Wrists and hands can have a profound effect on the entire body. They not only help us with quadruped (hands and knees) exercises, but in many of our day-to-day activities like typing, gripping and even balance!

If you’d like to learn more about the anatomy and function of the wrist and hand, check out my article from last week “Wrists and hands impact the entire body!

Today, we’re going to focus on one technique we can use to strengthen and bring more Range of Motion (ROM) to the wrist and hand. We’ll explore how to determine if there’s a limited ROM and how to perform an quick isometric exercise to increase this ROM while also building strength in the wrist.

 

What is an isometric exercise?

I’m sure you’ve heard of isometrics (Iso) before, but here’s a definition from Wikipedia to get us all on the same page:

“isometrics are a type of strength training in which the joint angle and muscle length do not change during contraction (compared to concentric or eccentric contractions, called dynamic/isotonic movements). Isometrics are done in static positions, rather than being dynamic through a range of motion.”

Typical Isos are exercises like quadruped knee hover, plank, side plank. You could even press your palms into one another in a prayer pose to get the same effect.

 

How can I use isometric exercises?

Sometimes one side of the body moves more or less from the other. This is a sign that muscles are weak and not working very efficiently. A simple isometric exercise (Iso) can help to strengthen the limited range of motion as a whole, and coax weak muscles back to life, rather than letting one or two strong ones do all the work.

A word of caution! Isos are meant to be performed gently so that the “bullies” (stronger muscles) don’t have a chance to jump in and take over. Each repetition is held for a count of six. And usually six repetitions are all you need to see and feel a difference!

 

Where do I start?

Before performing Isos, it’s important to test the Range of Motion. This will help determine the muscular imbalance.

It is best to assess Range of Motion (ROM) on your clients in a supine position with the elbow flexed to 90 degrees and the palm supinated (facing their bicep). Begin by having your client perform the movements of pronation/supination, flexion/extension and radial/ulnar deviation actively (without your help) rather than passively. Watch closely and note which movements seem limited.

If you have trouble remembering, go ahead and write it down. You will want to perform your Iso’s on the most limited ROM’s. Make sure to compare both right and left side of each movement.

When you are ready to perform your passive assessment please do not use force in any of the movements. Note a soft end feel at the end of their ROM.

Also, make sure to perform your passive ROM assessment in the order listed below: pronation/supination, radial/ulnar deviation, flexion/extension.

 

Pronation/Supination: (Passive ROM Assessment)

Label_Pronation & SupinationWith the client in Supine position and the elbow flexed 90 degrees, place your palms on either side of the clients’ wrist and clasp your fingers.

Remember that it is the Radius that turns around the Ulna. The Ulna does not rotate around the Radius. Gently turn the wrist into Pronation until you feel a soft end feel to the motion. Immediately assess the other side to compare movement. Now do the same for Supination.

Once you have determined which side and which motion is more limited, assume the same clasp of the hands about the clients wrist and gently find the soft end feel of their limited ROM. Keeping your hands steady and stationary ask the client to gently (only 20% of their available strength) increase the range into your clasp while maintaining your position (like a wall). Count to 6 slowly and rest. Repeat the isos for 6 repetitions and then have the client actively re-assess ROM and look for improvement.

 

Radial/Ulnar deviation: 

Using the same clasp as previous test, keeping the clients’ palm and fingers open, gently tip the hand toward the pinkie finger for ulnar deviation and toward the thumb for Radial deviation. Due to joint structure there will usually be more motion toward the ulna. Assess each motion separately from side to side and feel for asymmetry.

 

 

Flexion/Extension: (Passive ROM Assessment)Label_Flexion & Extension

For Flexion/Extension the placement of the hands is slightly different. Clasp the clients’ hand palm to palm with your same hand (their right to your right). Your other hand will support the opposite side. Gently assess Flexion/Extension without forcing and feel for the soft end of their ROM.

 

Do the isos!

Now that you’ve determined which ROM’s are the most limited, it’s time to do the actual Iso. Choose the position with the most limited ROM and use the same grip as above. Your position must be stationary and the clients’ effort is to gently force into you. Don’t try to resist into the client. Do each isometric exercise six times and hold for six seconds.

Isometric exercises when performed with proper test position and degree of force can be extremely helpful to increase ROM as well as strengthen muscles in that range. It will also help to relieve the sensation of tightness as the joints in the wrist become more stable. These are easy to perform with your client and will provide excellent results that they will notice right away!

 

Let’s review the process

  1. Perform a passive ROM assessment in the following order:
  • pronation/supination
  • radial/ulnar deviation
  • flexion/extension

Make sure to compare both right and left side.

  1. As you perform the passive ROM assessment, make note of the most limited ROM’s. Which position and which hand had the most restriction?
  1. Perform an isometric on the hand with the most limited ROM in the position with the most limited ROM.
  1. Go ahead and retest the passive ROM and notice if there’s any difference. Sometimes clients can actually feel a difference too.

 

My challenge to you

I challenge you to try this process a few times this week. If Iso’s of this kind are a new technique for you, practice on a friend or colleague before trying it on a client.

It may take a bit of time at first, but with just a little bit of practice, you’ll be able to whiz through this in just a few minutes. Trust me, the results will be profound and make a world of difference to your clients.