What is Osteoarthritis (OA)?
Due to wear & tear, the cartilage that protects the end of bones in the joints becomes damaged, and ligaments meant to keep joints in place become loose and unstable. The synovium, meant to cushion cartilage & prevent friction in the joint becomes inflamed. The combination of these two events can cause pain & stiffness in the affected joint.
Joint protection strategies can help prolong the joint's ability to move effectively & manage pain when performing daily activities, since arthritic joints cannot tolerate as much stress as healthy joints, activities such as pushing, pulling, twisting, and lifting.
Respect the pain
1. Once you feel pain from activity, stop!
· Important to take notice of pain & use it as a warning sign – pushing yourself may cause increased pain the following day, as well as damage the joints
· Pace yourself – allows you to continue doing the things you enjoy doing for a longer timeline, instead of having to stop for good – stopping activity altogether can lead to stiff joints!
· Work out pain threshold – how long you can do an activity before feeling pain.
o If you feel pain next day following activity, it means activity should have been stopped earlier the previous day
Pain threshold= use traffic light analogy:
· If pain at 3 or 4 (or below) out of 10, green light: OKAY
· If pain between 5 - 7, yellow light: Use Caution (may need to stop activity slightly earlier, use less force, use bigger/stronger joints, etc.)
· If pain approaching 8(+) out of 10, red light: STOP & rest
2. Avoid/decrease activities that cause pain that lasts for more than an hour or so.
· Take breaks/change activities prior to feeling pain rather than getting to the point of pain before stopping (ex: if you know you feel pain after 5 minutes, stop after 3 minutes)
o Knowing your threshold will help plan this
3. Splinting/orthoses may support and help rest joints that are painful
4. Take rest breaks
5. Use adaptive tools whenever possible (jar openers, bag carriers, grocery dollies, use machines such as a food processor, etc.)
6. Alternate between: sitting & stretching, light & moderate activities throughout day
7. If feet are painful, wear proper shoes – talk to doctor or therapist about specific recommendations for you
Use larger, stronger joints – larger joints are stronger than smaller joints. Save smaller, weaker joints for specific jobs that only they can accomplish (such as precision) and try to use large joints whenever possible.
· Use palms of both hands instead of fingers to grasp, lift, pull, carry, twist, & pushing
· Use arms instead of hands
· Carry bags/backpacks/purses on shoulders rather than carrying/grasping them in hands or on forearms – if shoulder is painful, use a backpack
· Keep smaller objects close to body & try to spread load across multiple joints
o Avoid grasping/lifting with thumbs, use both hands and keep as much of hand in contact with the object
· Hug bigger objects close to body so the items are supported by larger joints like the arms, shoulders, and trunk rather than just hands
o Support weight with forearms, keep elbows close to body
· Use thigh muscles to rise from chair instead of pushing off with hands
· Have children hug you prior to lifting and carrying them.
Reduce effort & force
· Try to relax grip as much as possible - do NOT want ‘death-gripping’!
· Use padding to build up grip required for object & ease pressure on smaller joints
· Use assistive devices that can save the labor required during daily tasks, reducing strain on joints over the whole day
· Use prepared foods & freeze leftovers for easy mealtimes
· Avoid low seating/beds to have to push up off of
· Slide heavy objects instead of trying to pick them up
· Keep a healthy body weight to reduce load on joints
· Try to keep from using stairs more than necessary (example: complete the work on each floor before moving to another)
· Take breaks often when doing things, and spend less time doing them
· Whenever possible, ask for help!*
· Use gel pens to write – smoother & do not require as much pressure/force
· Sharper blades = easier to glide
o In the kitchen: using a sharper knife requires less force than dull ones
o For gardening: use sharp shovel & place on ground, step on it to force into ground rather than trying to use hands/wrists (using bigger, stronger muscles)
· Spare your fingers as much as possible!
o Avoid prolonged pinching/gripping motions
o Use less force to hold tools/equipment
o Rest hands flat & open rather than in a tight fist
· Take more trips to grocery store and get less stuff each time – avoid carrying too much stuff in at one time
o Make bags small, with not many items in each
o Using paper bags are easier to hug/carry
Balance Rest & Activity
· Use pain threshold as guidance to manage how long you work and when to take breaks
· Many people give up activity if it causes pain, but it is more effective to do a little at a time with plenty of rests vs. no longer doing something you enjoy. That’s where life gets its meaning!
o Rest BEFORE feeling tired
o Take frequent & short breaks
o Avoid doing activities where you cannot take breaks
o Avoid staying in one position for long periods of time
o Alternate between heavy and light activities
o Take more breaks when you are getting inflammation
o Allow extra time for activities to avoid rushing
o Plan day ahead of time
o Cut out activities you do not need to do
How to break up activities: Wash a few dishes, fold part of the laundry, wash a few more dishes, fold a few more items of clothing, make a cup of tea, finish folding laundry - mix & match with your daily activities/responsibilities
Use good body mechanics:
· Position yourself correctly & use muscles best suited for specific task – minimize the stress on your joints
· Pick up items from floor by first bending knees and hips, and stooping down, or sit in a chair & bend over
· Avoid twisting & awkward position – reaching for objects in the back seat of a car from the front seat
· Keep hands below “3” & “9 o’clock” positions on steering wheel when driving
· Use abdominal muscles to help you roll over out of bed
· Arrange work area wisely:
o While sitting: make sure there is good back & foot support, forearms & upper legs shoulder should be well-supported resting on the floor, may want to raise chair to make it easier to get up
o If typing for long periods & chair doesn’t have arms, consider using wrist or forearm supports. An angled work surface for reading and writing is easier on your neck.
o For standing – height on work station should enable working comfortably without stooping
· Anti-vibration gloves are very helpful when using any tools that vibrate!
Exercise in pain-free range
· Protecting your joints & doing exercises together – this reduces strain on your joints while strengthening the muscles that support them
· By making the muscles around your joints stronger & helping to support them, you are less likely to develop deformities. Exercise also helps you maintain your range of motion. If you do not move your joints, they can stiffen & your muscles can waste away
· Your therapist should give you some exercises to help you with your specific pain & joint deformities
Exercise tips:
o Try doing hand exercises in warm water as this can help relax your hands & loosen stiff joints (esp. in the morning) make the exercises easier to do, and also help reduce pain
o Balance rest & exercise
o Do not strengthen exercises when you have a flare-up
o If you get any pain that lasts longer than one hour after exercise, it means the exercise is too stressful. Do not do it again until reviewed by your therapist.
Avoid ‘positions of deformity’
· Rheumatoid arthritis or osteoarthritis can cause various deformities in your finger joints. If you notice early that any of your joints are becoming misshapen, change the way you do things to reduce strain on them.
o Try to be aware of how you use the joints that ache. (Think about what is happening to your fingers when doing activities, are they being pushed towards your little finger? Try to correct this by turning the faucet on with one hand & off with the other, always pushing towards the thumb.
o Use stable joint positions – keep thumb & index in opposition (an “O” position) with the wrist straight
o Make sure work surfaces are at right height for you so you do not have to stoop or stretch when you use them
The 4 “Ps” of protecting your finger joints
1. Problem-solve: if a task causes you pain or discomfort, think about how you can adjust how you are doing the task. Consider your position, the joints you are using, how much weight you are carrying,
2. Plan: think about the things you need to do for the day/week, & try to space out the more demanding tasks à keep supplies within easy reach, between eye level & hip level; eliminate clutter, save time & energy finding items you need; avoid rushing, which can increase stress & pain
3. Prioritize: consider the tasks needed to be performed first and by you, and what tasks someone else may be able to perform.
4. Pace yourself: take frequent rest breaks, spread demanding tasks apart, and change your position often.
Keep moving
· Don’t give chance to become stiff – keep them MOVING
o Remember: "Motion is lotion!"
· When writing/doing homework, release grip every 10-15 minutes or when hand feels tired
· If at computer, do hand/thumb stretches for at least 10 seconds every hour
· On long car trips, take break every hour or so to stretch
· On airplanes, choose aisle seats to allow legs to shift more easily
· Doing repetitive tasks, change body positions every 20-40 minutes
References: ·
Arthritis Foundation. (n.d.) 16 joint-protection tips. https://www.arthritis.org/health-wellness/healthy-living/managing-pain/joint-protection/16-joint-protection-tips
King’s College Hospital. (2019). Joint protection techniques for hand/finger arthritis. Information for patients. National Health Service [NHS]. https://www.nhs.uk/conditions/arthritis/living-with/
Mayo Clinic. (2020). Rheumatoid arthritic pain: Tips for protecting your joints. https://newsnetwork.mayoclinic.org/discussion/consumer-health-tips-for-protecting-your-joints-from-rheumatoid-arthritis-pain/
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