SELF WRIST & HAND 1
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All of the stretches described in this chapter are detailed to stretch the right side. Key Points for Success: Sit comfortably in a position where you can straighten or fully extend your elbow and be able to assist yourself with your opposite hand. Many of the hand and finger muscles cross the elbow joint. For this reason it is important to keep your elbow straight or fully extended to be certain you are stretching the entire length of the muscle. Keep your movements slow and precise. Breathe in before you move and breathe out while you move. Body Awareness: Alternately focus on the muscles moving the joint and the muscles being stretched. Check for tension during the movement. Remember to move your wrist or finger(s) first and then assist yourself. Never force your assist. Never strain with your movement. If your muscles are shaking, you are working too hard; breathe and relax. 3
Wrist Flexion 1 & 2 Area Being Stretched: Back of Forearm Muscle Emphasized: Extensor Carpii 1. Turn your R hand so that your palm faces towards the ceiling. 2. Place your L hand over the back of your R hand. 3. Bend your R hand, bringing your hand towards your face and your fingers towards the ceiling. 4. When you cannot move farther on your own, assist yourself gently with your L hand. 5. Hold for 2 seconds. 6. Return to the starting position. #2 - REPEAT the above sequence with your R palm facing and moving towards the floor. REPEAT the above sequences at 45 degree angles, to the L and R. Helpful Hints: Keep your shoulders relaxed and your elbow locked throughout the movement. Flex through your fingertips while bringing your hand towards your elbow. These stretches need to be followed up with strengthening to achieve balance between your flexors and extensors. Mr. Stretchy: Careful now! Be sure your movement is up towards the ceiling or down to the floor, not directly towards your body. 4
Health Tips: Mr. Stretchy: Wrist Flexion 3 & 4 Area Being Stretched: Back of Wrist Muscles Emphasized: Extensor Carpii 1. Turn your R hand so that your palm faces towards the ceiling and make a fist. 2. Place your L hand over the fist of your R hand. 3. Bend your R wrist, bringing your fist towards the ceiling. 4. When you cannot move farther on your own, assist yourself gently with your L hand. 5. Hold for 2 seconds. 6. Return to the starting position. #4 - REPEAT the above sequence with your R palm facing and moving towards the floor. REPEAT the above sequence at 45 degree angles, to the L and R. Helpful Hints: Keep your shoulders relaxed and your elbow locked throughout the movement. Flex through your knuckles while bringing your fist towards your elbow. These stretches need to be followed up with strengthening to achieve balance between your flexors and extensors. Mr. Stretchy: Keep your finger tightly curled in to be certain of stretching the entire length of the muscle. 5
Wrist Extension 1 & 2 Areas Being Stretched: Front of Forearm and Wrist Muscles Emphasized: Flexor Digitorum, Flexor Carpi and Palmaris Longus 1. Turn your R hand so that your palm faces downward. 2. Place your L hand palm to palm with your R hand. 3. Bend your R wrist, bringing your hand towards your face and your fingers towards the ceiling. 4. When you cannot move farther on your own, assist yourself gently with your L hand. 5. Hold for 2 seconds. 6. Return to the starting position. #2 - REPEAT the above sequence with your R palm facing and moving towards the floor. REPEAT the above sequence at 45 degree angles to the L and R. Health Tips: These stretches will relieve pressure in Keep your shoulders relaxed and your the carpal tunnel. elbow locked throughout the Mr. Stretchy: movement. Extend through your fingertips while bringing your hand towards your elbow. Be sure your movement is up towards the ceiling or down to the floor, not directly towards your body. 6
Wrist Ulnar Deviation Area Being Stretched: Outside of Wrist Muscle Emphasized: Extensor Carpi Radialis Longus 1. Bend your elbow and rest it against your ribs and your palm facing upward. 2. Wrap the fingers of your L hand over the outside of your R wrist. 3. Bend your R wrist, bringing your hand towards your ribs. 4. When you cannot move farther on your own, assist yourself gently with your L hand. 5. Hold for 2 seconds. 6. Return to the starting position. Keep your shoulders relaxed. Extend through your fingertips while bringing your hand towards your ribs. Keep your elbow against your ribs. 7
Wrist Radial Deviation Area Being Stretched: Inside of Wrist Muscle Emphasized: Extensor Carpi Ulnaris 1. Bend your elbow and rest it against your ribs with your palm facing downward. 2. Place the saddle of your L thumb on the saddle of your R thumb. 3. Bend your R wrist, bringing your hand towards your ribs. 4. When you cannot move farther on your own, assist yourself gently with your L hand. 5. Hold for 2 seconds. 6. Return to the starting position. Keep your shoulders relaxed. Extend through your fingertips while bringing your hand away from your ribs. Keep your elbow against your ribs. 8
Finger Rotation Area Being Stretched: Webbing of fingers Muscles Emphasized: Lumbricals, Palmar and Dorsal Interossei 1. Grasp the index finger of your R hand with your L hand. Be certain to grasp your entire finger, down to the lowest joint. 2. Turn your finger in the opposite direction of its rotation. 3. When you cannot move farther on your own, assist yourself gently with your L hand. 4. Hold for 2 seconds. 5. Return to the starting position. 6. REPEAT the above sequence with each finger including your thumb. Helpful Hints: Precautions: Proceed slowly if you have arthritis. Grasp your entire finger to avoid stretching the ligaments. Keep your shoulders, elbow and wrist relaxed. Do one repetition per finger for fingers 1-4 and then repeat in the same manner until a full set has been done on each finger. If any of your finger joints need individual attention, repeat the above sequence by stabilizing each joint in turn. Mr. Stretchy: Remember, grasp your whole finger and assist evenly along its entire length. 9
Finger Extension 1 2 Areas Being Stretched: Palm of Hand and Front of Wrist Muscles Emphasized: Flexor Digitorum Superficialis and Profundus 1. Turn your R hand so that your palm faces downward towards the floor. 2. Grasp the index finger of your R hand with your L hand below the knuckle. 3. Extend your index finger towards your elbow. 4. When you cannot move farther on your own, assist yourself gently with your L hand. 5. Hold for 2 seconds. 6. Return to the starting position. #2 - REPEAT the above sequence with each finger and then with your palm facing upwards. Advanced Movement: As you flexibility improves, extend your wrist at the end of your movement. Precautions: Proceed slowly if you have arthritis. Grasp your entire finger to avoid aggravating the ligaments. Keep your shoulders relaxed and your elbow locked throughout the movement. Extend through your fingertips while bringing your finger towards your elbow. Helpful Hints: Do one repetition per finger for fingers 1-4 and then repeat in the same manner until a full set has been done on each finger. If any of your finger joints need individual attention, repeat the above sequence by stabilizing each joint in turn. Mr. Stretchy: Remember, grasp your whole finger and assist evenly along its entire length. 10
Finger Flexion 1 2 Areas Being Stretched: Back of Hand, Fingers and Wrist Muscles Emphasized: Extensor Digitorum and Indicis 1. Turn your R hand so that your palm faces downward towards the floor. 2. Grasp the index finger of your R hand with your L hand below the knuckle. 3. Keeping your index finger straight, bend it towards your palm. 4. When you cannot move farther on your own, assist yourself gently with your L hand. 5. Hold for 2 seconds. 6. Return to the starting position. #2 - REPEAT the above sequence with each finger and then with your palm facing upwards. Advanced Movement: As you flexibility improves, flex your wrist at the end of your movement. Precautions: Proceed slowly if you have arthritis. Keep your shoulders relaxed and your elbow locked throughout the movement. Flex through your fingertip while bringing your finger down, towards the floor. Helpful Hints: Do one repetition per finger for fingers 1-4 and then repeat in the same manner until a full set has been done on each finger. If any of your finger joints need individual attention, repeat the above sequence by stabilizing each joint in turn. 11
Finger Flexion 3 4 Areas Being Stretched: Back of Wrist, Hand and Fingers Muscles Emphasized: Extensor Digitorum and Indicis 1. Turn your R hand so that your palm faces downward towards the floor. 2. Curl your index finger in as tightly as you can. 3. Grasp the index finger of your R hand between the thumb and index finger of your L hand. 4. Bend your R wrist towards the floor. Keeping your index finger bent, continue to curl it towards your palm. 5. When you cannot move farther on your own, assist yourself gently with your L hand. 6. Hold for 2 seconds. 7. Return to the starting position. #4 - REPEAT the above sequence with each finger and then with your palm facing upwards. Advanced Movement: As you flexibility improves, flex your wrist at the end of your movement. Flex through your knuckle while bringing your knuckle down, towards the floor. Mr. Stretchy: Keep your finger tightly curled in to be certain of stretching the entire length of the muscle. 12
Finger Ab/Adduction 1 & 2 Areas Being Stretched: Webbing of Fingers Muscles Emphasized: Lumbricals and Interossei 1. Bend your R elbow and place the fingers of your L hand between your R index and middle finger. 2. Spread your R index and middle fingers. 3. When you cannot move farther on your own, assist yourself gently with your L hand. 4. Hold for 2 seconds. 5. Return to the starting position. REPEAT the above sequence with each set of fingers. #2 - REPEAT the above sequence separating your fingers at 45 degree angles away from each other. Keep your shoulders and elbow relaxed. Maintain your wrist in a neutral position throughout the movement. While separating your fingers, extend all the way through your fingertips until you reach the end of the movement. 13
Thumb Flexion 1 3 Areas Being Stretched: Base of Thumb and Outside of Wrist Muscles Emphasized: Extensor Pollicis and Flexor Radialis Longus 1. Straighten your R arm with your palm facing your body. 2. Make a fist with your R thumb tucked inside. 3. Place your L hand over your R thumb. 4. Bend your R wrist towards the floor. 5. When you cannot move farther on your own, assist yourself gently with your L hand. 6. Hold for 2 seconds. 7. Return to the starting position. REPEAT the above sequence with your wrist #2 - flexed and #3 extended at 45 degree angles. Precautions: You may be sensitive to this movement. Remember to be gentle and proceed slowly. Helpful Hints: Turn your thumb nail towards the ceiling before you begin the stretch. There should be no rotation of the thumb before or while stretching it. Keep your shoulders relaxed and elbow locked. Mr. Stretchy: Remember to actively flex your thumb as you flex your wrist. 14
Thumb Abduction 1 3 Areas Being Stretched: Pad of Thumb and Webbing of Thumb Muscles Emphasized: Opponens Pollicis, Adductor Pollicis 1. Bend your R elbow and rest your R palm, facing downward, on your thigh. 2. Grasp your R thumb in your L hand. 3. Move your thumb away from your index finger. 4. When you cannot move farther on your own, assist yourself gently with your L hand. 5. Hold for 2 seconds. 6. Return to the starting position. REPEAT the above sequence moving your thumb at a 45 degree angle #2 - towards the ceiling and #3 - towards the floor. Precautions: You may be sensitive to this movement. Remember to be gentle and proceed slowly. Grasp your entire thumb to avoid stretching the ligaments. Helpful Hints: Turn your thumb nail towards the ceiling before you begin the stretch. There should be no rotation of the thumb before or while stretching it. Keep your shoulder, elbow and wrist relaxed. 15
Thumb Extension 1 & 2 Area Being Stretched: Pad and Webbing of Thumb Muscle Emphasized: #1- Flexor Pollicis, Palmaris and Opponens Pollicis #2- Adductor Pollicus 1. Bend your R elbow and rest your R palm, facing downward, on your thigh. 2. Grasp your entire R thumb in your L hand. 3. Move your thumb away from your index finger and then up towards the ceiling. 4. When you cannot move farther on your own, assist yourself gently with your L hand. 5. Hold for 2 seconds. 6. Return to the starting position. #2 REPEAT the above sequence moving your thumb down towards the floor. Precautions: Grasp your entire thumb to avoid stretching the ligaments. Helpful Hints: Turn your thumb nail towards the ceiling before you begin the stretch. There should be no rotation of the thumb before or while stretching it. Keep your shoulder relaxed 16
Thumb Adduction 1 2 Area Being Stretched: Base of Outside of Thumb Muscle Emphasized: Abductor Pollicis 1. Bend your R elbow and rest your R palm, facing downward, on your thigh. 2. Grasp the outside of your R thumb in your L fingers. 3. Move your R thumb over the back of your R hand. 4. When you cannot move farther on your own, assist yourself gently with your L hand. 5. Hold for Repetitions: 2 seconds. Two Sets of 8-10 6. Return to the starting position. #2 - REPEAT the above sequence with your palm facing upward and your thumb moving across your palm. Precautions: Grasp your entire thumb to avoid stretching the ligaments. Helpful Hints: Turn your thumbnail towards the ceiling before you begin the stretch. There should be no rotation of the thumb before or while stretching it. Keep your shoulder relaxed 17
Key for Protocols of the Hand and Wrist - Name of Stretch Muscles Stretched Wrist Extension 1-3 Wrist Flexors Wrist Flexion 1-3 Wrist Extensors Wrist Ulnar Deviation 1-3 Flexor Radialis Longus Flexor Pollicis Wrist Radial Deviation 1-3 Extensor Ulnaris Finger Rotation 1 Lumbricals and Interossei Finger Extension 1-2 Finger Flexors, Palmaris Longus Finger Flexion 1-4 Finger Extensors Finger AB/Adduction 1-3 Lumbricals, Dorsal Interossei, Palmar Interossei Thumb Abduction 1-3 Adductor Pollicis Thumb Flexion 1-3 Extensor Pollicis Thumb Extension Flexor Pollicis, Palmaris, Opponens Pollicis Thumb Adduction 1-2 Abductor Pollicis 18
Complete Protocol for the Wrist and Hand - Expect the complete protocol to take 20 minutes per side. Stretch Page Wrist Flexion 1-4 W4-W5 Wrist Extension 1-2 W6 Wrist Ulnar Deviation 1-3 W7 Wrist Radial Deviation 1-3 W8 Finger Rotation 1 W9 Finger Extension 1-2 W10 Finger Flexion 1-4 W11-W12 Finger Abduction 1-2 W13 Thumb Flexion 1-3 W14 Thumb Abduction 1-3 W15 Thumb Extension 1 W16 Thumb Adduction 1-2 W17 19
Protocols for Hand and Wrist - Carpal Tunnel - The timing below considers 1 side. The following protocol is for a repetitive stress injury (RSI), not for a neurological problem. See a physician and/or a knowledgeable practitioner for diagnosis and treatment if you suspect you have more than a RSI. Primary Purpose - Reduce the inflammation in the flexor tendons (front of forearm and wrist). Common Challenges As a result of misuse, repetitive movement and/or inactivity due to pain, the extensors (back of hand and wrist) become weak. Building strength in the extensors is often the most difficult challenge. Long Term Goals - Create balance between the flexors (front) and extensors (back) of the elbow/wrist and the pronators and supinators of the elbow. Stretch 15 Page Wrist Flexion 1-4 W4-W5 Wrist Extension 1-2 W6 Finger Extension 1-2 W10 Finger Flexion 1-4 W11-W12 20
Ganglion Cyst - The timing below considers 1 side. Primary Purpose - Create space in the joints of the wrist and hand. Common Challenges - The awkwardness of the movements required to create space between the metacarpals presents a challenge in opening up the hand. Long Term Goals - Create balance between the flexors (front) and the extensors (back) of the hand and wrist. Stretch 15 Page Wrist Flexion 1-2 W4-W5 Wrist Extension 1-4 W6 Finger Extension 1-2 W10 Finger Flexion 1-4 W11-W12 Finger Abduction 1-2 W13 21
Trigger Finger - The timing below considers 1 side. Primary Purpose - Eliminate the chronic spasm of the flexor (front) tendons of the fingers. Common Challenges As a result of prolonged contracture of the finger flexor tendons, tendinosis (calcification) may have set in. This will require a lot of patience with many repetitions and sets in order to reverse the condition. Due to the nature of the contracture, it may also be necessary to stretch each joint of the finger individually. Long Term Goals - Create balance between the flexors (front) and the extensors (back) of the hand and wrist. Stretch 15 Page Wrist Flexion 1-2 W4-W5 Wrist Extension 1-4 W6 Finger Rotation 1 W9 Finger Extension 1-2 W10 Finger Flexion 1-4 W11-W12 22
Arthritis - The timing below considers 1 side. Primary Purpose - Eliminate the inflammation in each finger joint. Common Challenges As a result of prolonged inflammation of the finger joints, calcification and the start of fusion may have begun. This will require a lot of patience with many repetitions and sets in order to reverse the condition. You will need to stretch each finger joint individually according to its deformation Long Term Goals - Create balance between the flexors (front) and the extensors (back) of the hand and wrist. Stretch 15 30 Page Wrist Flexion 1-4 W4-W5 Wrist Extension 1-4 W6 Finger Rotation 1 W9 Finger Extension 1-2 W10 Finger Flexion 1-4 W11-W12 Thumb Adduction 1-2 W17 Thumb Abduction 1-3 W15 Thumb Flexion 1-3 W14 Thumb Extension 1-2 W16 Finger Abduction 1-2 W13 The above protocol cannot take into account the exact nature of the deformation that may have set in due to arthritic changes. It is recommended to have a trained practitioner assess the joint and determine which direction it must be moved in order to reverse the changes that have occurred. 23
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