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Do your summer plans include home improvement projects? What about vacation plans or a road trip?

These are just some of the activities that often require the use of hand tools. Even seemingly simple or frequently-completed tasks may put you at risk of injury to your hand and/or upper extremity if you fail to follow guidelines for the proper selection and use of hand tools. In celebration of Healthy Hands Week – June 7-11, 2010 – the American Society of Hand Therapists (ASHT) offers some prevention and safety tips to minimize the likelihood of hand injury and trauma from using hand tools.

Minimize the potential for musculoskeletal problems

1. Read the manufacturer’s directions on the proper methods for using the hand tool, and adhere to precautions.

2. Ensure your work area has good lighting.

3. Avoid multi-tasking while using hand tools; concentrate on your task.

4. Be aware of the stress from force and repetition when using a hand tool. Give yourself frequent mini breaks (10-15 minutes will usually provide your muscles adequate rest), and allow your body to recover from fatigue.

5. If you need to use gloves when handling a hand tool (due to cool temperatures, protection or tool vibration), select gloves that will allow you to operate the tool safely, with the least compromise to your hand grip.

Select your tools wisely

1. Select an optimal hand tool that is appropriate for the desired task.

2. Consider the weight of the hand tool. A lightweight tool will limit muscle fatigue, and reduce misdirected efforts during operation.

3. Make sure your hand tools are properly maintained. Does your tool require oiling on a regular basis? Is it susceptible to rust? Should it be kept sharpened?

4. In certain circumstances, a larger hand tool diameter may prove to be an important contribution to maintaining a good and comfortable grip. “Precision grip” refers to small diameter handles of 8-13 mm, while “power grip” corresponds to larger diameter handles ranging from 31-38 mm and 50-60 mm.

5. The tool’s handle surface material is important, and must provide sufficient friction to aid in a secure grip to prevent hand slippage. For example, rubber grips or a tacky surface may be applied to your current tool handles, altering them to require less gripping force.

6. Handles should be shaped to fit the hand for proper grasp, avoid contact stress and allow the hand and wrist to maintain a neutral position to the forearm.

7. Avoid short tool handles that apply contact stress. Instead, use handles that are longer than your palm to avoid contact stress.

8. Don’t assume manual hand tools are safer than power tools – or vice versa. Manual tools require exertion of force by squeezing handles together, twisting, pulling and pushing. Power tools require support and proper positioning for force application, and may provide “kick-back,” or reaction to the force generated. Be mindful that if the increased forces required to operate a tool safely are more than an operator is capable of exerting, then strength and control may be compromised, leading to an accident or injury.

9. Do not use your body to replace a hand tool.

10. For a hand tool to be truly ergonomically designed, the National Institute of Occupational Safety and Health (NIOSH) states it is important for a tool to fit both the user and task being performed without creating awkward postures, harmful contact pressures or other safety and health risks.

Set up the proper workstation

1. Organize your work environment so manual operations may be performed with elbows close to the sides of the body (approximately a 90-degree angle).

2. Tasks requiring precision work are more easily performed with a work station that provides a sit/stand option and offers support under the elbows, forearms and hands.

3. Working postures with arms outstretched forward or to the side will result in rapid fatigue of the shoulders and neck muscles, and reduce the precision and general level of skill necessary to safely and efficiently operate hand tools.

For additional information about hand tool safety

Visit the American Society of Hand Therapy’s (ASHT) website, www.asht.org, to find a hand therapist or locate a hand therapy clinic near you, or refer to the following resources:

• A Guide to Selecting Non-Powered Hand Tools

www.cdc.gov/niosh/docs/2004-164/pdfs/2004-164.pdf

• Simple Solutions for Hand-Intensive Work

www.cdc.gov/niosh/docs/2007-122/hand.html

Author: Barbara Winthrop Rose, MA, OTR, CVE, CHT, FAOTA

Reviewers:

Kathy Brou, OTR. CHT

Linda Klein, OTR, CHT

Dorit Aaron, MA, OTR, CHT, FAOTA

May 26, 2010

* Photo: NIOSH, “A Guide to Selecting Non-Powered Hand Tools

When to Use Hot or Cold?

            Something like this has probably happened to you in the past.  You get a call from your best friend, and he asks for your help moving a “few” boxes out of his garage to make room for his brand new deep freezer.  “Sure,” you say.  After all, a friend in need is a friend… who you may need to help you one day.  You go to his house, and he opens the garage door.  As it rises, you feel as though you’re looking into the back of a double-wide Fed-Ex truck, the week before Christmas, prior to the first delivery.  Quickly you realize that a “few,” is more like a few hundred.  But, you are not easily discouraged. You begin the day energized, and for some reason, actually looking forward to conquering this mountain of cardboard.  In any case, you could use the exercise, since you haven’t exactly been faithful with working out 4 days a week.  The task begins smoothly.  Around lunch time, you feel pretty good.  But, by five o’clock your muscles are aching, your feet hurt, and you realize the boxes that you were lifting at nine o’clock this morning were on top, because they were light.  Now you are lifting the boxes full of books; books with paper constructed of lead.  Finally, you are carrying out the last box.  After the work he invites you into his home for some fresh iced tea.  Your legs are so sore that you’re barely able to maneuver yourself up the three stairs into his kitchen.  “Wow, that was some job,” you say as your eyes are scanning the room for the nearest place to sit.  “Yeah,” says your friend, “it’s a good thing all we have left is to move the freezer into the garage, I don’t think I could do any more.”

Coping with the Pain

            The next morning… well technically afternoon since you slept until 12:30, you attempt to get out of bed.  Okay… you think to yourself.  I can do this. 

You can’t recall ever hurting this bad.  All you really know at this point is that you have got to do something for this pain.  You begin by looking in the medicine cabinet.  You might take something for pain, if you have anything.  “Martha!!!” you yell, “What can I do for this pain?” 

            “Put some ice on your legs,” she says “that’ll make you feel better.”

            You don’t know why, but before she said that you were thinking to yourself that you should put some heat on your legs.  Now what? You think; Heat is the opposite of ice.  Am I going to make it worst if I use the wrong one?  I couldn’t possibly hurt more than I do now.  Which one should I choose?

How Does Heat Relieve Pain?

            Heat therapy works in several ways to give you the sense of pain relief.  But heat does more than make you feel better; it actually helps to heal the injured tissue.  Heat therapy dilates blood vessels in the area in which it is applied.  The increased diameter of the vessels allows increased flow of oxygen and nutrients to the muscles, helping to heal the damaged tissue. Heat also provides another stimulus to the sensory receptors in the skin, which means that applying heat will decrease transmissions of pain signals to the brain and assist in relieving the discomfort.  Heat application increases the extensibility of soft tissue including muscles, connective tissue, and adhesions. Consequently, use of heat for pain management will also benefit people who complain of muscular tightness.

How Does Ice Relieve Pain?

            Ice can help provide pain relief as well.  Ice application slows the inflammation and swelling that occurs after injury. Pain is often accompanied by some type of inflammation, and addressing the inflammation helps reduce the pain.  Ice has a numbing quality that may provide localized anesthesia (absence of sensation). Cryotherapy (ice therapy) slows the nerve impulses in the area, which interrupts the pain-spasm reaction between the nerves. Cryotherapy decreases tissue damage.

When to use Heat

            Heat is especially useful for the treatment of chronic pain.  This includes chronic neck or back pain.  If you find your neck is aching by lunch time every day, it may benefit you to apply a moist heat pack to the area.  The heat will bring nutrients to the painful area to assist in healing the painful area.  Heat is also useful if your muscles feel tight.  For the best results, you may use heat prior to stretching, to decrease the pain associated with muscle tightness.

When to use Ice

            You have probably heard of the acronym R.I.C.E. (Rest, Ice, Compress, Elevate).  This is intended for the quick management of an acute injury, such as an ankle sprain, or a pulled muscle, until you can consult a physician.  Ice is best used immediately after an injury.  It is also useful if swelling or bruising is present.  Ice is best under these circumstances because of the vascular constricting property of extreme cold.  This tends to push fluids out of the swollen area into the general circulation.  Both heat and ice are good options for the treatment of localized pain and muscle spasm.

When NOT to use Heat or Ice

            There are a few times when you should not use heat or ice.  Heat is not indicated for the treatment of inflammation.  If your skin appears red, or if your joints are swollen or bruised you should not heat this area.  As described above, heat increases the diameter of blood vessels, which increases the amount of blood that gets into the area.  If you already have swelling, you do not want to attract more blood to the area.  Heat should also not be used in the vicinity of active cancer due to increasing blood supply to tumors may supply nutrients to the neoplasm, encouraging growth.  Heat should never be used in the area of blood clots.  It should also not be used in the area of hemorrhages or potential hemorrhages.  In rare cases heat may actually cause swelling or bleeding.  Finally, neither heat nor ice should be used in areas of poor sensation, because of the potential of burns or frostbite.

             Ice should not be used for the treatment of pain in people with hyper sensitivity to cold.  It is also not indicated for the treatment of pain due to poor circulation as ice will further decrease circulation.  There are some rare blood disorders that are also sensitive to ice, and you should consult a physician if you experience sickness or bruising after using ice.  Special care should always be used when treating the very young or very old with heat or ice. Pregnant women should also consult a physician prior to using heat or ice.

 Application

            Neither heat nor ice should be applied directly to the surface of the skin for more than a few seconds in one place.  You should use some sort of barrier to protect your skin.  With ice, one towel is generally a sufficient barrier.  When applying heat you may need to use up to 12 layers of towels, depending on the temperature of the heat pad.  You should visually check the surface of your skin at least every five minutes when using heat.  Redness is a good indication that you need to add more barrier between yourself and the source of heat.  Only apply heat or ice for 15-20 minutes per treatment for best results.

            The next time you need to plant a small forest in your back yard, invite your friend over to help you plant “a few flowers.”  At the end of the day you can tell him, if he happens to feel “a little sore” tomorrow, to put some ice on the aching muscles.  If he is still sore after a few days, he may want to try heat.  That will help too.