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A B M P m e m b e r s ea r n F R E E C E h o u r s by rea d i n g t h i s i s s u e ! 65 EXERCISES: STABILIZING THE CMC JOINT 8 1. Place the thumb in a "C," as if you are holding a ball (Image 8). Hold this position for 5–10 seconds, repeating 10 times. Start with one set per day, then increase. 2. Place and hold the thumb in a "C" position, using the opposite hand to stabilize, then lightly pinch (Image 9) and remove the supporting hand (Image 10) from this position without letting the metacarpophalangeal or interphalangeal of the thumb collapse for 10–12 reps. Start with one set per day, then increase. 3. Place a thin rubber band around the hand and thumb and move the thumb out and away from the palm 10–12 times, ending with a rounded "C" position (Images 11 and 12). If you have pain, you can do this without a rubber band and just do the movement. Avoid flexion of the first metacarpophalangeal joint. Start with one set per day, then increase. 4. To work the first dorsal interossei muscle, place your hand on a table and your index finger away from your middle finger (Image 13). First do the movement, then resist the movement by placing your other hand/finger on the lateral side of the index finger (Image 14). Do this 10–12 times. Start with one set per day, then increase. 5. Add resistance to the first dorsal interossei muscle by placing a rubber band around the index finger at the proximal phalanx, then abduct and adduct the index finger (Images 15 and 16). IN SUMMARY As with any professional who uses their hands for precise work, we are at risk for pathologies of our hands. It is imperative we take care of our hands and protect them as much as we can. Notes 1. Joshua Gillis et al., "Review of Thumb Carpometacarpal Arthritis Classification, Treatment and Outcomes," Canadian Journal of Plastic Surgery 19, no. 4 (2011): 134–38. 2. Richard Kim and Robert Strauch, Musculoskeletalkey.com, "Ligament Stabilization of the Unstable Thumb Carpometacarpal Joint," accessed March 2023, https:// musculoskeletalkey.com/ligament-stabilization- of-the-unstable-thumb-carpometacarpal-joint. 3. Virginia O'Brien et al., "Dynamic Stabilization of the Painful Thumb: A Historical and Evidence-Informed Synthesis," Journal of Hand Therapy 35, no. 3 (2022): 388–99. 4. Gillis et al., "Review of Thumb Carpometacarpal Arthritis Classification, Treatment and Outcomes." 5. J. Edward Flynn, "Adduction Contracture of the Thumb," The New England Journal of Medicine 254 (1956): 677–86. 6. The Mayo Clinic, "Joint Protection for People with Hand Arthritis," last modified February 25, 2021, mayoclinic.org/diseases-conditions/arthritis/ multimedia/joint-protection/sls-20076400. 7. Virgina O'Brien, Medbridgeeducation.com, "Evidence Based Intervention to Restore Dynamic Thumb Stability," accessed March 2023, medbridgeeducation.com/course-catalog/ details/evidence-based-intervention-to-restore- dynamic-thumb-stability-virginia-obrien-hand- therapy. 8. Jan Albrecht, Caring for the Painful Thumb, (New Ulm, MN, Corporate Graphics, 2015); O'Brien, "Evidence Based Intervention to Restore Dynamic Thumb Stability." Lynette Lombardo, OTR/L, CLT, LMT, works in an outpatient rehabilitation clinic as an occupational therapist with hand, neurological, lymphedema, and post- breast surgery patients. She has been an occupational therapist for over 22 years and a massage therapists for over 16 years. Self-Care Between Clients After each massage client, practitioners should do self-massage for the forearm and thumb, using a golf ball and either their hands (knuckles or stacked fingers) or a hard surface. This simple sequence offers trigger-point release to address the opponens pollicis, flexor pollicis brevis, abductor pollicis brevis, and adductor pollicis. With your palm flat on the ball, massage tight thenar muscles in a circular motion. With the ball in your palm, use the opposite hand to massage tight thenar muscles. Put the ball on the distal forearm and use your other hand to massage anterior muscles. Massage the distal forearm and anterior muscles by moving your forearm forward and backward over the ball.