What is hand therapy? Emily’s journey to becoming a Climbing Certified Hand Therapist

Welcome.

Before continuing, please find a brief definition of CHT (Certified Hand Therapist) versus PT (Physical Therapist) or OT (Occupational Therapist):

https://asht.org/patients/why-see-hand-therapist

Emily is an occupational therapist first. A short, elevator speech for occupational therapy is: using your preferred and required daily tasks as pieces for intervention plans and goals for maximal healing of your mind and body in order to increase function and independence.

For example, my preferred daily habit is rock climbing, and my required daily tasks are dressing myself, driving my car to work, walking my dog, etc. If I have finger pain, I need an OT to reduce my pain to the point I can crimp, zip my tightest jeans, turn the key in my ignition, and hold my dog’s leash without pain even if she pulls. Great, an OT can do this, but can all OT’s do this? Do all OTs and PTs have enough knowledge about my finger to do this?

Possibly, but unlikely. An OT and/ or PT education is vague, with several specialization options existing post- graduation. Emily took two neuro courses in grad school five to six years ago; if you sent her to a neurology post- op center right this second she would be as lost as you are. She knows the premise and main principles of neuro OT, but this is not her specialty, thus not her expertise.

Only two classes? That’s crazy; was there only two hand classes as well?

Actually, there was only one hand therapy elective course, which delved deeper than the two anatomy courses.

Emily began her Masters of Occupational Therapy two days after graduating with her Bachelors of Health Science in May of 2017. She graduated with her Masters of OT in January of 2019 and began three part time jobs at various hand therapy clinics after receiving her license on February 11, 2019. Emily started studying for the CHT exam at this point.

Why did Emily have three part time jobs?

It was extremely difficult to find a reputable job in hand therapy as a new graduate. For this reason, Emily attempted to maximize her experience by working three jobs and shadowing at another. It was not until July of 2019 Emily was offered a full time job in the bay area of California. This company was contracted to Tesla, meaning most patients were factory workers with traumatic injuries or repetitive strain injuries from working on an assembly line for up to twelve hours a day for five consecutive days, or higher- ups with repetitive strain injuries from constant computer use for at least five consecutive days.

Upon accepting this full time position, Emily was now deemed full time and thus able to begin tracking her hours for the CHT exam. The CHT exam requires a minimum of three years and 4,000 hours of in-person hand therapy experience before one is able to sit for it, making her eligible for the Fall, 2022 exam.

In March of 2020, Covid-19 struck, causing Emily’s job to downsize secondary to repetitive strain surgeries being deemed as non-essential until May of 2020. Emily’s gym, Planet Granite, also underwent several restrictions, including being temporarily closed. This caused Emily to finally begin climbing outside.  

Emily had sport climbed outside twice prior to this point. Being that she was actively searching for a job and unsure at this point in the early Covid times, she did not socialize with many people in order to avoid contracting Covid, forcing her to boulder alone.

The first time she boulder’ed outside she stretched her intrinsics and extrinsics, used a make shift tension block to warm up her grip, did an obnoxious amount of shoulder and hip circles, and jogged probably about one mile.

She barely sent a V0.

She came back the next day, completed the same routine, and then crushed the same V0.

Little did she know, a random man was watching her do this lengthy warm up routine then send three routes.

On the third day, this man finally approached Emily and basically asked what the heck she was doing. Through her mask she explained she had no idea how to boulder outside but was teaching herself, as she had literally nothing else to do. The man asked why she was warming up with such longevity and then barely climbing, to which Emily explained she was planning a long climbing career with as little injury as possible. This man (his name was Stephen) explained he had been climbing for eight years and currently had two pulley injuries. Reluctantly due to Covid, Emily forced Stephen to use hand sanitizer and mask up (sorry, Stephen J ) and then stretched the intrinsics of his two “pulley injuries” for about 10 minutes each. Stephen then showed increased range of motion and less pain when climbing. He literally used the word “Flabbergasted” to explain how he felt post- stretching.

For Emily, her 13 months of hand therapy experience prepared her for this interaction. To her, this was common knowledge. Of course it was intrinsic tightness and not a pulley injury based on how Stephen explained his mechanism of injury, demoed his range of motion, pointed to where he felt his pain, and showed Emily how he crimped. To Stephen, who did not have an OT degree and hand therapy experience, this was “flabbergasting”. It was in this moment Emily realized how much potential her two worlds of hand therapy and climbing had to collaborate. She combined her expertise as an OT to use climbing as an intervention plan and a goal, and her emerging expertise as a hand therapist to fine tune and perfect these intervention plans.

Although seemingly perfect, this combination of rock climbing and hand therapy required two more things: more expertise in the world of rock climbing, and more expertise in the world of hand therapy. Emily applied to a Doctoral level OT program at her Alma Mater, Quinnipiac University, to increase her knowledge of research and moved to Colorado, where climbing gyms were strict but open and Clear Canyon was only 20 minutes away from her new apartment, and she began filling her restricted social times with countless hours for the CHT exam.

In September of 2021, Emily travelled back to Santa Cruz and sent the same V6 Stephen was attempting back in March of 2020. In May of 2022, Emily graduated with a clinical Doctorate in OT with her thesis being on her newly patented orthotic for low grade pulley injuries. In November of 2022, Emily was notified she past the CHT exam, an exam which had a 57% pass rate. In Spring of 2024, Emily is still climbing and running her occupational therapy, hand therapy, rock climbing clinic in Denver, Colorado. She has kept her license in California and applied for ones in Nevada, Wyoming, and Utah. She travels to train other climber/ hand therapists so we can formally welcome our rock climbing community into the world of hand therapy to promote healthy and happy sends.