What Is Manual Hand Therapy?

Hand therapy has been firmly rooted in the rehabilitation profession for decades. It is a specialized type of therapy that focuses on the complex anatomy and function of the upper extremity, particularly the hand, wrist, elbow, and shoulder. Hand therapists are occupational or physical therapists who, through advanced training and experience, specialize in treating conditions affecting the hands and upper extremities. Hand therapy combines comprehensive knowledge of the upper extremity with expertise in rehabilitation to evaluate and treat a variety of conditions. It involves skilled interventions intended to produce any or all of the following effects: improve tissue extensibility; increase range of motion of joints; mobilize or manipulate soft tissues and joints; induce relaxation; change muscle function; modulate pain; and reduce soft tissue swelling, inflammation or movement restriction. Hand therapy involves a range of techniques used clinically for the treatment of upper extremity pain and dysfunction. The mechanical stimulus from hand therapy interventions starts a series of neurophysiological responses within the nervous system responsible for pain inhibition. It targets the muscular, skeletal, and nervous systems of the hand and upper extremity. Hand therapy is a complex intervention, resulting in the interaction of multiple complementary mechanisms. Full understanding of key mechanisms through which hand therapy works is continually being researched, but studies have identified how it likely works through neurophysiological, biomechanical, and psychological mechanisms.

What Types of Hand Therapy Techniques Are There?

Clinical decisions that determine the use of hand therapy techniques are best provided for individual patients on the provider level, instead of using a “one-size-fits-all” approach. There are a variety of manual techniques that can be utilized to achieve a patient’s goals related to hand function. The primary techniques include: joint mobilizations, soft tissue mobilization, active release techniques, nerve gliding, edema management, and targeted strength and mobility exercises. Our hand therapists have often received additional certifications in specialized hand therapy approaches in an effort to maximize our patients’ outcomes. Research has shown that best treatments for upper extremity conditions and injuries are a combination of manual therapy techniques and targeted exercise. These principles are at the core of our treatment philosophy and they are part of the reason why we have such high outcomes for our hand therapy patients.

Active Release Technique (ART)

Active Release Technique is a movement-based soft tissue technique utilized to treat problems with the muscles, tendons, ligaments, fascia, and neurological tissue of the hand and upper extremity. When utilized in a hand therapy plan of care, ART is used to restore function, movement, and reduce pain. It is done by attempting to reduce muscle restrictions, release entrapped nerves, or decrease hypersensitivity in tissue. This form of manual therapy involves having the patient move the affected tissue in specific patterns while the clinician manually applies pressure, which is particularly effective for conditions like carpal tunnel syndrome, De Quervain’s tenosynovitis, and trigger finger.

Joint Mobilizations

There are multiple contributors to decreased functional mobility in the hand, and often a muscle is not the primary perpetrator. The small joints of the hand and wrist can cause aberrant movement patterns that result in dysfunction and pain. A skilled hand therapist will determine the quality of capsular mobility of these joints, and address any restrictions within. Joint mobilization is a passive movement of a joint within its normal range of motion. It is a hands-on technique of different forces, depths, and speeds. Specific application of a joint mobilization will be determined by the clinician based on a patient’s specific joint dysfunction. Research has consistently demonstrated a strong relation between joint mobilizations and inhibited muscular tension, muscle spindles, and Golgi tendon organs. Desired outcomes of joint mobilizations include improved range of motion, decreased muscle spasm, and decreased pain in the fingers, thumb, wrist, or elbow.

Myofascial Release

Myofascial release is a technique that is used to treat musculoskeletal or sensory pain, and to improve joint mobility in the hand and upper extremity. Restricted tissues are targeted, and manipulated to attempt to return normal movement patterns to muscles/fascia. Reducing the tone or tension of tissue promotes improved mechanics, and circulation, and allows for normal stimulation of muscle tissue, which is especially important in the intricate musculature of the hand.

Soft Tissue Mobilization

Soft tissue mobilization encompasses an array of manual techniques designed to relieve pain or tone related to muscles, tendons, nerves, and ligaments in the hand and upper extremity. These techniques have to be specific to each patient and tailored to their impairments. Variations of soft tissue mobilization include myofascial release, effleurage, petrissage, cross friction massage, tissue strumming, tissue broadening, trigger point releases, and active release techniques. These are particularly effective for conditions like tendonitis, post-surgical scarring, and muscle strains in the hand.

Neural Mobilization

Neural restriction can be a contributor to pain, impaired strength, and limited mobility in the hand. Neural mobilization, or nerve gliding, is a passive manual technique involving combined movement of the upper extremity in specific ways to elongate particular nerves such as the median, ulnar, or radial nerves. Desired outcomes include improved range of motion and decreased pain, particularly in conditions like cubital tunnel syndrome, carpal tunnel syndrome, and thoracic outlet syndrome.

Edema Management

Hand injuries and surgeries often result in significant swelling that can impair function and delay healing. Hand therapists employ specialized techniques for edema management including elevation, compression, manual lymphatic drainage, contrast baths, and kinesiology taping to reduce swelling and improve circulation in the affected areas of the hand and wrist.

Custom Splinting and Orthotic Fabrication

Hand therapists are skilled in the design and fabrication of custom splints and orthotics to protect healing structures, prevent deformity, increase function, or position the hand optimally for recovery. These may include resting splints, dynamic splints, or functional positioning devices tailored to the individual’s specific needs.

Schedule a consultation

The team of hand therapists at CAO Sports Performance & Physical Therapy are well trained and experienced in specialized hand therapy techniques. Schedule a hand therapy appointment to learn more about our comprehensive approach to upper extremity rehabilitation at one of our offices in California, Leonardtown, or Waldorf, Maryland. We provide the highest level of hand therapy care in Southern Maryland.