Why Choosing the Right Resistance Is More Than a Matter of Habit
In many rehabilitation settings, therapists gradually develop a "go-to" resistance level because it usually works. This approach remains effective—until it no longer does. Perhaps wound healing has progressed considerably since the previous appointment. Or perhaps a patient with rheumatoid arthritis has significantly less strength on a flare-up day than during the last treatment session. The resistance of therapy putty is not a minor detail—it is the primary variable that determines the effectiveness of the exercise. If the resistance is too low, the therapeutic stimulus is insufficient and meaningful adaptation fails to occur. If it is too high, newly healing tissue may be overloaded, and the exercise becomes frustrating rather than motivating.
Understanding Therapy Putty Resistance Levels
Across virtually all manufacturers, therapy putty is available in a range of resistance levels that are typically distinguished by color. These levels generally progress from very soft to very firm. Although this color-coding system is an industry standard rather than a medical guideline, it has become so widely established in hand therapy that it serves as a common language among therapists when selecting and discussing appropriate resistance levels.
From Joint-Friendly to Very Firm
At the lower end of the resistance spectrum is a joint-friendly option that offers only minimal resistance during fist closure and finger extension exercises. Our online shop also offers an especially gentle alternative with TheraPIE Putty Light. Unlike conventional therapy putty, this version is characterized by its lower density, resulting in a lighter overall weight. In addition, its lower viscosity gives it a softer consistency, making it particularly suitable for patients with limited load tolerance or sensitive joints.
At the opposite end of the scale are very firm resistance levels that challenge even individuals with considerable hand strength. Between these two extremes lies a range of intermediate resistance levels that allow gradual progression in small, clinically meaningful increments. The objective is not to reach the firmest resistance as quickly as possible. Instead, the goal is to select the resistance that best matches the patient's current functional capacity—and to reassess that choice regularly as rehabilitation progresses.
Assessing Functional Capacity: What Determines the Appropriate Resistance?
A patient's functional capacity is not a fixed value. It changes over time depending on the stage of healing after an injury or surgery, the underlying diagnosis, and even the patient's condition on a particular day. In clinical practice, three situations are encountered most frequently.
Newly Injured or Recently Operated Tissue
Immediately following an injury or surgical procedure, tissues are in the inflammatory and early proliferative phases of healing. During this stage, the primary goal is usually controlled movement, not strength development. If resistance exercises with therapy putty are indicated at all, they should only begin after clearance has been given by the treating physician or surgeon. The resistance should be low enough to allow smooth movement without compensatory patterns or an increase in pain. When in doubt, choose a resistance that is too soft rather than too firm.
Advanced Healing and Strength Development
Once tissue healing has progressed sufficiently and resistance exercises have been medically approved, the therapeutic focus gradually shifts toward strength and muscular endurance. At this stage, the resistance should provide a noticeable challenge while still allowing precise, well-controlled movement. In most cases, gradual progression over several treatment sessions is far more effective than making a large increase in resistance all at once. Biological tissues generally adapt more successfully to consistent, moderate loading than to occasional maximal stress.
Chronic Conditions and Functional Loading in Daily Life
Chronic conditions, such as hand osteoarthritis, require a different therapeutic approach. In these cases, the primary objective is rarely to achieve the fastest possible strength gains. Instead, the goal is to apply a level of resistance that supports mobility and hand function without provoking symptom flare-ups. Resistance should therefore be selected on an individual basis and reassessed regularly. A resistance level that feels appropriate on a day with minimal symptoms may prove excessive during a flare-up or on a day with increased pain and stiffness.
The 10-Repetition Rule of Thumb
A practical guideline commonly used in hand therapy is the 10-repetition rule. If a patient cannot perform an exercise with proper movement quality for approximately ten repetitions, the resistance is likely too high. Conversely, if the exercise feels effortless and no longer requires focused motor control, the resistance is probably too low. While this rule should never replace a professional assessment of the patient's healing stage, it serves as a quick and practical reality check in everyday clinical practice—particularly when treating several patients consecutively and there is limited time for extensive reassessment.
Clinical Example: Progressively Increasing Resistance
Returning to the patient introduced at the beginning of this article: following her flexor tendon repair, she has reached a stage where loading and exercise are well tolerated. She performs the prescribed exercises with the yellow therapy putty without any visible effort. After consultation with the treating hand surgeon and in accordance with her individual healing progress, the therapist decides to trial the next resistance level—the red therapy putty. The 10-repetition rule serves as the initial evaluation tool. If she is able to complete the exercise with good movement quality, the new resistance level is maintained during the following treatment sessions. If compensatory movements appear or the patient reports increased pain, the resistance is reduced again. Every adjustment is documented, ensuring that subsequent treatment sessions clearly reflect when and why the resistance level was modified. Once the appropriate resistance has been established, our article "Practical exercises with therapy putty" for practical exercise programs designed to improve strength, mobility, and coordination. For patients with limited load tolerance, a joint-friendly therapy putty such as TheraPIE Knete® Lightprovides an ideal starting point. The complete range of therapy putty resistance levels can be found in our Onlineshop.Frequently Asked Questions (FAQ)
How often should the resistance level of therapy putty be adjusted?
There is no fixed rule. In clinical practice, it has proven useful to briefly reassess a patient's functional capacity at every—or at least every second—treatment session and to use the 10-repetition rule as a practical guideline, rather than leaving the resistance unchanged for weeks at a time. Ideally, resistance progression should also be supported by regular grip strength measurements using a hand dynamometer. This allows therapists to objectively monitor improvements in hand strength and provide professional documentation for the referring physician.
Can I use therapy putty at home without therapeutic supervision?
Therapy putty can be an effective home exercise tool between treatment sessions, provided that both the exercise program and the appropriate resistance level have been determined in advance—ideally together with a therapist. However, in cases of acute injuries, recent surgery, or unexplained symptoms, the use of therapy putty should first be discussed with the treating physician or therapist.
Is firmer therapy putty always better for improving strength?
No. Excessive resistance can compromise movement quality and overload healing tissues. The appropriate resistance is the one that allows correct movement execution over multiple repetitions—not necessarily the firmest resistance level available.
Are there conditions in which resistance exercises with therapy putty should be avoided?
There is no universal answer, as the decision depends on the individual's diagnosis and stage of recovery. Caution is generally advised in cases of acute inflammation, recently treated injuries without medical clearance for loading, or severe pain. The final decision should always be based on an individual medical and therapeutic assessment.
References
- Howell J.W., Peck F. (2013): Rehabilitation of flexor and extensor tendon injuries in the hand: Current updates. In: Injury, 44(3), S. 397–402. https://doi.org/10.1016/j.injury.2013.01.022. URL: https://www.injuryjournal.com/article/S0020-1383(13)00035-1/abstract
- Kloppenburg M., Kroon F.P., Blanco F.J., Doherty M., Dziedzic K.S., Greibrokk E., Haugen I.K., Herrero-Beaumont G., Jonsson H., Kjeken I., Maheu E., Ramonda R., Ritt M.J., Smeets W., Smolen J.S., Stamm T.A., Szekanecz Z., Wittoek R., Carmona L. (2019). 2018 update of the EULAR recommendations for the management of hand osteoarthritis. In: Ann Rheum Dis. 2019 Jan;78(1): 16-24. doi: 10.1136/annrheumdis-2018-213826. Epub 2018 Aug 28. PMID: 30154087. URL: https://pubmed.ncbi.nlm.nih.gov/30154087/
- Kraemer W.J., Ratamess N.A. (2004). Fundamentals of resistance training: progression and exercise prescription. In: Med Sci Sports Exerc . 2004 Apr;36(4):674-88. doi: 10.1249/01.mss.0000121945.36635.61. PMID: 15064596. URL: https://pubmed.ncbi.nlm.nih.gov/15064596/
This article does not replace individualized therapeutic or medical assessment. The appropriate resistance level should always be selected in the context of the patient's diagnosis, stage of healing, and current functional capacity. Therapy putty can support the rehabilitation process, but it is not a substitute for professional therapy or medical treatment. If symptoms persist, pain increases, or there is uncertainty regarding progression of loading, further medical or therapeutic evaluation is recommended.
The IHHC Editorial Team is responsible for creating, reviewing, and continuously updating the content published by the International Hand Health Community (IHHC). Its mission is to present current knowledge from hand therapy, occupational therapy, physiotherapy, rehabilitation, and medicine in a way that is evidence-based, practical, and easy to understand.