HAND FUNCTION

Protecting Your Hands Without Resting Them Into Weakness

The best evidence says using your hands, with the right technique and the right splint at the right time, protects them better than sparing them does.

Week of September 18, 2026. Angelo Papachristos PT, ACPAC. RheumAcademy | Arthros Inc.

She put a jar of jam on the desk between us. She had brought it from home because she could not open it that morning, and she wanted me to see the moment, not just hear about it. Fifty-eight, rheumatoid arthritis for six years, well controlled on her medication. Her real question, once we got to it, was quieter than the jar: if my hands hurt when I use them, am I wearing them out faster, and should I be resting them in splints?

The fear underneath the question

The instinct makes sense. A joint hurts when you load it, so loading it must be damaging it, so the protective move is to use it less. Patients have been telling me some version of this for years, and older joint protection advice sometimes encouraged it, framing the hand as a thing to spare.

That framing is mostly wrong, and it costs people function. Hands that are rested lose grip and dexterity quickly, and weak hands struggle with exactly the jar, the key, the kettle that brought the person to clinic. The evidence we have points the other way. Structured use, sensible technique, and a splint chosen for a specific job protect hand function better than avoidance does.

The exercise evidence is better than most patients are told

The strongest trial in this space is SARAH, led by Lamb and colleagues in the Lancet in 2015. In it, 490 adults with rheumatoid arthritis and hand problems were randomised to usual care, or usual care plus a tailored programme of hand and wrist strengthening and stretching, taught by a therapist and continued at home. Hand function improved in the exercise group, and the improvement was still there at twelve months. The effect was modest, about four points on a hundred-point hand function scale, but it held at a year and the programme was cheap to deliver, which matters when you are deciding whether it is worth your time. Pain did not differ between the groups and no serious harms were recorded.

The follow-up is the part patients need to hear. When Williamson and colleagues went back to the same people at an average of 26 months, in BMJ Open in 2017, the exercise group was still better than where it started, but the gap between the two groups had closed, and most people had stopped doing the exercises. The benefit lasted as long as the habit did.

Two things about SARAH are worth carrying home. The exercises were done by people whose disease was already being treated with medication, so this was an add-on to good drug control, not a replacement for it. And the gains were in function, the thing patients actually feel, not just in a grip measurement. In my clinic, grip strength tends to track with how well people manage daily tasks, so building it is not a vanity number.

I told my patient that the jar was not evidence her hands were failing. It was evidence her grip had drifted down, which is a fixable problem, and one that gets worse the less she uses the hand.

Joint protection is a set of habits, not a set of rules you read once

Joint protection has real evidence behind it, but with an important catch about how it is taught. Hammond and Freeman studied an educational-behavioural joint protection programme for people with early rheumatoid arthritis, less than five years from diagnosis, with one-year results in Rheumatology in 2001 and longer follow-up in Clinical Rehabilitation in 2004. The finding that changed how I practise: the comparison group was not given a leaflet. They had eight hours of standard arthritis education, including two and a half hours on joint protection, and it still did not change what their hands did during the day. Teaching the habits behaviourally, with practice, problem-solving, and follow-up, did. At one year those people had less hand pain, less morning stiffness, and better daily function. At four years they were still using the techniques, with less morning stiffness and better daily function than the standard group.

What the habits actually are is unglamorous. Use larger, stronger joints for a job when you can, so carry a bag on your forearm rather than pinched in your fingers. Spread load across several joints instead of one, so lift a pot with two open palms rather than gripping the handle. Swap the tool, not the task: a jar opener, a wide-grip peeler, a lighter kettle, a key turner. None of this is about doing less. It is about doing the same things with less strain on the small joints that take the brunt of inflammatory disease.

Resting splints and working splints do different jobs

This is where patients most often get generic advice, and where the details matter. A resting splint holds the wrist and fingers still, usually worn at night. Some of my patients find one eases a painful night, but you should not expect it to improve your hand function or your grip. Adams and colleagues tested static resting splints in early rheumatoid arthritis in Rheumatology in 2008 and found no significant benefit for hand function, grip, deformity, or pain over occupational therapy alone. About a quarter of the people given splints never wore them, and the authors concluded that resting splints should not be routine in early rheumatoid arthritis. So a resting splint is a comfort tool for a painful night, not a treatment that changes the course of your hand.

A working or functional splint is a different device with a different purpose. In my experience a wrist working splint supports the wrist during tasks and can reduce pain while you do them, with the trade-off that it can get in the way of fine finger movement and sometimes reduces the very grip you were trying to use. Wear it for the heavy task, take it off for the fiddly one.

The best single splint trial is at the base of the thumb, the joint that gives out in hand osteoarthritis and makes pinching painful. Rannou and colleagues, in Annals of Internal Medicine in 2009, tested a custom-made splint for base-of-thumb osteoarthritis worn at night in 112 people. There was no difference in pain at one month. At twelve months pain and disability were both better in the splinted group, which tells you these things reward patience.

The guidelines agree on direction and are honest about certainty. EULAR's hand osteoarthritis recommendations, led by Kloppenburg, list thumb base orthoses with education and exercise as core non-drug care. The American College of Rheumatology's 2026 update, released this month as a summary ahead of the full paper, conditionally recommends hand orthoses for thumb base and finger joint osteoarthritis and rates the certainty of evidence as low. If your thumb base is the problem, ask specifically for a splint made for that joint, not a general wrist support.

Where the evidence is thin, and I will say so

We do not have good long-term proof that any of this prevents the joint deformities people fear, the drifting fingers and the bent thumbs. The Hammond trial did find fewer wrist and knuckle deformities in the joint protection group at four years, but it was one trial of 127 people, deformity was not its main question, and it has not been repeated. Resting splints did not change finger drift in the Adams trial. Modern medication does far more to prevent that than any splint or exercise, which is the honest order of importance. The hand programmes improve how your hands work and feel now and over the following year, for as long as you keep them up. That is a real prize on its own, and I would rather promise you that than a slowing of x-ray damage I cannot back up.

The splint literature is also mostly short and small, and much of it is in rheumatoid arthritis and thumb osteoarthritis specifically. If you have lupus, myositis, or spondyloarthritis affecting the hands, the exercise and joint protection principles still apply, but the trials were not run in you. The same goes for exercise in hand osteoarthritis, where the 2026 American guideline recommends it conditionally on low-certainty evidence, so a therapist tailoring to your hand matters more than any published protocol.

What to do, and the conversation to have

Ask for a referral to an occupational therapist or a hand therapist, and ask early rather than once the deformity is set. The best time to see one is when a task first gets hard, not after you have given it up. The 2026 American College of Rheumatology osteoarthritis update makes this a good practice statement: people whose arthritis limits daily tasks with the hands and arms should be referred to occupational therapy. A good therapist will build you a short home exercise programme of the SARAH type, teach joint protection as habits you rehearse rather than rules you read, assess your grip and pinch, and, if you need one, make or fit the right splint for the right joint and tell you when to wear it. Bring the specific tasks that are failing, the jar, the key, the buttons, so the plan is built around your actual day.

With your rheumatology team, keep the hand conversation tied to disease control. Persistent swelling and pain in the small joints can be a sign your medication needs adjusting, and no amount of splinting substitutes for that.

Questions for your care team

Can I be referred to an occupational or hand therapist for a tailored exercise and joint protection programme?

Is my hand pain a sign my disease control needs reviewing, or is it mechanical wear I can manage with therapy?

If a splint is worth trying, which joint is it for, is it a resting or a working splint, and when should I wear it?

Between visits, can I track my grip by which everyday tasks I can and cannot do (jars, keys, buttons, kettle) so we can see if the programme is working?

What this does not mean

Using your hands, and doing hand exercises, does not wear your joints out faster, and none of this is a reason to stop or reduce your medication. A splint is an add-on for comfort or a specific painful joint, not a replacement for disease control.

References

Lamb 2015 - SARAH hand exercise trial in RA. Lamb SE et al. Exercises to improve function of the rheumatoid hand (SARAH): a randomised controlled trial. Lancet. 2015;385(9966):421-429.
https://pubmed.ncbi.nlm.nih.gov/25308290/

Williamson 2017 - SARAH extended follow-up. Williamson E et al. Hand exercises for patients with rheumatoid arthritis: an extended follow-up of the SARAH randomised controlled trial. BMJ Open. 2017;7(4):e013121.
https://pubmed.ncbi.nlm.nih.gov/28404610/

Hammond 2001 - joint protection programme early RA one-year. Hammond A, Freeman K. One-year outcomes of a randomized controlled trial of an educational-behavioural joint protection programme for people with rheumatoid arthritis. Rheumatology (Oxford). 2001;40(9):1044-1051.
https://pubmed.ncbi.nlm.nih.gov/11561117/

Hammond 2004 - joint protection programme RA long-term. Hammond A, Freeman K. The long-term outcomes from a randomized controlled trial of an educational-behavioural joint protection programme for people with rheumatoid arthritis. Clin Rehabil. 2004;18(5):520-528.
https://pubmed.ncbi.nlm.nih.gov/15293486/

Adams 2008 - static resting splints early RA. Adams J et al. The clinical effectiveness of static resting splints in early rheumatoid arthritis: a randomized controlled trial. Rheumatology (Oxford). 2008;47(10):1548-1553.
https://pubmed.ncbi.nlm.nih.gov/18701540/

Rannou 2009 - splint for base-of-thumb OA. Rannou F et al. Splint for base-of-thumb osteoarthritis: a randomized trial. Ann Intern Med. 2009;150(10):661-669.
https://pubmed.ncbi.nlm.nih.gov/19451573/

Kloppenburg 2019 - EULAR hand OA management recommendations. Kloppenburg M et al. 2018 update of the EULAR recommendations for the management of hand osteoarthritis. Ann Rheum Dis. 2019;78(1):16-24.
https://pubmed.ncbi.nlm.nih.gov/30154087/

ACR 2026 - osteoarthritis guideline summary. American College of Rheumatology. 2026 Update of the American College of Rheumatology Recommendations for the Management of Osteoarthritis of the Knee, Hip, and Hand. Guideline summary, approved by the ACR Board of Directors September 8, 2026. Full manuscript not yet published.

This article is for education and does not replace individual medical advice. Your care decisions, including any change to medication, exercise, or splinting, should be made with your own rheumatology and therapy team, who know your history and your hands.

Angelo Papachristos PT, ACPAC. Advanced Practice Physiotherapist. Co-Founder, RheumAcademy. Co-Founder, Arthros Inc.

Hand Function