Osteoarthritis of the hands is a chronic, progressive degenerative disease of the joints of the hands, the main cause of which is the deterioration of joint cartilage. It is associated with pain, reduced grip strength, loss of range of motion, and joint stiffness, leading to impaired hand function and difficulty in performing daily activities. Guidelines for the treatment of OA emphasize the importance of non-pharmacological measures, such as physical therapy, use of orthoses and patient education, in reducing pain, improving mobility and increasing functionality of the affected joints and therefore improving quality of life. Non-pharmacological measures are recommended as first-line treatment or as part of a comprehensive treatment plan that is combined with pharmacological modalities. These approaches are supported by scientific evidence and are considered safe and effective for managing symptoms and improving functionality in patients with hand OA. According to the current evidence-based knowledge, there is moderate to high evidence supporting joint protection education, exercise, topical application of thermal procedures and the use of orthoses in hand OA, while there is low evidence for magnetotherapy, electrotherapy and acupuncture. The limited number of high-quality randomized studies on non-pharmacological treatment modalities limits international guidelines in providing recommendations with strong evidence for the effectiveness of individual non-pharmacological measures in the treatment of hand OA. In addition, there is a lack of recommendations on the optimal intensity and duration of exercise, which requires further research of high methodological quality to reach a consensus on this issue.