♪ Bob and Brad ♪
♪ The two most famous ♪
♪ Physical therapists on the internet ♪
- Oh. - We're not even ready.
Hi folks, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- And we are the most famous physical therapists
on the internet. - In our opinion, of course.
- Today we're gonna talk about hand and finger fitness
to stop pain and stiffness after surgery
or if you just plain have arthritis.
- There you go.
- So these are things that unfortunately
plague a lot of people.
- Right, particularly the arthritis,
kinda like getting gray hair as you get older
for a lot of people. - Yeah, it tends to be
a part of life unfortunately. - Yeah.
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- The roller, Bob.
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So all right Brad, what are we doing here?
- Hand, wrist, you know, I just don't like to look at,
I know, I was just talking to a friend of mine,
she said she wanted to talk to me about some exercises
for her hands as they're very arthritic.
And actually mine are too in the last couple of years.
I get up in the morning and, oh, I--
- You're starting to feel it. - Cannot make a fist.
And if I force it, it hurts, it's no fun.
So you just don't wanna to get after it in any way.
There's a certain method and procedure to go through it.
It's not very hard, but you got to get
taken through it. - You just need to know it.
- There you go, or after a surgery, you know.
If you've had an injury, a broken wrist, your hand,
and you've been in a cast for six weeks,
you're gonna have stiff joints, stiff tendons.
And it's the same principle, either way you can work this.
And either way you're gonna be stiff
in the morning when you get out of bed.
- Yeah, and it's really important to understand
that actually movement is good for arthritis.
The more you get the synovial fluid moving,
the more you get the blood flowing, the better it is.
The only exception, I would say,
is if the arthritis gets so bad
that you just don't even wanna move the joint.
And that's pretty far along,
maybe a rheumatoid arthritis generally, but--
- Yeah, it's pretty severe and you probably know it by then.
So the first thing you do when you've got that,
where you can't make the fist and the wrist is stiff
and if you push it it's really, it becomes painful
and just like, you don't wanna do that.
- Yeah, you wanna work in the range that it allows you.
- Yup, so it's simply, and actually we're gonna start,
we call it proximal and go distal in the therapy world,
so we're gonna actually start in the wrist.
Don't worry about the fingers first,
get the wrist moving first.
- And you're doing this right away in the morning
in bed, right? - In bed,
before you get out of bed.
Yep, work that back and forth,
and you can do both hands at once.
- So this is flexion and extension
of the wrist. - Right, right.
I'm just gonna show you one, and do that the best you can.
And then you go ulnar and
radial deviation. - Radial deviation, yeah.
- And work that direction.
And then you can throw some circles in there,
clockwise and counter clockwise.
Usually about 10 repetitions of all these will be fine.
You'll know, but 10's a pretty good average for most people.
And then you get that wrist movement.
Then you go to the fingers, and this is simple.
Close the fist as tight as-- - As much as it'll allow.
- Right, yeah. - Comfortably.
- You can push it a little bit, then open it,
and then close it and just work it.
And typically the first time you close it maybe get to here,
but after about 10 of it you'll notice
it gets a little bit better.
But don't worry about getting it all the way tight.
Just, that's all I want you to do.
Then forget about it, get out of bed,
carry on with your activities of daily living
for the next 30 minutes or so,
and then come back and do the same exercises again.
Work your range of motion, and if they're a little tight,
now this time you can actually push a little bit
and go to the end range, 'cause we wanna get that.
Do your ulnar and radial deviation.
- Yeah, because over time,
if you don't stretch it a little bit,
you may start to lose the motion and then it gets worse.
So you wanna maintain the motion.
- And it's gonna be a little uncomfortable
but you don't have to push it into a sharp pain,
but just a stretch. - You can bump into the pain,
you can bump into it. - Yup, bump into it.
And again, 10 repetitions each way and work your circles.
It's kinda hard to push the circles,
that usually just works out with the,
after you did the passive range with the flexion
and the ulnar and radial deviation.
So, and then the fist here,
and hopefully by now you've got a little more range
and then you can get in, and what I do is,
I have my patients do as well as with myself,
I just go over the top and I'll give a full gentle squeeze
to see if you can get a full fist.
You may or you may not, but more than likely
you're gonna get more than you did initially in bed.
And then when you open it you just go palm to palm
and you can go this way and this way the best you can.
Now, if your fingers are so stiff you're still at this,
you haven't created the flat palm to palm,
you do the best you can and work it back and forth.
- Yeah, that's a great stretch to get all of them at once.
And you're getting into extension,
and that's the direction you tend to lose,
it tends to tighten up this way.
I might recommend too, Brad, that you might,
if you want to work the thumb a little more,
- Sure, you bet. - you could go to each finger,
and touch like that and then reverse.
- As a matter of fact, next week, or, yeah, next week,
we're gonna do one on just the thumb.
- Oh you are, I'm sorry.
Maybe I'm jumping ahead. - No, no, it's good
to forecast a little bit, Bob. - Throw a little thumb
in there so that, 'cause that joint is a little different,
it has a rotational component to it, where these don't.
- The opposing digit.
- That's opposing digit, that's right.
- In my case my third digit, my middle finger,
is much more painful, much tighter than the rest of them.
I really don't know why.
I know I injured it in the past, that's probably why.
So I do-- - Easy one to jam.
- Yeah, I do work that one more than the other ones.
I'll go strictly and do the same things
and focus on that finger a little bit more.
And it's actually developing a trigger finger syndrome,
it's kinda interesting. - It is.
That often comes along with arthritis, too.
- So don't get too concerned about that.
Then the next thing, you wanna keep the muscles strong
and do some for that, so after those first exercises,
later in the day this is what I recommend,
it works out well for most people,
is a ball that's got one of these squish
where we can, yeah, can you go into that?
It's got like the gel inside and you can work it.
I like it because you can work each individual finger
if you have one finger that's more stiff
or weaker than the other, you can kind of
touch your thumb in there. - Yeah, it's really flexible.
You can get them all, you can work one at a time.
And if you have too big a ball,
you're not getting way down into those intrinsics.
- Now this ball works okay,
but it's a little bit firm, it's not quite soft.
But it depends on the individual,
you got to look for-- - Yeah, the spikes
probably don't help either, do they?
- Well, actually it feels kinda good.
They're not hard spikes,
they're a little soft. - Oh yeah, I guess they,
I guess they don't feel too bad,
almost like a little massage.
- Yeah, it could be good for you.
So these are just balls that I buy
at like Walgreens or one of the big box stores.
You can go online, you can buy them all over the place.
And you can get them for a few dollars a piece.
You don't have to get the therapeutic expensive ones,
although you can if you'd like to.
- So we're gonna mention maybe just one modality, Brad.
So like if you wanted to, just a simple way
to make your hands feel better with arthritis
is called contrast baths.
So if you have two sinks, you fill up one with water,
pretty warm to the point where you still can tolerate it,
but it's about as hot as you can tolerate
without burning yourself.
And then the other one is completely cold water.
And you start off, you put your hands
in the hot water for like five minutes,
and then you go and put it in the cold water for one minute.
And then it's back and forth for one minute after that.
You start with five, then you go one, one, one, one, one.
- For how long?
- Well, you can do it for however long, 10 minutes, or--
- So you're gonna go back and forth
three to five times, or so. - Yeah, yeah, yeah.
- Yeah, I don't think there's any magic number
how many times you go back and forth.
And work your hands while you're doing it.
- And if you may not tolerate,
maybe your hands feel better in the cold,
actually my right hand feels good with cold.
- Does it really? It's not common,
but I had a patient that way.
She had an extremely bad knee arthritis
and she really liked cold packs, and like I said,
it's not common, but-- - No, that's not.
Well, that's why we always leave it up to people,
because it certainly doesn't hurt.
You know, what you can do is
you can fill up the one sink and do the dishes in it.
- There you go. - And then have
the cold in the other one,
so do the dishes for five minutes,
then put your hand in the cold water, then go back
and do the dishes. - Be productive.
- Yeah, that's right. - There you go.
We're all busy people, we've gotta get things done
while we're taking care of our hands.
- There you go, very good, so.--
- All right, we salute you with our hands.
- Good luck. - Yeah, good luck.
(brief gentle music)