Using Joints Wisely

Using your joints

Don't overuse your joints

If you have arthritis it is healthy for you to keep active and to move your joints. But when your joints are inflamed (painful warm and swollen) or there is joint damage you need to take certain precautions.

Overuse and abuse of joints with arthritis can lead to:

• more pain and swelling
• more joint damage
• loss of function
• loss of independence

In this article

Described in this article are some ways to reduce the stress on joints affected by arthritis while you're doing everyday tasks. You probably won't need to use all of these ideas and you may find it hard at first to change your usual ways of doing things. But if you get into the habit of doing tasks in safer ways you'll be rewarded with less pain easier movement and more energy.

You will also find listed here some examples of simple devices you may be able to use. These items are not for everyone and can be harmful if used improperly. You need to use your available motion and strength before considering a special device. It may be hard to decide when an aid is needed. Check with your doctor or with your physical or occupational therapist to make sure you're using your joints in the right way.

Basic principles

Respect pain

Pain is one of your body's signals that something is wrong. Pain may be caused by swelling joint damage muscle tightness or spasm. If you place your joints under harmful stress you almost certainly will feel pain. Don't take the attitude that you can "tough it out." If you do you may experience more pain later.

Be alert for pain that lasts more than two hours after completing a task. If this occurs try doing the task differently the next time. Either take breaks during the activity use less effort or work for shorter time periods. For example if you wash and wax your car and find that your joints hurt two hours later then next time take breaks between washing waxing and polishing. This applies to your exercise program as well.

Also don't try any activity that puts a strain on joints where you have pain or stiffness. For example if your wrist is sore you shouldn't play tennis. However you might be able to swim instead.

Become aware of body positions

Some positions and movements can put extra stress on involved joints. Even when these joints are not hot swollen and painful they need to be used in their most stable positions.

Avoid activities that involve a tight grip. If your hands are affected by arthritis holding an object tightly can harm the weakened joints. You can buy items with enlarged handles to lessen the strain on your hands. You can also build up the handles on pens eating utensils tools or brushes by taping a layer or two of thin foam rubber around the handles (or by using a foam rubber hair curler or pipe insulation).

Avoid activities that put too much direct pressure on your fingers or thumbs. Pushing down on your dinner knife with your finger when cutting meat is an example of direct pressure. Instead try holding the knife like a dagger or using a pizza cutter. Use a knife to open a milk carton or a box instead of pushing with your thumb. To avoid opening push-button car doors with your thumb use a door opener aid with a lever handle.

Avoid tight pinching squeezing or twisting motions. Spread your hand flat over a sponge or rag instead of squeezing. To open a screw-top jar lean on the jar lid with the palm of your hand and turn the lid with a shoulder motion to reduce stress to your fingers. Use a rubber gripper or use a drawer to hold the jar while you twist the cap. You can also purchase a jar opener that allows you to hold the jar with two hands while turning it. Remind the family not to close jar lids so tightly the next time! Use push type ratchet or power screwdrivers instead of twisting the standard type handles.

Use good posture to protect your neck back hips and knees. When you have pain or stiffness in any of these areas you need to pay special attention. Use a book rack so you don't have to strain your neck looking down.

Whether you sit or stand to work surfaces should be at a correct height. Your elbows should be at right angles and your shoulders should be relaxed when you work. To make it easier to get out of a chair use pillows to make a seat higher. Learn proper body mechanics for lifting bending reaching and rising from a chair.

Control your weight

Extra pounds put more stress on weight-bearing joints (hips knees back and feet). This extra stress can lead to further joint pain and damage. Losing weight will be helpful to your joints. Check with your doctor to find the best weight-loss program for you. You'll also look better probably have more energy and feel healthier too!

Avoid staying in one position for a long time

When joints or muscles are kept in the same position for a long time pain and stiffness may increase. For example writing a long letter or doing needlework keeps your hand in the same position for a long time. Do a quick body check of your jaw neck shoulders arms hips legs and ankles. It's a good idea to frequently relax and stretch these areas especially any area that feels tight or stiff. Shrug or rotate your shoulders in big circles to reduce the tension that collects there.

Use your strongest joints and muscles

Remember to use the strongest joints and muscles whenever possible. By using larger joints or your whole body you can reduce the stress on smaller joints. Here are some examples:

• Carry a purse with a shoulder strap rather than holding it in your hand or use a backpack or fanny pack.
• Push open a heavy door with the side of your arm not with your hand or lean into it using your body or hip.
• Add cloth loops to drawer pulls and the refrigerator door handle so they can be opened using your forearm.
• When using stairs go up with your stronger leg first and go down using your weaker leg first. Always use a hand rail if available.

Pay attention to body mechanics

• When lifting something that is low or on the ground bend your knees and lift by straightening your legs. Try to keep your back straight.
• Use reachers instead of bending to get something from the floor or cupboards.
• If you have to bend try to keep your back straight.
• To get up from a chair slide forward to the edge of the chair. Keep your feet flat on the floor. Lean forward then push down with your palms-not your fingers-on the arms or seat of the chair. If you have wrist pain you can push off with your forearms against the top of your thighs. Stand up by straightening your hips and knees.

Distribute weight

Spread the weight of an object over many joints to reduce the stress placed on any one joint. For example use the palms of both hands to lift and hold cups plates pots or pans rather than gripping them with your fingers or one hand only. Use padded oven mitts for hot dishes. Carry heavy loads in your arms close to your body instead of gripping them with your fingers or hands.

Balance rest and activity

Both work and leisure activities are important for people with arthritis but you can overdo them. It is wise to take short breaks and alternate heavy and light activities throughout the day. Learn to balance periods of work with rest breaks so you don't place too much stress on your joints or get too tired. You may need to take longer and perhaps more frequent rest breaks when your disease is more active.

Part of this balancing includes pacing yourself during the day and also from day to day. Allow plenty of time to finish the things you start so you won't feel rushed. Don't try to do too much at one time. Pacing also includes doing the hardest things when you're feeling your best.

Plan ahead

You can make your life easier by planning ahead. Perhaps each night you could prepare a written schedule of the next day's tasks. Think about what the tasks involve--the amount of time they require and how tiring they are. Remember to build in rest periods and to alternate heavier with lighter tasks.

Be realistic. Look at all of the activities you do in a normal day and week and eliminate the ones that are not necessary. Delegate some of the others. Set priorities for the remaining tasks but remember that you can change your priorities if needed.

Organize your tasks. Combine steps and find shortcuts. For example you can save time and energy by fixing simple meals that require little preparation. If you want to serve more complex dishes choose a day when you have more time. Cook extra portions and freeze them to use on days when you don't feel like cooking.

If you have a basement laundry area bag your laundry and drop or drag it down the steps to avoid carrying heavy loads and making several trips. Plan to stay there until the laundry is finished. Have a place to relax while waiting or use the time to catch up on reading or letter writing.

Organize work and storage areas: Keep all the equipment necessary for any task together in one area within easy reach. For example:

• Keep your baking equipment in one place.
• Keep pots by the stove.
• Keep the same cleaning supplies in several places: kitchen and bathrooms both upstairs and downstairs.
• Store heavy jars and boxes at elbow level.
• If you must store objects up high be sure they are lightweight. Use a long-handled reacher or tongs to get them down.
• Keep appliances that you use most often (such as a toaster) out on the counter.
• Keep shelves shallow (preferably only one row deep) or use space savers such as Lazy Susans and pullout shelves.
• Use a pegboard at the workbench for easy access to tools.

Sit to work

If possible sit at a comfortable height to work. Many of the tasks you usually do standing can be done seated and this will take the weight off your hips knees and ankles. For example sit to cook iron wash dishes work at your tool bench and even to dress. A high stool may be useful for some of these tasks. Use good posture to avoid straining your shoulders and neck.

Use labor-saving devices

Many different devices have been developed to make tasks easier and more efficient. You can find these in local hardware and variety stores pharmacies and medical supply shops. Check with an occupational therapist who can answer your questions and help you choose the best device for you. It can be costly to order from catalogues and find the item doesn't work for you.

These devices can:

• provide leverage to give you more force
• keep joints in the best position for function
• extend your reach when range of motion is limited
• help you avoid strain on joints

Ask for help

While it may be hard to admit that some things are more difficult to do than before it is important to get help when needed especially for activities that are particularly stressful to your joints. Your family and friends will understand you better if you share your feelings with them and let them know how they can best help you. You might try telling them on a scale of one to ten (with "ten" being the worst} how much pain or fatigue you're having.

You may even find that your family and friends have some of the same emotional reactions to your arthritis as you do. They may feel shut out or frustrated when they aren't able to help. Tell them that the amount of pain and stiffness you feel varies throughout the day and from day to day. Try to involve your family in decisions about sharing chores and making new arrangements of shelves and furniture. Ask your friends for their understanding if you have to change or postpone plans you've made.

Practical tips

Now that you've learned several principles for using your joints wisely let's see how they apply to practical situations. This section offers many hints for conserving your energy and using your joints wisely. There are also suggestions for self-help devices and adapted products. Remember to use your available motion and strength before considering these products.

On the job

Whether you work at home or in a office factory or other setting you'll find that by making some simple changes you can be more comfortable and lessen the strain on your joints (see figure 1).

Respect pain: Try to avoid or modify activities that cause pain. If you have painful hands but must work at a computer try to rest your hands frequently or talk to your supervisor about making changes. These might include adjusting the level of your keyboard or using a wrist support at the edge of the keyboard. Avoid activities that involve a tight grip or squeezing. Use tools with built-up handles. Build up pens and pencils with foam rubber. Use scissors that spring open. Use good posture. Use work surfaces that allow you to keep your back straight and your shoulders relaxed. If you work at a desk you can use a slanted top a drafting table or a document holder to reduce the strain on your neck and upper back.

Avoid staying in one position: Change your body position and move your neck shoulders arms hips and legs often to avoid stiffness. If your job requires a lot of standing shift your weight from one leg to the other by placing one foot on a box footrest or stool in front of you. Wear comfortable supportive shoes.

Use your strongest joints and muscles: Remember proper body mechanics. To lift something bend with your knees not your back. Carry your briefcase with a shoulder strap.

Balance rest and activity: If your job requires a lot of standing or walking take frequent rest periods. Try to lie down for a while during your lunch break or sit if lying down is not possible.

Organize work areas: If you use tools place them at a convenient level. Use a Lazy Susan or desktop organizer to keep items within easy reach.

Sit to work when possible: A well-designed chair for working should provide good back support and should swivel or be easily moved. It also should be adjustable to the proper height for any activity.

Use labor-saving items: Use specially designed tools such as pistol grip ratchets and ergonomic hammers that keep your wrist in a stable position. Use a rolling cart or luggage tote instead of carrying heavy objects in your hands.

Ask for help: Have a talk with your supervisor (or the personnel director) about your needs. Most employers will want to protect their investment in your training and experience. Therefore they will often make changes to enable you to keep working. A vocational rehabilitation counselor from the State Department of Rehabilitation or an occupational therapist may be able to help sort out your needs.

In the kitchen

• Plan meals ahead to lessen last minute tasks.
• Use electric appliances such as can openers mixers blenders fry pans crockpots microwave ovens knives and dishwashers to get the job done with less time and energy.
• Place a mixing bowl in the sink when stirring. A damp cloth underneath will help to keep it from slipping.
• Hammer rust-proof nails through a cutting board to secure vegetables while cutting.
• Use a French Chef's knife which keeps hands in good position for cutting slicing and chopping.
• Use disposable aluminum baking pans for easier cleanup.
• Spray a nonstick product on pans or line with foil before baking or frying.
• Let dishes drain and dry in a rack.
• Use lightweight baking dishes plates pots and pans and serve from them.
• Use a wheeled cart to move heavy items from place to place.
• Sit on a high stool while cooking or washing dishes.
• Use convenience foods such as precut potatoes and onions.

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Figure 1 - Practical tips for the workplace

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Figure 2 - Practical tips for the kitchen

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Figure 3 - Practical tips for housecleaning

Figure 4 - Practical tips for the bathroom

Laundry and housekeeping

• Do only the tasks that are really necessary. For example buy permanent-press items that don't need ironing.
• Use separate laundry baskets to sort clothes before taking them to the laundry room. After the clothes come out of the dryer sort them into different baskets for each family member to put away.
• Sit to sort fold and iron clothes.
• Put casters on furniture.
• Use a sponge mop with an easy squeezer a "janitor's pail" with a wringer or a pail on a wooden dolly.
• Use a long-handled feather duster.
• Dust with a mitt using circular motions with your hand extended.
• Wear an apron with big pockets for carrying cleaning supplies.
• Store cleaning supplies everywhere they are used.
• Use an automatic toilet bowl cleaner and spray-on mildew remover so you won't need to scrub.
• Alternate heavy tasks such as mopping floors with light ones such as dusting.
• Just do one major cleaning task a day such as washing clothes or cleaning the bathroom.

Bathroom

• Sit on a bath stool in the shower or tub.
• Wash with a bath mitt or a long handled brush.
• Extend or build up handles on brushes and combs with rulers foam rubber or pipe insulation.
• Install lever-type faucets which can be controlled with the palm or build up faucet handles or use a non-skid pad.
• Put grab bars around the tub and toilet.
• Use a rubber suction mat or nonskid strips in the tub or shower.
• Squeeze a toothpaste tube between your palms or put a washcloth under the tube and lean on it. You can also buy toothpaste in a pump dispenser.
• Use an electric toothbrush or one with a built-up handle.
• Use a raised toilet seat if you have trouble sitting or rising from the toilet.
• Use a free-standing mirror to put on makeup so you don't have to lean over the sink and strain your back.

Bedroom

• Use long-handled shoe horns and sock aids.
• Wear shoes that fit and provide good support. Some shoes have velcro closures or elastic shoelaces.
• Wear pre-tied neckties.
• If possible replace buttons with velcro or use a button hook.
• Use a zipper pull or add a loop chain or large paper clip to make a zipper easier to grasp.
• When making the bed finish one side at a time.

Leisure

• Use a card rack or holder or a brush to hold playing cards.
• Lay newspapers open on a table to read; use a book stand.
• Use felt-tip pens which require less pressure or larger pens which are easier to grip.
• Use a push-button phone or a pen tip to dial. Get a headset so you don't have to hold the receiver.
• Use specially-made lightweight tools with built-up or extended handles for gardening and other yard work.
• Use a gardening stool designed to reduce the stress on your back and legs.
• Break up long shopping trips into several shorter ones.
• Use a fishing rod holder or camera strap to free your hands.
• Play golf for nine holes and then rest before starting the second set. Ride a golf cart and use lightweight clubs.
• Use a three-wheeled bike for greater stability.

In the car

• Have power steering brakes windows and seat controls.
• Build up tops of keys or use key holders to make turning easier.
• Use a car door opener (self-help device) to reduce stress on your hands.
• Use a wide-angled mirror if you have trouble turning your neck

In conclusion Although it is important that you use your affected joints wisely all the time it may take a while before this seems natural to you. If you continue to find things too hard or painful to do talk to your doctor or therapist. There are many techniques aids and devices other than the ones described here that might help solve your problems.

Credits

Some of this material may also be available in an Arthritis Foundation brochure. Contact the Washington/Alaska Chapter Helpline: (800) 542-0295. If dialing from outside of WA and AK contact the National Helpline: (800) 283-7800.

Adapted from the pamphlet originally prepared for the Arthritis Foundation by Dena Slonaker, OTR, MSEd. This material is protected by copyright.