I hand quilt usually with a lap hoop but sometimes without. I use a Thimblelady thimble which has you pushing the needle with the pad of your finger vs the tip of your finger. And if you use her method of quilting, you are essentially 'rocking' the fabric vs rocking your hand. If you use a hoop/frame, the trick is to keep the work very lose in the hoop so you can move the sandwich rather than your hand. It really is 'painless' quilting. If you use her longer needles, you can load many more stitches. I still prefer Roxanne needles though. I think they are a bit stronger. I can still manage to load a good 4-6 stitches on a #11 Roxanne between with no issue using a very lose work area.