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hands-5.jpg
31/Aug/2022

Written by hand therapist Catherine Reid, B.App. Sci, (OT), M.Sci (H&UL rehab), MAHTA (As awarded by the AHTA), CHT(USA)

It’s no secret I love hands! They’re amazing, complex and delicate structures. They help us connect with the world and each other. They allow us to touch, feel, carry objects, pick up kids and perform all kinds of everyday tasks.

That’s why I’m passionate about people being proactive and looking after them.

As an Accredited Hand Therapist* I’m often asked about the things people can do to look after their hands. Here are my top five tips.

1. Look after the skin on your hands

Your skin protects your hands from the outside world. It’s constantly renewing itself. Every time you wash your hands, you rub away dead skin cells. It’s important to look after your skin by keeping it as clean as possible and using a gentle hand wash. In some cases, gloves might be a good idea, for example if you’re using chemicals to clean your shower, or work in a café washing dishes.

Keeping your hands clean isn’t just about them looking good. It’s also about avoiding infections. Anyone who’s had an infection in their hand will tell you it‘s very painful. This is due to the many nerve endings you have in your fingertips. And because you use your hands so often, it’s hard to avoid banging or knocking an infected or injured hand.

An infection can also limit your hand’s movement, which, if left untreated, can become permanent.

Obviously, keeping your hands clean is impossible with some jobs, so keeping the skin in good shape is essential. Using a good moisturiser or barrier cream after washing is recommended to avoid small cracks developing in the skin. These cracks allow dirt and germs to enter your body, increasing your risk of infection.

Keeping your skin hydrated and moist helps keep your skin supple and leads to faster healing.

2. Stay strong

Many people don’t realise they’re losing strength in their hands until they have a functional problem, such as pain when opening a jar or difficulty gripping a doorknob.

That’s why I recommend exercises to strengthen your hands when you start to notice a problem. Many people strengthen their hands by squeezing a ball; if this is the case, I recommend a softer ball so your fingers can move through a greater range when squeezing. A cheap alternative to squeezing a ball is squeezing plumbing insulation. You can buy it by the metre at hardware stores for a few dollars and in different diameters to suit your hand size.

Accredited Hand Therapists can provide you with exercises for specific muscles or to deal with particular issues you’re having. They may use strengthening tools, exercise putty, and/or exercise bands.

3. Keep your joints moving

As the saying goes, ‘motion is lotion’ as far as your joints are concerned, so don’t let them stiffen up!

At the ends of the bones in your joints, you have a layer of cartilage. Cartilage is a firm cushion that absorbs shock and enables the bones to glide smoothly over each other. The joint is wrapped inside a tough capsule filled with synovial fluid. This fluid is the oil in your joints. It provides nutrition for the cartilage and helps provide a cushion between the cartilage. It moves across the joint’s surfaces like a drop of oil on a door hinge. When you move your hands, the synovial fluid is spread around the joint. So tasks that have you holding something for a long period without changing grip aren’t good for the joints. It’s not allowing the synovial fluid to lubricate the joint. Rather than not perform the activity, take frequent breaks and move your fingers. And try to avoid activities that push your fingers into extremes of range, for example, lifting items that are too large using only one hand.

Similarly, use bigger, stronger joints where possible. For example, carry shopping bags on your forearm rather than with your fingers.

Accredited Hand Therapists can instruct you in exercises for specific joints, such as the joint at the base of the thumb. To maintain good movement, moving your joints through the full range of movement and stretching out to the ends of the range is important. Tendon gliding exercises are often used for this purpose as they glide one set of tendons over the other and move each joint through its full range. Click here for examples of tendon glide exercises.

 4. Use the right tool for the job.

We often force our hands into extreme positions or keep going with a task until our hands are aching, especially if we’re in a rush or just want to get a job done.

But using the right tools can be gentler on your hands. For example, large or fat handles can spread loads more evenly or over several joints. Tools that use a lever to reduce the required force are also preferable; for example this tool (see image) helps open ring-pull cans.

There are also many electric tools for use in and around the home, reducing the required force. For example, instead of hand pruning a hedge, you can use electric shears. I know which I’d prefer!

You can buy aids and other tools from supermarkets, chemists, hardware stores, and home health care stores. Musculoskeletal Australia also has a range of tools available through their online shop.

5. Seek professional help

If pain or inflammation persists for more than a few days, seek professional help. Pain can be a warning sign that your joints are being overworked. Inflammation can be due to joints, muscles and/or tendons being overused or other health issues such as diabetes or heart disease. Prolonged inflammation can make it difficult to move your fingers. It may be that the structures in your hand need a rest to allow them to heal.

Your GP or a practitioner in hand therapy can help diagnose the problem and provide you with techniques to manage the pain or prevent the problem from becoming worse.

Accredited Hand Therapists can be located via the Australian Hand Therapy Association’s web page under the “Find an Accredited Hand therapist” section.

And check out my other article, ‘Can a hand therapist help you?’.

*As awarded by the Australian Hand Therapy Association

Contact our free national Help Line

Call our nurses if you have questions about managing your painmusculoskeletal condition, treatment options, mental health issues, COVID-19, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.


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10/Aug/2022

Written by hand therapist Catherine Reid, B.App. Sci, (OT), M.Sci (H&UL rehab), MAHTA (As awarded by the AHTA), CHT(USA)

A surgeon once told me that the human body’s most elegant anatomy was in the hand. I might be slightly biased, but I had to agree! The hand is amazing and complex in the way it’s structured and works.

There are 27 bones in your hand compared with just 3 in your leg. These bones are moved by over 30 muscles, all working in unison to provide smooth, coordinated movements. Your nerves help you control these movements enabling you to adjust your strength or fine coordination to suit the task.

Your hands can convey your feelings through touch and gesture and help to communicate your thoughts. In fact, some people will tell you they can’t talk without using their hands!

Your wrists, elbows and shoulders work together to position your hands in space. Any problem along the chain of your upper limbs affects your ability to fully function. Imagine how difficult it would be to reach up to do your hair if your shoulder was stiff, or to do downward dog in yoga with a painful wrist!

We connect with the world through our hands, performing everyday activities, and many of us earn our living with our hands. That’s why it’s essential that we take good care of our hands.

For some people, this may include seeing a professional.

What is hand therapy?

Considering the importance of our hands, it should be no surprise that there are professionals devoted solely to their rehabilitation.

Hand surgeons are either orthopaedic or plastic surgeons who’ve undergone additional training and study to specialise in treating problems of the hands, wrists and arms. They may use surgical and/or non-surgical treatments.

Hand therapy practitioners are qualified physiotherapists or occupational therapists registered with the Allied Health Practitioner Regulation Agency (AHPRA). They have extensive knowledge and skill in understanding and treating problems with the fingers, wrists, elbows and shoulders. The Australian Hand Therapy Association (AHTA) defines hand therapy as “the art and science of rehabilitation of the upper limb – shoulder to fingertip”.

What is an Accredited Hand Therapist (AHT)?

In 2017, the Australian Hand Therapy Association implemented a credentialing program to ensure accredited therapists offer a high standard of practice. All Accredited Hand Therapists have undertaken advanced education and assessment of the upper limb and have had over 3,600 hours of hand therapy clinical practice. After they’re assessed as competent to provide safe, evidence-based diagnosis, advice, and treatment, they’re awarded the credential of Accredited Hand Therapist by the Australian Hand Therapy Association Credentialing Council.

What conditions are treated?

Accredited Hand Therapists diagnose and treat a large variety of musculoskeletal conditions of the upper limb. They include:

  • arthritis
  • nerve compressions (e.g. carpal tunnel syndrome)
  • fractures, joint injuries and dislocations
  • tendinopathies (e.g. tennis elbow) and other soft tissue injuries
  • pain conditions
  • nerve and tendon injuries
  • burns and scar management
  • sporting injuries
  • work-related injuries
  • post-surgical conditions.

What happens at an appointment?

When you meet with an Accredited Hand Therapist, you’ll work together to develop a treatment plan. It will take into consideration your specific situation, symptoms, and the environment in which you live and work.

Some treatments aim to resolve a problem, for example, improving muscle strength or range of motion after a fracture. Some treatments may be preventive and involve teaching you to manage symptoms like pain or swelling in response to an injury or illness.

Assessments may involve specific measurements; for example, the therapist measures your wrist’s range of movement or grip strength. Assessments also include your experience of the problem, for example, when you describe the location of the problem, how your symptoms feel and affect you, and the things you noticed or experienced when you first noticed your symptoms.

Treatments often use heat, ice or electrotherapy to improve healing, orthoses (splints) to rest soft tissues (e.g. muscles, tendons, ligaments), and specifically targeted exercises to improve movement and strength.

You’ll be encouraged to complete a home program when possible, so education will also be a large part of your treatment.

To achieve the best outcomes, therapists may collaborate with other health professionals such as hand surgeons, rehabilitation consultants or GPs.

Where do I find an Accredited Hand Therapist?

Accredited Hand Therapists can be found throughout Australia in private practice (sometimes co-located with hand surgeons), in public hospitals and in community settings. In Australia, there are over 400 Accredited Hand Therapists in metropolitan, rural and remote locations. You can contact a hand therapist through the AHTA “Find an Accredited Hand therapist” web page or email the AHTA at enquire@ahta.com.au.

You use your hands all day long, so receiving the best care to recover after surgery, injury, or a medical condition is essential. Your hands deserve the best, and so do you!

Contact our free national Help Line

Call our nurses if you have questions about managing your painmusculoskeletal condition, treatment options, mental health issues, COVID-19, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.


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07/Jul/2022

Guest blog by hand therapist Catherine Reid, B.App. Sci, (OT), M.Sci (H&UL rehab), MAHTA (As awarded by the AHTA), CHT

The advent of COVID has seen many more people riding their bikes, either for exercise or for their daily commute. It’s a great exercise for the heart and lungs and a low-impact exercise for people with musculoskeletal conditions.

In recognition of the health and environmental benefits of riding a bike, the United Nations declared June 3rd to be World Bicycle Day. Unfortunately, as a hand therapist, I frequently hear patients complain that hand and upper limb pain or weakness limits their ability to ride.

Hand therapists are experts in rehabilitating the upper limb. We understand anatomy and how it relates to everyday activities. We can help determine what’s causing the problem, if it’s due to an injury, illness or activity, and provide appropriate treatment.

Some pain experienced when riding a bike may be due to vibration transmitted up through the bike into the arms or due to the prolonged time or force with which the handlebars are gripped.

If you love to ride but find it a bit painful, here are my top 10 tips for protecting your hands and upper limbs while riding. The best place to start is from the ground up.

1. Tyres

If you’ve ever ridden a bike or billy cart with solids tyres rather than rubber, air-filled, pneumatic tyres, you know what a difference a little air and rubber can make!

Yet even with pneumatic tyres, vibrations or jolting through the handlebars can be painful for people with arthritis or joint injury. Ensuring the tyres on your bike are properly inflated can help reduce stress going up through the arms and into your body. The current thinking in the biking world is that wider tyres with less pressure offer better rolling resistance and comfort.

Wheels for bikes can also vary in stiffness depending on the design and the material they’re made from, so some are better at absorbing shock than others.

2. The frame

If you plan to explore the world and take your bike with you, you need to consider the weight of your bike. Is the weight manageable for you?

And when choosing a bike rack, one mounted on the back of the car might be an easier option than lifting your bike over your head onto the roof of a car. Lower lifts reduce the strain on sore or stiff shoulders.

Carbon fibre and titanium bikes are much lighter than traditional steel-framed bikes but come at a cost.

Another consideration is that the further away your seat is from the handlebars, the more of your weight your arms will be supporting.

3. Shock absorbers

The front fork of a bike can have shock absorbers that reduce the force going up into your arms from uneven terrain while keeping the tyres in contact with the ground for better control. They can be easily adjusted to provide more or less bounce.

4. Stem flexibility

The stem attaches the handlebars to the bike, and the modern stems have pivots, elastomers and moving parts to provide suspension. They may be as effective at smoothing the force from rough terrain as the fork suspension but may be a cheaper option to retrofit to a bike.

5. Handlebar shape

There’s a huge variety of handlebar shapes, which roughly fall into three categories: swept back, drop or flat handlebars. Some of the handlebars offer several different grip positions enabling the rider to vary their grip.

For example, the drop bars enable the rider to use three different positions

  • the hooks, the part that curves or drops down, taking most of the weight through the hand;
  • the hoods are the rubber covers around the hinges of the levers. For smaller hands, it might be more comfortable holding the levers here, but there’s some loss of strength as the grip is near the hinge and not the end of the lever;
  • the third place you can hold a drop bar is on the top of the bar. This gives the rider a more upright position and places the hands in a palm down position, but this is a less anatomically friendly position for the wrist. Placing hands in a palm down position also puts pressure on the nerves in the palm of the hand, which can cause compression neuropathies such as carpal tunnel syndrome or cyclist’s palsy. Carpal tunnel syndrome affects the thumb side of the hand, while Bicycler’s neuropathy affects the little finger side; both conditions cause numbness and tingling in the hand.

6. Handlebar rise and sweep

Handlebar rise is the vertical rise measured from the centre of the bar to the bar end. The handlebar height can be adjusted by raising the stem or by increasing the rise of the handlebars. Increasing the rise changes the body position of the rider to a more upright position, meaning more weight is placed through the saddle, and less weight is placed through the shoulders, wrists and hands. Handlebars can have an upsweep and a backsweep. Sweep is the angle from the stem to the end of the bar either in an upward angle (upsweep) or in a backward angle (backsweep). More upsweep generally places more pressure on the hands, wrist and shoulders, whereas more backsweep places the wrists in a more natural (palms facing) position.

7. Handlebar material

The material the handlebars are made of can affect their ability to reduce or dampen the forces going through them. Carbon fibre and aluminium dampen vibrations better; however, steel and titanium flex. A little bit of flex in a handlebar is a good thing as it absorbs some of the force from bumps in the road.

There’s also a line of handlebars that have a foam-filled core to deaden the vibration through the core.

8. Grips and tapes

Larger grips generally distribute the weight more evenly through the hand. There are lots of commercially available grips, and many can be retrofitted to your bike.

Some change a flat handlebar to provide a vertical grip as well, allowing for a change of hand, wrist and elbow position. This can help reduce hand stiffness and provide rest from pressure on a particular joint or nerve. Tapes can either be gel or cork. The advantage of cork tapes over gel is that they don’t compress over high-pressure areas and are generally more durable.

9. Gloves

Gloves offer added protection from blisters and falls and improve grip. Glove fit should be firm so they don’t bunch up and cause pressure areas. They should also fit firmly around the cuff so water can’t leak in when it’s raining.

Keeping hands warm with waterproof or thermal gloves helps maintain hand dexterity, especially for arthritic hands. Lightweight, breathable summer gloves with wicking ability may be helpful to reduce sweaty palms, which reduce grip.

Some gloves have padding to reduce vibration, which irritates the nerves of the hand, or silicon tips or open tips to improve touch.

Gloves can provide skin protection in the case of a fall or protection for mountain bikers with inbuilt carbon fibre inserts to protect the backs of the hands from trees.

10. Gears and brakes

Traditionally gears fall into 3 categories:

  • Twist or grip shifters,
  • Trigger shifters, or
  • Shimano Total Integration (STI) brake lever shifters.

More recently, digital computerised gear mechanisms have been introduced. They require very little resistance to use, but unfortunately, they’re expensive to retrofit to your bike.

Twist shifters can only be fitted onto straight handlebars and are controlled by rotating the wrist. They’re easier on the fingers and the thumb as wrist motion is used to control the gears. So if you have painful fingers or reduced dexterity, twist gears might be advisable. Twist shifters are known to become stiffer over time, which might put undue strain on the wrist. They also require frequent repositioning of the wrist.

Trigger shifters generally require little force and can be activated with different fingers. To shift gears, the top lever is moved with the fingers, and the bottom lever is moved with the thumb. The benefit of trigger shifters is that the wrist stays in a neutral position. This is helpful if you have tennis elbow as it reduces strain in the muscles at the elbow joint.

STI Brake lever shifters are a combination of the gear shifter and the brake lever on the one fitting. This allows the rider to shift gears without moving their hand from the bars. They’re generally found on touring or racing bikes and can be activated while holding the hoods. They require minimal force to use.

Brakes can either be hydraulic or cable brakes.

Hydraulic brakes are preferable if you have upper limb problems as they take far less force to use. The back pedal (coaster) brakes are less common these days and are generally found on cruiser bikes or kids bikes. They’re worth considering if you have poor eye-hand coordination or poor hand strength. If the levers are too far out from the bars, people with smaller hands have difficulty reaching their fingers around the brake levers, making it difficult to grip forcefully. This can be adjusted with small rubber inserts placed at the hinge end of the brake lever.

Getting your bike tailored to meet your specific needs may just require some minor changes to your existing bike. But sometimes, purchasing a new bike can be more cost-effective. Remember, changing any part of your bike will affect your bike’s fit and may affect your bike’s handling. It’s worth getting your existing bike correctly fitted to you before making too many expensive changes.

If changing your bike isn’t helping, then you need to see a hand therapist to evaluate the cause of the pain and, if needed, provide upper limb exercises, treatments or supportive splints to enable you to keep riding. A hand therapist in your local area can be found on the Australian Hand Therapy website.

Our guest blogger Catherine Reid is an occupational therapist with a Master of Science in Hand and Upper Limb Rehabilitation. She’s a full member of the Australian Hand Therapy Association and works in her private practice Western District Hand Therapy, in Warrnambool, Victoria.

Contact our free national Help Line

Call our nurses if you have questions about managing your painmusculoskeletal condition, treatment options, mental health issues, COVID-19, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

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