Understanding Hand Osteoarthritis
- Dr. Brian Abelson
- 21 hours ago
- 9 min read
Osteoarthritis (OA) is the most common joint disease in the world. It occurs when the structures that support joint movement, cartilage, bone, ligaments, and surrounding tissues, gradually change over time.
Cartilage is the smooth tissue that allows joints to glide without friction. When cartilage begins to break down, the joint may become stiff, swollen, and painful.
Hand OA most commonly affects:
The distal interphalangeal joints (DIP), the joints closest to the fingertips
The proximal interphalangeal joints (PIP), the middle finger joints
The carpometacarpal joint (CMC), the base of the thumb
The thumb base is particularly vulnerable because it absorbs large forces during gripping and pinching.
Worldwide, hand osteoarthritis affects roughly 10–20% of adults over age 60, with higher rates in women (Kolasinski et al., 2020).
But the structural changes seen on imaging do not always explain the full picture.
Some people with obvious joint changes have minimal symptoms. Others with modest findings experience significant stiffness and pain.
To understand why, we need to look deeper.
Seven Forces That Keep Hand Osteoarthritis Alive
Joint Load and Repetitive Mechanical Stress
The hand performs thousands of tasks every day.
Pinching, gripping, typing, lifting, twisting, and tool use repeatedly load the small joints of the fingers and thumb. Over time, certain joints begin to absorb more stress than others.
The thumb base, for example, can experience forces up to 12 times greater than the force applied at the fingertip during pinch activities.
When joint motion becomes restricted or muscular support declines, load becomes uneven.
Some structures become overloaded while others underperform.
Over time, this imbalance contributes to joint irritation and degeneration.
But mechanical stress alone does not explain the whole condition.
Many people perform repetitive tasks for decades without developing severe symptoms.
Other forces are involved.
Loss of Motion and Reduced Joint Nutrition
Joints rely on movement to remain healthy.
Unlike many tissues in the body, cartilage has very little direct blood supply. Instead, it receives nutrients through a process called diffusion, where nutrients move through joint fluid during motion.
When joints stop moving regularly, fluid exchange decreases.
The result is a less nourished joint environment, increased stiffness, and reduced lubrication.
Pain then encourages further avoidance of movement.
This creates a cycle:
pain → guarding → reduced motion → increased stiffness → more pain.
This is why gentle movement and joint mobilization are important strategies in managing hand OA.
Movement helps restore fluid exchange and improves joint mechanics.
Soft Tissue Tension and Forearm Overload
The muscles that move the fingers do not actually live in the hand.
Most of them live in the forearm.
The flexor muscles close the hand and create grip strength. The extensor muscles open the hand and allow the fingers to straighten.
When these muscles become tight or overworked, they place additional tension on the finger joints and tendons.
Over time, this can lead to decreased finger mobility and increased pain.
This is why treatment often extends beyond the hand itself.
Addressing tension in the forearm muscles and fascial tissues frequently improves hand mobility and grip strength.
The hand works as part of a chain, not as an isolated structure.
Watch the video to the right as Dr. Abelson demonstrates his approach to treating hand osteoarthritis. In the video, he addresses not only the local joints of the hand, but also the surrounding structures throughout the kinetic chain that influence hand function.
His integrated approach combines soft-tissue techniques from Motion Specific Release (MSR), precise joint mobilization, and Traditional Chinese Medicine principles through acupressure to help reduce pain, improve mobility, and restore function.
Nervous System Sensitivity
Pain is not produced only by tissues.
It is produced by the nervous system.
When pain persists for long periods, the nervous system can become more sensitive, a process called central sensitization. In this state, the brain amplifies incoming signals from joints and muscles.
Small mechanical stresses may then feel disproportionately painful.
Muscles surrounding the joint may tighten reflexively, a protective response known as muscle guarding.
Guarding is not a sign of weakness.
It is the body attempting to stabilize an area it perceives as threatened.
The solution is not to force the system.
Instead, gradual exposure to safe movement, strengthening, and manual therapy helps retrain the nervous system to interpret movement as safe again.
Loss of Strength and Grip Decline
Grip strength is one of the most important markers of overall function.
When grip strength declines, simple tasks such as opening jars, carrying groceries, or turning a key become difficult.
Research has also shown that grip strength is closely linked to general health.
Large population studies have found that low grip strength is associated with increased risk of cardiovascular disease, frailty, and all-cause mortality (LaMonte et al., 2026) .
In other words, grip strength reflects more than hand health.
It reflects whole-body resilience.
This is one reason strengthening exercises play such a central role in osteoarthritis care.
Clinical studies show that targeted hand strengthening can improve grip strength and reduce pain in individuals with hand OA .
Strength restores confidence and function.
Inflammatory Load
Osteoarthritis is often described as “wear and tear.”
In reality, it is also an inflammatory condition.
Low-grade inflammation within the joint contributes to cartilage breakdown and pain sensitivity.
But inflammation is not limited to the joint itself.
Systemic factors can increase inflammatory activity throughout the body.
These include:
Highly processed diets
Excess sugar intake
Chronic stress
Poor sleep
Excess alcohol
Physical inactivity
These factors increase circulating inflammatory molecules such as interleukin-6 and tumor necrosis factor-alpha, which influence how sensitive joints become.
Reducing inflammatory load through diet, physical activity, and lifestyle changes can therefore improve joint tolerance.
Fear and the “Wear and Tear” Narrative
Perhaps the most underestimated factor is belief.
When people are told their joints are “worn out,” they often begin protecting them excessively.
Movement becomes cautious. Load decreases. Strength declines.
Ironically, this protective behaviour can accelerate functional loss.
The hands become weaker, stiffer, and more sensitive.
Pain increases, which reinforces the original fear.
But the human body is remarkably adaptable.
Even joints with structural changes can improve function when the surrounding muscles, connective tissues, and nervous system are retrained.
Confidence in movement is not psychological optimism.
It is part of rehabilitation physiology.
The Integrated Approach
Calm. Restore. Build.
Because multiple forces contribute to hand osteoarthritis, treatment rarely succeeds through a single intervention.
Stretching alone is not enough.
Medication alone is not enough.
Manual therapy alone is not enough.
Current clinical guidelines emphasize multimodal care that includes education, exercise, and self-management strategies .
Recovery typically unfolds through three overlapping phases.
Phase 1 – Calm the System
When joints are highly irritable, the first goal is to reduce reactivity.
During this phase the emphasis is on regulation.
Manual therapy can improve joint motion and provide sensory input that reduces protective muscle guarding.
Gentle mobility exercises help restore predictability to movement.
Warm water or paraffin heat treatments may reduce stiffness and improve circulation.
Acupressure and soft tissue techniques can decrease pain sensitivity around the wrist and hand.
Sleep quality and stress regulation also become important, because both influence inflammatory activity and nervous system sensitivity.
The objective is not fatigue.
The objective is to calm the system.
Phase 2 – Restore Motion and Function
Once sensitivity decreases, treatment becomes more active.
The focus shifts toward restoring movement and rebuilding functional capacity.
This phase may include:
Joint mobilization of the fingers, thumb, and wrist
Soft tissue work for forearm flexors and extensors
Dexterity exercises for coordination
Low-load strengthening of grip and pinch patterns
Functional training for daily tasks
Exercise programs that improve joint mobility and strength are widely recommended in international guidelines for hand OA management .
As movement improves, the nervous system gradually recalibrates its perception of threat.
Pain decreases as capacity increases.
Phase 3 – Build Strength and Resilience
Eventually rehabilitation must progress beyond symptom control.
Strength becomes central.
Progressive grip training, forearm strengthening, and whole-arm conditioning help distribute load more efficiently across the hand.
This reduces stress on the smaller joints.
Stronger muscles also improve joint stability and movement efficiency.
Importantly, flare-ups can still occur.
They are not failures.
They are feedback indicating that load temporarily exceeded capacity.
A brief reduction in load followed by gradual progression helps restore balance.
The goal is not a perfect hand.
The goal is a resilient one.
Conclusion
Hand osteoarthritis is rarely just a cartilage problem.
It is often a system that has remained in protection for too long, influenced by joint load
imbalance, reduced motion, soft tissue restriction, nervous system sensitivity, inflammation, weakness, and fear of movement.
When these forces reinforce one another, the hands begin to feel unreliable and stiff.
But persistence does not mean permanence.
The hands remain highly adaptable.
When the right inputs are applied in the right sequence, calm the system, restore motion, and build strength, pain often decreases and function improves.
The goal is not simply to reduce discomfort.
The goal is to help people keep using their hands for the things that make life meaningful.
References
Hennig T, et al. (2013). Hand exercises improve activity performance, grip strength, and pain in women with hand osteoarthritis, randomized controlled trial.
Hunter DJ, Bierma-Zeinstra S. (2019). Osteoarthritis. Lancet, 393(10182):1745–1759.
Kolasinski SL, et al. (2020). 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Care & Research, 72(2):149–162.
LaMonte MJ, et al. (2026). Grip strength and mortality in older adults. JAMA Network Open.
Østerås N, et al. (2017). Exercise for hand osteoarthritis. Cochrane Database of Systematic Reviews.
Ottawa Panel. (2005). Evidence-based clinical practice guidelines for therapeutic exercise in osteoarthritis. Physical Therapy, 85(9):907–971.
Overton C, et al. (2022). Clinical guidelines and management strategies for osteoarthritis.
Rogers MW, et al. (2007). Strength training improves grip strength in older adults with hand osteoarthritis. Journal of Aging and Physical Activity.
Terpstra SES, et al. (2022). Management of hand osteoarthritis. Hand Clinics.
Zhang W, et al. (2007). EULAR evidence-based recommendations for the management of hand osteoarthritis. Annals of the Rheumatic Diseases, 66(3):377–388.
DR. BRIAN ABELSON, DC. - The Author
With over 30 years of clinical experience and more than 25,000 patients treated, Dr. Brian J. Abelson is the creator of Motion Specific Release (MSR), a multidisciplinary assessment and treatment system that integrates biomechanics, fascia science, neurology, manual therapy, exercise rehabilitation, and acupuncture. He is an internationally recognized best-selling author of 10 books and 200+ articles, and has trained healthcare professionals through structured MSR courses and clinical education programs throughout Canada and the United States. Dr. Abelson practices at Kinetic Health in Calgary, Alberta, and continues to develop educational resources focused on long-term function, resilience, and the health trajectory shaped by everyday choices.
For patients, his goal is simple: reduce pain, restore movement, and build long-term independence. For practitioners, MSR provides a practical framework you can integrate directly into daily clinical care.
Why Choose MSR Courses and MSR Pro?
Elevate your clinical practice with Motion Specific Release (MSR) training and MSR Pro, a comprehensive, evidence-informed approach to musculoskeletal assessment and treatment designed to improve diagnostic precision, hands-on skill, and patient outcomes.
MSR proficiency goes far beyond videos and articles. True clinical mastery requires hands-on training, refinement of palpation and force application, and a deeper command of applied anatomy and biomechanics. MSR is a skill-based system built through deliberate practice, real-time feedback, and mentorship, where clinical reasoning and tactile execution come together.
Here’s why practitioners join MSR:
Proven Clinical System: Developed by Dr. Brian J. Abelson, DC, with over 30 years of clinical experience and more than 25,000 patients treated, MSR integrates the most effective components of osseous and myofascial therapies into a cohesive, repeatable framework. The system is grounded in clinical logic and supported by patient outcomes, with a clinic success rate exceeding 90% in decreasing pain and improving function.
Comprehensive, Practical Training: Courses blend rigorous clinical education with hands-on technique development. You’ll strengthen orthopedic and neurological examination skills while learning targeted myofascial procedures, fascial expansion concepts, and osseous adjusting and mobilization strategies that translate directly into daily practice.
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Unlock your practice’s full potential with MSR Courses and MSR Pro, and join a community of practitioners committed to excellence in musculoskeletal care.
YouTube Channel
Explore Dr. Abelson’s YouTube channel, Kinetic Health Online, with 200,000+ subscribers and 38+ million views.
The channel features a large library of evidence-informed musculoskeletal education, including Motion Specific Release (MSR) procedures that integrate fascial-based concepts, manual therapy, movement science, and select Traditional Chinese Medicine (TCM) principles.
You’ll also find:
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