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Intrinsic-Plus Position Hold

Draftmotor-control50%beginner⬤ expert-opinion evidence
View FHIR resourceFHIR R4 ActivityDefinition — the interoperable form of this exercise

Positions & Range of Motion

Start
seated with the forearm supported and the hand relaxed
End
MCP joints flexed 60–90° while the IP joints are held fully extended, forming a flat 'tabletop' hand, sustained for the hold
Range of Motion
isometric hold at MCP flexion 60–90° with full IP extension; minimal joint excursion once the position is set

How to Perform

Isometric hold at MCP flexion 60–90° with simultaneous IP extension. Targets lumbricals; guards against claw-hand deformity.

Watch on YouTube↗

Opens a YouTube search for “Intrinsic-Plus Position Hold”

Starting position: seated

Coaching Cues

  1. 1

    Long fingertips, flexed knuckles — lumbricals hold the shape

    (verbal)
  2. 2

    Make a flat tabletop with the hand

    (verbal)
  3. 3

    Hold the shape steady for ten slow seconds

    (verbal)
  4. 4

    Free hand on volar MCP confirms knuckle flexion

    (tactile)

Evidence-Based Dosing & EMG Data

Recommended Dosing

3–10 reps, 5–10 s holds, daily (extrapolated from general hand protocols).

EMG Activation Data

No published EMG for isolated lumbrical activation — position is anatomically rational but unvalidated.

Muscles Involved (3)

Primary Movers

Lumbricals (Hand)— No EMG data available

Secondary Movers

Extensor Digitorum— Provides IP extension

Synergists & Assistors

Dorsal Interossei (Hand)Synergist

Easier Variations ↓

1

Passive Positioning

Therapist or opposite hand places and holds the intrinsic-plus posture.

2

Single-Finger Intrinsic-Plus

One digit at a time to reduce coordination demand.

Harder Variations ↑

1

Putty Resistance

Press fingertips into putty while holding MCP flexion + IP extension.

2

Elastic-Band Resistance

Band at fingertips pulling into extension, resist with intrinsic-plus.

Target Movements (2)

Finger Flexion (MCP)Metacarpophalangeal Joints
Finger Extension (MCP)Metacarpophalangeal Joints

Why This Exercise Matters

Everyday activities this exercise helps you do — essential means it directly trains the capacity the task needs:

Gripping a CupTyping

Research Notes

Primary watch-out is FDS/FDP substitution; cue palpation at volar MCP. Position is used widely in post-op splinting protocols.