Basic Facts About Hand Grip Strength
Grip strength is the amount of force you’re able to generate when grabbing something. There are various ways to test grip strength, including an instrument called a hand dynamometer, which you squeeze. The dynamometer has a gauge that records the force of the squeeze. When someone with RA has trouble bending their fingers because they don’t have full range of motion (ROM), they’ll have a harder time getting any force behind their grip and record a lower score, explains Mary Ann Wilmarth, DPT, CEO of Back2BackWellness, located outside Boston. Dr. Wilmarth is a health and patient advocate for people with arthritis-related conditions and a psoriatic arthritis and osteoarthritis patient herself. The initial increase in strength was “likely to be partly due to effects of anti-rheumatic treatment, with reduced synovitis of wrists and finger joints,” explains Carl Turesson, MD, PhD, a professor at Lund University in Malmö, Sweden, and a coauthor of the study. “Hand training may also have contributed.” The participants in the study may have joined as part of rehabilitation, and some most likely performed home exercises, Dr. Turesson explains, though it was not formally part of the study nor was this information collected by researchers. Over time, however, deterioration of the joints can lead to a loss of grip strength. Further studies from the same group have shown that inflammation in the wrist has a major impact on grip strength, although other joint pain and general inflammation also contribute. Patients with severe pain and disability at the time of diagnosis were more likely to have impaired grip strength after five years. This may guide future structured rehabilitation. “The importance of hand training in patients with RA is nowadays widely recognized. In Sweden, it is recommended in the recently updated guidelines for management of musculoskeletal diseases from the National Board of Health,” Turesson adds. A study published in December 2020 in ACR Open Rheumatology compared the impact of psoriatic disease, which includes psoriatic arthritis (PsA) and psoriasis, and RA on hand function. The study assessed grip strength and fine motor skills, and participants also reported their experiences via questionnaire. There were 299 participants: 101 with RA, 92 with PsA, and 106 in the control group. According to the results, RA and PsA had a similar effect on hand function, and the impact was more pronounced in women.
RA Hand Grip Strength Challenges and Recommendations
Wilmarth takes a positive approach to the Swedish research and offers some encouraging words to people living with RA. “We need to continue to move forward and perform additional studies, taking into account medications, function, exercise, pain level, control groups, and as many variables as possible. This is not simple with such a dynamic area of the body as the wrists and hands.” she explains. And ultimately, the good news is that there was some good news from the Swedish study: “Grip strength did improve in the first year,” Wilmarth says. “The important things to remember here include the following: maintain function with your hands and all that entails, namely ROM, strengthening, self-care, rest, proper ergonomics, use of adaptive equipment and splints when necessary, modalities and medications,” says Wilmarth. “We have to figure out how to maintain grip strength with a disease that’s not predictable,” she says. “When we’re working with orthopedic issues, the condition is usually more predictable. RA and inflammatory arthritis are more difficult to deal with — no question about it — but that doesn’t mean we can’t deal with it. It just means we have to be patient and continue to work on strengthening.” Turesson adds, “With more intensive pharmacologic treatment and structured rehab training, even more pronounced improvement could be possible. My advice is to be active and work together with health professionals to find ways to improve function and reduce long-term disease impact.”
The Overall Importance of Strength
“It’s not an option to not keep up our strength,” Wilmarth stresses. To help you do that, consider Wilmarth’s beginner approach to hand grip strengthening.
Rest Your Hands, Fingers, and the Small Joints Within
Your hands rarely get a break. Whether you’re lifting, grabbing, writing, drinking, or doing dishes, your hands are constantly in motion and working. There are ways to use your larger muscles more effectively and let your hands and fingers focus on fine-motor work. Then they can save the power gripping for when it is truly needed. Place yourself in the most ideal ergonomic position. This will help your hands. Don’t try to power through when you feel any pain. Take a break. Your body is telling you what you need to do.
Accept Temporary Help That Frees Up Your Hands
To give your hands a bit of a break when you’re feeling weak or experiencing a flare, use assistive devices so you avoid further weakening or injuring the joints. “There are so many aids or adaptive equipment you can buy that can take stress off your hands,” Wilmarth says. “Be sure to use them when you’re not strong enough or anytime to prevent any injuries. If you need to wear a resting splint when you’re flared up or having problems, or when you’re asleep, for instance, be sure to do so.” RELATED: 8 Hacks to Help Rheumatoid Arthritis Hand Pain And Wilmarth stresses, “Don’t forget that activities of daily living, which incorporate everything you do in between formal exercise — driving, holding groceries, carrying laundry, using your smartphone — affect your hands as well.”
Exercise Your Hands to Keep Up Strength
If you’re living with RA or PsA, you must maintain your strength so you don’t further injure the joints in your hands. “If you don’t have strength to support the joints in the correct, neutral position, or any position, you are at greater risk of injuring them or risking pain,” says Wilmarth.
Take Medications and Work to Strengthen Hand Muscles
“We now take a two-pronged approach to treatment. Medications help systemically so you don’t get any erosion of the joints, and you also have to strengthen and work all muscles, so muscles become strong, balanced, and in the optimal position to prevent further deterioration of the joints,” Wilmarth says. “When you have an issue of weakness, or an even bigger issue, pain, the symptoms exist almost 24/7 for your hands. Women may have weaker grip strength as noted in some of these studies. And unfortunately, it doesn’t take long for grip to deteriorate.”
Grip Strength Basic Training
An important note: Check with your rheumatologist, physical therapist, or occupational therapist before starting any exercise plan or making changes to your current routine. “It’s essential to make sure it’s the right time to start,” Wilmarth says. Once you get the green light, give the following grip-strengthening routine a shot. Begin with a warm-up. This can be something as easy as walking around the house, riding a stationary bike, or doing some tai chi — anything that gets the body warm and the blood pumping — for about five minutes. “You just don’t want to start with cold hands,” Wilmarth says. “Some people with RA can have Raynaud’s [a condition that causes the blood vessels to narrow, preventing the blood from getting to the surface of the skin, turning affected areas white, blue, and cold], so don’t skip this step.” Follow up with some gentle ROM and stretching exercises. Sometimes putting your hands in a bucket of warm water while doing some easy ROM exercises can be helpful. It could be as simple as opening and closing your hands. Use your thumb to touch each of your fingers tip to tip. You may not be able to make it at first but go as close as possible. Make a little bit of a fist, trying to get your fingers down to your palm eventually. Next, move your wrist up and down as far as you comfortably can. First try with your fingers bent, then with them straight. Finally, make nice, easy circles with your wrists. “Always stay within your comfort zone. If necessary, do a half circle and reverse direction,” Wilmarth says. “If you’re having a bad day, don’t force anything,” she continues. “Remember, every day can be different and every person is different. Don’t compare your progress with anyone else’s.” Do some strengthening. Use a soft foam or stress ball, a towel, a clean sponge, or even some fun squeaky toys. You can also try this in warm water. Grip the item, hold for three to five seconds, and relax. “Think of this as a bell curve,” Wilmarth says. “Gently squeeze in, hold, and gently release.” Additional exercises. If you have been able to complete the movements above, and you have been cleared by your healthcare team, then you may be able to try the following exercises.
Sit down facing a table. Place your hand flat on the table and then gently lift one finger up off the table at a time. This will be just a minimal amount to begin with in a pain-free ROM.Gently spread your fingers and thumb apart from one another while your hand is flat on a table. Then bring your fingers and thumb back together.With your hand flat on a table, fingers together, gently walk your thumb away from your fingers, then walk your second finger toward your thumb, followed by your third, fourth, and fifth finger, in small movements as tolerated. Bring back to starting position and repeat as tolerated.Make the letter C with each hand. Lift your hand, curve your fingers downward and your thumb in, as if you were grabbing a small ball, forming the shape of a C. Straighten your fingers and repeat.Make a table shape with your hands. Hold them straight in front of you, fingers pointing up, then bend your fingers 90 degrees, if possible, while keeping the finger joints of each hand straight. Go slowly and be gentle.If you can pinch with your fingers, hold a piece of paper while pulling the paper with the other hand for a few seconds to start.End with a cooldown. This can be a mirror of your warm-up.
You can spread out your exercise over the course of the day — it’s okay to start with just one minute at a time if that’s all you can tolerate. Your goal is to build up to 10 minutes, two or three times a day, which includes all exercises. Eventually, you want to be able to perform 30 minutes at a time, after building up to this slowly over one to several weeks.
Try the Routine Often and Keep Comparing How You Feel
See how you feel later that night and then again the next day, Wilmarth suggests, saying, “Make sure nothing has gotten worse for you. After you’ve done it one day, repeat the routine a couple of days later. Then try every other day, building up from one to two to three times a day until you are doing 10 minutes of exercise two to three times a day as tolerated.” The important thing is to keep your hands moving and maintain and build grip strength. If all goes well, you can increase the amount of resistance you’re using. “As you progress, try different types of secondary gripping exercises,” Wilmarth suggests. “Gripping a pulley when doing upper back exercises, working on grip strength by holding free weights when doing biceps curls, or exercises with forearms when doing wrist flexion or extension — there are other ways to improve grip strength without working purely on grip strength.” Don’t forget that no two days are the same when you have a chronic illness. Make sure to listen closely to what your body is telling you and how you are responding each time you perform your exercises. Additional reporting by Beth Levine.
