Arthritis is a very common condition, that causes an uncomfortable pain in joints around the body.
There are two common types of arthritis – osteoarthritis and rheumatoid arthritis.
Osteoarthritis occurs when the cartilage lining of joints becomes rough and thin, meaning more pressure is put on tendons and ligaments, causing pain and stiffness. Rheumatoid arthritis is completely different, with the immune system being the cause, affecting joints and making them painful and swollen. It usually affects the joint’s outer covering, known as synovium, before spreading across the joint.
Both types of arthritis can affect many joints across the body, most commonly the knees, hips and hands. Focusing on arthritis of the hand, fingers and wrist, we’ve come up with a useful guide to help you deal with the pain arthritis may be causing you – with some simple exercises!
We asked fellow hand and wrist experts across the UK, and the rest of the world, to suggest exercises to reduce pain caused by arthritis. Here’s what they had to say…
Giles Bantick
Giles BantickConsultant Plastic Surgeon and Hand Surgeon
www.handsurgeonlondon.co.uk
“I recommend thenar cone strengthening exercises for patients with thumb base osteoarthritis.”
Thenar cone strengthening exercises strengthen the flexor muscles and tendons in the fingers, hands, wrists and lower arms. There are several methods and products available for this sort of technique, one of which can be seen in action in the below video:
Mr Maxim D Horwitz
Mr Maxim D HorwitzConsultant Hand and Orthopaedic Surgeon
www.thehanddoctor.co.uk
Arthritis of the hand is a condition best dealt with by a multidisciplinary team including a hand surgeon , a rheumatologist and an occupational therapist. It is important to have excellent hand therapy to make sure that patients can maintain residual function with good control of pain relief with safe and appropriate drugs. Information leaflets such as those provided by the Rheumatology Council are often very beneficial.
Treatment starts with strengthening, splint age and occasionally steroid injections. Joint fusion and replacement are part of the surgical treatment plan but must be considered in line with the overall health and goals of the patient.
Dr. Stephen J. Leibovic
Dr. Stephen J. LeibovicMedical Director of Virginia Hand Center
virginiahandcenter.com
Arthritis is a condition where the cartilage cushion that normally exists between all bones in a joint wears out. Normally, bones are lined by cartilage and the joint is contained within an envelope or “capsule.” The capsule is filled with joint fluid. The cartilage and the joint fluid are similar to bearings and oil in a mechanical joint. As the cartilage wears out, the joint becomes inflamed and painful. Stiffness ensues and the patient becomes reluctant to put weight on the joint.
No exercises can restore the cartilage, and our efforts to replace or rejuvenate cartilage through medical or surgical means have not been very successful. However, exercises can help reduce the stiffness, as well as reduce the pain of arthritis.
Generally, exercises that result in movement of the joint through a full range of normal motion, without exerting excessive force on the joint, are preferred. For the finger joints, simple flexion (bending) and extension (straightening) of the joints are the common motions that can be performed. Light squeezing can help strengthen the muscles that power the joints, but excessive squeezing or gripping can exert too much force on the joint and worsen pain or inflammation. Since the finger joints are essentially “hinge” joints (joints that allow motion in only one dimension), no other motions are possible.
The wrist joint is not a hinge joint. Rather, motion is permitted in three dimensions. Again, exercise that results in movement of the joint through a full range of normal motion is preferred. Light resistance can be employed, using either rubber band like material (“Thera-Band” ®) or light weights. I do not like to emphasize increasing the range of normal motion by stretches at the end points of joint motion in arthritis as one might do if a patient has stiffness from scarring as a result of injury. This would lead to excessive pressure on the joint at the extremes of motion and may be counter-productive in arthritis.
The elbow joint, like the finger joints, is a hinge joint. Exercises should engage the full range of motion of the elbow joint, from full extension (straightening) to full flexion (bending). In addition, the forearm can be rotated into a supinated (palm up) position or a pronated (palm down) position. Thera-band, wall mounted pulley and weight systems, and light free weights can be used for the elbow exercises.
The shoulder is a little more complicated, because a condition called “impingement” frequently occurs in the same age group as those with arthritis. The shoulder joint has a much larger range of normal motion than any of the other joints in the upper extremity (elbow, forearm, wrist or hand). The shoulder can usually “circumduct” which is a motion that allows the arm to extend in broad wide circles centered on the shoulder. However, in patients with impingement, the biceps tendon and rotator cuff muscles in the shoulder can become pinched between the head of the humerus (the round “ball” at the top of the arm bone) and the acromion (the bony protuberance at the outer end of the collar bone). Impingement can be quite painful, especially in positions where the arm is overhead. Therefore, if pain is present these positions should be avoided. Without pain, the patient can again do full range of motion exercises, as well as light weights or Thera-Band.
In patients with arthritis, warming the joint always allows more motion, less pain, and enhances the exercise experience. This can be done with a warm wet towel wrapped around the joint prior to exercising, a warm bath or shower, or other methods of applying heat. “Wet” heat is usually preferable to dry heat, as it tends to penetrate the tissues more thoroughly.
In summary, the pain of arthritis can be relieved and the stiffness avoided by gentle range of motion exercises in all joints involved. High impact exercise should be avoided. Light weights can be used, as well as light resistance from Thera-Band or other assistive devices. Wall pulley systems, weight machines and free weights can all be used, with low weight. Warming the joint prior to exercise is always preferred. Joint motion can result in less stiffness as the joint lubricating properties of joint fluid work on the joint. Pain can be relieved by relief of stiffness as well as the release of natural endorphins which are frequently released with human activity.
Professor David Warwick
Professor David WarwickConsultant Hand Surgeon
www.handsurgery.co.uk
I am not aware of any evidence that exercises per se have any role in the management of arthritis. Our hands are used all the time and to do specific exercises over and above daily use would seem to me to be fairly pointless. However there are things that can help:
Reassurance that arthritic symptoms very often fade away is the best management. Precipitous surgery is unwise as it will not allow the natural history to expose itself. Steroid injections into particularly inflamed joints can calm symptoms down for quite some time.
Paul Foster
Paul FosterAssociate Hand Therapist
www.merivalehandclinic.co.nz
The thumb is the most important and frequently used part of the hand. We use the thumb for both dexterity and for strong gripping. Arthritis literally means “inflammation of the joint” and is caused by gradual “wear and tear”. Inflammation can cause pain, swelling and stiffness, especially of the joint at the base of the thumb. Repeated pinching, gripping, twisting or turning objects can make this degeneration worse, and both weakness and pain increase. X Rays can show how advanced the arthritis may be. Conservative treatment includes anti-inflammatory medication, splinting, a specific exercise programme, and learning less stressful ways of using the thumb.
Exercises for the initial splinting stage – Do not aggravate pain with any of these exercises. Remove splint to carry out these exercises twice daily, repeat each exercise five times and hold each for three seconds.
1. Range of Motion Exercises
Hold palm flat and slide thumb out, and then lift thumb up and over palm.
2. Static Strengthening Exercises
Gently pinch a circle shape with your thumb and index finger. Place pressure on your index finger and hold, then pressure on your thumb and hold. Pressure in on thumb and hold and pressure up on thumb and hold.
3. Expanding Ball
Imagine a small ball growing larger in your cupped hand. Let your fingers and thumb expand with the ball. Concentrate on expanding the thumb, first from the middle MCP joint, keeping it slightly bent, before finally expanding the thumb tip.
4. Thumb Prints
To help stabilize the middle joint of the thumb in preparation for strengthening your “circle grip”. Stand the thumb tip gently on a table, keeping all the joints slightly bent. Imagine you are rolling the thumb pad to make thumb fingerprints. Try to keep your wrist still.
Progressive Strengthening Exercises whilst weaning off the splint – carry out these exercises 1-2 times daily and repeat each exercise 5-10 times.
5. Ball Exercise
Rest hand on table. Tighten fingers and thumb around a ball eg. tennis ball. Gently squeeze.
6. Circle Pinch
Pinch a small piece of sponge, or light peg using the circle pinch. All joints of the thumb should be slightly bent. Relax slowly.
More simple hand and wrist exercises to combat arthritis pain
As well as the exercises and opinions offered by various experts above, we’ve also compiled an extra list of exercises for you, to help you deal with the joint pain and stiffness of arthritis in the hands, fingers and wrists.
1. Make a fist
Simply hold your hand up straight and slowly bend it into a fist, leaving your thumb on the outside. Be sure to do this gently, not squeezing your hand once in a fist. Once you’ve made a fist, open the hand again until your fingers are completely straight. Repeat this ten times.
2. Finger stretching
First, place your palm flat on a table or surface, and gently straighten your fingers as flat as they can go, whilst being careful not to force the joints. Hold the stretch for around 30 seconds and then release. Repeat this four times.
3. Finger curves
Point your hand straight up, and then curve all of your fingers inwards until they meet, forming an “O” shape. Hold the “O” for several seconds and then straighten the fingers, repeating this process several times.
4. Finger lifts
Put the hand flat against a table or surface and then slowly lift each finger into the air one at a time, starting with the thumb. Hold each finger up for a few seconds before lowering it.
5. Wrist stretching
If arthritis is affecting your wrist joint, then this stretching exercise is for you. Hold your arm out, with the palm facing downwards. Then, using your other hand, press the hand down until a stretch is felt in the wrist and arm. Be careful not to push too hard when doing this. Hold the position for a few seconds and repeat the stretch around ten times.
6. Finger claw stretching
Targeting arthritis pain and stiffness in the fingers, hold your hand out with the palm facing towards you. Then, bend all of your fingertips at the same time, so they’re touching the base of their own fingers, making your hand look almost like a claw. Hold this position for around 30 seconds and then release, repeating this exercise four times.
7. Grip strengthening
As well as pain and stiffness, another effect arthritis can have on the hand is a loss of grip. To strengthen your grip over time, hold a ball in your hand and squeeze it as hard as you can, holding the pressure for a few seconds and then releasing. Repeat the squeeze between 10 and 15 times, depending on how your hand feels, and then perform the exercise again 2 or 3 times weekly, leaving a 48 hour rest period in between.
If you’re worried about arthritis in your hands, wrists or fingers and want some advice on how to treat the condition and its symptoms, get in touch now to arrange a consultation with Ladan Hajipour. For full contact details, go to LadanHajipour.com/contact