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Survey Results: Dupuytren, Sports, and Floor Exercises

Survey Results: Dupuytren, Sports, and Floor Exercises

Many people with Dupuytren disease report problems with hand-intensive sports and floor exercises relating to their Dupuytren disease. How common is this? Is it all due to bent fingers or are there additional issues? This 2017 Dupuytren Research Group survey reviews the results of 504 participants with Dupuytren disease.

Survey participants were evenly divided by contracture: one-third had no contracture, one-third had contractures involving one hand, and one-third had contractures of both hands. Two-thirds of the study participants had undergone some type of procedure for contracture. 90% of right hands and 80% of right hands were affected. Three-quarters reported Dupuytren disease affecting both hands.

 

 

 

A small number of participants were excluded from analysis because they did not perform sports or floor activities. Of the rest, two-thirds reported Dupuytren-related problems with these activities.

 

 

Forty percent of patients with no contractures reported problems with some of these activities. Two-thirds of those with contracture of one hand and three-quarters of those with contractures in both hands reported problems.

 

 

Problems may be from Dupuytren or from its treatment. Nearly half of those without current contracture and three-quarters of with contracture had previously been treated for contracture. The next chart separates effects of contracture and prior treatment.

 

Patients without contracture have similar levels of difficulty with sports and floor activities whether or not they have had previous treatment. Patients with contractures have greater difficulties if they have had prior treatment.

 

 

 

What kinds of activities were most affected by Dupuytren? The survey listed 20 categories of activities. All 20 activities were reported to be affected by Dupuytren, some more than others. Click the image for more detail.

More than one in five Dupuytren patients with contractures of both hands reported Dupuytren-related problems with canoeing/rowing, golf, pushups, weightlifting, yoga, or combinations. This chart shows the percentage of people reporting problems with each broken down by those with no contracture, contracture of one hand, or contractures of both hands. Because not all activities are attempted by all people, this underestimates the actual effect.

Let’s look at these patterns. It’s not surprising that pushups and yoga are frequently reported by people with contractures: they require a flat palm. Why did over one-quarter of people with no contracture report problems with pushups – or with any of these activities? Why did over one-quarter of people with contractures report problems with activities which don’t require straight fingers – rowing, golf, and weightlifting?

These findings question the basic assumption that Dupuytren is simply a problem of bent fingers. It’s clearly not. Dupuytren hands without contracture are not normal, and procedures which straighten Dupuytren contractures don’t make hands normal. Dupuytren disease affects hand use well before any contracture develops. Pain, tenderness and awkwardness of use are more common than generally recognized.

This is borne out in comments by survey participants, listed below. They paint a very different picture than what is described in hand surgery textbooks. Some complaints could be due to arthritis, tendinitis, or other conditions, but the similarity of complaints is striking. In aggregate, they tell a story of a condition which can profoundly impact life, something far beyond the problems caused by a bent finger, something which is not made normal by any current treatments. They tell a story of a disease which needs a fundamentally different treatment than is currently available.

“Impossible to place full with on right hand, when palm down on the floor.”

“CrossFit is difficult. Any sustained grip such as on a pull up bar makes it even harder to open my hand even to the point of contracture. CrossFit requires moving from movement to movement often going from a closed grip (barbell, pull-ups) to an open grip (push-ups, burpees, hand stands).”

“Painful when I’m finished exercising.”

“It has gradually gotten worse to the point where it is now painful to grip a golf club with my left hand. I had surgery years ago on my right hand.”

“Also affects Pilates–of which I am a devoted practitioner.”

“Anything that requires grip, my hand gets easily fatigued, red, irritated and sometimes itchy afterwards.”

“Any floor work that requires palms to be flat on the floor, downward Dog, pushups, plank is painful.”

“Unable to put my hands flat.”

“Because my finger(s) are affected, I don’t utilize the proper musculature and there is an imbalance that results in my whole body due to this.”

“I’m an aerialist and my hand becomes tired faster now. I don’t have contracture yet, but I think that is partly due to the stretching we do to our hands.”

“Actually may have improved my golf swing since I can’t grip the club as tightly.”

“The inability to straighten all my fingers affects my ability to fully participate in the activities I checked in the previous page.”

“Tennis provoked wrist pain, which made me give up playing tennis. Pushups are hard to perform and put a lot of strain on the fascia palmaris and flexor tendons. I do gentle stretching of the fascia palmaris & affected flexor tendons to keep them at length as much as possible and follow a diet that keeps my inflammation low. Putting strain on the flexor tendons enhances the contracture.”

“My ring finger was affected so I could only use middle, index finger and thumb. I could not put my hand flat on the floor for planks so I did them from the forearm. Many times, I had to make a fist to get off the floor. Pull-ups appeared OK but I was using three fingers. When deadlifting I had to put the bar in the palm of my hand rather than gripping it. Even though my ring and baby finger wrapped around the handles for dumb bells and kettlebells I was only using the index finger and thumb.”

“Difficulty in grasping objects and holding something securely. Putting any weight on hands is very painful.”

“All floor exercises very hard unless using ‘fist to floor’ technique which also hurts… general pain from Dupuytren’s can affect other sports, particularly tennis in my case, although I still play.”

“I cannot put my hand flat on the floor, which makes it painful for some positions.”

“Extended hard gripping causes pain afterwards.”

“I have troubles when it comes to fully straighten my hands, especially doing push-ups, so I decided to get 2 blocks from work, 4” by 4” so that way I can lay only my palms on the blocks and not the fingers, almost like an L upside down. Yoga is more challenging to do. I can’t do the downward dog amongst other positions, it’s almost impossible, so I gave up doing it (sad). The other sports I don’t really do them so I don’t know if they affect me or not.”

“Chronic joint pain in both of my pinkies.”

“I could not do any of the activities mentioned, because of pain in both hands and fear of prompting additional lumps (I currently have 12 in right hand and 6 in left hand). The checked selections are ones I would like to do.”

“I have to adapt so choose floor and yoga exercises I can do comfortably or with only little pain but I do not like it as it limits my horizons.”

“Cannot do yoga because downward dog position puts too much stress on my fingers. I have even tried moveable push-up bars instead of lying my hands flat on the floor but not fast enough to keep up with the pace of the class. Golf still works for me and is my primary activity. My left hand has had surgery and right hand needle aponeurotomy. I am 77 and it all seems to have arrested.”

“left hand getting worse but not yet to point of right hand when needed surgery.”

“I am not able to put my right hand flat on any surface, but I have discovered yoga blocks that help me get around that problem (i.e., downward dog poses).”

“I find it hard to grip and keep the desired pressure and position on my tennis racquet and golf club.”

“My hand strength is limited after procedures for Dupuytren’s.”

“I had to give up all the sports I used to do.”

“I am a windsurfer, kitesurfer and I love riding bikes and playing guitar, and my Dupuytren’s has effect all – and am not sure how much longer I can do them for / for now I have given up windsurfing and just save it for special days / steroid injections have helped.”

“I help my 16 year old with his basketball practice. Lately I can’t grip the basketball as well as I would like to. I also practice cross ball with him and have done so often over at least ten years. Always prided myself on how well I played cross ball and my grandson Nash was very impressed so that made me feel special lately no so good. Very sad.”

“I can grip almost anything, but releasing my hands from gripping something is difficult and takes time.”

“I feel a lot of pressure in my palms and wrists.”

“Skiing is harder due to inability to hold poles correctly. Floor exercises are hard, as hands do not go flat.”

“Bearing a lot of weight on a dups hand during bench pressing, Olympic lifting and press-ups can be uncomfortable and sometimes painful where the bar rests on a raised lump.”

“The ‘on all four’ posture in which both palms are flat on the floor is difficult, thus affecting the ability to do many Pilates exercises.”

“Loss of some feeling in my fingertips from the surgeries.”

“Pain has increased significantly.”

“It’s hard for me to carry anything heavy or use my left hand, I have pain with the disease.”

“I need to clench my fist to bear Wright on my left hand. Holding the end of a single blade canoe paddle for more than an hour causes me a pain in my left hand as it rubs on the exposed nodules in the Palm of my hand.”

“Need to use two hands to grab large glasses or bottles.”

“Impact sports aggravate the condition and exacerbates the pain, also causes circulation problems.”

“I have difficulties with most activities requiring my hands.”

“I ride (a horse) and am quite limited in what I can do. Horse is good for me so I won’t quit!.”

“Difficulty reaching the brake level on my bicycle. Difficulty holding my camera and manipulating all of the buttons and lens. I can no longer get either hand flat on the floor, which affects yoga and general exercise. Difficulty holding ski/hiking poles for a long time. The fingers that have had surgery stiffen up and get very cold easily.”

“The nodule in my right hand hurts when cycling. I have a hard time getting skiing and cycling gloves on my left hand.”

“I have learned to adapt, but, it is more difficult as Dupuytren contractors. Thus, recent surgery.”

“My wrists are very stiff which limits rotation when I golf, Also doing push-ups or plank I need some sort of elevation for my hands because they cannot be flattened.”

“I often have trouble pulling on boots or lacing-up athletic shoes to go for a hike or run. I have trouble with lifting large pans while cooking, because my hands don’t have strength. I have trouble with certain gardening activities because of paint or trouble managing rakes, shovels, etc.”

“I have difficulty gripping, and weight bars or rackets put pressure on the nodules, which cause pain.”

“Don’t do things that put pressure or weight on my hands.”

“I don’t do a lot of sports mostly hiking, but I like taking the kids bowling and I cannot now. Of course, my right hand doesn’t lay flat so floor exercises are difficult and painful.”

“Hands flat on may is usually very painful. I haven’t done any climbing or bouldering in years but suspect that would be impossible for my hands now.”

“I cannot place my hand flat on the ground to do plyometric push-ups. I have difficulty doing burpees for the same reason.”

“I cannot climb out of a swimming pool.”

“Dr. operated on my right hand. The area addressed in the surgery is now MUCH worse. I can no longer grasp a glass. The span between the thumb and forefinger is continuing to narrow. I am not experiencing this symptom on the left hand. I have also developed a trigger finger on the finger operated. Yoga moves are requiring more and more modification. I cannot manage any position requiring putting my hands on the floor. Piano playing is out. I am three notes shy of an octave at full span on right hand and one on the left. The right ring finger depresses a key whether that note is in the chord or not. Grrrrr! The left hand is affected, though not to the degree that my right hand is. I wish I had never had the surgery. I say it only made the Dupuytren’s mad!.”

“Though not sports, many tasks like opening jars, difficult locks, buttoning, unbuttoning are problematic.”

“Difficulty pushing up off floor with hands – hard to push all my weight on them.”

“Drop things constantly. Difficulty in biking, braking.”

“Both of my hands hurt most of the time. I can’t count on them when strength is required. It is difficult to straighten them out fully and weigh bear. There are many crafts also that I have given up due to my hands.”

“Cannot lay hands on the floor to support my body.”

“I only checked those things that I have tried. Any of the activities would be a problem for me, due to hand sensitivity, not to mention Ledderhose. I golf but wear double gloves. I canoe but pad the paddle. I ride a bike, but also wear padded gloves.”

“Push-ups. Also, the vibration from weed eating is horrible in my hand. Just extra information.”

“After I started lifting lite weight training, I developed contraction in my left thumb. I don’t know if it was related to the weight training or not!.”

“I have problems with grip, but also a concern that these sports may further exacerbate the condition.”

“I tried yoga for several weeks. I tried to modify positions by using clenched fists (for push up type positions). This was very difficult and hurt my wrists. I had to drop out. I can’t catch a ball well if at all. This makes playing with the grandchildren difficult.”

“Not being able to get my hands fully flat makes it difficult to lift my body weight.”

“My grip action is affected, at times my badminton racket flies out of my hand. My right thumb has very little strength but luckily, I am left handed. Floor exercises cannot place my hands flat on the floor, affects getting up from the floor, as I cannot push myself up by my hands.”

“Can’t grip a football, basketball, baseball, even to play catch with kids and grandkids, can’t hardly get in any yoga postures to strengthen core so as to help degenerating discs in back, which was a great way to spend time with my daughter and wife.”

“Even though I can straighten right fingers, the right hand is still affected in yoga. It is difficult to flex the right hand backwards, very tight with lots felt in the fingers.”

“I have it in both hands. Worse in my right. My hands and knuckles are always stiff and sore. I don’t have good grip strength in either hand. So it really affects everything I do every day.”

“Hard to access my arm strength cause I distrust my hands.”

“Cannot place hand flat on floor. Cannot open hand fully. Scar tissue from surgeries limits hand movement. Occasional pain limits hand movement.”

“Use much lighter dumbbells because of fear of getting worse. Can’t do push-ups unless I roll something (mat) under my hands. Trying not to let it stop me from exercising and weightlifting. Can’t do most exercises involving hands on floor unless I roll something up.”

“Mostly affects ability to place my fingers evenly on the floor making my foundation less stable. Before my surgery, the contracture in my pinkie finger made it very difficult to do weight bearing doing yoga or push-ups.”

“Cannot do any floor exercises that require me to put hands flat on floor. ie pushups, squat thrusts etc. Hate it!.”

“Hurts to salsa dance bc if pulling on fingers/grasping while my hand palm is sore all the time.”

“Cannot interlace fingers and reverse hands.”

“Because I cannot put my hands flat on the floor, grip, and hold weights, it limits my weight bearing activities, which I should be doing as a Caucasian female over 40. It puts me at higher risk for osteoporosis. The Dupuytren’s is complicated by arthritis in both hands.”

“Typing.”

“Cannot do anything that requires use of hands. Cannot even hold a glass. Must use stemware or coffee cup.”

“The right and left hand contracture effects both my left and right arms in regard to full extension of fingers, and therefore anything attached to the movement of my fingers and hand.”

“In yoga, I cannot flatten my hands onto the floor for many poses so weight is not evenly distributed within my hands.”

“I have to do these exercises with a closed palm.”

“Dupuytren makes it important to cushion my hands when doing push-ups, which are less problematic when done on a carpeted floor but still require some additional cushioning. Before my hand surgeries (needle aponeurotomies), when riding my bicycle, I would have to be cautious about my little finger getting caught on the handlebar when dismounting the bike. The contracture makes holding a basketball quite difficult. A bowling ball is less problematic, but it does make holding the bowling ball less comfortable. And while this is not sports related, I can’t sit on the ground and put my arms in back of me to prop myself up, because the little fingers won’t sit flat, which makes the pressure on the fingers noticeably uncomfortable.”

“You cannot straighten my finger. It impossible to pick up a cup with one hand. Please help. I feel crippled. I work at a computer all day and I am falling behind because I am very limited.”

“I can’t fully extend my hands anymore and I especially can’t bend my hand back at the wrist as I once could making a proper pushup impossible. I can’t easily grip small diameter objects like a golf club as tightly as before. I had fat grips put on my clubs. I can grip tightly but not a narrow thing like a rope without some difficulty! Very frustrating since everything else is normal and I am a boat Captain!.”

“It prevents me from keeping a firm grip from anything I am holding such as a golf club, hockey stick or weightlifting bar.”

“Cannot do push-ups to straighten.”

“Cord has developed in several places in my left hand. Pressing my weight in a push up causes pain in my middle and 3d fingers.”

“It’s hard to do any floor activities.”

“Presently, I can no longer do any kind of gripping or pulling physical activity with my left hand without pain and aggravation of my DD. Whenever, I attempt to do so, I run the risk of my left hand becoming inflamed and triggering further progression. I need to be very cautious. My hope is my nodules and cords will toughen up overtime allowing me to be more active.”

“I do lap swimming and the Dupuytren’s in my hands and feet now makes this activity uncomfortable. I find anything using your handgrip is impaired. My fine motor skills are starting to be affected by the contracture – not a happy camper.”

“The cord between my thumb and forefinger makes it painful to ride a bicycle (I do ride a motorcycle frequently, and struggle a little with the clutch) or do push-ups.”

“Because of the lack of flexibility, I have to be much more careful. I broke my 3rd metacarpal while fencing because my finger was not able to bend backwards.”

“The problem is mostly the pain of pressure on nodules. Before surgery on my right hand, I was still able to use hiking poles, but with my little finger bent rather than gripping. A slip or fall might have been unpleasant.”

“I can do no exercise at all if there would be any contact with the palms of my hands. I can use only fingertips and then not for extended period of time. I was an athlete.”

“None of my fingers lie flat. Three on each hand are bent into the palm. Index fingers are both bent at least 40 degrees. No grip of any sort available on either hand.”

“Floor exercises become painful on my right hand.”

“Difficulty with biking.”

“I wonder if too much focus on hand/arm balances, handstands, etc. in yoga are what triggered my Dupuytren’s.”

“I can’t completely flatten my hand for push-ups or other floor/yoga exercises requiring a flat hand…doing pull ups/pat pull downs can be painful because it compresses the nodules on my palm; I d not tried a glove but don’t believe it will make much difference.”

“I cannot put my hands flat on the floor when doing any kind of floor exercises and including yoga. I usually put my weight on my knuckles or use a rolled up mat that allows me to rest me hands on something soft and curl my fingers into the mat.”

“Difficult handling, shooting a basketball. When doing pushups I have to use the base of my hand to contact the floor.”

“Nodules are my biggest problem with these activities. I use padded gloves, which so far makes it manageable.”

“Can’t close my hand around any racquets.”

“Can’t do yoga or push-ups.”

“My hands both hurt…esp. at night.”

“Have to either do push-ups on fists or with a special device. I do have a little uncertainty with some handholds while climbing but it does not totally prevent me from climbing. The little finger does hurt when trying to catch a hard thrown ball in the glove with baseball. As long as the little fingers can go around the piece of equipment, I can do the exercise. Quick releases are impossible, however. My feet have the disease but because I am a runner. The lumps have gone down and are not a problem even though they are minimal. The lumps are in the instep and have not affected the toes.”

“When I throw a ball for my dog, I cannot predict where it will go even though I always aim it forwards and beyond where the dog is waiting. Sometimes it actually goes up in the air and behind me now. I find it frustrating, but the dog loves the challenge.”

“I still ski although I have difficulty wearing gloves.”

“Some days and sometimes I seem to have slightly better or worse flexion ability in both or either hand.”

“Generally impedes getting up and down off floor for many activities.”

“I recently had my third Dupuytren surgery. Twice on my right hand and once on my left. I am currently experiencing symptoms again on the index and ring fingers of my right hand. I have been unable to lift weights for more than two years due to Dupuytren’s. This lack of activity has greatly reduced my muscle density.”

“When I do push-ups, I have to do fist pushups.”

“Pain on the front of knuckles if pressed. Also residual pain after exercises where affected fingers were stretched too much.”

“Without the bicycling gloves I wear regularly, my (post-op) palms get irritated after playing platform tennis or lifting small weights.”

“I so miss yoga. It was my salvation before Dup. I have tried to adapt by using gloves/props, but there is so much that requires putting weight into flat palms on the floor.”

“It is impossible to do traditional push-ups and other floor exercises. It is depressing not to be able to exercise and do the things that give me fun, entertainment and maintain a healthy lifestyle.”

“Gripping either the golf club or the tennis racquet is painful. Also, my grip is a loose grip, not as tight as before. Let’s just say I am lucky I have not hit anyone when it leaves my hand.”

“Floor exercises are hard with contracted fingers. I will compensate by curling up yoga mat to create a couple of inches of cushion under each palm, which keeps fingers elevated off of the floor.”

“It’s mainly my wrists, the initial cause of my getting Dup was the insult of left hand carpal tunnel surgery and middle finger trigger fix.”

“My hand will not lay flat I must get up using my fist.”

“It’s very difficult to even get down on the floor because I can’t flatten either of my hands because of curve fingers. I can only straighten one finger. Obviously, I can do no exercises that involve my hands.”

“I get cramps and throbbing pain after push-ups and punching I try to exercise regularly but pay for it with throbbing pain afterwards.”

“Nodules are painful when I do any of these exercises for any extended time.”

“Painful hands after any of these sports I also developed frozen shoulder so not able to do any sports.”

“Tend to avoid any activities that put stress on hand.”

“Sometimes painful to exercise where you have to place hand flat on floor.”

“The more I exercise the worse it makes my Dupuytren symptoms.”

“Banging affected fingers is painful. Had to change grip when paddling in kayak races.”

“The pain and seemingly aggressive progression of the DD make me favor my left hand. It’s not that I can NOT do these activities; it’s that I don’t feel comfortable adding any unnecessary stress to it. I suspect lifting weights is what triggered the onset of my DD.”

“I do not enjoy any group classes because the adaptations I have to do are embarrassing. I make adjustments for body weight exercises like push-ups. Bicycling is what I miss the most and I wish I could do yoga.”

“I had to cut back on weight lifting especially.”

“Pushups pull ups shaking hands typing.”

“I have breath difficulty washing my hair, hands, and body. Blow-drying my hair is hard because I’m not able to grip the brush. Many times my husband has to cut my food for me, rather embarrassing in public.”

“Group classes like HIIT or GRIT.”

“Any activity that would require me to “catch myself”, such as soccer and basketball, is severely hindered by my left hand’s fingers inability to straighten out. Attempting to do so is extremely painful and awkward.”

“When your fingers don’t straighten out getting up from the floor is a problem. I like to paint my house and clean but getting on the floor and up is out of the question. Even the hand a had surgery in is not straight enough to push me up….terrible.”

“Problems with lifting a heavy bar or hanging exercises.”

“My hands are constantly in pain and hurt to grip anything, pick up anything or stretch out my hands.”

“I have to alter the way I do activities to still do them. Doing anything that would require me to put my hand flat, for example; pushups, I have to bend the most affected fingers to my palm to put my hand on the ground or simply make a fist instead. When climbing a lot on a regular basis, I feel that my affected hand plateaus with its level of strength.”

“Biking was not in the list, but I”m unable to cycle due to the pressure on my hands.”

“Pilates.”

“Very discouraging….affects one’s ability to use the rest of one’s body for physical exercise or recreation.”

“I am able to get round the problem by knuckling my fingers, but can’t do as much this way.”

“Stiffness & pain in the affected hand, wrist and arm. Weakness in the affected hand.”

“Grip strength diminished, pain in palms leaning on bicycle handles, fearful of inability to engage bicycle hand brakes, squeezing any handle is uncomfortable – golf clubs, tennis racquet, etc. Hands hurt when used to aid in getting up off of the floor.”

“I have now pretty much given up teaching martial art weapons classes as this hurts now.”

“Trigger finger starts happening when gripping bars or stretching the palm.”

“Especially weight bearing – no contracture yet but when doing down dog, the top half of my ring finger goes stark white and has a compression ring around the middle joint. Very uncomfortable tugging.”

“Holding weights, pull downs and weight machines which require gripping. Yoga I do a lot of chair yoga. Climbing machine I need my gloves and only use one of many at gym due to being easier to use with gloves.”

“It is all but impossible to do any activities which requires a flat hand on the the ground.”

“It is difficult and painful to put my palms flat on the floor. Instead, I will rest my weight on my knuckles which is not very comfortable.”

“Had to quit most every sport. Had to stop jet ski and ATVing. Have a hard time getting up from anything i have to push up from. Can’t grip anything firmly. Very limiting disease.”

“Pain.”

“I can’t do anything that requires a flat palm/fingers (like pushups or planks).”

“I cannot grip any type of racquet for tennis or a paddle for kayaking because 3 fingers are curled into my palm. I practice yoga but have to do poses on my forearms because I cannot lay my hands flat.”

“Having limited range of motion in my ring finger also causes pain and irritation in my elbow when putting my hand on the ground.”

“Tough to do pushups.”

“I believe climbing activated my disease. My hands tingle and hurt when I grip. It also hurts when my hand is flat and planking etc.”

“Cannot put a lot of weight on hands.”

“Although I can get my fingers straight I cannot apply a lot of pressure (body weight) on either hand. It hurts too much and I could not lift myself off the floor using my hands.”

“Can not flatten my hands so cannot do pushups or any exercises using hands.”

“Pain and stiffness.”

“I had to stop all exercise due to this horrible disease!!!!”

This has to stop. Dupuytren sufferers deserve better. This is the goal of the Dupuytren Research Group.

Charles Eaton MD
Nov 1 2017

 

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