September 2011 |A Better You | Helping Your Hands

For pain-free hands, look to your neck and arms

By Suzanne Martin, PT, DPT

As a teacher, think how many times a day you use your hands. As a dancer, consider the beauty of a delicate hand in a port de bras. Our hands are priceless, yet we don’t always think of protecting their health.

While we hear plenty of stories about injuries to feet, knees, hips, and backs, hands can also land in harm’s way. One dancer I know developed arthritis of the thumb after a partner squeezed her hand so hard that it was severely sprained. Another dislocated her thumb and fractured a nearby bone while performing a finger turn with her partner.

Most school owners do a considerable amount of desk and computer work, which can lead to hand pain. And those of you who are mothers might complain of hand and arm pain from handling children.

People often suspect carpal tunnel syndrome—a high-pressure problem due to swollen nerves and tendons—when their hands, wrists, or forearms ache, but that’s not the only possible culprit. Nerves run from the neck all the way into the hands, and tightness or irritation can cause pain anywhere along this route. Most hand pain comes from overuse and not traumatic injuries.

Body connections
Hands, neck, and arms go together as one unit. To have happy hands, you must have a properly aligned neck that allows you to breathe into the area above the collarbone. Letting your head jut out in front of your body’s center of gravity often leads to problems with the arms and hands.

The neck vertebrae are unique in that the bones can actually telescope forward like a giraffe’s neck. Watch someone giving a lecture or teaching—often, she’ll push her face forward as she works to engage her audience. The more animated the speaker is, the more this forward pressure tends to happen.

Proper head alignment is needed when you’re dancing, such as in spotting. But as teachers, you mark combinations more and dance less, which means that your neck alignment is sure to go if you’re not vigilant.

Nerve pain and pathways
Arms and hands are susceptible to pain from tight nerves. Nerves are encased in a sheath, and if they are tight they will not glide within that sheath as they are designed to do. As a teacher dances less and loses neck flexibility, her cervical (neck) nerves may become tighter and lose their glide. The nerves wind from the back of the neck down through the scalenes, which line the sides of the Adam’s apple, forming what’s called the brachial plexus network above the collarbone and ending in the armpit or arms.

Dancing and performing require a great deal of respiratory diaphragm use, and the scalene neck muscles work in opposition to the diaphragm, just like the biceps muscles in your arm works in opposition to the triceps. When the biceps flexes, the triceps has to relax (extend). The diaphragm and scalenes work in a similar fashion—if one is at work, the other will relax.

Because dancers spend hours holding their arms up or out to the side, the deep neck muscles (the scalene muscles) can become tight. Tightness in the scalenes can cause the major nerves of the arms (all the way down to the fingers) to experience pain or tingling. Working the diaphragm can help to lessen the tension on this area.

To have happy hands, you must have a properly aligned neck that allows you to breathe into the area above the collarbone. Letting your head jut out in front of your body’s center of gravity often leads to problems with the arms and hands.

Dancers tend to have a tight thoracic outlet (a small area above the collarbone where the scalenes are; if you lift your arm in port de bras, you’ll feel these muscles tighten). Teachers work these muscles a lot. They hold their arms up demonstrating, pick up small children in class, do hours of computer work, pick up barres, and sweep the floor. And because dancers often have loose joints, their forearms and wrists often aren’t very strong, so other muscles pick up the slack.

Taking steps to healthy hands
We’ve discussed how posture, the muscles of the neck and collarbone, the tightness and gliding capacity of the nerves, and the full action of the respiratory diaphragm all play a part in healthy hands. Attention must also be paid to how the hands and wrists are used, and steps taken to protect them. Here are some ideas and tips to keep your hands happy while they work.

  • Think of your head as a bowling ball. Keep it over your center of gravity in the pelvis. Notice how you hold your head as you demonstrate or watch your students. Keep your jaw a bit slack and relax your tongue so that the tip slightly touches the roof of the mouth.
  • Stretch the sides of the neck. Reach behind your back and hold the elbow of the other arm. Gently tilt the head away from the side you’re holding and let the ear feel heavy while you take several deep breaths. Then open the collarbone muscles by lifting the clavicles and rolling the shoulders gently backward 4 or 5 times.
  • Stretch the front of the neck and chest by performing the “butterfly” off the edge of your bed. Lie on your back with your armpits at the edge of the bed. Keep your knees bent and press your back firmly into the bed. Clasp your hands behind your head and point the elbows toward the ceiling in a closed-arm position. Then gently arch backward and open your elbows, supporting your head. Open your mouth and breathe deeply 4 or 5 times. Close the elbows and curl up to come out of the position.
  • Lie down on the floor or bed and move your arms as if making snow angels, then cross your arms and mime pulling a shirt off over your head. Repeat the sequence several times.
  • Place your hands on the floor or a counter so that the third fingertips point to one another, about a foot apart. Gently move one shoulder toward the opposite hand, then move the chest past the midline and move the other shoulder toward its opposite hand. End by rounding up through the chest, making a big curve in the breastbone (as if drawing an oval in space). Repeat several times and then reverse the direction of the shoulder oval.
  • While standing, reach one arm up and the other down with the palms of each hand facing inward toward the body. Squeeze the shoulder blades together while simultaneously squeezing the front of the ribs. (Think about “making dimples” in the ribs below the breasts. This engages the upper abs to help balance the trunk in a correct posture.) Continue to reach up and down for 5 counts, then switch sides. Repeat several times.
  • If you have painful arms and hands, take a brisk walk. Let the arms swing gently and don’t hold anything. (Unfortunately, walking the dog doesn’t count due to frequent stops and leash wrangling.) Just 10 to 20 minutes a day of therapeutic walking keeps your diaphragm doing what it does best.
  • While sitting, try a simple roll of the shoulders, then squeeze the shoulder blades together.

Keep a light grip
Be careful how your use your hands and wrists. Use a light grip whenever possible, letting your palm and biceps do the work. The neutral position of the hand is a slight curve with a gently cupped palm. The back of the hand should form a straight line with the back of the forearm. Avoid a deep crease between the hand and the forearm while performing any hand work or computer use. If you use a laptop computer, rest your hands on its surface; for a desktop computer, try using a gel pad under your wrists for both keyboarding and mousing.

All that time on the computer, gripping a steering wheel, and juggling endless chores can catch up with the best of us. A little knowledge and due diligence go a long way to avoiding chronic hand pain.

I have faith in you.