Hope this helps - Nerve Glides
Hi everyone,
I have wanted to post something along this line regarding - "General Care for the Therapist". Something that will outline daily stretches, etc., that will keep our hands and UEs in good health.
All therapists - MT's, OT's, PT's, etc; who use massage and perform "manual" type tx on a daily basis will benifit from these ex's listed below.
I am an MA/OTRL (hand therapist) and do these myself everyday. The idea is to do these in order to prevent injury from occuring. These ex's, along with other tx techs, will also help relieve min to mod symptoms.
This is just a start. There will be more to come: (please read and try this cut and paste)
Other things to watch out for: CMC joint of the thumbs; always warm them up 1st; use MC joints as alternative or other parts of your hand, etc to reduce stress to joint tissues; do regular stretching (elongation) to joint spaces to allow S fluids to "repack" and lubricate J spaces.
Tendon Gliding Exercises
Nine tendons pass through the carpal tunnel. Four of the nine tendons bend the tips of the fingers; another four of the nine tendons bend the middle joints of the finger, and the ninth tendon bends the thumb tip. The purpose of these exercises is to glide the tendons gently through the carpal tunnel to minimize microscopic adhesions, reduce congestion, and improve lubrication in the tendons. These are not strength exercises. Perform the exercises gently or they may cause a pain flare-up.
hook fist - touch your fingers to the top of your palm. The large knuckles should be pulled back as much as possible.
full fist- touch your fingers to the middle of your palm. All three finger joints should be bent.
straight fist - touch your fingers to the bottom of your palm. The tips of the fingers should be straight.
thumb flexion - Start with your thumb pulled back from your palm as if you are hitch-hiking, then move your thumb across your palm and try to touch the tip of the thumb to the bottom of the small finger.
Nerve Gliding Exercises
The three nerves that supply power and sensation to the hand begin at the spinal cord in the neck. They have some elasticity, like a rubber-band, and lengthen and shorten as we move our arms. With repetitive trauma, microscopic adhesions can bind the nerve. Then, when the nerve over-stretches, we experience sensations such as pain, numbness, tingling, or coldness in the fingers.
If you are experiencing nerve symptoms, these exercises to glide (or slide, or pump) the nerves are critical. In fact, in one study, the chances of avoiding surgery improved dramatically when nerve glides were added to the therapy program.
It is very important not to over-stretch the nerve while exercising or you will create symptoms. Perform these exercises at a quiet time when you can pay close attention to the signals from your body. Feeling some tension is good but do not stretch to the point that you feel pain or numbness. You may feel tension anywhere along the nerve pathway, sometimes at quite a distance from the site of pain. I've had clients feel tension in their arms, shoulders, neck, even chest and back!
I teach clients to gently "pump" the nerve so that it is carefully teased out of adhesions. Some therapists instruct their clients in a sustained hold of 10 seconds. Try it both ways and see which feels better for you.
Median Nerve Glide (the carpal tunnel nerve)
Sweep your arm out to the side until it is slightly behind you, palm facing forward, elbow gently straight
Pull your wrist back until you feel a gently tension somewhere in the arm
Relax the wrist forward until tension is relieved
Repeat 10 times
Ease the tension on the wrist to about half
Holding this position, gently raise your arm until you feel tension (stay below shoulder height)
Lower the arm until tension is relieved
Repeat 10 times
Ease the tension on the arm to about half
Tilt your head (bring opposite ear towards opposite shoulder) until you feel tension
Straighten the neck until tension is relieved
Repeat 10 times
Ulnar Nerve Glide (the funny bone nerve)
Place your arm out to your side with the wrist pulled back as if you are saying "stop"
Bring your fingers toward your ear as if to cup the ear with the palm, fingers pointing to the shoulder. Stop when you feel a gentle tension.
Bring your hand back out to the side until tension is relieved
Repeat 10 times.
As an alternative:
Hold your arm out to the side, elbow straight, fingers gently curved but not in a fist
Rotate your arm fully until the palm is up.
Gently tilt your head (bring opposite ear towards opposite shoulder) until you feel tension
Straighten the neck until tension is relieved
Repeat 10 times
Radial Nerve Glide (the back of the hand nerve)
Place your hand at your side with the back of the hand facing forward
Push your shoulder down towards the floor (the movement comes from the shoulder, do not lean)
Bend your wrist toward the palm until you are in the "waiter's tip" position (as if you are a waiter unobtrusively taking a tip)
Move your arm back behind you and up at a slight angle to the side until you feel tension
If you feel as if you need more stretch, gently tilt your head (bring oppositie ear towards opposite shoulder) until you feel tension
Straight the head or move the arm back down until tension is relieved
Repeat 10 times
These nerve glides deserve a repeat of the previous cautions. Stretch only until you feel a gentle tension. Avoid pain. Perform in a quiet environment and listen carefully to your body's feedback while performing.
Finger & Thumb Stretches
Finger abduction and adduction (Spread the fingers apart widely then bring them back together)- This is an exercise that just feels good and can help reduce swelling in the fingers. It also stretches the hand out of the position it is held in for most of the day.
Thumb stretch - Using your other hand, pull the thumb back into the hitch-hike position. You should feel a nice stretch in the muscles at the base of the thumb. Push from the base of the thumb where it meets the palm. Do not pull from the thumb tip. This can hyper-extend the tip or the middle thumb joint. This is an important stretch to perform if you use a blackberry or text-message frequently.
Wrist stretches & Forearm Muscle Stretches
These are great stretches for elbow pain or forearm tightness. Make sure to keep your shoulders relaxed. The muscles of the arm being stretched should be relaxed - do not activate the muscles. The other hand is doing all the work to provide the stretch. If necessary, start the stretch with the elbow tucked in to your side and then gradually straighten the elbow while you maintain the stretch with the other hand until you feel a good stretch. Do not hyperextend your elbow. If performing these stretches with your arm held at shoulder height is uncomfortable, you can relax the shoulder and arm so that it is half-way between the shoulder and the side of your body. These stretches should not hurt; however, it is okay to feel a gentle "good pain". Hold for 30-40 seconds. Perform 2-3 stretches before and after strenuous activity and every 1-2 hours or so during non-strenuous activity.
Forearm Extensor Stretch: Place your hand in front of your body with the elbow straight and the palm down. Let gravity bend the wrist forward. With your other hand, gently push the wrist further until you feel a good stretch. Hold for 30-40 seconds. Close your fingers gently to increase the stretching sensation.
Forearm Stretch-Fingers Relaxed Forearm Stretch-Fingers Bent Forearm Stretch-Arm Relaxed
Forearm Extensor Stretch with Full Pronation: Same as above but rotate the palm outwards as if you are swinging the small finger up towards the ceiling. Hold for another 30-40 seconds. Close your fingers gently to increase the stretching sensation.
Forearm Flexor Stretch with Pronation: Place your hand in front of your body with the elbow straight as if you are saying "stop". Support the hand being stretched with the other hand. Relax the muscles of the arm being stretched so they are not activated. Gently push the wrist further with the other hand until you feel a good stretch. Hold for 30-40 seconds.
Forearm Flexor Stretch with Supination: Begin from the "stop" position with the fingers pointing up towards the ceiling. Swing your fingers out and rotate your arm until the fingers are now pointing to the floor. Make sure the muscles are relaxed and not pulling the wrist back actively. Gently push the wrist further with the other hand until you feel a good stretch. Hold for 30-40 seconds. This forearm stretch is often the most uncomfortable for people to perform. If necessary, bend the elbow to make this stretch more comfortable.
OK I know this is a lot. Please take your time with this and try them one at a time so this is not an overload. You will notice a diffrence!
Take care,
LG
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