Clipper technique

Fair enough Catfoot.

I've cracked a thread off for it here

http://www.podiatry-arena.com/podiatry-forum/showthread.php?p=196926#post196926

Because NHS provision is a somewhat different question. I do think if an NHS pod says they have RSI I think its a mite cheeky to say "you can't have, the NHS don't do nails". I can think of three pods in my team who have had carpel tunnel syndrome over the last 10 years and I think there is some research from scotland on RSI in the NHS from disposable instruments.

Anywho. To the other thread for that.

 

I do appreciate your work in that area Del.

Joking aside, I've learned a great deal from Private practitioners (yes del, mainly you). PP DOES cultivate a different skill set and yes I think NHS work can foster bad habits and mindsets.

 

I think we , and by we I mean those from all sides that met and became friends all that time ago on the Biomx workshop at Tamworth and listened to each others stories and concerns, left that weekend with a lasting mutual respect for each other and an understanding of the workings of each others working practices.

( now termed clubism) apparently

We work together regularly now Rob and enjoy the banter ( as do the patients) and yes we have learned from each other. I now have a network of pods/friends I can chat with , ask advice from and offer advice to.

Made me a better practitioner and I hope contributed to making others the same.

Yet another example of common sense when put into practice IT WORKS :drinks

Cheers Mate
D

 

Joe thats the thing with RSI do it enough times - who would have though 11 years would need to see a physio for RSI of the thumb from too much texting.

But I agree add scaple work - skin stretch hand more I think and you have increased the loads and chances of RSI

 

This could have been an excellent Pod Arena type discussion but it has taken some wading through to find the relevant points. There's a bit too much loving going on and it is distracting.....DTT get your photographer to change camera angle....that'd help for starters.

OK the discussion seems to have focused very much on handling technique of nippers, a bit on sharpness and size of equipment. What about all other aspects? Sterilisation causes massive impact on nipper function. Has this been overlooked? Sorry I can't face reading back on all the back slapping and sniping. Heat and pressure eventually weakens the nipper function particularly the spring function (way before the sharpness is effected) - something that effects the efficiency of the nipper, impacting on the hand. Replace regularly.

Drilling nails seems to be out of favour due to health risks. Being trained many moons ago, reducing the thickness of the nail before cutting reduces the impact of stress on the hand but according to evidence inhalation of nail dust puts us at far too much risk. Shame really.

A new contributor seems to have rattled a few cages but I respect their input as an attempt to widen the debate. He/she makes some good points. One being the actual ergonomics of the nipper in hand....I have to agree with their summary that with an efficient technique, using the appropriate nipper, pressure is exerted equally through fingers 2-4 with very little impact on the thumb. I disagree entirely with DTT's summary, in fact exerting pressure through fingers 4 and 5 would likely shift the overuse problem here instead. Try his technique for the day and also keep count on how many times you drop the nippers. Not good.

So far the debate has concentrated on all the things as professionals that we can control but what about the things we cannot?

I have to concur with Joe that I do not believe that nail cutting is the main cause of RSI but it would take a brave research student to challenge this misconception. I have indeed suffered RSI in the left arm ( I am right handed) and the cause was entirely due to the reach and stretch needed to achieve skin tension. On the occasions that I do "feel" the right MCP joint it is after a heavy day with extreme corns!

I would suggest that the original poster on the other thread examines closely their "skin" techniques as well.

GB

 

Ahh George (or is it georgina)????

The mixer and fixer makes the usual appearance.

FYI the photographer was a relative of the pt I was tx, so I simply tried to show the grip in stages.

I have never dropped nippers in 23 years of practice using that grip nor do I suffer with RSI.

All my instruments are sterilised in a vacuum autoclave...so perhaps that should become the standard for EVERYONE ????

Nail reductions? YES still do them with a spray drill works perfectly, H & S ? wear a mask I do as required.

Disagree with me ? you were put on this earth to do that wer'nt you ? whether I'm right or wrong you and yours from the cesspit will twist everything to your own ends and then shout foul to the moderators to get the threads closed ( how many is it now ?? you and yours must have set a record )

I could go on BUT

As Einstien said, Insanity is repeating the same task and expecting a different outcome........think about it

Cheers D

 

I certainly agree that reducing nails seems to be falling from favour, which is a real shame! I've seen a few "old school" pods do this incredibly well with a blade, but that too seems a dying art.

I suspect there are several potential causes of RSI in podiatry of which nippers is but one. But let's not forget that this started with someone ho DID have RSI from nippers. This thread was an offshoot of that thread on Nipper RSI.

I'm certain You're right and that Other things cause problems also.

Which technique do you use George? You're obviously an experienced and knowledgeable pod / fhp, You've critiqued, which Is fair enough, would you be willing to contribute also by showing us your technique? A picture is worth a thousand words or so I'm told...

Sorry about the love. Sometime I have so much of it it spills out. I'll try to curb my affection for my colleagues.

 

Robert

I use all the techniques you originally describe - they are probably the basic ones taught but the action and pressure exerted through the fingers is entirely different to how DTT describes. Relying on 4 and 5 only reduces the control of the nipper and exerts too much pressure onto the tendons over the 4th and 5th metacarpels.

Having spent x amount on physio in the 90's to relieve tendonitis in the left lower arm, I spent many hours looking at my technique. It was skin tension, it was over use and simply the only way was to cut down the hours of work I was doing. Problem resolved but along the way I learnt good habits of instrument renewal. Recently I shared this with an associate who was complaining about MCP pain in her right hand. She'd been using the same ones 5 days a week for over 5 years.

What this thread has done is illuminate how we use our nippers and from what I have read, it is probably quite hard to overuse the MCP joint and with the emphasis moving away from nail care in the NHS wouldn't it be worth someone logging the amount of MCP pain and looking at scalpel technique rather than assuming it to be nipper use. Its a while since I trained via the diploma route and all focus then was on patient comfort when learning scalpel use. There was no consideration to the operator. Look at the amount of stress that goes through the thumb when using the scalpel.

This is why I urged the original poster of the original thread to look at skin technique as well.

Has any research ever been done into the impact of stress on the thumb joints due to scalpel use? I can't find any.

GB

 

To follow on from George's post I found this interesting thread on another site

http://www.salongeek.com/nail-geek/131374-tendonitis-nails.html

so it seems we are not alone in regard to this problem. Having never had a professional manicure/nail extensions I cannot comment on the techniques that nail technicians use - maybe someone else can?

----------------------------------------------------

To move on to Mr Bean's calculation of an NHS pod's working hours @ 6.5 hour per day I would calculate it out as follows, based on my own experience of NHS work.

Mon - Thurs 8.30. - 5.00.pm less 1 hour for lunch = 30 hours
Fri 8.30 - 4.30.pm less 1 hour for lunch = 07 hours

Total weekly hours 37.

but we were allowed 1 hour per day non-clinical time to set up clinics, answering correspondence, decontaminate instruments etc. So that gives available clinical time at most 6.5 hours per day.
IMO 28 patients cannot be seen in that time allocation unless the podiatrist was working into their lunch hour and clerical time. Working at that pace will inevetably take a toll on the individual's health.

regards

Catfoot

 

Could not agree more!

My Stomach ulcers have been zesty today!

 

Assuming you can get fingers 4 and 5 around the handles, the amount of force needed there will be less than at fingers 1 and 2 (jaws on thumb side of hand.) Yes, you loose a little control when the jaws are further away from your hand, but you gain levarge on the hinge of the nippers.

Using the very ends of the handles may lead to a few more drops, but with experience the drops can be reduced.

Physics is not just for orthotics.

Eric

 

Hi Eric

Thank you for your explanation.

It is all down ( I think) to the size of nipper / hand/ arc of nipper grips and the preferred grip.

As you can see I favour a 5 inch straight fine cut jaw which has a fairly wide arc on the grips, which sits comfortably in the palm of my hand and is completely stable

In the pics was trying to demonstrate the complete grip and to emphasise the force required to move away from 2/3 MCJ to what I use which is ( and I have been conciously thinking about it whilst working), to 4/5 usage,in an effort to help a colleague with RSI.

The remaining digits sabilise and guide but do not play a part in applying pressure .

So

Having sustained 2 punch fractures to my 4/5 metacarples in my younger days, I still use those mainly and dont suffer with RSI....must be something in it dont you think ????

Thanks again for your input.

AND

apologies to all for my error for those that have the opinion "we have a thumb and 4 fingers" should have read from the start "taking the pressure from 2/3 to use 4/5 " to alternate the loading,for those of us that take the thumb as the first finger / mcp the apology is not required. sorry
Cheers
D

 

FWIW, my grip depends on the angle the patient has their feet & my level of fatigue.... Is there anything worse than trying to reach the 'difficult' spot & the patient begins to either dorsiflex their ankle or hallux?

 

I personally find the backhand grip hard on the wrists, use both hands. ( Impresses px no end - "ooo - it must be great to be ambidextrous!")

 

Does any instructional video footage regarding clipper technique, in addition to use of other commonly utilised podiatry instruments, appear on the internet? It would prove to be welcome footage when advising the likes of students.

Regards
Anthony

 

Grip with nippers:
I am a right hander I use 5 1/2 inch concave clippers with the internal concave surface towards the digit. I often use the bottom jaw of the clipper to act as a guide to assist in creating an natural arc across the front edge of the nail. I use whatever technique the nail requires, a great nail might need 6 or more cuts using the front 1/4 of the blades, I might use the middle section of the blade for a robust large cut or for max cut least effort the rear of the blade I have a fairly large male hand, I weight about 14 1/2 stone and train a bit, my forearms are reasonably strong. RSI in my opinion is often caused by repeatedly using a technique that angles the wrist or uses the wrong section of the blade or if the practioner is attempting to repeatedly cut too much nail and they are weaker in the arm thus fatiguing musles. A back handed grip is very useful to master saving one from contorting to go in the opposite direction. I am able to change between forehand and back hand grip withouth the use of my left hand because my arm is strong enough and my hand is big enough. I use all fingers to tighten a grip on a big robust cut, if it resits then I will resort to smaller cuts, I notice that I tend to use my 4th and 4th 5th for most of my work. The clippers fit into the palm of my hand for most of my work but I move it about depending on the job I need htem to perform.
If one is trying to use one technique... expect trouble.