Joint Protection for the Person with · PDF fileMost joint ailments caused by inflammation are called arthritis, from the Greek words arthron, for joint, and itis, for inflammation

Joint Protection for the Person with Arthritis

Page 1 of 42 MC1837 Joint Protection

This booklet is intended for someonewho has arthritis. It provides generalguidelines for limiting stress on yourjoints and for protecting them fromdamage or deformity. Specificsuggestions for modifying day-to-dayactivities and for using adaptiveequipment are given to help youmanage your arthritis and allow youto be as active and independent aspossible.

Introduction

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Most joint ailments caused byinflammation are called arthritis, fromthe Greek words arthron, for joint, anditis, for inflammation. Osteoarthritisand rheumatoid arthritis are two ofthe most common joint ailmentsafflicting people. Of these,rheumatoid arthritis is the mostdebilitating.

What is Arthritis?

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Osteoarthritis, also called “wear-and-tear arthritis” or degenerative jointdisease, develops as the natural resultof time and normal use. Thus, theathlete who sustains joint injuries andthe laborer whose joints arechallenged every day by demandingphysical activity are at increased riskof developing arthritic joints later inlife. People who developosteoarthritis experience pain andaching in an affected joint during orafter use. When the afflicted jointbecomes swollen, it looses flexibility.Discomfort in a joint before or duringa change in weather is also a commonoccurrence.

Osteoarthritis


Rheumatoid arthritis is thought to bean autoimmune disease. Anautoimmune disease is a disease thatoccurs when antibodies that arenormally formed by the body’simmune system to fight infection,react against the body’s normaltissues. Unlike osteoarthritis whichaffects only the muscles and bones,rheumatoid arthritis is a systemicdisease. It can affect the entire bodyincluding the muscles, bones andorgans such as the heart, lungs andeyes. Rheumatoid arthritis tends toaffect more than one joint at a time,particularly after sleeping or afterperiods of limited movement, causingstiffness and aching throughout thebody. It often has a symmetricalimpact; when it affects a joint on oneside of the body, it is likely to affectthe corresponding joint on the otherside of the body.

Rheumatoid arthritis is marked byperiods of flares and remissions.During flares or “flare-ups” theaffected joints become swollen, stiff,painful and warm to the touch. Youmay experience morning stiffness, lossof appetite, weight loss, fatigue and alow grade fever. During periods of

Rheumatoidarthritis

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remission, symptoms may temporarilydisappear. Your lifestyle and themedications you take influence thelength of your remission andfrequency of flares.

Contact the National ArthritisFoundation at the address below formore information. The national officecan inform you whether a localchapter exists in your community.

Arthritis Foundation1330 West Peachtree StreetAtlanta, GA 30309(404) 872-7100

Web site: http://www.arthritis.org.

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People with osteoarthritis typically donot acquire the same joint deformitiesas people with rheumatoid arthritis.However, the joint protectionprinciples described in this bookletapply to people with both types ofarthritis.

The guidelines and exercisessuggested in this booklet are for use athome following instruction by yourhealth-care provider. These exercisesand activities should not producepain. If you experience pain whileperforming one of these exercises oractivities, stop immediately. Relax andrepeat the exercise or activity withreduced speed and intensity. If painpersists, stop the exercise or activityand speak with your health-careprovider.

Important Notes

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Following are general guidelines tohelp you protect your joints frominjury as you perform daily activities:1. Recognize and acknowledge your

pain.• Learn to recognize the difference

between the general discomfort ofarthritis and the pain fromoveruse of a joint.

• Modify your activity level ormethod of doing a task to avoidexcessive pain. Pain that lastsmore than one hour after anactivity or includes joint swellingindicates that the activity was toostressful.

• Understand that painful, swollenjoints are more likely to bedamaged.

2. Avoid using your hands in waysthat may increase the potential fordeformities, such as those explainedto you by your physical oroccupational therapist.• Avoid hand positions that push

fingers toward the little finger(ulnar deviation) See figure 20 onpage 32. Motions of your fingersshould be in the direction of yourthumb whenever possible.

General Principles ofJoint Protection

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• Avoid making a tight fist or tightlypinching an object against yourindex finger. This positionincreases the likelihood of ulnardeviation. Large-circumference orbuilt-up handles can help you tograsp an object more easily whilereducing the amount of ulnardeviation (see figures 1 and 2).

Figure 1. Large circumference handle

Figure 2. Built-uphandle

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• Hold an object with an open handand curved fingers (see figure 3).Don’t use a “tabletop grip” withbent base joints and straight endjoints.

Figure 3. Open hand position• Avoid resting your head on your

knuckles.• Modify activities that require

excessive pressure, such asholding a pen or turning a waterfaucet on and off. Write with alarge barrel pen or pen to which agrip has been added. Use an easyglide pen with a roller ball or gelink.

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• Use a sponge in an open handwhen washing dishes, your carand wiping counters andwindows. Press out water usingan open hand or your fist.

• When shaking hands, let theperson you are greeting extendtheir hand first, then grasp theperson’s fingertips, thumb orforearm or take their handbetween both of yours.

• When turning a round door knob,hold your arm parallel to the doorand use a wrist or forearm motion(see figure 4).

Figure 4. Opening round doorknob

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• Install lever door handles toreduce stress to hand joints (seefigure 5).

Figure 5. Lever doorknob extension

• When traveling, transport yourluggage with a lightweightluggage cart with wheels, orluggage or backpack with wheelsand extended handles. Avoidcarrying your luggage.

3. Use correct body mechanics toprotect your joints.• When standing, use work

surfaces that allow you to workcomfortably without stooping orelevating your shoulders.

• Increase the height of your chairand toilet seat to decrease stresson your hips and knees as you sitand stand.

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• To reach a lower surface, sit on achair and bend over. To pick upitems from the floor or a lowshelf, bend at your knees andhips, if you are able, to minimizestress on back. Bending from thewaist will increase the stress onyour back.

• Slide objects along a counter orworkbench rather than lift them.

• Hold bulky or heavy objects closeto your body when carrying themso you can support the weight onyour forearms (see figure 6 ).

Figure 6. Carrying an object

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• Divide groceries into several bagsto distribute the weight.

• Move from a sitting to a standingposition by sliding your bodyforward in your chair. Do notmove your feet forward. Leanforward so that your weight ismore directly over the balls ofyour feet and use your legs tostand up. If necessary, use yourforearms or palms to push up onthe arms of your chair or a nearbytable (see figure 7). Do not pushwith your fingers.

Figure 7. Moving from sitting to standing

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4. Use the strongest joint available for a job.• Support carried items with your

forearms, distributing the weightequally between your arms andbody.

• Carry groceries in a paper bagagainst your body rather than in aplastic bag hanging from yourfingers.

• Open cabinets with a wrist orforearm loop to decrease stress onyour fingers (see figure 8).

Figure 8. Forearm loop

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• Place a shoulder strap purse overyour head with the strap lyingdiagonally across your back andchest.

5. Change position often.• When driving, writing or doing

handwork, release your gripevery 10 to 15 minutes.

• On long car trips, get out of thecar to stretch and walk at leastevery hour.

• While watching television, get upand move around every 30minutes.

6. Conserve energy.• Balance periods of rest and

activity during the day. Spreadchores such as cleaning and yardwork throughout the week ratherthan try to finish chores in oneday.

• Work at a steady, moderate rateand avoid rushing.

• Rest before you become fatiguedor sore.

• Alternate light and moderateactivities throughout the day.

• Alternate sitting and standing.• Get assistance.• Delegate strenuous work to

others.14


• Allow yourself adequate time.Avoid the stress of rushing.

• Transport heavy items with autility cart to avoid extra tripswhen setting a table or unloadinggroceries or household items.Use a wheel barrel or garden cartto move lawn supplies.

• During any activity, sit ratherthan stand to reduce stress on thehips, knees and back.

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Follow these guidelines to help protectyour joints when dressing, groomingand bathing:1. Plan extra time so that you are not

rushed. 2. Choose loose-fitting clothes that are

comfortable and easy to manage. • Wear clothing with front openings

and easy-to-handle fasteners suchas zippers with large tabs, largebuttons, Velcro™ or large hooks.

• Use a button aid to fasten smallbuttons on clothing (see figure 9).

Figure 9. Button aid

Joint Protection WhenDressing, Grooming andBathing

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• To eliminate buttoning, useVelcro™ tabs or attach cuffbuttons with elasticized thread toallow your cuff to stretch so youcan slip your hand throughwithout unbuttoning it.

• Do not pinch tightly when yougrasp a zipper tab. Instead, use azipper pull (see figure 10), keyring, large zipper ring or a loop ofinvisible fish line at the end of azipper so you will not need topinch the tab.

Figure 10. Zipper pull

• Avoid tight collars. Necklineswith V-necks, scoop necks andboat necks are easiest to manage.

• Select clothing made from stretchfabrics.

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• Wear slip-on shoes or use elasticshoelaces or shoes with Velcro™closures.

• Wear lightweight jackets orlightweight, down or fiber-filledcoats in the winter. Velcro™closures are easiest to manage.

• If your range of motion is limitedand pulling clothing over yourhead is difficult, step into garmentsor try wrap-around garments. Yourtherapist may be able to suggestother helpful dressing techniques.

• When inserting arms into sleeves,first insert your weakest arm orthe arm with the least range ofmotion. Undress that arm last.

• If slipping your arms into coatsleeves is difficult, try a cape orponcho.

• Fasten back-closing bras in thefront at your waist, then turnaround and pull into place. Usinga bra extender, which can bepurchased at a fabric store, will aidin sliding your bra into position.Women may find that front-closing bras or sports bras areeasier to manage than back-closingbras. When dressing after a bathor shower, powder applied on andunder your breasts will allow yourbra to slide into place more easily.

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• Avoid wearing girdles and garterbelts because pulling them onand off strains the fingers.

• Thread your belt through the beltloops before putting on pants.

• Wear a clip-on tie or leave theknot loosely tied and slip the tieover your head if tying a necktieis difficult.

3. Select hair styles that requireminimal care.• Use lightweight electrical

appliances for hair care.• Rest your elbow on a counter or

table to comb your hair. • Use long-handled brushes and

combs with adjustable handles(see figure 11).

Figure 11. Long-handled brush

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4. Use built-up (large circumference)or lengthened handles with surfacesmade of rubberized material toimprove your grasp and to make upfor the decreased range of motion inyour joints.• Use built-up handles on makeup

applicators and lipstick tubes tosimplify makeup application.Built-up handles also may beadded to toothbrushes and eatingutensils (see figure 12).

Figure 12. Built-up handle

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• Use a long-handled shoehorn or asmall footstool to help you reachyour feet (see figure 13).

Figure 13. Long-handled shoehorn

• Use a stocking aid to put on yoursocks if you have difficultyreaching your feet (see figure 14).

Figure 14. Stocking aid

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5. Use bath benches, grab bars andtoilet seat risers for bathing andcaring for your personal hygienewith greater ease, safety andindependence. This equipment canbe purchased from a medical supplystore. • Bathing aids such as long-

handled sponges and brushes canhelp you reach your feet andparts of your body that mightotherwise require stretching.

• Bathing with a nylon mesh bodysponge will help you to relaxyour grasp.

• Use pump containers for soap,shampoo and toothpaste.

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Follow these guidelines to help protectyour joints when working in yourkitchen or storage areas: • Organize your work areas so that

items are easy to reach. Dispose ofitems that are seldom used.

• Hang utensils, tools, pots and panson pegboards.

• Install turntables and pulloutshelves in your cabinets to help youavoid unnecessary lifting.

• Store frequently-used heavy itemsin cabinets that are located betweenyour hip and shoulder height.

• Locate tools, cookware andappliances near the area where youwill use them.

• Cook with lightweight non-stickpans.

• Choose prepared food andconvenience items wheneverpossible. For example, purchasechopped walnuts rather than wholenuts you must chop.

• Hold a knife like a dagger and use asawing motion and gentle pressureto cut. Electric knives and kniveswith offset hand grips and serratededges are especially effective (seefigure 15).

Joint Protection WhenWorking in Your Kitchenor Storage Areas

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• A cutting board with a nail can helpto hold food while cutting orpeeling (see figure 15).

Figure 15. Knife with offset hand grip; cuttingboard with nail

• Use electric appliances and toolssuch as food processors, blenders,electric knives and can openers inthe kitchen. Use electric drills,power saws and automatic garagedoor openers in the garage.

• Use a peeler with a large-circumference handle rather than aknife when preparing fruit andvegetables.

• When rolling out pie crust or cookiedough, place your hands flat on therolling pin to move the pin ratherthan grasping the handles.

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• Install a jar opener in the kitchen toassist you in opening tight screw-oncovers (see figure 16).

Figure 16. Jar opener

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Follow these guidelines to help protectyour joints when working at your desk:• When writing, use adequate lighting

and correct posture. Adjust yourchair height so you can sitcomfortably without elevating yourshoulders when resting your arms onthe table. Writing materials should bepushed forward or placed on the tableso that you can work comfortablywithout bending your neck.

• Relax your hand and neck musclesevery 20 to 30 minutes.

• If holding a pen is painful, you maylessen your discomfort by writingwith a larger barrel pen or using apen grip or sponge roller to enlargethe barrel (see figure 17). Nylon tip,felt tip, rolling ball or gel ink penspermit easier gliding and requireless pressure than do pencils andballpoint pens.

Figure 17. Wide barrel pen

Joint Protection WhenWorking at Your Desk

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• When reading, use open hands or abookholder to support your book(see figure 18). You may also placeyour book on a lapboard or table toavoid prolonged holding.

Figure 18. Bookholder

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Follow these guidelines to help protectyour joints when cleaning:• Clean one area or floor level at a

time to reduce the number of tripsfrom room to room and up anddown stairs.

• Store cleaning supplies in areas thatyou use them.

• Avoid unnecessary bending andstooping: use long-handled mops,dustpans and brooms and, ifpossible, raise your front-loadingwasher and dryer by placing themon blocks for easier access.

Joint Protection WhenCleaning

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Follow these guidelines to help protectyour joints when exercising:• To maintain flexibility without

damaging your joints, move eachjoint through its full pain-free rangeof motion at least once daily. Thispain-free range may vary from dayto day.

• Do the exercises your physician andoccupational or physical therapistrecommend. Do not overexercise orpush yourself when your joints arepainful or swollen.

• Incorporate tasks of daily living intoyour exercise program. Forexample, pick up light objects fromthe floor or from the highest shelfyou can reach comfortably.

Joint Protection WhenExercising

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Follow these guidelines to help protectyour joints when taking part inhobbies, leisure and recreationalactivities. Limit participation inactivities that stress the joints such asknitting, crocheting, needlepoint,bowling and sports such as tennis andfootball. Consider these activities:• Garden with plants that require

minimal care, such as indoor orpatio plants. When weeding,position yourself comfortably on astool and use long-handled tools.Weed after a rain, or water yourgarden the night before weeding tosimplify weed removal.

• Paint, create ceramics and drawusing paint brushes and pencilswith built-up handles.

• Play an instrument. However, limitthe length of playing time to protectyour joints from stress or injury.

Joint Protection WhenTaking Part in Hobbies,Leisure and Recreation

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• When playing card games, use acard holder and a card shuffler forassistance (see figure 19).

Figure 19. Card holder

• When fishing, use a rod holder orbuilt-up handle on your reel andwear a light-weight life vest.

• When golfing, use a golf cart andgolf clubs with enlarged grips tominimize discomfort. A golf ballcaddy and golf tee placer willextend your reach when placingyour ball and tee.

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To help manage arthritis that hasaffected your hand, your physicianmay prescribe a splint. The splint willhelp to rest your joints and reduceinflammation. Your therapist canprovide you with the specific reasonsfor your splint and instruct you in itswearing schedule and care.

Prolonged inflammation orinflammation that does not respond totreatment may damage bones, cartilage,tendons and ligaments and increase thepotential of joint deformity for peoplewho are affected by rheumatoidarthritis. Splints help slow the formationof joint deformities that people withrheumatoid arthritis may develop.People with osteoarthritis typically donot develop these same joint deformities.Joint deformity that occurs in the handcan include the following: • Ulnar deviation — the fingers “drift”

toward the little finger (see figure 20)

Figure 20. Ulnar deviation

Splinting for JointProjection

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• Swan neck — the middle fingerjoints collapse and the end jointsflex or straighten unnaturally (seefigure 21). This deformity caninterfere with ability to grasp anobject.

Figure 21. Swan neck

• Subluxation — when a joint or boneis no longer in alignment with acorresponding joint or bone (see figure 22).

Figure 22. Subluxation

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Swan neckdeformity

Subluxationdeformity


• Boutonniere — flexion of the middlejoints of the fingers and theextension of the end joints (seefigure 23). This deformity canbecome fused and prevent you fromstraightening your fingers.

Figure 23. Boutonniere

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Boutonnieredeformity


When performed as directed, theseexercises may maintain or increase therange of motion of the joints in yourhand. Repeat each exercise ________times, ________times a day.

Do each of the following exercisesslowly and smoothly: 1. Bend and straighten the end and

middle joints of your fingers whilekeeping the knuckles straight (seefigure 24).

Hold this position for ________seconds. Relax and repeat.

Figure 24. Hand exercise 1

Hand Exercises for JointProjection

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2. Make a gentle fist by touching yourfinger tips to your palm or to thebase of your thumb (see figure 25).

Hold this position for ____ seconds.Relax by straightening your fingerswithout spreading them.Repeat.


3. Straighten your fingers withoutspreading them apart (see figure 26).

Hold this position for ____ seconds.Relax and repeat.


36


4. Make an “O” by touching your thumbto each fingertip (see figure 27).

Hold each position for ____ seconds.Relax and repeat.


5. Rest your hand on a table with yourpalm down. Move your thumbaway from your hand. Move eachfinger, one at a time, toward yourthumb (see figure 28).

Hold each position for ____ seconds.Relax and repeat.


37

1

24

3

5


Contrast baths alternate using hot andcold water to help prevent swelling inyour hands or feet that may occur ifyou were to soak them in only hotwater. When performed as directed,these baths may help you relax andreduce pain in your hands or feet.

Important: These baths should notproduce pain. If you experiencepain at any time, stop the bathimmediately and, depending onwhich part of the bath is painful,either cool the hot water or warmthe cool water by several degreesand continue. If pain persists, stopdoing the baths and speak withyour healthcare provider.

To prevent burns, use a thermometerto measure the temperature of thewater before placing your hands orfeet in the bath. Use the temperaturesas prescribed on page 39 to preparethe water for contrast baths.

Contrast Baths for theHands and Feet for JointProtection

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Fill one large basin or container withhot water at:

_________ degrees Fahrenheit

_________ degrees Centigrade

Fill another large basin or containerwith cold water at:

_________ degrees Fahrenheit

_________ degrees Centigrade

39


Begin and end baths in hot water.Place your hands or feet in the hotwater and then the cold water,according to the following schedule.

HOT COLD

10 Min.1 min.

4 min.1 min.

4 min.1 min.

4 min.1 min.

4 min.

Contrast baths should be taken onceor twice daily.

You may need to refresh the watertoward the end of the baths tomaintain the proper temperatures.

Schedule

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BARBARA WOODWARD LIPS PATIENT EDUCATION CENTER

Mrs. Lips, a resident of San Antonio, Texas, was a loyal patient of Mayo Clinic for more than 40 years.She was a self-made business leader who significantly expanded her family’s activities in oil, gas andranching, even as she assembled a museum-quality collection of antiques and fine art. She was bestknown by Mayo staff for her patient advocacy and support.

Upon her death in 1995, Mrs. Lips paid the ultimate compliment by leaving her entire estate to MayoClinic. Mrs. Lips had a profound appreciation for the care she received at Mayo Clinic. By naming theBarbara Woodward Lips Patient Education Center, Mayo honors her generosity, her love of learning, herbelief in patient empowerment and her dedication to high-quality care.

BARBARA WOODWARD LIPS PATIENT EDUCATION CENTER

Mrs. Lips, a resident of San Antonio, Texas, was a loyal patient of Mayo Clinic for more than 40 years.She was a self-made business leader who significantly expanded her family’s activities in oil, gas andranching, even as she assembled a museum-quality collection of antiques and fine art. She was bestknown by Mayo staff for her patient advocacy and support.

Upon her death in 1995, Mrs. Lips paid the ultimate compliment by leaving her entire estate to MayoClinic. Mrs. Lips had a profound appreciation for the care she received at Mayo Clinic. By naming theBarbara Woodward Lips Patient Education Center, Mayo honors her generosity, her love of learning, herbelief in patient empowerment and her dedication to high-quality care.

©2001

MC1837rev0301


Documents

Joint Protection for the Person with · PDF fileMost joint ailments caused by inflammation are called arthritis, from the Greek words arthron, for joint, and itis, for inflammation