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Managing Rheumatoid Arthritis in Hand Therapy
184 Plays4 days ago
This week, Megan sits down with Hand Therapy Academy to chat about rheumatoid arthritis management. From splints to exercises, she shares helpful tools that therapists can use right away.
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Transcript
Introduction to Megan and Rheumatoid Arthritis Management
00:00:06
Miranda Materi
Hello, I'm Miranda.
00:00:07
Megan
And I'm Megan, and we're Hand Therapy Academy.
00:00:11
Miranda Materi
All right, we have, we're back on with Megan. Megan, thanks for coming. She's been a therapist for four years and is a certified hand therapist as well. And we were just talking a little bit about managing um rheumatoid arthritis and how we do that as a hand therapist. But we were also talking about, um,
00:00:29
Miranda Materi
Like sometimes you feel like you're doing something for these patients and they're not getting better or they never get better. um So she's going to kind of share some tips and tricks that she's done and some things that she's had success with.
00:00:41
Miranda Materi
Okay.
00:00:43
Megan
ah Thanks for having me again.
Techniques for RA Management
00:00:46
Megan
I've been having more success with my RA patients lately, and I feel like I take a similar approach to it that I do kind of with some of my hypermobile Ehlers-Danlos syndrome patients. But a lot of times what I've been starting with is edema management and manual work to kind of, you know, bring blood flow, all those things we know to do to help with pain.
00:01:10
Megan
but then also compression to help with the inflammation and splinting for immobilization in that immediate timeframe when they're having a lot of pain, especially for the wrist. They've made some wrist splints that have helped kind of calm everything down.
00:01:25
Megan
And then as the inflammation gets better, the pain is getting better. They're not in a season of flaring. We've been doing some gentle strengthening with the putty, proprioceptive exercises, range of motion,
00:01:38
Megan
Even stretching for one patient that I thought it would be too painful, but he's been doing some wrist stretching and feeling a lot better afterwards and doing like stamping in the putty for more of like a stabilizing strengthening task.
Approaches for Younger RA Patients
00:01:51
Miranda Materi
Yeah, I think that's an interesting point that you make because I think we think about rheumatoid arthritis and we think we don't want to irritate things or we don't want to be doing strengthening stuff. um But actually, i think it's just doing the right strengthening stuff, right? Because we don't want to wear out their joints more than we have to, but also we don't we know that with stability, you know, you can have less pain if you have more stability in your hand and more strength in your hand.
00:02:15
Megan
Yeah, and I know that my patients, you know, a lot of them have been younger, relatively patients with RA. And I know that whether I do strengthening and stabilizing stuff or not, they're going to go home and use their hand. They're just going to be in pain when they do it.
00:02:30
Megan
So I feel like giving them that light strengthening kind of shows them one, how much they can tolerate with their hand that doesn't irritate it. So they don't overdo it and help stabilize those joints for a little more stability and decreased irritations.
Proprioceptive Exercises and Home Management
00:02:44
Miranda Materi
And what type of proprioceptive, I know it depends on the patient, but what type of proprioceptive stuff are you doing for the wrist?
00:02:50
Megan
For the wrist, things like gentle exercises that include motion with it. So a disc stacker, usually a light disc stacker. I don't even do the big, like full-size disc stacker.
00:03:04
Megan
wrist maze, if they can tolerate the motion it takes to do it A disc spinner, just anything that gets blood flow while also kind of giving that input to it. And then I also like doing a bead rotation in a cup.
00:03:17
Megan
So I have them go into supination and put a couple beads inside a cup that they can see in. and then rotate their wrist. It's kind of like using a gyro ball, but not as aggressive and have them try to glide the beads around the bowl really smoothly. So they're getting that input and they're getting that sensation of feeling where the beads are in the cup.
00:03:36
Megan
But again, it's not a super aggressive exercise.
00:03:39
Miranda Materi
Okay, that's a good one. And then what about for home? Are you like saying, oh, I want you to go home and do this stuff at home or how does that work?
00:03:46
Megan
Mostly at home, I'm working on making sure they're incorporating edema and pain management techniques because a lot of my patients, you know, they don't know those yet. They're not using them. So I start with contrast baths, elevation, icing if it doesn't irritate the arthritis, compression glove use, and then I'll add in you know, you could be doing...
00:04:07
Megan
a bead rotation. If you have a cup or a bowl and a ping pong ball at home, you could do that once a day. But to be honest, most of them like doing the exercises in therapy and then the pain and edema management at home has been helping them with their pain a
00:04:22
Miranda Materi
Okay. And then what, okay, so you talk about ice. What about heat? like what Like when you do ice versus heat for this clientele?
Using Heat and Ice in Therapy
00:04:30
Megan
So I do have them use heat if they're going to do exercises and be trying to stretch or use or move their wrist and then ice afterwards. I usually recommend ice in the evenings if it's painful.
00:04:42
Megan
And then instead of like heat, like we would typically think like a heat pack, I recommend hot water in the morning that they put their hand in and kind of loosen up their fingers inside the hot water, making a fist, opening their fingers.
00:04:54
Megan
I might even give them a light, like a yellow sponge to squeeze.
00:04:57
Miranda Materi
Thank you.
00:04:58
Megan
to help relax everything and loosen it up rather than like a stationary hot pack. So we use that kind of heat in the morning. And then that ice, usually I recommend doing it with a contrast bath so that it's dilating and constricting the blood vessels to bring fresh, healthy blood and also get rid of the swelling.
Exercise Introduction and Patient Education
00:05:16
Miranda Materi
Okay. I like that. And then I would say for like, so with these patients, um how do you know like what you're, like if you're giving them all this stuff, do you like add it in slowly so they don't, like how do you know what's going to irritate versus what makes them better or is it just kind of like a gut intuition thing?
00:05:34
Megan
I guess a little bit of both. I start slow. So I don't, I definitely don't do any strengthening on the first day unless I'm like really confident based on interviewing them and doing their eval that that's what we should be doing.
00:05:36
Miranda Materi
Yeah.
00:05:45
Megan
So I start with the exercises that have the least amount of motion and the least amount of weight. I focus heavy in the beginning on edema, pain management, doing a little more manual therapy to get some, you know,
00:05:57
Megan
gentle joint distraction and and stretching to increase mobility in their usually fingers or wrist. And then as they come back and are like, I felt great after that. I haven't had any pain all week. i'm like, okay, let's add in some light putty squeezing. And then if that feels good, we can start with some stamping. And i kind of very slowly add things in and I wait until the next week. Sometimes I'll do at least two visits of it if they're coming twice a week to see how they react to it before I add something new in.
00:06:28
Miranda Materi
Yeah, I think that's great. And that's kind of the beauty of seeing patients, you know, once or twice a week in the clinic is because you can advance them slowly versus, yeah yes, you could give them like six, x or you know, four exercises or whatever, but you don't really know how they're going to respond, especially with some of the more chronic complex cases.
00:06:47
Megan
Yeah. And especially just sometimes, you know, I get older men in here with RA, they're pretty stubborn. And I know if I give them exercises, they're just going to go home and do everything I gave them.
00:06:58
Megan
And they're going to come back in more pain. So I find it's better to just not even tell them about strengthening it until we get to a point where we can do it.
00:07:06
Miranda Materi
Yes. Yeah, that's very true. And then that comes with knowing your patients, right?
00:07:11
Megan
Yeah. Yeah. I'm like, you know what?
00:07:12
Miranda Materi
Yeah.
00:07:12
Megan
We can do some tending glides. If you really want an exercise to do at home on day one, that's a great one to do We'll look at other stuff later.
00:07:21
Miranda Materi
yeah Yeah. I feel like with like some of these conditions too, it's a lot of like just education too.
00:07:27
Megan
Yeah. I would say, especially the first visit or two, it's probably half education and half exercise or manual therapy.
00:07:28
Miranda Materi
similar
00:07:36
Miranda Materi
Right. So you may be showing them an exercise, but then teaching them something for home.
00:07:40
Megan
Mm-hmm. Yeah.
00:07:41
Miranda Materi
Yeah.
Engagement and Feedback Channels
00:07:42
Miranda Materi
Okay. Thanks for sharing all your tips, Megan. If our audience has anything they want to add or want to share, please reach out to us, info at hamtherapyacademy, or you can also reach out to us on Instagram at hamtherapyacademy.