Rheumatoid Arthritis is an auto-immune inflammatory arthritis that if it is not
treated it can slowly destroy the joints of the shoulders, elbows,
wrists, fingers, knees, ankles and feet. Medication and anti-inflammatory diet are
the most important methods to stop the disease and avoid joint destruction.
Exercises are used in conjunction with medications to preserve the function of the
joints, to avoid disability, to improve morning stiffness and to reduce pain.
So, today I will show 9 exercises that people with rheumatoid arthritis need to do everyday,
for the rest of their lives. Once they learn this routine, they can do anywhere, anytime,
and it doesn’t take more than 15 minutes. In the beginning, when you are learning you may
get confused and it may take half an hour, but with practice you will master this technique
and avoid a lot of problems down the road. So, let’s talk about Exercises for Hand RA
For these exercises you will need a bit of equipment:
A soft ball A sponge
An elastic band Resistance band
The hand is affected in almost all patients with rheumatoid arthritis,
and it is also a major cause of limitation for daily activities.
Therefore, I will focus today on exercises for the hand in this video.
Many years ago, there were some physicians and therapist who believed that exercises led
to more inflammation, cartilage destruction and more pain. We now know that this is not true.
There are many randomized trials showing that exercises contribute to the maintenance
of the healthy joints, decrease pain, reduce stiffness and deformities.
Medication and anti-inflammatory diet are the main treatments stop rheumatoid arthritis
Exercise is the best method to avoid disability from rheumatoid arthritis
and preserve function of the hands Remember: Motion is lotion
And remember that many people with rheumatoid arthritis may develop OA,
or osteoarthritis, so it is better to start exercising to prevent OA on the top of RA.
What are the best types of exercises for rheumatoid arthritis?
I reviewed a large randomized trial of exercises for rheumatoid arthritis,
and I will demonstrate the best exercises here:
General Exercises are highly recommended. These are not exercises focused on the hands.
They are aerobic or cardio exercises, range of motion, walking, swimming,
biking, and dancing. Watch my other video here where I demonstrate dance for arthritis.
Before I continue, please remember that this video is for educational purposes only. If you have
rheumatoid arthritis, ask your physician or your physiotherapist if you can do these exercises.
In case of emergency go to the nearest emergency department or call an ambulance.
If your hands are swollen, you may want to apply ice to reduce the inflammation. If they are stiff,
especially in the morning, you may apply heat or use a hot pack to warm up the synovial liquid.
If you have instability or hypermobility of the joints, these exercises may cause some
dislocation and more pain. How do you know if you have instability or hypermobility? First,
you should ask your doctor or your therapist if you have this or not. The joints will be moving
beyond of the normal range of motion and doing a lot of popping sounds and will be very painful.
Let’s talk about the specific hand exercises now. There are mainly two type of recommended
exercises: mobility to preserve the range of motion and strengthening. I’ll show 5 mobility
exercises and 4 exercises to strengthen the muscles. It is important to maintain
the muscle strength because they will help to stabilize the joints and avoid deformity.
I’m going to use this worksheet to take notes of the repetitions. I’ll put a link
to this document in the description of this video below, you can download it there.
Let’s start with mobility exercises. Also called range of motion exercises.
When you do these exercises remember that motion is lotion. The more you move, the more your
synovial membrane will produce synovial fluid, and synovial fluid is what lubricates the joint. Now,
if these movements are aggravating your pain, please talk to your doctor
or your therapist. You may need some help with pain medications or anti-rheumatic drugs.
The first exercise is Metacarpophalangeal (MCP) Flexion, these are the joints between the hand
and the fingers. It is where the thumb meets the index finger.
They are also known for the large knuckles. These joints do two movements.
Flexion and Extension. we'll practice these movements
now don't do anything with the thumb now keep the wrists aligned let's start with five repetitions
and hold for five seconds one two three four five and repeat five times one two three four five
one two three four five so you repeat this as many times you can in the beginning
take note in your worksheet and also how many seconds you can do and try to increase
the repetitions to 10. once you can do 10 repetitions then try to hold for 10 seconds
2 Tendon gliding. The muscles that move
our fingers are in the forearm. You may feel them here if you move your fingers.
The tendons that connect these muscles to these bones have to pass through some
pulleys in the hands. So, this exercise is
to lubricate the pulleys and the joints. I have another video about trigger finger,
which is a thickening of the pulleys. It is very common and painful among people with rheumatoid arthritis.
To avoid the formation of this callus in the pulley, we need to move slowly, and regularly.
You see, the fingers have phalanges. The thumb has two phalanges, the other fingers
have three phalanges. They are called proximal phalanx, middle phalanx and the distal phalanx.
And between the phalanges we have the inter-phalangeal joints,
the proximal and the distal We call them PIP and DIP
Proximal interphalangeal joint and distal interphalangeal joint.
This is an excellent exercise to move all tendons that are attached to all phalanges.
We have tendons on the back of the fingers that do the extension of the fingers,
or straightening of the fingers. These tendons are attached to muscles in the dorsum of the forearm.
Then, we have tendons at the front of the fingers, they do flexion of the fingers,
or bending. These tendons are attached to the muscles in the front of the forearm.
I recommend starting with the hands up, this helps to reduce swelling of the hand.
Keep the thumb quiet. We will come back to the thumb later.
Let’s start with all fingers straight Try to straighten them and
don’t move your wrist side to side. Keep your forearm, wrist and fingers aligned.
If you can’t do this with them up, then you may support them on the table, or on your lap.
so the first position is one straight line, the second position is the hook,
so bend the distal and middle phalanges, keep the metacarpal phalangeal joint straight,
hold for five seconds. One, two, three, four, five. so now you bend the metacarpophalangean
joint. this is a full fist. hold for five seconds. and the fourth position is the tabletop. and the
fifth position is the full fist. Here, you keep the distal phalange joint straight. so
let's start with five repetitions. Okay. and we're going to hold for five seconds. so we start with
a straight line. One, two, three, four, five, the hook, one, two, three, four, five, the full fist,
the table top, and the last one the fifth position. One,
two, three, four, five, and start all over again. repeat five times and take note on your worksheet
how many repetitions and how many seconds you were able to hold, then increase the repetitions until
you can do 10 repetitions. once you can do 10 repetitions then increase to 10 seconds, hold .
3. Finger abduction In addition to bending and straightening,
in medical terms we say flexion and extension, the fingers also do other movements.
They open and close.
This is really important because we do a lot of activities of pinching and holding things.
The muscles that control these opening and closing are inside the hand, here in the metacarpal area.
This movement of opening and closing we call abduction and adduction.
Any movement that brings a body part close to the centre is called adduction.
So, when I do this with my shoulder, this is adduction. Any movement that moves a body part
away from the centre is called abduction. So, this shoulder movement is called shoulder abduction.
So, let’s do finger abduction. Hold for 5 seconds. Now, let’s do finger adduction. Hold for 5
seconds. Repeat this 5 times.
As you progress, increase to 10 repetitions. Then increase to 10 seconds hold.
4. Finger radial walking One of the common deformities that we see in
hands of people with rheumatoid arthritis is called ulnar drift or ulnar deviation.
The forearm has two bones, the ulna and the radius. Ulnar deviation means that
the fingers are bending towards the ulnar side. It happens because of how the arthritis affects
the metacarpophalangeal joint. This exercise is to prevent this
deformity from happening. If this deformity already has happened, then this exercise will not
be effective to correct the deformity, in this case, the person may need surgical correction.
Place your hand on a table, or on your lap. Start moving the fingers to the radial side.
One by one. Start with 5 repetitions.
As you become better at doing this, you may increase to 6, 7, 8, 9 and 10 repetitions.
5. Wrist circumduction The wrist is the where the radius
and ulna connect with the bones in the carpal area of your hand. There are many joints there.
These joints are commonly affected in rheumatoid arthritis.
So, hold the forearm. Start doing circular movements to the right,
Then to the left. Start with 5 repetitions.
As you become better at doing this, you may increase to 6, 7, 8, 9 and 10 repetitions.
Take notes on your worksheet.
Now we will do four exercises to strengthen the muscles.
6. Eccentric wrist extension I have a couple of rubber bands that I bought
on the Internet. They vary in resistance levels. This green one is extra light.
You can start with this one Then progress with the light
Heavy And extra heavy
I think I am missing the middle one here. I’ll put the link to buy these elastic loop
bands in the description of the video below. So you can purchase them. You hold them with your fingers,
so you are already strengthening the fingers, and then you fix your elbows close to your body. move the wrists backwards. Start with 1 set of 10 repetitions, then
Increase to 2 sets of 10 repetitions And then 3 sets of 10 repetitions.
So you are strengthening the muscles inside of your hand. And also the wrist muscles. If you get tired you can stop.
You don't need to do all of them at once. 7. Gross grip Grab a soft ball,
then squeeze it for 5 seconds. One
Two Three
Four Five
Start with 1 set of 10 repetitions, then Increase to 2 sets of 10 repetitions
And then 3 sets of 10 repetitions. You can also increase the amount of seconds that you hold the ball.
You can carry the ball in your purse, in the car, when you are in line waiting. So you can be doing this exercise anywhere.
8. Finger adduction Get a clean sponge
Place it in the middle of your fingers And press the sponge for 5 seconds.
One Two
Three Four
Five. Then the other finger. One, two, three, four, five. The other one. One, two, three, four, five.
You see? It is not easy in the beginning. And you do this for both hands. Then you can start increasing the number of seconds.
Hold up to 10 seconds. And also increase the number of times you do per day. And take notes in the worksheet to see your progression.
9. Pinch grip This last exercise will involve the thumb.
Make sure that you don’t have instability of the thumb.
There are two important joints that move the thumb, the CMC and the MCP
This one is the Carpo-metacarpal joint or CMC This one is the metacarpal-phalangeal
joint or MCP. Ask your doctor or your therapist
to tell you the situation of your CMC and MCP. If you have instability, then you may need to
restrict the movements of these joints and wear some splints to avoid dislocation and more pain.
If you don’t have instability, then it is safe to do thumb exercises.
This pinch grip exercise you need a soft ball or a sponge.
Grab it between your thumb and alternate with each of the other fingers, the index finger,
the middle finger, the ring finger and the pinky finger.
In medical terms we call them digit 2 or D2, Digit 3 or D3, D4 and D5.
Press tight Start with 1 set of 10 repetitions, then
Increase to 2 sets of 10 repetitions And then 3 sets of 10 repetitions.
Try to do these exercises daily. If you have pain,
you may apply a topical anti-inflammatory, but ask your doctor or your pharmacist first.
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