How to reduce wrist and shoulder pain when using a chef knife.

I have always enjoyed seeing a chef carry all their knives to and from work. Like any trade’s person, care for your tools is paramount. Chefs are excellent at caring for their tools but leave much to be desired when it comes to maintain the body wielding them.  Today we are going to cover some common injuries working with a chef’s knife and how we can take steps to prevent them.

Now before we get into this, I do want to note that this article is not designed to treat the signs and symptoms of carpal tunnel syndrome. If you are experiencing chronic pain in your hands at work please go to your doctor and get it assessed by them. They will connect you to a specialist that can help get you on a path to recovery. This article focuses on ways to reduce your chance of showing the signs and symptoms of carpal tunnel syndrome.

Shoulder, Elbow, Wrist. Connected for better or worse.

The human arm has been designed for a large range of motion. This was helpful for climbing when we lived in more prehistoric times. Our elbow can produce force and help us lift and carry objects. Finally, our dexterous hands are able to hold and manipulate any object or tool to get a task done.

While the huge range of motion of our arms allows us to do many tasks, they can easily repeat a task that may not be the safest to prevent repetitive strain injuries. Let’s start with the wrist and work our way up the arm.

Wrist Movements and Problems:

Chef’s usually hold a knife with a pincer grip. Using the thumb and index finger to hold the blade wile the palm and fingers wrap around the handle to steady the movement. This allows fast and accurate work when chopping or prepping various food items.

The wrist has 7 bones in close proximity. Within these bones there are tendons, nerves, ligaments, and blood vessels passing through them.  The bones are arranged to allow for flexion, extension, radial deviation, and ulnar deviation. Simply our wrists are designed for a high amount of movement. However when we hold one position for an extended period of time we run the chance of impinging various structures that pass through the bones of the wrist.

One common injury we may see is carpal tunnel syndrome (CTS). This occurs when the median nerve is impinged as it passes through the carpal tunnel. This is usually caused by the transverse carpal ligament becoming inflamed by the wrists being held in an awkward position for an extended period of time.  CTS is usually pain through the thumb index and middle finger and can be debilitating in server cases.

Hold a chef’s knife with a flexed wrist is a perfect culprit for the cause of these symptoms. But we can remedy this problem with a few specific fixes to the workstation.

Reducing your chance of wrist pain

Workstation Height for high precision work.

If you are doing high speed work like julienning or dicing there is a chance that the workstation can be too low and will place our wrist in an extended position. This can cause the pressure on the carpal tunnel and boost the chance of carpal tunnel. To remedy this, we want to create the conditions for a neutral wrist position.

Reduce flexion positions while working with a chef knife

Reduce flexion positions while working with a chef knife

 
Maintain a flat neutral wrist as often as possible.

Maintain a flat neutral wrist as often as possible.

 

When julienning, or dicing you want the workstation to come up higher so that you are not forced to extend the wrist. Bring your forearm and hand up your stomach until you have a neutral wrist and a 90- 110 degree position at the elbow. This is the height you want the board at to work on. This will allow for precision and speed while still maintain a safer wrist position.  You can raise cutting boards to the height you need by ordering a riser or stacking some cutting boards together. Make sure you place a wet cloth between each board to keep it from slipping. Always make sure that surface you are working on is secure to prevent any accidents.

Shoulder Position and maintenance while working with a chef knife.

The workstation height will create the conditions for a safer wrist and elbow position. The shoulder is going to take a little more practice and training. During knife work we want to make sure our shoulder stays in a relaxed or lowered position. Many chefs will hunch over time because they are looking down at there work.

We want to create opportunities for the shoulders to be held in slightly retracted position. Think all the cues for ‘proper posture’ you were told growing up. The easiest way to get this position is to raise your shoulders towards your ears-> pull them back - > and then lower them back down. See the pictures below:

Now obviously you will not be able to maintain this position forever. No one can hold the perfect position forever because this takes energy. The best way to remedy this is to take regular movement breaks to give our shoulders a break. About every 20 – 30 minutes you can do one the following three movement patterns. They will take 30 seconds to do so they won’t drop your productivity.

8 Shoulder rolls back wards and forwards. 

Gif Credit to: spotebi.com

Gif Credit to: spotebi.com

5 Shoulder blade pinches.

Chest opener and Back hunch stretch

Hold for only about 5-10 seconds

Hold for only about 5-10 seconds

Hold for about 5-10 seconds.

Hold for about 5-10 seconds.

Once you build the habit for these exercises you will not notice the time it takes to complete them is pretty short. The exercises will promote a better posture by create the movement needed to prevent your shoulders from falling in.

Go give this a try! Your wrists and shoulders will thank you

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Reduce back injuries for servers with 2 gym exercises.

Servers/ Waiters/ Bartenders exist in a special place in the occupational health field. While being on their feet all day, they are tasked with creating exceptional guest experiences by taking care of their every need. This ultimate goal can cause quite a few servers to use less than ideal movement patterns to get the job done.

When you start your career in the front of the house you may not notice these patterns since they don’t cause pain.However, over time improper movement patters can lay the groundwork for pain and discomfort via muscle imbalances and weakened joints.

Fortunately, you have a kinesiologist like me to help you out. I am going to go over a major movement dysfunction that causes pain for servers. Why this pain may be felt from this movement. And finally I will give examples of gym exercises that will harden your body and reduce the chances of these problems.

*Now before we get into anything, I want to make it clear that you should not start a new exercise program without consulting your doctor. These exercises I recommend are based with the assumption that you have no pain and have no medical reasons to prevent strength training. This will not fix or remedy pain felt due to work practices. If you are feeling pain regularly you need to talk to your doctor and get set up with a regulated health professional who can assess and diagnose you before prescribing treatment and exercise interventions that will not aggravate your pain. * 

The Movement Problem #1: Loading through the lower back.

The lower back houses a lot of important anatomical structures. Not only does it contains the end of the spinal cord, it also connects the pelvis to the spine, and is the insertion point for many muscles. And while the low back is quite the marvel for its ability to support and move us, it can commonly become weakened when we rely on it to do the job of some of our larger muscles

It is common for our leg muscles become tight and weakened from work. The hip flexors, hamstrings, glutes, and quads to name a few. When this happens the muscles may start to contract or relax incorrectly for the tasks we require of them. Out of necessity, other muscles will take up the task of moving in the way we want. When we have a dysfunction in our hips, quite often the load is transferred to our lower back.

The most common task that causes this is lifting an object by bending at the hips without bending our knees. Two examples of this is when you clear a filled tray from a table and when you lower a plate down to place it in front of the guest.

When lifting improperly, it is common to see the shoulders hunch forward and a hump to become pronounced in the spine. In this scenario, the spine has been forced into a flexed position and will cause the muscles and tendons to elongate due to this load.  Some of these muscles are quite small, only spanning between one vertebra and are not designed to hold heavy loads of an over-flexed spine.

This position can be the cause to varying different problems but some of the most common ones are pulled tendons and muscles, herniated discs, and pinched nerves.

Luckily the lower back and lower extremities are designed to lift heavy loads. We just have to set them up for success.

Firstly, the lower back needs to be trained to create stability, not mobility. Think of the core musculature around the lower back like those lifting belts you see power lifters use. You want the core muscles to tighten to create a strong pillar that the lower extremities can use to create force. A good comparison is walking on stable ground or walking across a floor made of foam. You can’t get as good of a push off the foam floor because it is not a stable surface. Same thing happens when you don’t have core stability.

To create stability, we are going to need to train and strengthen the core musculature. Canada has one of the top spine experts in the world named Dr. Stuart McGill. He recommends 3 big core exercises to create a strong and long-lasting lower back. They are:

  • The Bird Dog

  • The Side Plank

  • The Modified Curl Up.

Bird Dog:

How to Set it up:  Start with your knees and hands on the ground with a flat back parallel to the floor.  Pull your shoulder blades down and back and tighten your core so that there is no arch in your back.

How to Set it up:

Start with your knees and hands on the ground with a flat back parallel to the floor.

Pull your shoulder blades down and back and tighten your core so that there is no arch in your back.

To Complete the movement:  Raise an opposite hand and foot off the ground and full extended them.  The focus is not having any movement through your lower back and core.  Hold this position for about 2 seconds and then return to the starting position.  Complete 8 - 10 times on both sides.

To Complete the movement:

Raise an opposite hand and foot off the ground and full extended them.

The focus is not having any movement through your lower back and core.

Hold this position for about 2 seconds and then return to the starting position.

Complete 8 - 10 times on both sides.

The Side Plank:

Set up:  On your side contract your core pull your shoulder blades down and back. From there raise yourself up onto your elbow and keep your knees in contact with the ground.  Hold this position for 15 - 30 seconds. The goal is to have no buckling at the hips or curves in the spine.  Repeat on both sides 3 times.

Set up:

On your side contract your core pull your shoulder blades down and back. From there raise yourself up onto your elbow and keep your knees in contact with the ground.

Hold this position for 15 - 30 seconds. The goal is to have no buckling at the hips or curves in the spine.

Repeat on both sides 3 times.

The Modified Curl Up:

The Set up:  Lying on the ground. place your hands underneath your low back. At all time your back will be in contact with your hands.  Bring one leg up to create more support on the floor.  Tighten your core and bring your shoulder blades down and back.

The Set up:

Lying on the ground. place your hands underneath your low back. At all time your back will be in contact with your hands.

Bring one leg up to create more support on the floor.

Tighten your core and bring your shoulder blades down and back.

To complete the movement:  Raise your whole torso off the ground about 3-5 inches.  Keep yourself from curling up and humping the lower back.  Hold for about 3 seconds.  Complete 8-10 reps.

To complete the movement:

Raise your whole torso off the ground about 3-5 inches.

Keep yourself from curling up and humping the lower back.

Hold for about 3 seconds.

Complete 8-10 reps.

These three exercises create stability through the spine by prepping the musculature for different forces and ranges of motion. These exercises can also be progressed from the basics as you become stronger in the gym. Add these to the end of your gym routine and you will have a stronger core than just doing thousands of sit-ups.

Once the core musculature has been strengthened, now it’s time to get the lower body extremities on board. Our legs and hips are designed to do the heavy lifting for us. The glutes, hamstrings, quads, and hip flexors, are all large muscles with functional levers to make heavy lifting easy.  The action we want to focus on is called a hip hinge.

Simply, the hip hinge is similar to the hinge on a door. The pivot for the upper and lower body will be the pelvis and the upper body and lower extremities will essentially stay straight creating a strong position to move the object and complete the movement.

The hip hinge movement pattern can be trained easily with a wonderful tool called a wall. Take 10 minutes to work through 8 – 10 reps of this pattern.  

Take a look at the training pattern below:

 Hip Hinge:

Set up:  stand near a wall. About a foot away from it.  Contract your core and pull your shoulder blades down and back.

Set up:

stand near a wall. About a foot away from it.

Contract your core and pull your shoulder blades down and back.

To Complete the movement:  Drive your hip backwards with minimal movement in your knees.  Keep going until your butt just touches the wall.  Drive back to the starting position by contracting the glutes.  Your upper body should have little or no movement.  Complete 8 - 10 reps.

To Complete the movement:

Drive your hip backwards with minimal movement in your knees.

Keep going until your butt just touches the wall.

Drive back to the starting position by contracting the glutes.

Your upper body should have little or no movement.

Complete 8 - 10 reps.

Hip Hinge with Weight:

When you feel like you have mastered the weight free version.  Find to light weights (5-10 lbs)  Keep the weight in contact with your thighs and set your upper body up the same way as before.

When you feel like you have mastered the weight free version.

Find to light weights (5-10 lbs)

Keep the weight in contact with your thighs and set your upper body up the same way as before.

To complete the movement:  Keep the weight in contact with your legs at all times.  Complete 8-10 reps.

To complete the movement:

Keep the weight in contact with your legs at all times.

Complete 8-10 reps.

Once you have the pattern down and you don’t have any unexpected humps in your back or shoulders, you can begin to add weight for even more strength and stability. Start small with a couple dumbbells and work your way up from there. Aim for high reps (8-10 per set) and low weight (5 or 10lbs in each hand) at first and remember that form is paramount when doing this pattern. These are all essentially deadlift patterns without necessarily having to do the full deadlift from the floor.  You may see this pattern in exercise guides called a ‘reverse deadlift’ and it is one of the easiest ways to train your glutes and hamstrings to do the heavy lifting they are designed for.

Add these exercises into your workout routine and you will have a strong core that reduces the chance of lower back injuries. Enjoy!

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