Hand and foot Rehabilitation: How an Exercise Physiologist Can Help

The hand and foot are some of the trickiest conditions to manage, as we use our hands and feet every single day to live and move around. This can increase discomfort and limit recovery, however wit the right management plan, these conditions can be tackled with higher success and increased quality of life.

As an Exercise Physiologist, Nick specialises in hand and foot friendly exercise programs that promote joint strength, flexibility, and overall well-being.

ECRB tendinopathy (Tennis Elbow)

ECRB tendinopathy, also known as lateral epicondylitis or tennis elbow, is a condition characterized by pain and inflammation of the lateral (outer) part of the elbow. The condition is caused by damage or degeneration of the extensor carpi radialis brevis (ECRB) tendon, which connects the muscles of the forearm to the lateral epicondyle of the humerus bone in the upper arm.

What causes it?

The most common cause of ECRB tendinopathy, also known as lateral epicondylitis or tennis elbow, is repetitive stress or overuse of the forearm muscles. This can be due to activities that involve gripping, twisting, or lifting with the hand and wrist, such as playing tennis, using a computer mouse, or performing manual labor. Poor technique during these activities can also contribute to the development of ECRB tendinopathy.

Signs and symptoms

Pain or tenderness on the outer part of the elbow
Weakness in the forearm muscles
Stiffness in the elbow joint
Difficulty gripping or lifting objects, particularly with the affected arm
Pain that worsens with certain activities, such as gripping or twisting
Pain that radiates down the forearm
In some cases, swelling or redness around the elbow

These symptoms usually develop gradually over time, but can also occur suddenly in response to a specific injury

Treatment

Eccentric Strengthening Exercises - Eccentric exercises focus on strengthening the muscle while it lengthens. Eccentric strengthening exercises for the forearm muscles have been found to be effective in reducing pain and improving function in individuals with ECRB tendinopathy.

Soft Tissue Mobilization - Soft tissue mobilization techniques such as massage or instrument-assisted soft tissue mobilization can help reduce pain and improve tissue mobility. These techniques can also help increase blood flow to the affected area, which can promote healing.

1st CMC Osteoarthritis (Thumb Base Arthritis)

The 1st CMC (carpometacarpal) joint is located at the base of your thumb — where the thumb meets the wrist. This joint is responsible for many thumb movements, including gripping, pinching, and twisting.

Osteoarthritis (OA) of the 1st CMC joint is a form of "wear and tear" arthritis where the protective cartilage in the joint wears down over time. This can lead to pain, stiffness, weakness, and difficulty with everyday hand functions.

It’s one of the most common sites for arthritis in the hand — especially in women over 40.

Why does it happen?

As we age, joints can undergo natural degeneration. The 1st CMC joint experiences a lot of force through repetitive gripping and pinching (think opening jars, turning keys, using a pen). Over time, this can lead to joint instability, cartilage breakdown, and eventually osteoarthritis.

Symptoms

Pain at the base of the thumb
Swelling or tenderness
Weak grip or pinch strength
Difficulty with tasks like opening jars or buttoning clothes
A “grinding” or clicking feeling in the joint
Visible enlargement or bump at the base of the thumb (due to joint changes)

Treatment

Keep Moving! While rest during flare-ups is important, ongoing gentle movement helps reduce stiffness, maintain range of motion, and support the joint.

Strengthening Exercises – Tailored hand and thumb exercises can help improve stability and reduce stress on the joint. A physiotherapist or hand therapist can prescribe exercises targeting the muscles around the thumb and wrist.

Bracing or Splinting – A thumb brace can provide support, especially during repetitive activities or flare-ups. It helps offload the joint and reduce strain.

Activity Modification – Avoid or adapt activities that require strong pinch or repetitive thumb motion. Use assistive devices (like jar openers or ergonomic pens) to reduce stress on the joint.

Other things to be aware of:

Don’t panic about X-ray findings! A lot of people show signs of osteoarthritis on X-rays but have no symptoms at all. What matters most is how your thumb feels and functions — not just what the scan says.

Pain medications: Over-the-counter pain relief and anti-inflammatories may help during flare-ups. Talk to your GP or pharmacist to find what’s safe and appropriate for you.

Heat and cold therapy:

Heat can help loosen stiff joints (think warm water or heat packs)

Ice can reduce inflammation during flare-ups

Flare ups

It’s normal for symptoms to come and go. During flare-ups, the joint may feel more painful or swollen. This doesn’t mean it’s “getting worse” — it’s just part of how OA behaves.

Rest the thumb, use your brace, apply ice or heat, and continue gentle movement as tolerated. Avoid complete immobilisation for long periods.

DRUJ Instability (Distal Radioulnar Joint Instability)

The Distal Radioulnar Joint (DRUJ) is located at the outer edge of your wrist — where the two forearm bones (the radius and ulna) meet near the base of your little finger. This joint allows you to rotate your palm up and down (like turning a doorknob or using a screwdriver).

DRUJ instability occurs when the ligaments and supporting structures around the joint become stretched, torn, or weakened — causing the bones to shift or move more than they should. This can result in pain, weakness, or a “clunky” or unstable feeling in the wrist.

Why does it happen?

The DRUJ relies heavily on ligaments and cartilage to remain stable. Injury or overuse can affect these structures and cause the joint to become unstable.

Some common causes:

Fall onto an outstretched hand (FOOSH)
Wrist fractures, particularly of the radius
Ligament sprains or tears, especially of the TFCC (Triangular Fibrocartilage Complex)
Repetitive twisting or gripping activities
Congenital hypermobility – some people naturally have looser ligaments

Symptoms

Pain on the outer (ulnar) side of the wrist
Clicking, popping, or snapping sensations with rotation
A feeling of looseness or instability
Weak grip strength
Pain when lifting, twisting, or bearing weight through the hand

Treatment

Keep moving (sensibly!) – While it's important to avoid aggravating activities during a flare-up, complete rest isn't helpful. Controlled movement helps maintain strength and promotes healing.
Strengthening Exercises – A tailored programme that targets the forearm muscles (especially pronators, supinators, and wrist stabilisers) can provide the joint with better support. A physiotherapist can guide you through safe and effective exercises.
Wrist Bracing – A DRUJ-specific splint or wrist support can help reduce symptoms by stabilising the joint during everyday or high-load tasks.
Proprioceptive Training – Improving your joint’s awareness through balance and coordination exercises helps retrain your body to support the wrist under load.
Manual Therapy – In some cases, joint mobilisation or soft tissue release can help with stiffness or muscle tightness contributing to instability.

Other things to be aware of:

Scans aren’t everything – DRUJ instability often doesn’t show clearly on X-rays or even MRIs. Diagnosis is best made through a thorough clinical assessment that looks at movement, joint function, and symptom patterns.

Plantar Fascia Pain

The Plantar Fascia is a tendon-like structure that runs from your heel along the sole of your foot. This structure provides stability to the medial arch of the foot, particularly with gait (walking), running and jumping. If the plantar fascia is subjected to loads that it cannot tolerate, irritation and breakdown of the fascia can occur, leading to pain +/- inflammation.

What causes Plantar Fascia Pain?

Spikes in load that the plantar fascia cannot tolerate (such as a sudden increase in training, walking long distances in inappropriate footwear, or increase in jumping/changing direction activities) can lead to irritation and breakdown of the plantar fascia tissue. this can be referred to as Plantar Fasciopathy (previously plantar fasciitis). However, acute strains of the plantar fascia can occur as well, where you may feel a small pop in the sole of the foot following by pain, bruising, and pain with walking. This would be more indicative of a plantar fascia strain. In both cases, the treatment remains similar.

Signs and Symptoms

Pain at the sole of the foot or on the heel (generally medial to the heel itself as pictured)
Pain with the first few steps in the morning, which gets better as you get moving.
Pain after long walks or running
Pain with wearing footwear that is too flat or provides little support

Treatment

Activity modification – Reducing or modifying any aggravating activities or exercises. As a general rule, pain shouldn’t be higher than 3-4 out of 10 either during or after any given activity or exercise. If this is higher, the load/intensity of this exercise needs to be reduced.

Isometric Exercises, or ISOs – In the initial stages of rehab, Isometrics (or ISOs) of the calf/foot muscles (specifically targeting the plantar fascia itself) can help gradually build-up load capacity again with low risk of re-injury or pain flare-ups. In fact, ISOs can also have an analgesic effect on the fascia tissue, reducing pain immediately after the exercise. An Exercise Physiologist or Physiotherapist can help guide you on the correct dosage and intensity of your ISO exercises.

Gradual return to full activity – As pain permits, slow re-introduction into full load-bearing range of movement exercises of the foot and ankle. Again, pain levels should not rise to higher than 3 or 4 out of 10 when these types of exercises get introduced. Once these are more tolerable, a gradual return to full activity can start to occur. If you are returning to sport, introduction of plyometric (jumping and landing) exercises is strongly recommended.

Other options – if exercise-based treatment and activity modification doesn’t work in the medium-term (6-12weeks), local injection of corticosteroid into the fascia can help reduce the pain. However, this doesn’t fix this issue, as the muscle/fascia is still quite weak. What this CAN do is provide a relatively pain-free window to strengthen these tissues again without flare ups of pain, so that this does not become a recurring issue.

Achilles Tendinopathy

Achilles tendinopathy (previous called achilles tendonitis) is an overuse injury that causes Achilles pain in active adults. This condition usually coincides with spikes in activity or exercise intensity, which causes irritation and breakdown of the Achilles tendon due to a lack of load-bearing capacity.

What causes it?

As mentioned above, Achilles tendinopathy usually coincides with spikes in a combination of: exercise load, intensity, duration, or frequency. The tendon is not capable of supporting this spike and becomes irritated and starts to breakdown. This can happen in people who do a lot of running and jumping as part of their sport/training.

Signs and Symptoms

Pain felt in the Achilles/Heel, most commonly at the attachment of the Achilles at the bottom of the heel. It can also be sore in the middle of the tendon.
Pain worse initially into activity but improves as the tendon “warms up”.
Pain worse after activity, particularly in the morning
Pain aggravated by walking, wearing high-heeled shoes, jumping/landing from jumping, direct pressure over the tendon, going up or down steps or running.

Risk factors for Achilles tendinopathy:

Decreased calf strength (particularly if one side is weaker than the other)
Decreased use of calves for propulsion during running
Overweight/obesity
Prior lower limb fracture or injury
Taking ofloxacin (quinolone) antibiotics

Treatment

Isometric Exercises, or ISOs – In the initial stages of rehab, Isometrics (or ISOs) of the calf muscles (namely the gastrocs and soleus muscles) can help gradually build-up load capacity again with low risk of re-injury or pain flare-ups. In fact, ISOs can also have an analgesic effect on the tendon, reducing pain immediately after the exercise.

Gradual return to full activity – As pain permits, slow re-introduction into full muscle contractions of the calves, with a focus on technique. Again, pain levels should not rise to higher than 3 or 4 out of 10 when these types of exercises get introduced. Once these are more tolerable, a gradual return to full activity can start to occur. If you are returning to sport, introduction of plyometric (jumping and landing) exercises is strongly recommended.

Other things to be aware of:

Avoid compression and stretching – a tightness feeling can occur in the calves and Achilles when suffering tendinopathy. If this happens, avoid stretching the area, as the tendon does NOT tolerate stretching well! Instead, try some ISOs. Avoid anything that can compress this area too.

Injections – unless you have the co-injury of Achilles bursitis, corticosteroid injections can actually be detrimental to the integrity of the tendon, so these are to be avoided.

Hand and foot pain can make daily tasks challenging, but exercise therapy and rehabilitation can help you regain movement, strength, and confidence.

Book a session with Nick to start your recovery today.