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Published on July 11, 2012

Joint Protection Tips to Help Manage Arthritis

By Tammi Adam, MS, OTR/L, CLT, CPAM
Occupational Therapy, Avera Sacred Heart Hospital

Have you had a visit from your Uncle Arthur? How about a visit from Art? Many of us know who these folks are and have one in our immediate “family.” The Arthritis Foundation website (www.arthritis.org) indicates that Arthur, or Arthur-itis, affects many people. The website reports 27 million Americans are affected by osteoarthritis, and 1.3 million by rheumatoid arthritis. Even children are included in these ‘visits,’ with 300,000 American children challenged with some form of juvenile arthritis. 

Osteoarthritis is the most common form of arthritis, also known as degenerative joint disease. The lining of the joint (cartilage) wears down and allows the bony joint surfaces to rub together. This causes pain, stiffness and even loss of movement at the joint. Rheumatoid arthritis is a chronic disease that causes inflammation of the lining of joints (the synovium). 

There are several principles of joint protection I teach to my patients that can help to manage the disease processes by easing the pain or helping to prevent (further) deformity at the joints. The general principles and some examples (primarily for the hands and arms) follow:

  1. 1. Maintain muscle strength and joint range of motion (flexibility, strengthening and cardiovascular exercise), keeping exercises to a low number of repetitions and resistance, as well as performing in a slow, controlled manner.
  2. Avoid positions of deformity at the joints, as well as external pressures and internal stresses in the direction of deformity. When using the hands, the forces generated in pinch and grasp become increasingly deforming as resistance increases. Movements should be performed in a direction opposite the deformity.
    • Open jars on a nonskid pad and use the hand that allows you to turn toward the thumb, or use a jar opener
    • Press water from sponge or braid rather than wringing
    • Use a knife that is sharp, possibly have the blade protrude from small finger side of hand (dagger grip), or use a pizza cutter or T-handled knife to maintain neutral positions of the fingers and wrist joints
    • Hold spoon with thumb at the top when stirring
    • Use adapted tools with handles to eliminated wrist deviation, such as T-handled or 90 degree-angled knife
    • Smooth clothing/sheets with small finger side of hand leading and neutral wrist
    • Place pressure through palm instead of fingertips when pushing oneself up to stand
  3. Use the largest, strongest joints available for the job.
    • Carry pots, casseroles, and other heavy objects by placing one hand and forearm flat underneath and steadying the object with the other hand (oven mitts are necessary
    • Carry purses and bags over the forearm or shoulder vs. in the hand
    • Use a two-handed technique for lifting and carrying all heavy objects
  4. Use each joint in its most stable anatomical and functional plane.
    • May need to use a splint to hold fingers and wrist in good alignment during activities (or overnight to prevent further deformity)
    • Avoid twisting the knees when standing (stand straight up first before turning and walking, as well as lining up with chair before sitting)
    • Use correct patterns of movement
  5. Avoid holding one position for any undue length of time.
  6. Avoid starting an activity that cannot be stopped immediately if it proves to be beyond your capability.
  7. Respect pain as a signal to stop the activity.

Adaptive devices can also be helpful to allow you to follow the above principles. Some examples include: jar openers, book holders, zippers with large teeth and ring pull tab, chairs with elevated seat height (risers under base or lift chairs), toilet risers, long-handled shoe horns, sock aides, reachers, built-up (wide) handles on utensils, rocker- or 90-degree-handled knives, increased barrel size on writing utensils (and gel or felt-tip inks require less pressure as compared to ball-point pens). Electric devices are also helpful, such as an electric can opener instead of the pressures and positions needed with a manual opener.

Please contact Avera Sacred Heart Hospital Occupational Therapy department at 605-668-8268 with any questions or for more details.