Pen Push Up: Thumb Strengthening Exercise
The pen push up is a one-handed thumb exercise that only needs a pen or pencil. The client holds the pen in their fingers, uses the thumb to push it down through the grip, then uses the thumb extensors (the muscles that straighten the thumb) together with the fingers to push it back up.
This one-page handout is for clients and caregivers to use at home. It has photos of each step, sets and reps, and simple rules for pain and effort. Use it when you’re adding a low-equipment thumb strengthening and coordination exercise to a home program for a client who is ready for light resisted thumb work.
The handout was developed with Rachel Egan, OTR/L, MS, CHT, COMT-UE, a Certified Hand Therapist.
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The handout recommends 8–15 repetitions per set, for up to 3 sets. Clients should aim for an effort level of 4 to 6 on the Borg RPE Scale (a rating of perceived exertion, or how hard the exercise feels). Pain should not go up by more than 2 levels during the exercise. Change these targets if your plan of care calls for something different.
When you introduce it, show the client the movement first and then watch them try it. The photos show where the pen starts and ends, but the key point is easier to see in person: the fingers grip just firmly enough to resist while the thumb does the work. Before they leave, check that they understand both the pain rule and the effort scale, since those two numbers are what keep the home program safe.
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