Worse than holding babies or petting puppies, it's the parades, with their endless sea of hands to shake, that really takes it out of politicians seeking votes.

Glad-handing, it turns out, can have more than electoral consequences.

Touchy-feely politicians can really feel some pain — from repetitive stress injuries. That's why the Bethesda, Md.-based American Occupational Therapy Association has just published "Grip and Grin," a tip sheet about preventing such problems.

Doug Gansler, Democratic nominee for Maryland attorney general, knows firsthand the perils of improper shaking technique.

"Like all politicians, you've gotta stay in the center — not squeeze too hard, but not give 'em the 'wet fish,'" said Gansler, known for his door-to-door personal touch.

For those campaigning heavily, engaging in more than 1,000 shakes a week, "really pressing the flesh," as Maureen Peterson calls it, there is even more risk.

"The more repetition there is, the more apt you are to have an issue," said Peterson, chief professional affairs officer at the American Occupational Therapy Association.

Anne McCarthy, Republican candidate for Maryland comptroller, searched for words to describe some of the doozies she's gotten — mangled, squashed — grips so menacing that she wanted to shake her own hand in pain. "But I'm in public and I'm not about to. Tears almost come to my eyes and I'm thinking — Why?"

Despite the hazards for all pols, it is just those the association has endorsed who receive the brochure in the mail. The rest, it seems, are out of luck. So, in the interest of bipartisan camaraderie, here are some of the tips.

To guard against a stress injury, the pamphlet recommends that movers and shakers take frequent breaks to relax. Shrug your shoulders, hold for 10 seconds and repeat three times.

Election hopefuls can stay limber and prevent pain by doing hand-strengthening exercises such as flexing with a foam ball or squeezing their hands into a fist slowly.

Paying attention to body mechanics such as posture and grip can help a politico avoid injury. It helps to be in good shape to begin with, said Peterson.

But in the frenzy of campaigning, even those with the greatest electoral fitness can be susceptible.

It's impossible to anchor arms properly — they're just "flailin' in the wind" — when a grandstander grabs up toward bleachers or elbows deep inside a crowd, Peterson said.

The wrist is particularly susceptible to injury, so the brochure advises political hopefuls to use the entire arm, keep the elbow at a 90-degree angle and break the handshake quickly.

Gansler campaigned heavily before the primary by knocking on doors. One day he attended three consecutive parades.

"I felt like it had been crushed. There's always the wise-aleck that wants to give you the squeeze," he said of the hand shakes.

Because grips vary from person to person, politicians must do as they are wont: Take control of the situation.

"Rather than letting yourself be grabbed any old which way," switch it up and place an arm around someone's shoulder instead, Peterson suggested.

If that doesn't work, occupational therapists recommend changing hands, or, as a last resort, make the hands off-limits by holding a large object or wearing a drugstore splint.

If sore from baby-kissing, clenching, speech writing, or other strenuous activities, the pamphlet advises aspirants to "declare a recess."

When pain goes unacknowledged, it could become chronic, said Peterson. If numbness or tingling persists, see your favorite occupational therapist.

Kevin Zeese, the third-party candidate for the U.S. Senate seat in Maryland, said he prefers to hand out fliers rather than shake hands. With flu season just around the corner, it avoids the need to clean hands constantly to ward off illness. He's known politicians to carry around baby wipes.

There is an upside to campaign aches, Gansler said. "It means you've worked that day."

Capital News Service contributed to this report.