Major exercises for rheumatoid arthritis

                                   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. 

ROLE OF EXERCISES:               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 talk about  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.                        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.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.  

Before I continue, please remember that this article 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:These are joints and muscles exercises. It is important to maintain the muscle strength because they will help  to stabilize the joints and avoid deformity. 

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 1:Metacarpophalangeal (MCP)  Flexion,   

                                         Now 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. First is flexion and the other is relaxion. 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. and repeat five times  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 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.  To avoid the formation of 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. . 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 start with five repetitions. 

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,  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. .

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.

 Four exercises  to strengthen the muscles. 

1. Eccentric wrist extension   

             You need a couple ofI rubber bands that vary in resistance levels. . You can start with the light ,Heavy And extra heavy  .                                                  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.                                          2:Gross grip Grab   

           Take   a soft ball, then squeeze it for 5 seconds. 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.                                                        3. Finger adduction     

                    Get a clean sponge place it in the middle of your fingers And press the sponge for 5 seconds. Then the other finger.  The other one. 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.

4. 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 ,the Carpo-metacarpal joint or CMC and 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. 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. 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.