Using Natural Movement to Rehabilitate a Broken Hand
By Elisabeth Pinheiro, PT, Level 2 MovNat Certified Trainer
In April 2021, MovNat Master Instructor, Jerome Rattoni, needed physiotherapy to rehabilitate his hand. He’d fallen from a significant height, resulting in two broken hand bones. The breaks required surgery to fix the fracture, then physiotherapy work to recover movement. Here is an account of his journey to recovery.
After big traumas, it’s very important to work on your patients’ self confidence, keeping them active from day 1. In the first stage, when patients still have the cast on, the main focus must be more mental than physical, as the main obstacle is usually overcoming the fear of moving and loading the affected region. A common concern is worsening the fracture because patients don’t know which movements can and can’t be done at this stage.
So, in Jerome’s rehab, we started exploring and adapting the fundamental movements from the MovNat methodology (such as ground movements, get ups, crawling and jumps). Beginning with working the regions not affected made it easy to transition to the next phases of rehab.
After removing the cast, the hand tissues have become quite stiff because of the time spent inert and from the trauma itself. So, the goals of the second phase are:
- Improve hand mobility, especially the opening movement;
- Reduce edema/inflammation;
- Increase grip strength, which is very important for hand functions like picking up and holding objects
Back to Jerome’s rehab. I highlighted two main moves during this phase:
- Knee-Hand Crawl – focusing on hand mobility (flexion, extension and forearm rotation) and bodyweight load transfer
2. Moving a stick in different directions – developing grip strength and wrist mobility
Note: If you’d like to learn more about the clinical applications of Natural Movement, check out the MovNat Medical program.
After 2-3 weeks, we could already see a great improvement in pain levels, allowing us to increase the intensity and complexity of Jerome’s exercises and add two more Natural Movement skills: Throwing and Carrying.
The throwing moves are important for working fine motor coordination, grip strength of the hand/fingers, and light power, starting with small stones and gradually progressing to bigger ones.
For carrying stimulus, the Double Hand and Single Hand Carry are good choices to increase grip strength and muscular endurance, with loading based on pain intensity. In this second phase, we also stepped up some of the ground movements, adding moves that required Jerome to sustain his body’s load (such as the Tripod Position, Prone Get Up, and Foot-Hand Position).
It’s important to highlight that after a hand trauma like that, shoulder muscles are also compromised and need to be stimulated. To address that issue, in Jerome’s rehab we added moves like Incline Push Ups and Forearm Pull Ups on a low bar (called “wing drills” by him).
When pain levels become mild or disappear, around 6-8 weeks after starting the rehab process, we start to add moves that load the full bodyweight on the hand, like Foot-Hand and Inverted Crawls, Sprawls, and Traditional Push Ups.
After week 8, we already see moderate to good grip strength, which allows us to explore more climbing moves and throws with heavier weights. In this stage, we also aim to develop force transmission, integrating the trunk-shoulder-hand muscles in a synergistic way. For that, in Jerome’s rehab we started practicing Dead Hangs and Scapula Pulls, stimulating the hand to sustain the weight of the entire body off the ground. We increased the time spent hanging day by day, so to be able to progress to Hand Swing Ups, Pop-Ups, and Power Ups later.
Note: For a step-by-step guide to working up to advanced climbing skills from the ground up, check out 10 Steps to Master the Power Up (AKA Muscle Up).
For the last phase, our focus is on plyometric exercises, adding agility and explosivity moves. Inside the progressive “tree” of skills in the MovNat methodology, we’re finally able to explore one of the the high skills of the tree: vaulting. Vaulting incorporates a more complex group of movements, requiring a good sequence of muscle activation, good grip strength to support full bodyweight, and full body mobility.
After three months of treatment, Jerome was able to return to teaching MovNat certifications, fully recovered and without limitations.
About the Author
Elisabeth Pinheiro is a physiotherapist in Brazil who specializes in treating MSK dysfunction and chronic pain with movement. She is also owner of Clinic Roots, an MCT Level 2, an advisor on the MovNat Medical Board, and the first physio in Brazil to apply the MovNat methodology in rehabilitation. You can connect with her on Instagram at: @fisioelisabethpinheiro
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