And what can I do to make it hurt less?
Written By: Maury Argento
As a new mom I spend lots of time with other new moms. After we all got past the difficulties of post-partum healing and breastfeeding pain and sleep deprivation, life started to normalize a little bit. Then, just when life seemed a little better, we all started noticing this nagging pain in the wrist and the base of the thumb that was somewhat annoying before, becoming much worse. Some ladies I knew were in so much pain they had trouble sleeping during their few precious hours! The dreaded “Mom Thumb” or De Quervain’s Tenosynovitis; named for a Swiss surgeon from the late 1800s who “discovered it” (of course women have surely been suffering from this pain long before he “discovered” and named it). As a massage therapist myself I am always extremely careful with my thumbs and I fortunately was able to turn the corner pretty quickly so I thought I would offer some tips to moms (or dads) suffering from thumb and wrist pain.
What causes it?
The syndrome which is generally self-diagnosed and often resolved on its own, is caused by the inflammation of two tendons. These tendons slide under a sheath (or tunnel) that wraps around your wrist. Their job is to pull your thumb away from the rest of your fingers. Pain is often exacerbated by the fact that many women already have inflammation during pregnancy so their joints are primed for irritation. Then the repetitive motions of lifting, carrying and feeding babies, combined with the added weight and neck control (allowing you to pick up your baby under their arms) provides the perfect storm for tendonitis right around the 3 month mark. Typical “Mom Thumb” pain is centered around the medial (thumb side) of your wrist right at the base of the thumb. There can also be pain between the thumb and index finger (irritation of the abductor policis transversus muscle) which has a different cause. This pain is caused by putting too much strain on the muscle that closes your thumb towards your other fingers. It can also be caused by pulling your thumb away from your fingers. Long story short, your thumb is very strong and useful (what makes us the most dexterous mammals) but when it is overused, the tendons get irritated and inflamed which can lead to weakness and loss of function of the thumb. If this condition continues to progress, it can contribute to temporary loss of function of the entire wrist. This is because the sheath that contains the thumb tendons also makes up the carpal tunnel and tightness in one area can impinge other tendons of the hand and wrist.
What actions exacerbate the problem?
Any time you use your thumb to either grip towards your hand or pull away from your hand you are using those tendons. If you add weight to that action you are exacerbating the problem. The best way to save your thumb is to keep it in a neutral position (the position your hand rests in when floating in a hot tub). Ideally your bones should be stacked in a line. If you lift your baby by hooking her armpits in the “L” between your thumb and index finger, you are putting strain on that joint. If you hold your baby’s head with your hand while she is feeding, thumb out and wrist bent, you are putting strain on that joint. While breastfeeding, if you use your free hand to grasp your breast and hold your thumb out, you are putting strain on that joint.
What can I do about it?
Of course it is not practical to recommend not carrying your baby. Instead I would like to recommend some modifications on how your use your hands when engaging with your baby.
1. When lifting your baby under her arms, allow her to rest a little further along your hand and not right in the notch between thumb and index finger. Do not engage your thumb but let it rest on her chest in a neutral position. Keep your wrist and fingers in a neutral position (think of the hand floating in a hot tub). Lift from your arm biceps. Keep your shoulders down and your arms at a 90 degree angle and lift from your legs if possible. Be sure to engage your core before lifting (to save your back).
2.When lifting your baby from lying down, slide one hand under her head (keeping your wrist and fingers straight). Slide the other hand under her bottom (again keeping your joints stacked). Lift from your large arm muscles. Bring her to your chest and then support her with your forearms.
3. Before you go to bed at night place a small bag of ice (frozen water not a gel pack) on your wrist below your hand. The goal with the ice is to reduce inflammation which is a fancy way of saying less blood; allow blood to leave and prevent more blood from entering. Ice is a vaso constrictor (it makes blood vessels smaller so less blood can enter). Since blood is pumped from your heart, constricting the blood vessels between your heart and the painful area is most effective. If the ice is on your hand, you will prevent blood from getting to your fingers but not your wrist. so make sure the ice pack is right on the painful area or a little bit lower (closer to your elbow).
4.When sleeping, if you can, elevate your hands a little bit. Just a little bit of elevation will let gravity help the blood drain. You can put a body pillow across your lap and rest your hands on it.
5.If your friends and family want to hold your baby (and you trust them), let them. Give yourself a break when you can.
6.Try other nursing positions; using pillows or side lying so you do not need to hold your baby while feeding.
7. If you are comfortable enough, you can try sleeping with a wrist brace on. Some people contort their wrist and fingers in their sleep so keeping it in a neutral position while you are sleeping, can be very helpful.
8. Keep in mind, muscles are designed to contract and release. That is how they work best. When you hold a muscle in a fixed position for a long time it can get tired and irritated. Instead, allow the muscle to return to its relaxed state when not in use.
9. If you use pumping or nursing as a time to catch up on email and the news on your phone, try using your index finger to navigate; set the phone down and keep your thumb closed and wrist straight while navigating.
10. An experienced massage therapist can loosen the muscles that attach to these tendons and reduce some of the stress and pain. They can also move fluid from the area to reduce inflammation and pain.
The bottom line is, give your thumbs a break. For more tips and information go to MaurysMassage.com.
Maury Argento, a Certified Massage Therapist and staff instructor at the San Francisco School of Massage. She holds a Bachelors of Science in Biology from Washington University. Post-college she served as an Army officer, training, among other duties, injured and rehabilitating soldiers, helping them return to duty. After completing her service, Maury worked in robotic medical devices where she honed her understanding of the mechanics of the human body. Since 2009, Maury has been supporting the athletic community of the Bay Area as a sports massage therapist, running, and soccer coach. In 2014, as many of her female clients began starting families, she obtained her certificate in perinatal massage to support them. She now has a thriving private practice working with a range of clients from Paralympians and marathoners to weekend warriors and bike commuters.