What hand joint exercises and stretches are beneficial for patients with osteoarthritis (OA) or rheumatoid arthritis (RA)?

Beneficial Hand Joint Exercises and Stretches for Arthritis

Range of motion and strengthening exercises combined with joint protection strategies are strongly recommended for all patients with hand osteoarthritis and rheumatoid arthritis to improve hand function, reduce pain, and decrease joint stiffness. 1

Evidence-Based Exercise Recommendations

Types of Beneficial Exercises

1. Range of Motion Exercises

   • Finger flexion and extension (making a fist and then straightening fingers)
   • Thumb opposition (touching thumb to each fingertip)
   • Wrist flexion and extension
   • Finger abduction and adduction (spreading fingers apart and bringing them together)

2. Strengthening Exercises

   • Grip strengthening (squeezing a soft ball or putty)
   • Pinch exercises (pinching and holding small objects)
   • Thumb stabilization exercises (particularly for thumb base OA)
   • Resistance exercises with elastic bands

3. Joint Protection Techniques (to be performed alongside exercises)

   • Using larger joints for heavy tasks
   • Avoiding prolonged gripping or pinching
   • Using assistive devices for daily activities
   • Proper joint alignment during activities

Exercise Protocol

• Frequency: 2-3 times per week 1, 2
• Duration: 20-30 minutes per session
• Intensity: Low to moderate, avoiding pain exacerbation
• Supervision: Initially supervised by a healthcare professional (occupational therapist or physical therapist) with transition to home program 1

Application of Heat

• Apply heat (paraffin wax or hot packs) before exercise to improve joint mobility 1
• Heat application has shown better acceptance among patients compared to ultrasound therapy 1

Evidence for Effectiveness

Research demonstrates that hand exercises provide several benefits:

• Pain Reduction: Exercise reduces hand pain by approximately 5% compared to control groups 2
• Improved Function: Exercise improves hand function by approximately 6% 2
• Reduced Stiffness: Exercise decreases finger joint stiffness by approximately 7% 2
• Increased Grip Strength: One study showed a 25% improvement in grip strength with joint protection and exercise programs 3

Specific Exercise Program Example

1. Warm-up (3-5 minutes)

   • Apply heat to hands
   • Gentle massage of fingers and palm
   • Light wrist rotations

2. Range of Motion Exercises (5-10 minutes)

   • Make a fist then straighten fingers (10 repetitions)
   • Touch thumb to each fingertip in sequence (5 repetitions)
   • Wrist flexion and extension (10 repetitions)

3. Strengthening Exercises (10-15 minutes)

   • Squeeze therapy putty or soft ball (hold 5 seconds, 10 repetitions)
   • Pinch putty between thumb and each finger (5 repetitions per finger)
   • Finger abduction against resistance (spread fingers against rubber band)

4. Cool-down (3-5 minutes)

   • Gentle stretching of fingers and wrist
   • Light massage

Important Considerations

• Individualize Based on Joint Involvement: Different exercise regimens are needed for interphalangeal joints versus thumb base (CMC-1) joints 1
• Pain Management: Exercises should not significantly increase pain; mild discomfort during exercise is acceptable but should subside quickly
• Adherence Strategies: Self-reported adherence to recommended exercise frequency ranges from 78% to 94% 2, suggesting the importance of regular follow-up and reinforcement
• Long-term Commitment: Benefits may not be sustained if exercises are discontinued 2

Potential Adverse Effects

• Few adverse events have been reported, primarily consisting of temporary increased finger joint inflammation and hand pain 2
• Risk is minimal when exercises are properly instructed and performed

Clinical Pitfalls to Avoid

1. Overlooking Exercise Therapy: Exercise is essential but often neglected in favor of pharmacological management alone 4
2. Insufficient Instruction: Patients need specific guidance rather than general encouragement to exercise 1
3. Lack of Follow-up: Benefits may diminish over time without reinforcement and monitoring
4. Ignoring Pain Signals: While some discomfort is expected, exercises causing significant pain should be modified

Hand exercises and stretches should be considered a cornerstone of treatment for hand arthritis, with evidence supporting their role in improving symptoms and function when performed regularly and correctly.