Hands, Joint Protection, Exercises and Splinting
By Christina Macleod and Jo Adams
Taken from: NRAS magazine, Spring 2012
Hands are so important. Without thinking we scratch an itch, put on our clothes, pick up a pen and even more important wipe our own bottoms and pick our noses. I know that these are not nice things to think about but we all do them (well most us do even if we don’t admit to it!) But if you couldn’t do these things they would become really important to you. Some of us don’t mind if we have help to do things whilst of us may really not like asking for help. For most of us though it is important that we do our own personal care, scratch our own itches, clean our own teeth, put in our own contact lenses and blow our own nose. With the fantastic improvement in medication and care for people with rheumatoid arthritis, most people won’t have problems doing this kind of thing. But it is still vital that if you have a flare you do take extra care of your joints so that once the disease is under control again, as little damage has been done to your joints as possible, and you can get back to living a normal life without any limitations.
For your hands to work well you also need to take care of your wrists, elbows, shoulders and neck. The way to do this is to think about how you are doing things. Protecting your hands can be a three-pronged approach - joint protection, exercises, and splinting in that order.
Joint protection includes learning about how to use your joints in the best possible way. This helps you to avoid stress and strain on your joints and to treat them well.
To really get the most benefit from joint protection, research has shown that you need to do a 4 week course of two hours a week but sadly not many rheumatology outpatient departments have the resources to do this. Getting a referral to your occupational therapist for advice will help you access specialist advice on joint protection. Arthritis Research UK publishes a great little booklet called Looking after your Joints which will help you understand what joint protection involves. Get your self a copy, read it, get your family to read it and get them to help and support you make the changes needed.
Joint protection techniques get you to think about how you are using your hands to do daily tasks. If these daily tasks cause you pain in your hands, you need to work out a way of carrying out that action without putting strain on those joints. Try lots of different ways until you find one that doesn’t cause you pain. A useful tip is to get your family, colleagues and friends involved in helping you remember the best way to use your hand joints. Then they can help remind you when you forget! Try to make the new way of using and moving your hand joints become a new habit - we all know that changing habits takes time so don’t give up! To help, you may need to buy some gadgets. You might need to purchase a jar opener, L-shaped knife or change your bathroom taps to levers. Do try not to think of gadgets as disability equipment. Think of them in the same way that you would if you were to go on a diet or stretch before exercising. Gadgets like this are a tool to help prevent joint damage and even if you don’t have RA some hand deformities are common as you get older and some of us therapists even in our twenties/thirties use the L-shaped knife and jar key for opening jars to protect our joints. The other thing to remember is that small joints are far more vulnerable to damage than your larger joints so look after these little joints.
This is part of caring for your joints (there is a large UK national research project going on about this at the moment in which several hundred people are involved) so there is not currently research evidence to prove that hand exercises are beneficial or not. However, if you can exercise your hand and wrist muscles this should help protect from weakness and possible hand deformity. Healthy muscles will help strengthen the joints that are vulnerable. One of the main things to do is to exercise your joints to the fullest range once a day – that’s your shoulders, elbows, wrists, fingers and thumb. Do finger walking towards the little fingers using putty if you can. Get a referral to a physiotherapist for general exercises and a hand or rheumatology occupational therapist for hand exercises specific to your hands. Everyone’s needs are different but a therapist can help design and advise on an individual exercise routine.
This is something that a lot of people find useful at some point. Splints are for the most part to protect your joints and not to be worn all the time. The exception to this is when you have surgery or if you are trying to correct a swan neck deformity in your small hand joints. People report that they like wearing wristlets for painful wrists, or you can get wrist splints with metal in to hold the wrist in a more stable position. If you have swan neck deformity of your small finger joints then you might want to consider small finger based oval 8 splints or a silver ring splint. All these splints need to be fitted properly and your therapist can help you with this.