Monday, 7 July 2014

Move It or Lose It!!

For whatever reason, hand therapists have been a bit behind the ball when it has come to recognising the influence of proprioception on the joints of the hand and wrist. Proprioception has been poorly defined by brevity in the past; now it is best understood as a word that describes the sensory, motor and processing components that help a joint maintain its' stability during functional movement (Hagert, 2012). Unfortunately that definition doesn't mean much to a lot of people, and it's importance in hand and wrist health is not appreciated. 

So rather than force a patient to sit down with a dictionary, or lecture them until their eyes glaze over, I talk about the act of doing. Because if you are "doing", you are probably involving your proprioceptive skills. And if I can convince you to do your doing in a particular manner, then you can amplify those proprioceptive skills.

Osteoarthritis of the hand joints
Why is this important? Well, take oseoarthritis (OA). The lay understanding of this disease is that it refers to the loss of the layer of cartilage over your bones at the joints. When the cartilage is gone, you have bone on bone which is painful. That's osteoarthritis. Yes... to a point. Osteoarthritis is probably a disease that starts well before the cartilage is gone and the bone is degenerate. A new classification system has recommended that OA in the joints is a direct result of OA in the ligaments (McGonagle, 2010). As the ligaments weaken, they aren't able to provide joint stability, and the joint itself becomes stressed leading to bony OA (Tan, 2006). Follow that thinking, and we're back where we started, at proprioception.

Do circus elephants have better joints than their jungle cousins?
Perhaps, if we can convince patients at risk of developing OA (pretty much everyone), to use their hands in such a way that stress is minimised but importantly maximises proprioceptive input, the ability of ligaments to do their job will be enhanced. It goes beyond strength, and movement through a prescribed range because they are only two points of the triangle. Proprioceptive tasks need to be included to ensure joint stability is maintained, and in the case of injury, rehabilitated. That's the why. The "how" is a different matter all together! 

Look after those fingers,


Hagert, E., Mobargha, N. The role of proprioception in osteoarthritis of the hand and wrist. Current Rheumatology Reviews 2012; 8(4) 278-284

McGonagle, D. The anatomical basis for a novel classification of osteoarthritis and allied disorders. J Anat 2010; 216(3): 279-91.

Tan, AL. Combined high resolution magnetic resonance imaging and histological examination to explore the role of ligaments and tendons in the phenotypic expression of early hand osteoarthritis. Ann Rheum Dis 2006; 65(10): 1267-72

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