Those that can do...

Stuart Canavan is a physiotherapist that started his private practice around the same time as I started mine. We've stayed in touch over the years, as he and Kathryn Leggo morphed Rowville Physiotherapy into a giant sports medicine hub for the south eastern suburbs. 

They asked me in to chat with their physios about wrist injuries. I could have talked for days, but got an hour. Essentially my message became one of if you understand what goes where, and what does what, you can help the wrist regain the stability lost through injury. Ultimately, it is stability that is essential to the wrist above and beyond strength .

For too long, therapists and rehab professionals have been guilty of handing out static wrist curls and the like, building strength at the expense of stability; even as they prescribe exercises to maximise ankle or shoulder proprioception. In the hand therapy world, that's changing rapidly. Outside of that, the concept remains unusual, and challenging.

Ligaments need stress to be able to do their job. Their job is to tell the wrist what to do, when to relax, and when to tighten up. If they have a lay off, if they are locked up for a period of time, then they need re-education, much as the muscles do. So challenge them.

Do exercises for the wrist in unusual planes incorporating shoulders and elbows. Use balls, bouncing, rolling and catching. Swap a static weight for a dynamic one like a slosh pipe. Take the activities your patient likes to do, and include it as therapy. I had a fly-fisherman come in recently. On his first visit we got the basics under control. The second time he came by, he brought his rod and we fished for gravel in the car park. 

Anderson Hand Therapy may not have morphed into a hand therapy treatment centre megalopolis, but over the past 12 years, it has certainly allowed the part of my brain that devotes itself to hand rehab to morph into more than a one trick pony. And it all starts with what goes where.

Look after those fingers, Hamish