I started working with a client a couple of months ago who had (what seems to be more and more common) extremely limiting hand pain.  The initial success in dealing with pain that had existed for close to five years was excellent. Intensive treatment of the forearms, as has been underlined in other articles, quickly brought this under control.  So we started some barbell training, and continued with treating other areas that had frozen up over the course of five years of inactivity. Shoulders, calves, biceps, they all were attended to; however the pain in the thumbs didn’t seem to change. So my first folly befell me, I assumed it was simply an issue of lack of use over five years, surely this was the residual soreness that would attend the use of any area that had been neglected for so long.  Within a few weeks it became evident on our weekly visits that the thumbs were not improving. Then suddenly, a mixture of a few activities had them becoming worse, I was stumped. Direct treatment mixed with work on the forearms wasn’t solving this, we needed something better.  However I didn’t know what it was.

Four years ago at two in the morning I was on my motorbike and was rear ended at a red light. A tumble and a hard landing had left my wrists a disaster.  It had been through this that I had had first hand experience with excruciating hand and wrist pain. Climbing had then left me with a host of forearm work to do to remedy and keep finger and pulley injuries from occurring. Thumbs were new.

So I did something stupid in late November. I set about over taxing my thumbs, the goal to try and recreate the pain patterns that I had never felt but could see immobilizing my friend.  I needed to feel the pain to know how to track down its roots in my own arms to fix it.  Surprisingly it does not actually take much time to destroy ones thumbs when the forearms themselves are already a mass of knots and issues from heavy training.  It took me about a week.
I overused my ipad and phone with as much thumb use as I could.  Any soft tissue work I did was with thumbs alone, entirely unsupported.  I was in the back country excessively, poling my way up slopes, grasping with my thumbs as much as possible.  The usual strength and tendon training for my hands continued; the rehab stopped.  Within a week my thumbs throbbed continually, any grasping with them was almost impossible, and a stabbing pain in the thumb joint could occur at the slightest movement in the wrong plane.
This took about three weeks to fix, and at this point I am still continuing the new rehab elements to ensure that I don’t relapse.  I admit there was a couple times where I worried that I had actually succeeded in damaging my thumbs in some irreversible way.  So my first advice to anyone with any sense.  Avoid overloading your thumbs; they are a pain in the ass to fix.  It took me daily work, a lot of frustration, and almost a month to fix a problem that took a matter of days to set in place.  However before I list the specifics that I applied to fix my thumbs, here are some of the lessons learned:
  • Appreciate your thumbs, you use them more than you think.
  • If you own a tablet.  Never hold it unsupported while using your thumbs alone (ie gaming, split keyboards, or even just holding it with the wrist pronated, fingers below, hands on top), they are heavier than you think.  The angle that seems comfortable to hold the damn things creates a huge amount of stretch in the tendons attached to the thumbs and makes this whole thing a lot worse.
  • You have to limit thumb dominate grips while rehabbing.
  • Don’t fall on them.  This hurts a lot.

  • Have patience, appreciate the improvements, this takes a while.

So if you have thumb pain what should you do?  Here was my treatment plan:
1). 3x times a day rolling out the usual spots in the forearms with a lacrosse ball (see the hand rehab article).
I have already written an entire article complete with bad audio on how to roll the forearms. Check that for details.
2). 3x a day rolling out a bundle of fun spots that are located on the underside of the forearm about four inches from the wrist.
This is an entirely different set of muscles. Lets unpack this a bit; ie, I am going to show a photo that hopefully will aid in demonstrating the point.
Everything that has the word pollicis needs to be tackled. These will need to be hit from the underside of the forearm for the best results. I found the trigger point spot that seemed to be most tied to this to be about four inches from my wrist. I actually rolled it through a hoodie as actual direct contact was far to sore to be able to get any work done.  Remember the mantra of: constant pressure, then iron out.
It is always hard to determine how much pressure is correct without damaging oneself. I find that I sit at the comfortable edge of my pain face where I want to hit things and spend a good 20-30s per tender spot.  Usually a couple sets per arm.
3). Specific work in the joyous thumb muscles whenever I happened to have a spare minute or two.
Again a photo makes this a bit easier to grasp. The thumb is pretty complicated, and there are a lot of muscles in there which need some work.  For massaging this area I used the handle on a GHD.  As to an “at home solution”, a corner of a counter, or end of a broom handle would be perfect in terms of size if you could keep it from moving around.  I found these areas were the most enjoyable to massage as this is where I actually felt a lot of the pain and immobility. Any increase in circulation into this area just seemed nice, even if it was just feeding into the psychosis that “problem must be where the pain is”.  I would recommend against massaging these areas with your other hand as it will just perpetrate the issue of thumb fatigue.  Find a nob.
4). Contrast baths for the hands and forearms.
Okay so ice is supposed to be a debated point. So what, I may have no good evidence, but I find soaking in hot water followed by movement and light soaking in cool water to be a great combo, even if it is just so that your body can handle more doses of heat. Does it need to be immersion; maybe not. However I know it feels super good.  Big sink with hot water, put the forearms and hands in the water and stretch and soak up the heat.
5). Stretching of the forearms and fingers post trigger point work.
You can stretch while doing heat therapy. The big thing is just to stretch post trigger point work to help return that tissue to healthy length.