I hand quilt on my lap with no hoop and I quilt with my stitches running right to left. My left arm goes under the quilt and I "smooth and grab" with my left hand, meaning I feel the back with my hand and smooth any puckers and then kinda fold it over a few inches from where I'm quilting and "grab" the folded quilt with my left hand and rock the needle up and down as I take the stitches. I also use a metal thimble and I touch my first finger, (tip or nail) underneath before pushing my needle back up. When I used to quilt with a hoop, I'd get cramps in my hand, but no so much anymore since I quit using a hoop. I also quilt with friends on a big frame and then I quilt either up, down, or right to left, but I can't go from left to right. I pin baste and I pin closely, about every 3 inches which keeps the fabric, batting and back from shifting. I think the cramping comes from holding the quilt too tightly and after more practice maybe your hand will relax more! Hope you learn to enjoy it!