April showers bring May flowers and alongside those flowers emerge dried up leaves, weeds, and unidentifiable matter. Many of us dream about gardening, and when the first sunny day comes we are out there with rakes, shovels, spades, and wheelbarrows. We become the weekend warrior gardeners. Moving, lifting, pushing, and pulling feels good initially, but can eventually catch up to us. We can pay the price through a tired back, sore knees, or possibly significant hand pain, especially if there is arthritis.
Anatomy of the Hand
The anatomy of the hand is very intricate as there is a balanced system of tendons, ligaments, muscles, and bones that allow accuracy in coordination, manipulation, and strength. Our thumb and fingers have many motions and there is a need for a grading of pressure based on the activity. As time goes on, due to familial history, gender, or activities that one engages in, there is evidence of a wearing down of joints or an inflammation of joints. Probably the most common type of arthritis is OA (osteoarthritis), and with this is a “wear and tear of joints.” Pain and stiffness are hallmark signs of OA and it generally affects the wrist, the thumb CMC joint, and the IP joints of the fingers. As the joints wear down and lose cartilage, bony spurs or osteophytes emerge. The alignment of the joints can subsequently be altered, as certain muscle groups override others. The thumb can live more in the palm and the small joints of the fingers can become crooked. OA is a degenerative process and we can’t reverse it, but we can stave off unnecessary pain through avoiding exacerbating activities.
How to avoid the pain of osteoarthritis
In thinking about how to be successful in your gardening projects, it pays to keep a few things in mind:
1. The 4 P’s: plan, prioritize, pace, and posture
2. Conserve energy. Bite off small chunks of a project. Avoid double dipping into activities. Gardening followed by a long bike ride may be too much for the hands
3. Use the right tools for the job
a. Wider grip tools are better‐ there are ergonomically designed grips, but can also buy some pipe insulation and duct tape and enlarge the grip on tools for several dollars.
b. avoid long periods of vibration as with a weed whacker
c. make sure your tools are in good shape‐ sometimes it does pay to invest in nice tools
d. Your hands are tools in a sense, but avoid using them to ‘hammer,’ pinch repetitively, or dig directly in unknown territory‐use well fitting gloves for traction and safety.
4. Think about how you use your hands
a. Use larger muscles to get the job done. As an example, if there is a plot of weeds‐you can pull or pinch one weed at a time, use a hand shovel to get several out at once, or use a large shovel to wipe out a larger number. Lift things with two hands, use palms of hands vs. fingers and thumbs, lift with palms facing each other or turned upward, and hold things in a gross grasp vs. a lateral pinch grasp.
b. Avoid using a hook grip to carry heavy things as when you are carrying a suitcase.
c. Avoid repetitive and sustained motions with hands . Alternate heavy vs. light activities.
d. Avoid pushing up from a position with extended fingers. Avoid putting a force on the thumb side of the fingers
5. The biomechanics of the thumb is healthiest when assuming an “O” shape when pinching. A teardrop shape or a lateral or key pinch alignment imposes imbalance between the thumb CMC MCP and IP
6. Change positions and activities frequently as in every 20‐30 minutes. Prioritize activities. Get creative
with engaging in activities‐ set up the environment‐ bring pots to a table so that they are between shoulder and elbow height. Avoid weight bearing into hands and wrists for long periods. Use tools to open bags of potting soil, cut the plastic flower packs with scissors instead of pulling the plants out with fingers and thumb. Use a bucket with a big soft handle to carry things in, then turn upside down to sit on
7. There are some things that can be done prior to gardening or to relieve pain: “Get big”, inhale and exhale using big breaths, spread hands wide, warm up whole body, roll a soft ball or stress ball onto table to open palm, pinch and hold the webspace . Get strong in your core legs and scapular muscles.
8. Look at the whole picture‐ hydration, nutrition, low impact exercise, stress reduction, good sleep can all help with the symptoms of OA and keep you in the garden
9. Consider a consultation with an Occupational Therapist with a certification in Hand Therapy, OT CHT, for splinting, further joint protection techniques, and an HEP.
There may be a solution for you
Call our Occupational Therapist Kristin Biggins to schedule an appointment for splinting, joint protection techniques and an HEP to keep you doing what you love.