Pizza & Hands

By: John Flint, MD

What do they have to do with each other? 

Turns out a lot, and much more than just delivering pizza to your mouth. Hands are amazing instruments that we utilize nearly every moment at work, at home, or at school.  Hands are also critical in making a great pizza.

Fingers move in relatively simple patterns with flexion and extension or bending and straightening. They don't have much ability to change their direction or twist or turn but are excellent at wrapping around things or participating in pinching.  Even though the fingers don’t move in exotic ways, to surprise of many people, the fingers have very specialized jobs. The index and long finger are particularly good at reaching out and interacting with the thumb to pinch and pick up objects and to manipulate small objects. The ring finger and pinky finger are not nearly as helpful in picking up small objects or manipulating them. Their special job is to create power for the hand to help squeeze objects or hold on to tools etc. Sometimes the index and long finger are referred to as the “finesse” side of the hand and the ring and small finger are referred to as the “power” side.

The thumb can do what all the fingers do, and more. The thumb flexes and extends like the fingers but also has a special joint at the bottom of the thumb near the heel of the palm which allows the thumb to make circles. It is this joint of the thumb that allows the thumb to reach over and touch the pinky becoming the opposable thumb. The downside of this amazing motion and function is that this special joint gets worked repeatedly over the course of a lifetime, and eventually wears out for most people.

The wrist plays a critical role in expanding the possibilities of what a hand can do. The wrist can flex and extend and move side to side. However, it is the combination of these motions that really turns the wrist into a superstar.  Most people aren't aware but the most common motion the wrist makes, and the most functional, is what is referred to as the “dart throwers” motion. This is the motion of flexing or extending and also moving side to side at the same time. One can understand this motion by simply pretending to throw a dart and see how the wrist flexes and extends and moves to the side. In fact, it is this motion that is most commonly used in day-to-day activities.

What do fingers, thumbs and wrists have to do with pizza?

It turns out, a tremendous amount. A very popular style today is referred to as Napolitano/Neapolitan style or that originating from Naples, Italy. Neapolitan style pizza is made almost, if not exclusively, by hand. First, the dough is prepared with hand mixing instead of machine mixing to be gentle on the flour and to feel the moisture content--the finger bending and straightening motions are critical here.  If kneading is called for the fingers and wrist work together to develop the gluten/structure of the dough. Often the dough is allowed to cold ferment for days. When the dough ball is shaped into the circular pizza shape it is done so gently, often with just the pads or tips of the fingers. Master pizza makers, pizzaiolos, will often use a pulling or stretching technique and flip the dough back and forth from the table surface to their hand to create the round pizza shape. ( ) This requires an amazing amount of dexterity and agility and literally, hands-on practice. The pizzaiolos do this so effortlessly that it looks very simple and easy to do but a person only has to attempt to mimic their actions while making their own pizza to realize craft and skill that it takes to create a round pizza with even thickness.

The hands become critical again in applying the toppings. After the sauce is applied the thumb and finesse fingers, index and middle fingers, must pick the toppings such as fresh basil leaves distributing them over the pizza. The same fingers must then tear and place the mozzarella. Often then the hand and wrist work together to grasp olive oil bottle and dribble some oil over the pizza. The hand and wrist are critical to load the pizza on a peel [pizza spatula] and deliver it to the oven. After a short time, the Neapolitan style pizza is cooked and ready to eat. (To see the whole process and the amazing hands at work see (

So, next time you eat a Neapolitan style pizza (or any other style) at a restaurant remember all the different steps it takes to make that delicious pizza and how critical the hands were in each step and throughout the whole process.

Better yet, muster some courage and make one yourself at home.  While you do, notice how involved your hands are in each and every step.  When you do, you will appreciate a little more deeply what it means for something to be hand crafted.  After your hands have done all that work, you will be able to relish what your hands accomplished as you do the final step of getting that pizza from the plate to your mouth.  Ok, maybe the last step is doing the dishes, but let's leave exploring how good your hands are at that for another day.


Links to recipes and techniques for using your hands to create your pizza masterpiece:

Simple pizza dough recipe :

How to make Neapolitan style pizza:

Calculator to scale a pizza recipe:

How to stretch your dough:

Hand slap technique of stretching: ;

John Flint, MD is a board-certified and fellowship-trained upper extremity surgeon at Flagstaff Bone and Joint.  Dr. Flint is available to see patients at our Flagstaff and Kingman locations.