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Topic: Does Hand Therapy Have to be Painful?

The anatomy of the hand is quite complex, with many delicate structures jam-packed into tight spaces with no room for forgiveness. Even a small injury to one finger can limit the mobility and function of the entire hand. To appreciate this further, try this exercise: Use your left hand to hold the right ring finger straight and at that same time try to make a fist with the remaining fingers on the right hand. See how difficult/impossible this is? The reason is that there are some tendons that share a muscle, so without the full motion of all fingers, the hand itself can become compromised.

Many people with upper extremity problems report that their hand therapy experience has been painful. Some patients have even been told that it is necessary for hand therapy to cause pain. This is not true.

Generally speaking, pain is caused by stimulation of pain receptors. These pain receptors protect us from injury by alerting us to something that exceeds our tissues’ tolerances. If therapy is painful, it is normal for the patient to tense up, guarding against the anticipation of uncomfortable forces. This causes coactivation of muscles and adds to stiffness and resistance, thus compounding the situation.

Patients who are experiencing forceful, painful passive range of motion (where the therapist is pushing or moving a part beyond its comfortable range) should know that there are usually better ways to remodel tight tissues and stiff joints. And these alternatives are actually more effective.

The topic of painful hand therapy deserves more attention than it receives. Let me know your thoughts. Questions are welcome and encouraged.


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