I do use a hoop even if it is one of those snap together hand held PCP plastic frames. Most of my quilting of bed size quilts is done on either of two floor hoops, one round and the other square. Both are on a single leg and the frame can be rotated as needed. I use both hands, and quilt in what ever direction gets the job done. I wear a leather thimble on my right middle finger and on my left thumb. After 40 years the only difference between my hands is the right hand is a little faster. I used to use a #12 quilter's in between. With age and an autoimmune disease I have had to be demoted to a #9 inbetween needle. I even use it to do mending and to sew on buttons. It is not unusal for me to quilt for several hours at a time. My hands don't bother me nearly as badly as my back which has a good deal of arthritis.