By Amber Hanrahan, Qualified Physiotherapist, Perth, Western Australia.
As you are very well aware, your hands are your biggest asset as a groomer. Wrist pain can be a real problem, not just at work but also impacting everyday tasks at home.
There are two main types of wrist pain that you are susceptible to when grooming: De Quervain’s tenosynovitis and Carpal Tunnel Syndrome. Both are caused by overuse and repetitive movements, often referred to as RSI (repetitive strain injury).
I’ll explain both problems in detail, so you can look out for early signs and symptoms. I’ll share my top tips and some exercises to help reduce the risk of them happening in the first place.
De Quervain’s Tenosynovitis
Pain on the thumb side of the wrist due to inflammation around the tendons of the thumb. It is often described as a constant ache, a pulling sensation and even a burning sensation. Tenderness and swelling are common around the tendon sheath, which is a connective tissue ‘strap’ that holds the tendons down and prevents them from bowstringing. These structures may become sensitised, causing pain to extend into the forearm as well. The irritation of the tendons occurs from repetitive wrist movements. Pain can be triggered by making a fist, gripping, spreading the fingers apart or with a twisting movement, like opening a jar. As a groomer, you are more susceptible to this problem with work tasks like using scissors and razors (repetition of the task and twisting positions), and turning a tap on and off. Pain can also be triggered by picking up animals of varying sizes and weights, particularly when they are not cooperating! Outside of work, examples of aggravating positions include sleeping with your hands curled in, picking up children or shopping.
If you suspect you have this tendon problem, it’s best to see a physio. Usually, a splint is prescribed to help limit aggravating movements and positions. You can purchase one over the counter from the chemist; however, they tend to be bulky and difficult to achieve a personalised fit. So instead, I suggest seeing a physio or OT who specialises in hand therapy, as they will be able to make you a custom-made splint. If you are in Perth, I recommend Flex Physio. Other than splinting to offload the sensitive structures, physiotherapy may include massage, dry needling, mobilisations, taping and specific exercises.
Some things you can try for yourself:
· Self-resisted exercises
· Massage your forearms on the inside and outside using your hand or a small firm ball i.e., a tennis or lacrosse ball
· Try to sleep with your wrists flat (neutral position), as if they were in a splint.
· When your wrists are sore, limit lifting where possible; this includes not only at work but also at home!
Heat or Ice?
Well, it depends. Either could help with both of these problems. Inflammatory type pain is usually relieved with cool packs, whereas achy muscles are usually relieved with heat therapy. You could try both, not at the same time, obviously!
Carpal Tunnel Syndrome
A nerve-related problem that occurs at the front of the wrist and travels into the palm of the hand. The median nerve is compressed as it travels through the carpal tunnel in the hand. Sometimes pain isn’t always present, but other symptoms include numbness or tingling in the thumb and middle fingers. Loss of grip strength and hand coordination is another common complaint. If you notice the muscle at the base of the thumb is smaller than on your non-painful side, please discuss this with your physiotherapist. Usually, it occurs in one hand only, but if it’s present in both hands at the same time, it’s important to discuss this with your physiotherapist or GP. This type of pain often occurs in women more than men, aged 35-60 years old.
What can you do about it?
This problem is easy to diagnose and often responds well to treatment. If you suspect you have Carpal tunnel syndrome, the earlier you get an assessment, the better. It is best to see a physiotherapist first, or your GP, who will likely refer you to physio at some stage. Medical imaging is not essential for diagnosis. Management includes relieving symptoms through hands-on techniques (massage, mobilisations and movements) as well as exercise prescription. See the videos below for some examples.
We will also provide you with tips to incorporate throughout your day, tailored to your needs at work and your lifestyle. We recommend you reduce repetitive movements where possible and incorporate a variety of positions and movements to compensate. Let’s face it, not always possible! An ergonomic assessment of your workspace is recommended to ensure you are taking care of your body.
If left untreated, it can become persistent. Your GP may prescribe some pain medication and anti-inflammatories. As a last resort, referral to a specialist for surgical release around the nerves can be considered if conservative management has not helped.
Now that seems like all doom and gloom, right?!
How can we prevent these problems in the first place?
Strengthening the hand, wrist, shoulder and neck can reduce the likelihood of overuse and build your capacity beyond what your work demands. These preventative exercises are often ones that will relieve symptoms, too! We call it ‘pre-habilitation’.
Physio Exercises
Thumb isometrics (De Quervains)
- Hold for 10-30sec x3
- If you have pain, stop if the pain increases and apply less pressure
Elastic band
- As many reps as possible until fatigue
Wrist stretches – Prayer & Reverse Prayer
- Hold the stretch for 10-20 seconds
AROM Long finger flexors (Carpal Tunnel Syndrome)
- Repeat until symptoms change OR muscles fatigue
Dumbbell curls
- 8-12 reps. If you can do more than 15 reps, the weight is too light!
Lateral Raise
- 8-12 reps. If you can do more than 15 reps, the weight is too light!
Wall angels
- Move slowly x 6-8 reps, up to 12 in a row
If symptoms worsen or persist, see your healthcare professional.
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