Hand exercises for rheumatoid arthritis

6 Hand Exercises for Rheumatoid Arthritis

Losing hand strength and flexibility in your fingers is a common complaint for people with rheumatoid arthritis (RA). Fortunately, practicing a few easy hand exercises — no special equipment or much time needed — can be hugely beneficial both for stopping pain and stiffness and for improving joint function.

“It’s a nice way to get a little strengthening going and lets patients sense what their level of activity might be,” explains certified hand therapist Alice Pena, PT, who is a former spokesperson for the American Physical Therapy Association.

Some Rules of ‘Thumb’ for Maximizing the Benefits

If anything hurts, stop. In general, you can repeat the following exercises up to five times per session, once or twice a day. Talk to your doctor or physical therapist about the best number of reps for you to avoid strains.

Moist heat can make the motion of hand exercises for rheumatoid arthritis easier and help prevent discomfort. One option is to soak your hands in warm water for 5 to 10 minutes before you begin. Treating your hands with a warm paraffin wax bath or wrapping them in a towel soaked first in hot water are other options. You can also practice some of these exercises, such a making a fist, while taking a warm shower.

1. Increase Flexibility With Flat-Hand Finger Lifts

Start by placing your hands flat, palm down, on a table or against a wall. Then, starting with your thumb, slowly raise each finger individually off the table. Hold each finger up for one or two seconds, and then gently lower it.

2. Increase Your Range of Motion by Making a Fist

Start with your fingers straight out, then draw them together down into the center of your palm to make a loose fist. (Keep your thumb across your fingers and not tucked beneath them.) Hold this position for up to one minute, then open your hand slowly and repeat a few times on each hand.

3. Improve Your Grip by Walking Your Fingers

Place a hand towel or kitchen towel flat on a table. With one hand lightly cupped and supported by your fingertips and thumb, “walk” your fingertips toward you to pull the towel up into the palm of your hand. “Get as much towel into your fist as you can and gently squeeze,” says Pena. This keeps you aware of how RA might be affecting your grip and how strong your grip is, she explains. Repeat a few times then switch to your other hand.

4. Increase Your Dexterity With Finger Pinches

Pinching your thumb to the tip of each of your fingers one at a time can help make everyday tasks — such as tying shoelaces or doing up buttons — easier if you have RA. Take your thumb and touch it to a finger and press it firmly like a pinch. Hold for a second or two and release. Do this with each finger individually.

5. Keep Your Thumb Nimble With a Simple Stretch

Focusing on your thumb is necessary because it is so important to so many different hand motions. A key exercise for maintaining the thumb’s function begins with your thumb pointing outward, away from your palm. Then move your thumb across your palm to try to touch the base of your little finger. This kind of motion can help you grip circular objects, such as hairbrushes.

6. Maintain Flexibility by Spreading Your Fingers

Simply spread your fingers and thumb as wide apart as possible, slowly and gently. Hold for several seconds. This is a great way to reduce stiffness and strengthen the muscles around the joints in your hand.

Know When It’s Best to Take a Break

Succeeding with RA treatment means knowing when to temporarily lay off exercising, Pena says. For example, during flares or a worsening of your symptoms, it might be best to wear a supportive brace or a splint and forgo exercising to avoid additional damage to your joints. Listen to your body.

Hand exercise for women with rheumatoid arthritis and decreased hand function: an exploratory randomized controlled trial

Participants

Participants were females with RA reporting ADL task performance problems involving the hands, recruited from May 2014 to January 2016 through rheumatologists at outpatient clinics in Copenhagen and announcements in daily press. Potential participants were given further information and pre-screened for eligibility via telephone. If inclined to participate, they were examined by a rheumatologist to determine if they fulfilled inclusion criteria.

Inclusion criteria are as follows: females aged > 18 years; diagnosed with RA (ACR/EULAR 2010 Criteria) ; involvement of minimum of one tender wrist, MCP, or PIP joint; stable medication 3 months prior to participation, and self-reported decreased ability to perform ADL tasks involving the hands. Exclusion criteria are as follows: significant osteoarthritis of the hand (assessed by the rheumatologist); hand surgery within 6 months; other pain condition involving muscles and/or joints; prednisolone therapy; alternative treatments during study period; change in medical treatment during study period; inability to understand Danish; and finally any other contradictions for participating assessed by the rheumatologist. Participants were asked not to participate in occupational or physical therapy interventions elsewhere during the study period, aquatic physical therapy was allowed.

Ethics approval and consent to participate

Participants gave written informed consent. The study was approved by the ethics committee of the Capital Region of Denmark (H-3-2014-025) and registered at ClinicalTrials.gov (NCT02140866). The study was conducted in accordance with standards of the responsible committee on human experimentation and the Declaration of Helsinki. If participants experienced increased disease activity during the study period, US and rheumatologist examinations were made to determine if modifications or withdrawal were needed.

Study design and randomization

The investigator-initiated study was designed as an RCT with parallel groups. Participants entered an 8-week program and were randomly assigned to either intervention group (hand-exercise therapy and CIP, CIPEXERCISE) or control group (CIP alone, CIPCONTROL) with a 1:1 equal allocation ratio utilizing a concealment process. Randomization was made using sealed envelopes and carried out by the project secretary. The outcome assessors and data analysts were kept blinded to the allocation, and participants were instructed not to convey their group allocation. The persons performing US examination and evaluation were blinded to results of clinical examination and group allocation.

Intervention programs

The CIP consisted of an introduction to compensatory strategies including joint protection (JP), assistive devices, and alternative methods of performing ADL . The program was client-centered focusing on improving the ability to perform those ADL tasks that the single participant identified as purposeful to her life. It consisted of four 1-h sessions during an 8-week period. One occupational therapist (OT) (ISH) with > 10 years of experience performed all sessions. The first session aimed to identify the participant’s individual resources and problems in ADL task performance, goal setting focused on ADL task performance, and introduction to assistive devices. As homework, assistive devices were applied at home and the utility evaluated. In the second session, the OT presented JP principles and discussed these in relation to the participant’s ADL task problems. She supervised the participant to integrate JP principles and alternative methods of doing in ADL tasks. In the third session, the OT followed up on the use of JP principles and assistive devices at home and together they identified any additional ADL task, representing a challenge, and performed this under supervision. Optionally, additional assistive devices were handed out. As homework, the participant practiced JP principles and assistive devices in the chosen task. Fourth session, the OT followed up on homework, evaluated goals, and introduced how to apply for assistive devices and housing accessibility solutions in the home municipality. This fourth session, if relevant, was done as a telephone meeting.

The hand-exercise program lasted for 8 weeks as a strength increase is possible within this time frame and was designed based on recent research . First, the exercise intervention was performed four times per week with one session supervised by a physical therapist (PT), and the other three were home based. After 14 days. One PT (CB) with 3 years of experience performed the individual exercise sessions. Home-based exercise sessions were recorded in a diary. During the period, the exercise intervention was increased to once daily and the load was increased. The program consisted of three parts: (1) warm-up/mobility (10 min), (2) muscle strength training (20 min), and (3) cool-down (5 min). The warm-up was performed to prepare the joints for the muscle strength training and to improve flexibility; the muscle strength training was designed to ensure that relevant muscle was targeted within a period of 20 min. Resistance was supplied by exercise bands and Thera-putty. The amount of resistance was based on the weakest hand. The resistance intensity was set according to the participant’s self-reported experience of load using the Borg Scale . This load was chosen to minimize the risk of flare-up symptoms due to overload and to allow for progression. For cool-down, some of the warm-up exercises were receded. All participants received a detailed illustrated description of the exercise program (Additional file 2). In case of any flare-up in symptoms, the participant was set to only conduct the warm-up and cool-down part. Post exercise soreness and temporary fatigue was tolerated. Detailed description of the exercise program is presented in Additional file 3. If a participant failed to meet at an appointment, a phone call was made to maintain fidelity.

Outcomes

Primary outcome was observed, ADL motor ability measured by Assessment of Motor and Process Skills (AMPS).

Secondary outcomes were observed, ADL process ability (AMPS), self-reported ADL ability (ADL-Questionnaire, ADL-Q), self-reported disability (Stanford Health Assessment Questionnaire Disability Index, HAQ-DI), overall disease activity (DAS28), grip strength, and pain. Exploratory outcome was disease activity assessed by US.

AMPS

The AMPS is a standardized observation-based tool used to measure a person’s observed ADL task performance . The person being evaluated chooses and performs at least two standardized ADL tasks of relevance and appropriate challenge. During AMPS evaluation, two domains are evaluated, i.e., ADL motor ability (the amount of effort, fatigue and/or clumsiness) and ADL process ability (the degree of disorganization, inappropriate use of time, space, objects and ability to adapt actions). The 16 ADL motor and 20 ADL process skills are evaluated in terms of ease, efficiency, safety, and independence using a four-point ordinal scale. The available AMPS software , based on a many-faceted Rasch measurement model, makes it possible to convert ordinal raw scores into overall linear ADL motor ability measures and overall linear ADL process ability measures adjusted for task challenge, skill item difficulty, and rater severity. Measures are expressed in logits (log-odds probability units) . The overall ADL motor ability measure indicates how much effort or fatigue the person demonstrated, and the overall ADL process ability measure indicates how efficient the person was observed to be during the ADL task performance. Additionally, both ADL ability measures reflect safety and independence in ADL task performance. ADL ability measures above the 2.0 logit cutoff on the ADL motor scale and above the 1.0 logit cutoff on the ADL process scale indicate effortless, efficient, safe, and independent ADL task performance in everyday life. In contrast, ADL motor ability measures below the 2.0 logits cutoff indicate increased effort or fatigue during task performance. Moreover, ADL ability measures below the 1.50 ADL motor cutoff and/or below the 1.00 ADL process cutoff indicate a need for minimal assistance for community living. Finally, according to the AMPS manual a difference of > 0.30 logits on the AMPS ADL motor and/or ADL process scale defines a clinically relevant change . Studies support that the AMPS ability measures are reliable and valid in RA patients .

ADL-Q

Self-reported ADL ability was assessed using the ADL-Q, a standardized instrument with 47 ADL tasks developed to measure a person’s perceived quality of ADL performance . The person marks the quality of the ADL task performance using seven response categories reflecting efficiency, effort/fatigue, safety, and independence. Rasch methods are applied . Studies support that the ADL-Q can be used to generate valid measures of self-reported quality of ADL task performance among RA patients .

HAQ-DI

The HAQ-DI is developed to assess disability in RA . The questionnaire consists of 20 questions primarily concerning ADL tasks, a Danish version was used .

DAS28

Overall disease activity was assessed using the DAS28 which is based on count of 28 joints for swelling and tenderness, C-reactive protein level in the blood and the patient’s self-reported impact of disease on a visual analog scale (VAS Global health). The DAS28 score range from 0 to 9.4 .

Grip strength

The maximal grip strength was measured in kilogram using a digital hand Dynamometer (North Coast Medical Inc.). The grip strength was measured three times in both hands. The maximal force performed in each hand was used in the analysis.

Pain

Hand pain during activity and in rest was measured in both hands on a visual analog scale (VAS), where zero was no pain and 100 was maximal pain.

Ultrasound examination

Synovial hypertrophy and increased synovial perfusion are indications of disease activity assessed by US . Gray scale US is used to examine synovial hypertrophy seen as hypo-echoic structure between the tendon/muscle and the bone . Doppler US added to the gray scale image register movement of the blood as an indication of increased synovial perfusion. US has shown to correlate with measures of disease activity in RA . US examination in RA has shown to display sub clinical disease activity leading to disease progression on X-ray . The wrist and MCP 2–5 were examined both dorsal and palmar. The wrist was scanned in four dorsal and one volar position and the MCP joints in three dorsal and one volar position. Both synovial hypertrophy and Doppler were evaluated using a validated scoring system for RA . One score for synovial hypertrophy, one score for synovial perfusion (Doppler), and one sum score were calculated.

Sample size

Sample size calculation was based on previous data on AMPS ADL motor ability in women with RA . For a two sample pooled t-test of a normal mean difference with pooled variances (equal variances assumed) and a two-sided significance level of 5% (p ≤ 0.05), assuming a common standard deviation (SD) of 0.36 logits, a sample size of n = 32 participants per group was required to obtain a power of at least 90% to detect a group mean difference of 0.3 logits. It was decided to include n = 45 participants in each group.

Statistical analysis

Data analyses were carried out according to a pre-established statistical analysis plan (SAP); all analyses were done applying SAS (v. 9.4, SAS Institute Inc., Cary, NC, USA). Descriptive statistics and tests are reported in accordance to the “Enhancing the QUAlity and Transparency Of health Research” (EQUATOR) network . To evaluate the empirical distributions of the continuous outcomes, visual inspection was applied to suggest whether the assumption of normality was reasonable. The PROCUNIVARIATE statement was used for summarizing the data (descriptive statistics).

Intention-to-treat (ITT) analyses were made, i.e., analyzing participant outcomes according to the group to which they were allocated, even if participants did not receive allocated intervention. The ITT principle was done by replacing missing data with the value obtained at baseline.

At week 8, the CIPEXERCISE group was compared with the CIPCONTROL group using general linear model (analyses of covariance; ANCOVA) for mean changes from baseline and t tests for comparison of least squares means between groups. The model included change as the dependent variable (Δ), with treatment group as a main effect and the baseline score as an additional covariate. Results were expressed as the difference between the group means and 95% CI with the associated p values, based on the general linear model.

For sensitivity purposes, the analyses were repeated with further adjustment for disease duration and hand pain at baseline as there were group imbalances in these variables at baseline (Additional file 1: Table S1).

The proportion of participants responding to therapy (≥ 0.30 logits on the AMPS ADL motor scale) was analyzed using z test to evaluate the difference in the number of responders between groups.

8 Daily Arthritis Hand Exercises that Can Soothe Your Pain

Some tips for hand exercises for before you start:

Do them throughout your day. “Many of these exercises can done on the table or counter, but you can also do them wherever you are: standing in line, commuting on the train or bus, even in bed, before you start your daily activities,” Jacobs says.

Be gentle. Do all motions slowly, and stop when you feel tension so you don’t injure yourself.

For each exercise, hold for two to three seconds if possible, and do reps of 10 for each hand. The whole set can be done daily. But if anything hurts, stop.

Be mindful while doing the exercises. “Breathing in with your nose and out with your mouth to help relax and reduce stress is another thing to incorporate,” Jacobs says.

Jacobs recommends starting with these hand exercises for arthritis:

1. Make a fist

Start with your fingers straight and then slowly bend your hand into a fist. Make sure your thumb is on the outside of your hand. Don’t squeeze too tightly, then straighten again.

2. Bend your digits

Stretch your hand in front of you, palm up. Then take each finger and move it very slowly to the center of your palm. Hold it, then straighten.

3. Thumb bends

“Sometimes people have more issues with their thumb,” Jacob says, so when doing the digit exercise for your thumb, “bend it toward your palm—if you can reach your pinky that’s cool, and if you can’t, go as far as you can, hold and then start again.”

4. Make a C or an O

Move your fingers like you’re going to grab a little ball, and try to form a shape of a C or an O. Go as far as you can (an O would be making a complete circle with your fingers and thumb). Straighten your fingers and repeat.

5. Thumbs up

Have your hand in a loose fist with the pinky side of your hand on a table. Then point your thumb to make the thumbs up sign, put it down, and repeat.

6. Finger lifts

With your palm flat on a table, fingers spread slightly, lift each one slowly off the table, then back down before raising the next.

7. Wrist bends

Hold your left or right arm out with the palm facing down. Then take the other hand and gently press your whole hand down toward the floor. “People overdo this exercise so be very careful,” Jacobs says.

8. Easy squeezes

“Some people have a tennis ball or a stress ball and they like to squeeze that gently,” Jacobs says.

Hand Exercises to Avoid with Arthritis

Are there any had motions that aren’t good for people with arthritis? “A lot of repetition: typing on the computer all the time, constantly using one of your digits like texting with a thumb,” Jacobs says.

Also, “anything that might be heavily weighted you want to be very careful about, so avoid lifting something that’s very heavy,” she says. “You don’t want to injure yourself by overdoing it.”

In addition, you can keep of log of your activities and when you have pain, in order to identify individual triggers.

Keep Reading

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  • Kitchen Hacks for People with Arthritis Pain

You need your hands to cook, clean, type, and do just about everything else. But you probably don’t think much about how important manual dexterity is unless you have rheumatoid arthritis (RA) or another type of arthritis that attacks your hand and finger joints.

RA is a disease in which the body’s immune system engages in friendly fire against the joints. It often starts in your hands before spreading to the other joints.

“The hands and the feet are usually hit first, and these are the joints that are predominantly involved in everyone with RA,” says Eric Matteson, MD, a professor of medicine at the Mayo Clinic in Rochester, Minn. Hand exercises can help maintain range of motion, flexibility, and strength in your hands.

There is not a one-size-fits-all hand exercise prescription for people with RA, but a rheumatologist, physical therapist, or occupational therapist can help design a program especially for your hands. Here are seven hand exercises your program may include.

  • Hand Exercise for Rheumatoid Arthritis: No. 1: Start by holding your hand upright and pointing your wrist, fingers, and thumb upward. This also serves as the neutral starting position for many of the hand exercises that follow.Hold for 5 to 10 seconds.
  • Hand Exercise for Rheumatoid Arthritis: No. 2: Keep your wrist straight in the neutral starting position and bend the base joints of your fingers, which connect the fingers to the palm. Keep your middle and end joints and your wrist straight. “This is already a big effort for people with RA,” Matteson says. Hold for 5 to 10 seconds. Repeat twice daily on each hand.
  • Hand Exercise for Rheumatoid Arthritis: No. 3: Keep your wrist and the base joints straight, and bend your middle and end joints of your fingers toward your palm, one at a time. Hold each position for five seconds. Repeat on all 10 fingers twice a day.
  • Hand Exercise for Rheumatoid Arthritis: No. 4: Bend each finger from the base joint downward using your other hand to move your fingers. Repeat this movement using the second row of knuckles in your finger. Repeat this exercise on the third row of joints in your fingers, closest to the fingertips. Hold for 10 seconds. Repeat on all 10 fingers twice a day.
  • Hand Exercise for Rheumatoid Arthritis: No. 5: With your hand straight and fingers pointing upward, bend your fingers downward so they are touching your palm. Do not make a fist. Instead, your fingertips should be touching the palm of your hand. Hold for five seconds. Repeat on both hands twice a day.
  • Hand Exercise for Rheumatoid Arthritis: No. 6: Starting with your wrist, fingers, and thumb pointing upward, make an “O” by touching your index finger to your thumb. Hold this for at least 5 and up to 20 seconds. Repeat two to 10 times twice a day.
  • Hand Exercise for Rheumatoid Arthritis: No. 7: With your hands in the neutral position and all of your knuckles straight, slowly and gently spread your fingers as far apart as you can, like a fan opening up. From this position, make a fist. Hold each position for five seconds. Repeat on both hands twice a day.

“These hand exercises are really effective for stretching and maintaining mobility in your hands if you have RA,” he says. “We don’t do these exercises for strength because the strength that comes with good hand mobility in the activities of daily living is quite satisfactory.”

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