PHysical Therapy corner - Elbows, wrists, and hands

Spring is here, and we are back in our gardens! In last month's PT Corner, I gave some tips on how to create strong shoulders. Moving down the arm, here are tips for preventing injuries in your elbows, wrists, and hands by warming up, using proper mechanics as you garden, and performing stretches afterward.

Before
A dynamic warm-up before being active increases blood flow, priming our muscles to work. It also helps to increase the available range of motion in the muscles and joints to prepare them for the activity you plan to do. Gardening and yard work requires reaching in a variety of directions. It requires the elbows and wrists to bend and flex and our fingers to open and close. Here are examples of beneficial warm-up exercises to do before you start gardening.

1. Arm circles: Raise your hand in front of your body to an overhead position. Move it backward, lowering it to your side to the start position. Your arm should stay parallel to your body. Repeat 5-10 times.
2. Wrist range of motion: Stand with your elbows bent at your side. With a flat hand, move your wrists from side to side. Next, make a fist. Now, move your wrists up and down. Finally, with your hand still in a fist, rotate your wrist in a circle, first clockwise, then counterclockwise. Repeat each motion 5-10 times.
3. Tendon gliding of the fingers (see figure below)                                                      Start by sitting with your elbow on a table. Bend at your bottom knuckles so your fingers are in a duckbill position (#1). Straighten them. Repeat 5 X. Then bend your bottom and middle knuckles (#2). Straighten them. Repeat 5 X. Next, bend your fingers to make a claw fist (#3). Straighten them. Repeat 5 X. Then make a half fist (#4). Straighten it. Repeat 5 X.

During
Paying attention to the mechanics of your arms while performing yard work can help prevent overuse injuries such as carpal tunnel syndrome and tennis or golfer's elbow. Always keep your wrist neutral when using your hands and tools to dig, yank, or pull. Minimize side-to-side or twisting motions at the wrist. Engage your shoulders by pulling your shoulder blades back and together before pushing, pulling, lifting, or carrying objects. Properly fitting gloves can prevent objects from slipping and deter excessive squeezing and gripping from the fingers.

After
Static stretching involves holding a stretch for a sustained period. This type of stretching is best for after activity to prevent muscle tightness. Examples of stretches to perform after yard work include:

1. Wrist Flexor Stretch (#1) - lift your arm to shoulder height. Pull your fingers and palm backward with your opposite hand until you feel a stretch in your foreman. Hold for 30 seconds. Repeat 3X
2. Wrist Extensor Stretch (#2)- lift your arm to shoulder height. Using your opposite hand, push the back of your hand down until you feel a stretch in your foreman. Hold for 30 seconds. Repeat 3X​

     3.  Chest and Bicep Stretch - With your arms straight, clasp your hands behind your              back. Keeping your body upright, slowly raise them toward the ceiling until you feel            a stretch in your chest and the front of your arms. Hold for 30 seconds. Repeat 3X

Finally, self-massage techniques can also help reduce post-activity soreness. Regular massage can help the muscles maintain flexibility, enabling your joints to have the appropriate range of motion. Pressure applied should be tolerable for 1-2 minutes of self-massage.

1. Forearm massage - Place a small massage ball or lacrosse ball on a table. Put your forearm on the ball and gently move it back and forth. Repeat on the other side of the forearm. Avoid compression directly on the wrist or elbow joints.
2. Finger massagers—These inexpensive rings simply slip over your finger. Once it is on, rub it up and down to massage the sides of your finger.​

Author

Karyn Dulaney, PT, DPT, is a physical therapist who has practiced in outpatient orthopedics for almost 2 decades. She enjoys helping patients achieve their personal goals and maintain a healthy, active lifestyle. An avid outdoor enthusiast and competitor/participant in various adventure sports, she is passionate about helping others explore outdoor activities for the mental and physical health benefits that come with them. Karyn co-founded the  Community Gear Closet, which lends outdoor gear so others can have opportunities for their own outdoor adventures.