Updated: Nov 8
Hand osteoarthritis (OA) is often perceived as an irreversible affliction characterized by cartilage erosion and bone reshaping in the hands. Delving into its pathogenesis, especially the role of chondrocytes and inflammation, opens avenues for proactive management. This article highlights the synergistic approach of manual therapy and exercise in alleviating hand OA symptoms. Through tactile interventions and tailored exercise, we aim to mitigate pain, improve mobility, and challenge the debilitating narrative often accompanying hand OA.
Manual Therapy & Exercise
Conclusion & References
The Onset of Hand OA
Hand OA is marked by the slow wearing down of cartilage, a soft padding between the bones in our joints. Cells known as chondrocytes, living in this padding, are crucial for keeping it healthy. However, during hand OA, these cells undergo changes that contribute to the breakdown of cartilage. At the same time, the bones start to reshape due to ongoing joint damage. Both chondrocytes and certain cells driving inflammation actively partake in these processes, speeding up the progression of hand OA.
Chondrocytes in Action
In hand OA, chondrocytes are not merely bystanders but active responders to the condition. They release specific enzymes, like matrix metalloproteinases (MMPs), that act like scissors, snipping away at the cartilage structure and putting a pause on the creation of collagen, a key building block of cartilage. This off-balance between the breakdown and rebuilding of cartilage speeds up the wear and tear of cartilage tissue. When chondrocytes trigger an inflammatory response, it further fuels this destructive cycle, advancing the journey of hand OA.
Inflammation stands as a key player in the unfolding of hand osteoarthritis (OA). Cells geared towards fighting infections, like macrophages and lymphocytes, find their way into the soft tissue surrounding the affected joints. These cells release certain substances like IL-1 and TNF-α, pushing forward the breakdown of cartilage and ushering in more inflammatory substances. This inflammation kicks the destructive processes in hand OA up a notch, leading to increased pain and difficulty in movement.
Certain factors and lifestyle choices add fuel to the inflammation fire, speeding up OA's march. Lack of movement, skipping exercise, and carrying extra weight contribute to a body-wide inflammation. Regular exercise can tame these inflammatory responses, while sitting around tends to fan the flames, making hand OA worse. What we eat also weighs in. Diets heavy in processed foods, saturated fats, and refined sugars can stir up inflammation, weight gain, and insulin resistance, speeding up cartilage breakdown in hand OA.
Lighting up a cigarette is another wrong turn on this road, ramping up systemic inflammation. The harmful chemicals in cigarette smoke rev up inflammatory substances and block the body's attempts at repairing tissue, inflicting more cartilage damage in hand OA.
Manual Therapy and Exercise: Keys to Management
For tackling hand OA, the significance of non-invasive methods like manual therapy and exercise can not be overstated. Manual therapy, through techniques like joint loosening and soft tissue handling, can trigger several biochemical and physiological reactions leading to better joint movement and function. These techniques may spark the release of natural painkillers and anti-inflammatory substances, like endorphins and cytokines, easing pain and inflammation, and providing a relief for those grappling with hand OA.
On the biochemical front, exercise holds a vital part in keeping cartilage healthy and supporting joint function. Right amount of pressure on joints during exercise can boost the delivery of nutrients to the cartilage through joint fluid, encouraging cartilage cell metabolism and the creation of extracellular matrix parts like proteoglycans and type II collagen, essential for preserving cartilage health and structure.
Exercise also launches growth factors and curtails destructive cytokines, nurturing a balanced environment that promotes cartilage repair and rejuvenation over breakdown. Besides, exercise strengthens muscles around the joints, boosting joint stability and lowering the mechanical stress on the troubled joints in hand OA. This can help diminish the mechanical sparks of inflammation and cartilage wear, adding a valuable layer to the management of hand OA.
Advocating Manual Therapy and Exercise as Frontline Solutions
Elevating manual therapy and exercise as primary maneuvers in the management of hand OA is bolstered by a plethora of advantages, with scientific backing. Foremost, these methods are non-invasive and carry a lower risk profile.
Manual therapy tactics can trigger the release of internal painkillers and anti-inflammatory agents, effectively alleviating discomforting symptoms like pain and inflammation. Exercise, conversely, amplifies the delivery of nutrients to the cartilage, fostering a healthy metabolic activity in cartilage cells, and orchestrating a harmonious balance between tissue-building and tissue-breaking processes in cartilage tissue.These biochemical changes can potentially slow the disease progression.
Manual Therapy Demonstration
The following video provides tangible demonstrations of MSR procedures tailored for managing hand OA. A number of our patients have found these procedures to be highly effective in diminishing or even nullifying their symptoms and in slowing down the advance of hand osteoarthritis. Often, maintenance care has been instrumental in achieving these outcomes.
Stop Arthritis Pain - Hands and Wrists
In this video, Dr. Abelson, the architect of Motion Specific Release, showcases highly effective procedures for tackling OA in the wrists and hands. These treatments extend relief to individuals with OA through gentle manual techniques zeroing in on precise areas of the hand and wrist.
Treatment Frequency Recommendations
The proposed treatment regimen is designed to ensure a tailored approach that evolves with the patient's progress and comfort level. Sustained dialogue between the patient and healthcare provider is pivotal in fine-tuning the treatment frequency and strategy for enhanced tinnitus management.
Below, a potential treatment plan is presented based on either a positive response to treatment or the persistence of symptoms. For achieving optimum outcomes, patient adherence to both treatment sessions and home exercise is crucial.
Initial Treatment Phase:
MSR Manual Therapy: 2 sessions per week for two weeks to address hand OA.
Home Exercises: Daily functional exercise programs as prescribed by the MSR practitioner.
Evaluate the patient's response to therapy during follow-up appointments, typically after two weeks of treatment.
MSR Manual Therapy: Reduce to 1 session per week as symptoms alleviate.
Home Exercises: Continue daily routines; adjust as necessary based on professional advice.
MSR Manual Therapy: Maintain frequency at 2 weekly sessions, reassessing the treatment approach after two weeks.
Home Exercises: Re-evaluate and modify exercises under professional guidance, ensuring correct technique and adherence.
When performing manual therapy for hand OA, treatment should continue as long as there's an improvement in symptoms and function. If progress is noted and functional goals aren't yet met, ongoing therapy can be beneficial. If there are no noticeable results, only marginal improvements, or if progress plateaus, then treatment should be reconsidered or halted.
You should transition to maintenance care once the patient has achieved consistent symptom relief and optimal functional levels, ensuring that the achieved progress is sustained and potential recurrences are minimized. All decisions should be based on regular assessments and patient feedback.
MSR Manual Therapy: Monthly sessions or as needed for symptom management.
Home Exercises: Daily routines to maintain benefits and prevent symptom recurrence, with periodic reviews by healthcare professionals.
When considering treatment for tinnitus using MSR protocols, the primary focus is on achieving optimal results. The treatment plan is tailored, starting with four sessions in the initial phase. Based on the patient's response, sessions may be adjusted. The number of required visits is based on achieving the best possible outcome for the patient.
Exercise is a cornerstone in the management of osteoarthritis (OA), serving to fortify joint stability, enhance mobility, and mitigate pain. When harmoniously combined with manual therapy, the duo unfolds a synergistic effect, fostering not only physical alleviation but also encouraging a proactive engagement towards self-management of OA. Manual therapy can initiate the journey by alleviating pain and improving joint mobility, laying down a more conducive terrain for exercise. Subsequently, a well-tailored exercise regimen can maintain and further these gains by strengthening the muscles surrounding the joints, promoting a balanced joint load, and enhancing overall functionality.
Hands and Thumb - Self-Myofascial Release
This self-myofascial release video is an excellent way to release tension in your hands and fingers. These techniques combine compression, rolling and several pin and stretch procedures.
Hand Mobility Exercises - Bharatnatyam Inspired
In this video Kamali Abelson, who is trained in classical Indian dance (Bharatnatyam), demonstrates three exercise to increase your mobility and increase your neuromuscular control. In Indian dance hand gestures (Mudras), acting and pantomime is used to tell sacred tales from Indian Mythology.
Diet Inflammation and Disease Progression
Diet holds a pivotal position in managing hand OA and OA at large, where a balanced, nutrient-rich diet acts as a lever in dialing down systemic inflammation, decelerating disease progression, and uplifting overall health. Certain dietary elements are known allies in curbing inflammation and bolstering joint health. Consider the following elements:
Omega-3 fatty acids: Abundant in fatty fish like salmon, as well as flaxseeds and walnuts, carry strong anti-inflammatory credentials. They aid in lowering the levels of pro-inflammatory cytokines, thus easing joint inflammation.
Antioxidants: Including vitamins C and E, beta-carotene, and selenium, are the vanguards against oxidative stress, a common adversary in OA. Available in a colorful array of fruits, vegetables, nuts, and seeds, these antioxidants shield the cartilage from harm and put the brakes on OA progression.
Dietary Fiber: Housed in whole grains, fruits, vegetables, and legumes, extends its influence to inflammation control. It fosters a healthy gut flora, which in turn has been associated with reduced systemic inflammation.
Protein: Ensuring sufficient protein intake is crucial to preserve muscle mass and strength, forming a supportive network around the joints and minimizing mechanical stress on them. Sources like lean meats, fish, poultry, eggs, dairy products, legumes, and plant-based proteins like quinoa and soy stand as wise choices in this endeavor.
Processed Foods and Refined Sugars: Diets high in processed foods and refined sugars can trigger inflammatory responses. Studies have shown that processed foods and sugars can lead to the release of inflammatory cytokines, which can exacerbate OA symptoms and accelerate cartilage degradation.
Saturated Fats: Saturated fats, often found in processed foods, have been associated with increased inflammation. They can activate white blood cells to produce pro-inflammatory molecules, aggravating OA symptoms.
Trans Fats and Omega-6 Fatty Acids: Trans fats and Omega-6 fatty acids, when consumed in excess, can promote inflammation. Research suggests that high levels of Omega-6 fatty acids can lead to an increase in pro-inflammatory substances, which may worsen OA conditions.
Insulin Resistance: High consumption of refined carbohydrates can lead to insulin resistance, a condition linked to increased inflammation. Insulin resistance can potentially worsen OA symptoms and speed up cartilage breakdown.
Weight Gain: Weight gain, often propelled by diets rich in fats and sugars, can exacerbate OA symptoms not only through increased mechanical load on weight-bearing joints but also through systemic inflammation. When the body carries excess weight, it produces more inflammatory substances that circulate throughout the body, affecting non-weight-bearing joints such as those in the hands. This systemic inflammation can aggravate the symptoms of OA in the hands, underlining the importance of maintaining a healthy weight to manage OA effectively across all joints.
Stress and Cortisol: Stress, by triggering elevated cortisol levels, can heighten inflammation, thereby exacerbating osteoarthritis (OA) symptoms. Increased cortisol can accelerate cartilage breakdown, intensifying OA discomfort. Management strategies like adequate sleep and meditation can be instrumental in reducing stress levels, consequently curbing cortisol production and its inflammatory cascade, which in turn, may provide some relief in OA symptoms. This highlights the importance of a holistic approach, including stress management, in effectively managing OA.
Hydration: Adequate hydration is paramount in maintaining the health of cartilage, which is primarily composed of water. Drinking sufficient water helps maintain the elasticity of cartilage and the viscosity of synovial fluid, ensuring smooth joint movement and reducing friction that can worsen OA symptoms.
In conclusion, this article sheds light on the multifaceted nature of Hand Osteoarthritis (OA) and propounds a holistic approach towards its management, focusing on manual therapy and exercise as primary non-invasive interventions. Delving into the cellular intricacies, it highlights how chondrocytes and inflammatory processes play a pivotal role in the progression of OA. By juxtaposing the detrimental effects of lifestyle choices and the empowering benefits of manual therapy and tailored exercise, a pathway toward mitigating pain and improving joint function emerges.
Moreover, the interplay of dietary choices, weight management, and stress control further elucidates the potential of a comprehensive management plan. The tangible demonstrations of MSR procedures and exercise videos augment the article's practical utility, offering a hands-on approach to managing hand OA.
This narrative strives to challenge the debilitating perception of hand OA by promoting proactive self-management and fostering a symbiotic relationship between manual therapy and exercise. Through a blend of evidence-based interventions, lifestyle modifications, and patient-practitioner collaboration, individuals grappling with hand OA can envision a pathway toward enhanced mobility and a better quality of life. The overarching aim is to transition from merely managing symptoms to actively engaging in a lifestyle conducive to joint health and overall well-being.
DR. BRIAN ABELSON DC. - The Author
Dr. Abelson is committed to running an evidence-based practice (EBP) incorporating the most up-to-date research evidence. He combines his clinical expertise with each patient's specific values and needs to deliver effective, patient-centred personalized care.
As the Motion Specific Release (MSR) Treatment Systems developer, Dr. Abelson operates a clinical practice in Calgary, Alberta, under Kinetic Health. He has authored ten publications and continues offering online courses and his live programs to healthcare professionals seeking to expand their knowledge and skills in treating musculoskeletal conditions. By staying current with the latest research and offering innovative treatment options, Dr. Abelson is dedicated to helping his patients achieve optimal health and wellness.
Despite being in the field for over three decades, Dr. Abelson remains open to welcoming new patients at Kinetic Health, save for the periods he dedicates to teaching or enjoying travels with his cherished wife, Kamali. However, be forewarned, he will anticipate your commitment to carry out the prescribed exercises and punctuality for your appointments (smile). His dedication towards your health is absolute, particularly in ensuring that you can revel in life unimpeded. He genuinely delights in greeting both new faces and familiar ones at the clinic (403-241-3772).
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