- Hi, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- Together we are the most famous physical therapists
on the internet.
- In our opinion, of course.
- Brad, we had a person that contacted us.
His name is Ethan, and Ethan's having some trouble
with de Quervain's syndrome,
or de Quervain's tendonitis,
or de Quervain's tenosynovitis, or-
- It hurts right here.
- It hurts right here, yeah.
And he's actually a musician and he writes jingles.
He wrote the jingle for 5-hour ENERGY.
- Great, we're treating a star.
- Yeah, that's right.
So anyway, I thought we'd show him a program
that he could do for this.
This was designed by McKenzie.
Robin McKenzie, who has now passed away,
but, a rather famous physical therapist,
actually, probably the most famous physical therapist.
And this is his book on the extremities,
"The Human Extremities:
Mechanical Diagnosis And Therapy,"
wrote along with Dr. Stephen May.
- Sure. - Very good book
for a therapist.
- Sure.
- So we're gonna start off with...
The first thing you're gonna do...
Now this is for somebody
who's been having de Quervain's
or thumb pain for a long time, chronic.
- Right.
- And it's just not going away,
and what's happening is,
the tendons got inflamed,
and there's probably some scar tissue in there.
The blood flow's not flowing like it should anymore,
'cause the scars are stopping it from flowing.
- Right.
- It's built up a little bit.
It's just a mess.
It needs to be what they call "remodeled."
- Right.
It's a common occurrence
in different parts of the body.
- So, it's just not getting better.
So, you're gonna start off with your hand...
First off, you should see...
You wanna show it on you again, Brad?
It shows really well.
You have what is called the "anatomical snuffbox".
These are the tendons we're worried about, right here.
The ones closest to the palm.
- [Brad] Right. - [Bob] You see that?
- [Brad] Yep.
- [Bob] I know you see it, can they see it? (laughing)
- [Brad] See, yes. Matt says yes.
- [Bob] Okay.
So we're gonna put pressure right on that
when we do this exercise, okay?
So, you're gonna put your thumb
or your hand on a flat surface like this,
I'm gonna put pressure on there,
and you're gonna do this.
Bring the thumb up, pressure on.
- [Brad] He's pushing up this direction.
- [Bob] And I'm pushing at the same time.
- [Brad] So he's going up this way with his thumb
and pushing into that tendon.
- [Bob] And this probably will hurt on you,
you know, some pain has to be tolerated with this.
- [Brad] Sure.
- [Bob] So, we're gonna do 10 times.
Pressure on, pressure off.
Pressure on-
- [Brad] For just like that,
one to two seconds. - Yup.
Pressure on, pressure off.
- Now, should the symptoms stay the same,
get more painful or less painful
as you go through it?
- What I'd like to see is that
after you've done it,
it doesn't get worse.
- [Brad] Okay.
- [Bob] Okay, if it starts getting worse,
you might have to back off.
- [Brad] Sure. Okay. - You know,
over the next day or two.
Now, you can do that three to four times a day, Brad,
and eventually you can go every two hours.
- Okay.
- So that's one direction,
the other direction is...
How am I gonna show this, Brad?
I want you to go out, away from the hand.
- Right.
- This one was going this way.
So, I'm gonna push on it again,
again, it's gonna be down here
but I'm going away from the hand.
- [Brad] Yeah, I would put it in line this way.
- [Bob] Okay.
- [Brad] Going in this direction.
- [Bob] So, again, push on, pressure on.
Off.
On, off.
On- - [Brad] So from this angle,
it looks like this.
The first one was up like this.
The second one-
- [Bob] Is away.
- [Brad] Same pressure with the thumb here.
Different motion with the thumb here.
- Now those are two you're gonna start right away,
the third one you're gonna start right away too
is you're gonna take your thumb,
and you're just gonna stretch it
down towards the fifth finger
as far as you can go.
You may not be able to go very far...
Eventually I'd like to see you getting
down to that point.
And just kind of, again...
Pressure on, pressure off.
- [Brad] So, this is really just stretching the tendon,
right, Bob? - Mm-hmm.
We're remodeling the tendon,
trying to thin it out,
stretch it out.
- Get that scar tissue
that's all matted up, so to speak.
We need to break it up
so the motion becomes free again.
- And more blood flow to it.
- Sure. - Eventually, then,
those are going pretty well
in a week or two.
What you're gonna add is now a stretch
and now you're gonna go off the edge
of the table and you're gonna put the thumb on top
of the finger and you're gonna stretch down like this.
- [Brad] Sure.
And you can see this area right in here,
as the palm goes down,
these tissues get stretched,
and it helps remodel that tissue even more
because we're deviating further down.
- [Bob] Same thing, 10 times.
- [Brad] Okay.
- [Bob] Now, the final one is, if things are going well,
then you're gonna put the thumb down
and stretch it at the same time.
Now I feel that one, even.
- [Brad] Okay.
- [Bob] So, that one's pretty aggressive.
Again, pressure on, pressure off.
- [Brad] And you'll know if they're going well
if, day-to-day,
if you can go a little farther with-
- A little farther,
a little less pain, yep.
We're looking for less pain over time.
All right.
- If you happen to get flared up
and you overdid it...
A cold pack.
- A cold pack, ice it down.
Yep. - You bet.
- Then, the final one,
if the getting through those,
it's going pretty well,
but you're still having some pain,
now you're gonna put pressure on,
and you're gonna keep the pressure on, Brad,
and you're gonna go flex and extend.
The whole time.
Keep the pressure on the whole time.
- [Brad] And now we're getting
into that functional part of the thumb.
That's how the thumb normally works.
So we're getting near the end of the rehab.
- [Bob] Now this is gonna probably be
after maybe a month or so of doing therapy.
- [Brad] It takes a while
to develop this kind of chronic problem,
it doesn't go away in just a few treatments.
- It takes a while to remodel this.
I mean, good luck with it,
it's a tough thing,
I don't know what else to say, Brad,
you gotta put the work in.
And, again, you're gonna start off three to four times a day
and eventually work up to every couple hours.
- But then, you'll probably be able to back off.
- Right, oh, yeah,
eventually you can stop this
and not do it at all, but...
- Use your judgment and we'll keep on helping you
with more tips like this
to keep your body healthy, active,
and, remember:
we're not professional actors,
but we are professional therapists,
believe it or not. - That was a mouthful.
Good luck. (Brad laughing)