♪ Bob and Brad ♪
♪ The two most famous ♪
♪ Physical therapists on the internet ♪
- Hi folks, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- And we are the most famous physical therapists
on the internet.
- In our opinion, of course, Bob.
- This is a hint to what we're gonna be talking about
today, Brad.
- I thought it was the Fonz or something.
- Thumb, hey.
Today we're gonna talk about thumb and wrist pain.
The CMC joints specifically,
and we'll show you what that is.
It's a easy self treatment for pain-free daily activities.
And this is for a friend of yours, Brad.
- That's right, Bob, this is for Peggy.
Peggy we're gonna show you what you can do,
some exercise, massage.
- Is her middle name Peggy Sue?
- No, don't call her Peggy Sue.
She's a black belt, by the way.
Carry on. - Watch my mouth.
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- Wow, that was a good intro, Bob.
Okay, here we go.
So you know, I found with Peggy, she says,
oh, I've got wrist pain.
Pushing off a chair hurts, there's a number of things
throughout the day that are irritating her wrist,
and so I actually took a look at it and I said,
let's take a closer look,
and I actually zeroed it down to
she had movement in all her wrist.
It was down to a spot right here was the source,
but it felt like wrist pain.
So this kinda can get confused a little bit.
Mis-diagnose you may call it.
But anyways, it's the CMC joint,
which is an abbreviation actually for, let's do this,
carpal metacarpal. - Yes.
- So it's, well, let's show you right here.
This is the best way to do it.
I've got Sam.
- Very common joint to be affected, very common,
probably one of the most common in the hand.
- Sure, and there's some good news for this
'cause we could work with this.
Worst case scenario they actually do a joint replacement
right here and for the most part, it's pretty successful.
Obviously nice to avoid that if possible.
So here we've got the thumb, the little bone here,
then they've got the carpal and then we've got
this long bone and this goes up and right into
the wrist joint, so this joint right there,
can you zoom in on that, Peggy?
Peggy?
I'm sorry, Liz, I've got Peggy on my mind.
And it's right there and if you look at it,
it needs to move so your thumb moves.
And it's real critical and it's right there
next to the, it's basically part of the wrist.
- [Bob] And it's multi-directional.
I mean, it goes, you know, that's the whole thing
about the thumb, it can go in all directions.
- Right, that's what separates us from--
- [Bob] Something. - Yeah.
I remember that in school.
Anyways, we need to work with that joint,
and we need to do it specifically.
But before you do that, if there are things,
in her case she talked about pushing off a chair
which you do without even thinking about it,
ow that hurts, stop doing that.
It's irritating it, it's just gonna make it worse.
- It's not helping.
And don't test it either.
A lot of people have pain, they'll go,
I wanna see if it still hurts.
Avoid testing it for a while, let it calm down.
'Cause sometimes inflammation,
once it calms down, the problem is solved.
- And one way, 'cause you do that without thinking about it.
But if you put a wrist splint on,
you can have a generic one or one that's supports that area.
- They have a splint that are made for the CMC
so you can actually probably go on Amazon and just--
- And you could actually probably just get a
standard wrist splint just to remind you that
those things that you do without thinking about it,
that wrist splint would say, oh yeah that's right,
I can't do that 'cause it irritates it.
Plus it supports, so either way.
- Splints can be very helpful.
Yeah, I wouldn't necessarily wear it at night,
but during the day when you're using the hand.
- If you wake up and it's sore,
maybe that you're sleeping on it in a certain direction.
- In that case, you may wanna wear it at night.
- Exactly right, so I wouldn't put that out at all.
Very common with carpal tunnel.
Same concept, different source of pain however.
Now the next thing, once we eliminate
the common irritations, splinting it
or just keeping mindful, track of what's going on
with that joint, what we wanna do is massage the muscles
around the joint, we wanna increase the circulation.
A lot of times the muscles that control that
will actually tighten up as a result of that pain.
It's more than likely arthritic.
The joint is becoming arthritic, the muscles get tight.
The more the muscles get tight, the less the joint moves.
When the joint does not move, the arthritic pain
can get worse so it's a compounding,
like a snowball rolling down the hill.
We need to break that cycle and one of the ways
is with a splint and then we're gonna massage
these muscles.
This happens to be known as the hypothenar eminence.
No, I take that back, the thenar eminence.
- [Bob] Hypo goes on the other side.
- The thenar and I thought, why do they call it that?
This just on a side note,
and thenar, if you look that term up,
it means the ball of the thumb.
So here's the ball of the thumb,
and eminence we know that, an elevation.
It can be other things too.
- Your eminence.
- Yeah, but here we're looking at the elevation
of the ball of the thumb, so we're looking at the muscles.
That's why it's, the ball's got muscles in there.
- So Brad, would you also suggest, you know,
you get a massage, but would you also maybe
hit the tendon in there if it is sore?
- I think you could work that.
It depends on your response.
First we can maybe address the muscles,
and you're gonna get in there.
If you happen to have it on this thumb too,
that's a problem because you're probably
gonna use your thumb more to get--
- Then it's going to irritate the thumb when you massage.
- Right, you or you could get your spouse or family member,
someone possibly to do this.
But you really got to be careful 'cause it may hurt at first
but once you work on it for 15 to 30 seconds
and you break those muscle knots up
and you get things to feel better,
if that's the case, then you can work it for a few minutes
until your other hand gets tired.
- Well, the other option, Brad, is massage gun.
- Yep, this is an option but you're not gonna get
the big one, the big powerful one.
You're going to need to get a smaller one
and this one here works really well, just a little one.
And even this one is a reciprocating gun.
We're not gonna go straight in.
You might if you got a really big thumb.
But if you go sideways, it really can work well
and you can work it on there and it works really nice.
- [Bob] What's shocking about this is the Q2,
this thing is really powerful, Brad, though.
I mean, you can--
- [Brad] You gotta be careful with it.
- [Bob] I mean, I use it on my legs to my hip adductors.
- [Brad] Bob, we don't have to get that personal.
- [Bob] Well I'm just saying. - [Brad] Just kidding.
- [Bob] It's amazing. - [Brad] Yeah it is.
That's why you really have to do it at an angle
and I don't have it set on the highest setting.
I'm almost on the lowest setting.
- You can really get good leverage with it.
When I'm working on my calf, I can really push into it.
- We're talking about the (overlapping chatter)
- It's all about me.
- So anyways, and you can get to the joint
and work around that joint but you're only gonna continue
to massage that joint as after about 15 to 30 seconds
it starts to feel better.
If it just continues to be painful after that 30 second mark
then use the clock or a timer to look at that.
Then you don't even have to stay away from it
'cause you're just irritating it.
- Yeah, it's too tender, you might even try icing it.
You might do an ice massage on it even.
- So we're gonna work that aspect of it,
the massage and working the circulation
and get it moving that way.
And then the next thing is to actually
get a hold, let's get Sam over here again,
I knew I needed Sam one more time.
We're gonna try and get a hold of this bone right here.
And I'm Sam if we could do it, if we could grab the bone,
Liz, if you wanna, I thought I was gonna
call her Peggy again, I don't know what's wrong with me.
And we're gonna try and get that joint moving.
- [Bob] Mobilizing.
- Mobilize it without too much pain.
Now one that that sometimes works is if you pull on it,
put a little traction and then work the motion.
Sometimes you can try to rotate it
so if you put it on a real person.
Bob, you're doing it there?
I'm gonna grab here, but you gotta grab through skin
and muscle and tissue so it's harder to get
a hold of that bone.
And you're gonna work it.
Now one thing you can do is grab it with the other hand
and kind of get a grasp of it like this or like this,
and so you're trying to mobilize it.
Get things moving, but don't get too aggressive.
If it gives you sharp pain, that's too much.
Work it in the pain-free or just minimal pain
and then eventually break it loose hopefully
to get some of that arthritis moving.
Again, pull with traction, a little rotation.
You do have to experiment with this.
- And you certainly could do a little heat on it before,
which make it a little bit more able to have a mobilization.
I mean, you can put your hand in warm water.
- And you may have, if you really flared up
because you irritated it all day,
heat might not be the right thing.
You're gonna have to experiment with that.
- Right, ice versus heat versus what they call
contrast baths where you do cold water and hot water,
cold water and hot water.
- That a lot of people probably be the last thing
'cause it's harder to, you gotta set it up
and you have to take time with it.
- Sometimes it's a good time to do the range of motion
which you're gonna talk about now.
- Exactly, the next thing range of motion.
If you do heat it up and it gets looser as a result
of a hot pack or doing the dishes or something
in warm water, then simple touch thumb tip to finger tip.
And all four fingers gives you different range of motion.
- The thumb is having to turn and rotate in doing this.
- And you could just work it this way as well,
this way, we're just trying to get all range of motion.
Again, if it's real painful one direction, avoid that.
Say going across this way, ow, it hurts,
well, let's go back this way and do the opposite direction
10 times and then you can go back.
You can use the other hand to do a little passive range
to get the motion moving.
Once you get it kind of broken loose
and it's feeling a little looser and not so painful,
this might be a few days into it or even a week.
Then I'm gonna suggest get a ball, but not,
this ball is solid, it's just a foam ball.
Probably too much to get started.
Bob, you don't have to leave.
- [Bob] No, I'm gonna come back.
- So if you get one of these balls,
like this has a fluid in it, those are usually nice
'cause they're softer and you can go with
different directions like I'm putting my thumb,
I got Liz flying all over with the camera
trying to keep up with me, sorry about that.
And we can push like this.
And you're gonna find certain directions are tolerated
better than others, and you wanna work
the directions that feel better without creating sharp pain.
- [Bob] If that hurts, you can actually,
it's actually all you do is grab onto it a heavy weight,
lift it up and that's isometric strengthening now.
- By heavy weight, you know, three pounds for your thumb
is pretty heavy.
- [Bob] So you just pick it up, hold it for 10 seconds
and then down again and do three sets of 10.
- This other thing you take a simple rubber band.
Now you put it like this and I found out if you do this
it kind of happens like this so just twist it up
in your fingers a little bit.
So I've got it going around my pointer finger and my pinky
so that way it stabilizes it.
And all's I'm gonna do is bring the thumb out this way,
offers a little bit of resistance.
And you really don't need much more than a band.
- [Bob] You can go out to the side and you can also just
go straight forward.
- You don't need a big band 'cause your thumb
when you go out does not, you're not grasping thing
for power, you just want to get the thumb to move.
So a small rubber band is more than enough.
You know, all of these, 10 to 15 maybe 20 reps
if it's feeling good.
Do that.
I really think you can get that joint loosened up
if you follow these steps step by step.
Don't overdo it and take care of yourself.
- And remember to give us a thumbs up.
- Yeah thumbs up, that's right.
I thought you were doing the Fonzie thing.
- Hey.
- You know that Fonzie statue is in Milwaukee.
- Is it really, Henry Winkler?
- Yeah, he's down there, he's a full life.
He's short.
- Yeah he is short.
- And he's down there, you can get a picture taken with him.
- All right cool.
- That'd be fun with you, you're about three foot
taller than him.
Just a side note, take care.
- Thanks for watching.