Treating the Wrist and Hand? Don’t Forget About Proximal Stability!

Posted on in Clinical, News
Treating the Wrist and Hand? Don’t Forget About Proximal Stability!

When we are treating a specific region of the body, we also need to understand how other regions contribute to what the patient is experiencing. This can be true when treating a patient for hand or wrist pathologies.  Sometimes we need to look beyond what is in front of us and attempt to discover what other factors contribute to a given diagnosis.

Why Proximal Stability?

Proximal stability is necessary for distal mobility3,4.

We need to ensure the proximal muscles of a body region can provide enough support to allow distal body regions to properly function.  For example, to allow the wrist and hand to perform activities of daily living, we need a sense of proximal support from muscle structures including the shoulder girdle and the scapular muscles. Evidence suggests there are relationships between different body regions that will assist with clinical decision-making2.

Are there other factors to consider?

Contextual factors and allostatic responses can affect a patient’s recovery during the rehabilitation process thus recognizing fear avoidance, pain catastrophizing, functional mobility, and pain.1 Recognizing the patient’s belief system, values and expectations may be prognostic factors for individuals with musculoskeletal pain.

Understanding the potential relationships of these systems and how they relate to the patient’s clinical presentation is essential. We should look beyond the biomechanical aspect and nature of movement and realize there is a whole lot more involved.  Many different systems and processes of the human body are all working together in concert.  Clinicians should recognize there are more factors to consider than meets the eye.

Treating the Wrist and Hand? Don’t Forget About Proximal Stability!

The take home message is that we need to consider many different factors that can contribute to a patient’s clinical presentation.  And we also need to recognize that we are not just treating a specific body part, but the person as a whole.

Article Written By Eric Trauber, PT, DPT, OCS, CSCS, FAAOMPT


  1. Sueki DG, Cleland JA, Wainner RS. A regional interdependence model of musculoskeletal dysfunction: research, mechanisms, and clinical implications. Journal of Manual & Manipulative Therapy, 2013, 21(2):90–102.
  2. Wainner RS, Whitman JM, Cleland JA, & Flynn TW. Regional interdependence: a musculoskeletal examination model whose time has come. Journal of Orthpaedics & Sports Physical Therapy, 2007: 37(1): 658-660.
  3. Moreside, J. M., & McGill, S. M. Hip joint range of motion improvements using three different interventions. The Journal of Strength & Conditioning Research, 2012, 26(5), 1265-1273.
  • Kibler WB, Press J, Sciascia A. The role of core stability in athletic function. Sports Med 36: 189–198, 2006.