3rd November – Duration: 5 Hours (3-clients).

 

My first client was online and a 34-year-old male suffering from hospital diagnosed degenerative osteoarthritis (Kumavat et al., 2021) which at this stage was impacting more on his hands, which had flared up and were now recovering.   I always feel sorry for younger patients who are afflicted with arthritis, as it is such a debilitating disease, however as a practitioner I am also aware, my primary role is to assist healing, prevent further injury and where appropriate provide appropriate advice.  As (Daste et al., 2021) revealed, movement via forms of exercise is the best treatment for most forms of arthritis, and when clients are physically able; minus too much pain, conduct such, should be encouraged to do so within capabilities, and in this case via simple hand exercises (Fig 1) as an intervention that aims to improve the client’s mobility and strength and therefore, improving his functional ability. I provided simple hand exercises including:

Fig 1: Hand exercises for arthritis

 

I always try and break my treatments down into workable chunks with mobilizing exercises (Increase or maintain range of motion) and strengthening exercises (using resistance from putty, a gel ball, or resistance or elastic bands to strengthen hand, fingers or wrist muscles).

There are many physical and medical conditions that may affect the hand and need exercise as an intervention to help patients to perform their ADL activities independently and increase the strength of handgrip.

My next two clients today had sprained finger injuries, which occurred three weeks previously playing rugby. I discussed this with both patients prior and with their agreement, booked them both in together, as I felt as they knew one another, receiving treatment together may be beneficial.  However, I am aware certain individuals may prefer to be treated individually for all sorts of reasons. Initial X-rays revealed no broken bones and previous assessments diagnosed ligament sprains (Volar plate & MTP) which were taped (Buddy & criss cross at back of joint) to immobilise, prevent further injury, and allow recovery (Fig.2).  Existing taping was gently removed to reveal all visible swelling had gone and ROM conducted revealing joint movement was achievable, but some pain remained with tenderness when passive ROM was applied.

 

Fig.2 Overview of Injured Joint

Individual finger exercises were provided to gently stretch the flexor digitorum profundus tendons and increase ROM and strength using various hand stretches (Fig.3) in conjunction with putty ball and resistance band exercises to exercise extensor digitorum communis and extensor pollicis longus. Wrist, forearm, and shoulder stretches were provided (if no pain on fingers were felt), to ensure no weakening occurred through lack of mobility. The fingers were retaped on completion of the session to protect them (Zu Reckendorf et al., 2021). Advice on using a tennis or sponge ball at home was provided and to continue to refrain from sport at this time.

 

As is normal with sports activists, both clients were keen to return to rugby training soonest, and I reminded them that this simple flexibility and strengthening exercises will assist to prevent future injuries. Loading will commence once no pain is evident (static holding with fingers only) and one arm dead hangs on a bar, into their rehabilitation once full ROM minus pain is achieved.

 

In treating various injuries, I have found many sports and non-sporting individuals are not overly knowledgeable on injury prevention or protection techniques in various sports or normal daily functioning (NDF) as (Steffen et al., 2010) examined, hence I will continue to research specific injury prevention mechanisms to pass onto my clients for the future.  In the case of finger injuries, which are often repeated in contact sports such as Rugby and Basketball, pre-taping (de Sire et al.,2021; Jones, 2013), is proven to prevent initial and re-injury.

 

Fig.3 Finger stretching & strengthening exercises.

 

 

References

Daste, C., Kirren, Q., Akoum, J., Lefèvre-Colau, M. M., Rannou, F., & Nguyen, C.

(2021). Physical activity for osteoarthritis: Efficiency and review of recommandations. Joint Bone Spine, 88(6), 105207.

de Sire, A., Curci, C., Ferrara, M., Losco, L., Spalek, R., Cisari, C., … & Solaro, C.

(2021). Effectiveness of kinesio taping on hand functioning in patients with mild carpal tunnel syndrome. A double-blind randomized controlled trial. Journal of Hand Therapy.

Jones, B. (2013). The Effect of Ankle Taping on Reactive Agility Performance in Male

Rugby.

Kumavat, R., Kumar, V., Malhotra, R., Pandit, H., Jones, E., Ponchel, F., & Biswas, S.

(2021). Biomarkers of joint damage in osteoarthritis: current status and future directions. Mediators of Inflammation, 2021.

Steffen, K., Andersen, T. E., Krosshaug, T., van Mechelen, W., Myklebust, G.,

Verhagen, E. A., & Bahr, R. (2010). ECSS Position Statement 2009: Prevention of acute sports injuries. European Journal of Sport Science, 10(4), 223-236.

Zu Reckendorf, G. M., Artuso, M., Kientzi, M., & Rouzaud, J. C. (2021). Collateral

ligament sprains of the metacarpophalangeal joint of the long fingers: Results of a surgical series of 15 patients. Orthopaedics & Traumatology: Surgery & Research, 102952.