come. Repeat this action four or five times.

Thumb Flexion Stretch of the Middle (MP) Joint

Place your thumb on the dorsal surface of the IP joint and your index finger pad on the dorsal aspect of the CMC joint. Then ask the client to actively bend that thumb joint into flexion as far as they can without any pain. When they stop actively moving gently squeeze, moving the MP joint into flexion. Again, stop before there is any pain or discomfort.

Thumb Flexion Stretch of the Distal (IP) Joint - Copyright – Stock Photo / Register Mark Thumb Flexion Stretch of the Distal (IP) Joint Thumb Extension Stretch of the Distal (IP) Joint

Wrap your index finger around the dorsal aspect of the IP joint, and place your thumb pad on the client's thumb pad. Now ask the client to extend the distal part of their thumb like they were going to hitchhike. When they cannot actively move any further gently press the IP joint further into extension. Again stop before there is any pain at all.

Thumb Flexion Stretch of the Distal (IP) Joint

Place your thumb pad at the tip of the client's thumb and your middle or index finger on the middle joint of their thumb. Now ask them to flex the distal part of their thumb. When they cannot actively move any more, gently squeeze to move the IP joint further into flexion. Stop before any pain or discomfort is felt.

Strengthening the Thumb - Copyright – Stock Photo / Register Mark Strengthening the Thumb Strengthening the Thumb

After the client is relatively free of joint pain when doing the stretches regularly, add the strengthening component.  Have the client use a series of rubber bands with different thicknesses and strengths to perform a series of flexion and extension exercises. When exercising the thumbs with rubber bands in flexion and extension one hand holds the rubber band and the other flexes or extends against the force of the band.

This is the least expensive way to strengthen the fingers. There are a few mechanical devices easily found on the internet if the client prefers those. (The Xtensor Hand Exerciser,  the Thumb Helper, the Cando Digi-Flex Hand and Finger Exerciser, Finger Master Hand Strengthener, among others.

I will demonstrate the AIS techniques for the thumb flexibility in an accompanying video.  Here's the link for the video: https://vimeo.com/234886078.

If the joint pain/injury is severe it is best to start the process with a physician* giving a small anti-inflammatory injection into the affected joint followed by a few days of rest before starting the stretching and strengthening exercises.

Strengthening the Thumb - Copyright – Stock Photo / Register Mark The injection, if done well, will de-inflame the joint and make exercising it possible. The longer the joint stays inflamed the less likely the client will recover completely. People get used to having pain and don't realize that they can actually recover.

*The physician should specialize in hands or be experienced in giving finger and thumb injections. The injection must be given into the very small joints so precision is important. Hand surgeons, physiatrists and doctors specializing in sports medicine or prolotherapy are often the physicians to look for.

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