Get a grip…

You can get a lot of information from a handshake. A good, firm, vigorous handshake often tells me the individual is strong, healthy, interested and enthusiastic. However, a weak, limp, flaccid handshake often tells me the individual is cautious, timid, weak, lethargic or disinterested. And the over the top bone crusher handshake usually tells me the individual is trying to assert their dominance or are trying to over compensate for something else that is lacking.

crush handshake

The handshake has been around for as long as humans have evolved to walk upright and freed their front limbs from locomotion. The handshake is primarily used as a greeting in many cultures across the globe, with variations in how, where, and why it is done. For example in many tribal communities offering to shake hands with a stranger shows you are not carrying a weapon and so are not a threat. In Asia handshakes however are not often done, rather the bow is preferred, and in the Middle East you never offer your left hand to shake as it’s a great insult, and a woman’s hand is never to be touched unless it is offered by her.

The handshake has also evolved some rather bizarre rituals that can signify membership to a secret club or organisation, and in the sporting world they are often used to celebrate achievements with intricate and synchronised, fist bumps, hand slaps and that boggle the mind.

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Check it!

Now I always shake my patients hands when I greet them but I also like to check many of my patients grip strength. Checking grip strength has been found to be a quick, simple and reliable test for risk assessment for various other health issues such as cardio vascular disease and other causes of mortality (ref) and I think this is important to screen for in some patients. But the main reason I check grip strength is because I know is association with shoulder strength, and I deal with weak shoulders a lot (ref).

The shoulder is a slave to the hand. The sole purpose of the shoulder is to place the hand where we need it. The shoulder moves the hand to feed us, to clean us, to defend us, or just to reach for the tv remote control.

The hand and the shoulder are closely associated when injured, for example weakness of the Rotator Cuff has been found in those with hand injuries who have had no shoulder injury or problems (ref). We also know that by gripping it produces an increase in activity in the shoulder muscles without the shoulder even to have to move (ref and ref). Even just thinking about gripping and moving the hand has been shown to have a positive effect on muscle function and strength. This fascinating study here demonstrates that even when completely immobilised performing mental imagery exercises of wrist and hand exercises significantly prevents muscle atrophy. The power of the mind and its effects on the body are just amazing.

Train it!

Therefore if a weak grip means a weak shoulder, then I think training grip strength is something to consider with shoulder rehab. Grip strengthening is something I use often in my rehab with painful shoulders. First it can be used very simply just by repeatedly squeezing the hand when the arm and shoulder is static. I find simple hand squeezing and tensing is good for those really, really weak and really, really painful shoulders that can’t or don’t want to move much due to too much pain or fear.

Simply resting the arm in a comfortable position and squeezing the grip purposefully for a few minutes can work wonders on pain inhibition I find. If this is due to the analgesic effects of isometric contractions or some other non specific factor, i’m not sure, but for most with high pain and high fear levels simple purposeful gripping can be a really useful first strategy to start decreasing pain, fear and threat.

Purposeful grip strengthening can also help supplement rehab exercises for those patients with not so high pain or fear levels. I find using strong hand squeezing often helps those with those painful arcs on elevation from sub acromial issues. Simply getting patients to squeeze their hand as they move through their painful arc can quickly and effectively reduce it. Again why and how this works is unclear, it could be from the increased activity of the cuff better controlling humeral head movement, it could be from increased cuff muscle activity which then affects the scapulo-thoracic muscles and movements, or it could be from other non-specific factors such as refocusing attention to another area away from the shoulder, who knows, who cares!

grip

Using a purposeful strong grip is something that has and is still often used in strength and conditioning circles to help improve performance and training. It is a well established and well know technique to instruct a lifter to squeeze or crush the bar when doing heavy lifts. This not only helps with holding heavy bastard weights but also increases the activity of the shoulder muscles and so can help with control sensations during heavy lifting movement. Many lifters, myself included, will say that when squeezing the bar or handle hard an unstable heavy weight feels less unstable. I talk about grip and its role on my courses sometimes using my best Arine impression when I tell physios to get their patients to “grip it and rip it baby”. and if you want to hear more please find details of my courses here.

So ‘getting a grip’ can be a really simple yet effective strategy for helping painful and weak shoulders on a number of levels. So when you next do some shoulder rehab don’t only focus on the shoulder, or the cuff, or the scapula,, rather look at it as whole as well as thinking above and below the shoulder. A good place to start for many is to get them to “grip it and rip it baby”.

As always thanks for reading

Adam

11 thoughts on “Get a grip…

  1. Excellent..Interesting…
    But most Ehlers-Danlos – connective tissue disorders – have a weak hand-grip whether or not they are psychologically strong, enthusiastic or depressed & miserable people

  2. Thanks adam. Really interesting. I’ve recently started integrating this into Ax and rehab strategies and getting some really good results i weak/painful shoulders and unstable ones. Learning so much from yourself, Anju, Jo Gibson and Jeremy lewis. Keep them coming!

  3. Entertaining and thought provoking post as usual Adam. However I think your statement “Without a hand a shoulder looses its purpose” is ill thought out and does a disservice to many in that situation. The most glaringly obvious are the paralympic swimmers (see link) whose shoulders clearly have plenty of purpose.

    Respectfully

    Mark

  4. What grip exercise parameters are you using for your post operative patients (hold duration, intensity, volume)? Any tips on what seems to work best? Thanks!

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