Ten slow fists at the sink, and the honest odds for stiff hands

Move it monday

There is a jar of Carol's bread-and-butter pickles in our fridge door, and last week I could not get the lid off.

I tried a dish towel. I ran the lid under hot water. I slid a butter knife under the rim, a trick my father swore by. The lid did not budge… and the base of my right thumb ached like a bad tooth. Carol took the jar, gave it one twist, and handed it back. She has never lifted a weight in her life.

So I did what I always do… I went and read. The base of the thumb, where it meets the wrist, is one of the most common spots for osteoarthritis in the hand. Osteoarthritis is the wear-and-tear kind. The smooth pad on the ends of the bones, called cartilage, gets thin. The joint gets sore and stiff, and grip gets weak. It also likes the last knuckles near the nails, and the middle ones.

But then I read what helps. Much of it was what I feared: pills, splints, and shots. But high on the list was something that costs nothing. Move the hand. Not hard, and not fast. Slowly, and most days.

Why a stiff hand needs to move

Here is a thing I did not know. Your fingers have almost no muscle in them. They are pulled by tendons, the tough cords that tie muscle to bone. Most of the muscles that bend your fingers sit in your forearm. Make a fist and you can feel them work just below the elbow. The tendons run down through the wrist like the strings on a puppet.

Each finger joint sits in a small sac of fluid. That fluid is the joint's own oil. Movement helps spread it over the cartilage. Or put another way, a joint that sits still all night tends to be stiff at dawn. That is why so many of us wake with hands that feel like they belong to someone else.

NICE, the body that writes health rules for doctors in Britain, says all people with osteoarthritis should be offered exercise. Its 2022 advice names muscle strength work as one kind. It also warns that joints can hurt more at first, and that sticking with it is where the gain lies. That goes for hands as much as for knees.

The move: the slow fist

Sit at a table. Rest your forearm on it, with your palm turned to the side as if you were about to shake hands. If your hands are stiff, run them under warm water for a minute first. That is my habit now, at the kitchen sink, while the coffee drips.

Now bend all four fingers slowly into a fist. Take about three seconds. Keep your thumb on the outside, across the front of your fingers, not tucked in. Do not squeeze hard. The aim is to close the hand, not to crush a thing.

Then open slowly, over a count of four. Spread the fingers as wide as they will go and hold for one breath. Let the hand go limp. That is one. Do ten, then switch hands.

Here's the thing I got wrong for a week. I made a tight fist, as if I meant to punch someone. My thumb hated it. A soft fist is the move. And if a joint is hot or puffed up that day, skip it and try again the next day.

It may ache a bit at first. NICE says to expect that. A mild ache that fades within the hour is fine. Pain that lingers into the night is a sign to do fewer. Sharp pain, or a knuckle that swells up, means stop.

Both halves of the evidence

Now the honest part. In 2017, Cochrane looked at exercise for hand osteoarthritis. Cochrane is a group that gathers all the good trials on one question and weighs them up as a set. It found seven trials, with 534 people in all. That is a small pile of proof.

Exercise helped a little. Pain was scored from 0 to 10. People who did not exercise sat at about 3.9 at the end. Those who did came in half a point lower, at 3.4. Stiffness fell by 0.7 points on a scale of the same size. In other words, a small gain. Some of you will feel it… and others will not.

But Cochrane rated the proof as low quality. That means the true effect could be quite far from what the trials found. The trials were small. And people knew they were doing the moves, which can tilt the results. The authors said plainly that it is open to debate whether gains this small matter in a person's day. I respect that… few reviews say it out loud.

There is one more study I keep going back to, though it is about a different disease. Rheumatoid arthritis is the kind where the body's own defense system attacks the joints. In 2015, The Lancet ran a British trial called SARAH. It took 490 adults with sore, stiff hands from 17 sites of the NHS, Britain's public health service. One group got their usual care. The other also got a daily set of stretch and strength moves for the hands and arms. After a year, hand function on a 100 point scale had risen about 8 points in the exercise group. Usual care alone rose about 4. So a real gain, and a modest one.

That is not my kind of arthritis, and it may not be yours. But it tells me daily hand work, done with care, is not a reckless thing to do. Three of the Cochrane trials kept track of harm, too. They found very little, and none of it was serious.

So I keep at it. Ten slow fists at the sink each morning, then ten O's. Has it fixed my thumb? I have no idea. It feels a bit looser by the time I sit down to eat, but I cannot say how much of that is the warm water. We'll see. The pickle jar is still Carol's job… and I have stopped saying I loosened it for her.

Here is to a looser grip,
Walt

The Health Brief is for education only. It is not medical advice. Always check with your own doctor about your own situation.