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. If you like this video, give a thumbs
up here and subscribe to this channel. Watch my next video here
Good bye
