What is it?

As a new mom I spend lots of time with other new moms. After we all got passed the difficulties of healing and breastfeeding and sleep deprivation life started to normalize a little bit. Then, just when you think you can handle it, this nagging pain in your wrist that was somewhat annoying before, becomes almost unbearable! The dreaded “Mom Thumb” flairs up with a vengeance!! As a massage therapist myself I am always extremely careful with my thumbs and I fortunately did not succumb so I thought I would offer some tips to moms (or dads) suffering from thumb pain.

What causes it?

There is no official cause but the official name is 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). The syndrome, generally self diagnosed and resolved on its own, is caused by the inflammation of two tendons. These tendons slide under a sheath (often called a tunnel) that wraps around your wrist and 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 and 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. This pain is usually 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 in caused by putting too much strain on the muscle that closes your thumb towards your other fingers. It can also be cause by pulling against 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. Those inflamed tissues are further inflamed by use and you end up with weakness and loss of function. Additionally, the sheath that contains the thumb tendons also creates the carpal tunnel and can contribute to other wrist injuries.

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). 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 nice way of saying allow blood to leave and prevent more blood from entering. Ice is a vaso constrictor (if 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.
4. When sleeping, if you can elevate your hands a little bit. You can put a body pillow across your lap and rest your hands on it. Just a little bit of elevation will let gravity help the blood drain.
5. If your friends and family (and partner) 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.
9. If you use pumping 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 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.