Clinical Pearl Part 2: Thumb Reset | Modern Manual Therapy Blog

Clinical Pearl Part 2: Thumb Reset


After improving my wrist pain located around the EPB muscle belly with repeated flexion, I still had occasional loss of thumb extension at the IP, CMC, and MCP.

Here's part 1 of my Clinical Pearl.

Part of the flareup from two weekends ago was when I tried to counterstrain (neurophysiologic reset by slacking tissues) my wrist and thumb into extension. My wrist was much better and I got back to working out lightly. However, occasionally I would have a painful loss of thumb extension.

The solution?

Repeated end range flexion at the CMC, MCP, and IP. However, when end range loading the IP joint, the extensor tendons had to remain on slack, otherwise there would be end range pain and the tendons would remain worse afterward.

What's the take home in all of this? One, try the contrary direction when getting to end range. The reset works best when getting to end range and if a certain direction, often contrary to the painful direction can get to end range passively the painful motion is often rapidly improved.


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