When teaching exercises to patients the priority is often the patient’s key dysfunctional areas. In other cases spinal alignment and inner unit activation are top priorities. Further we can all be guilty of giving too many extrinsic cues to patients and we may want to focus on just one area of cueing too avoid confusing our patients. As a result the type of grip or hand position is often not considered.
Nonetheless, how important is the hand position? Cogley et al (2005) found that a narrow base elicited greater triceps brachii activity compared to a wide base during the press up. But more specifically what is the effect of the loading and positioning of the hand it self during exercise?
During normal development an infant develops grasp and hand function in a very specific pattern. Early attempts at gripping are done with an ulnar grip between the age of 4-4 ½ months. Later a radial grasp develops at the age of 6 months and then the pincer grip develop at 8-9 months. Similarly in the closed chain the infant favours the ulnar side up till 6 months at which point the pressure on the hand switches more to the radial side.
This loading of the hand has marked impact on muscular activity in the rest of the kinetic chain. When the weight is loaded through the ulnar side of the hand in the closed chain the upper trapezius will typically be over active. When this loading is corrected the upper trapezius will frequently relax.
For example in the 4 point stance below. In figure 1 the weight is loaded on the ulnar side and the upper trap is over active.
Figure 1. Ulnar Loaded Hand In 4-Point
Figure 2. Evenly Loaded Hand In 4-Point
In Figure 2 the weight is more evenly distributed and the upper trapezius can relax.
The same is true in closed chain gripping activities such as pull ups and open chain activites such as the bench press.
Hand position and loading of the hand is a very small element of coaching exercise but it can have a significant impact on the benefit of the exercise and can often be related to minor symptoms post exercise.