What is this thing called joint protection? Or, how to keep your joints strong and stable
My first professional job was as an occupational therapist in a rehabilitation hospital. I was 25 and had 23 years of JRA under my belt. At the time, I was living the common joke that health care workers make the worst patients because I was teaching people things about caring for their joints that I wasn’t doing for myself. I was young, and wasn’t ready to face the hard truths that my disease was showing me.
This changed unexpectedly one day. I was working with a 60- something patient who had severe RA. She was a bubbly, kind, caring, mother of seven. I was seeing her because her hands were so deformed that she was having difficulty using them, and making a splint for her so she could write. As I was doing this I was telling her about the concept of joint protection, something that she had never learned. Offhandedly, she said, “ I guess I shouldn’t have wrung out so many diapers over the years; it hurt so much every time.” This comment stopped me in my tracks and has never left my head. I realized in that moment that I had been given a gift that she had been deprived of and I had better take advantage of it. I had the knowledge about how to take care of my hands, and if I didn’t follow through and use this knowledge I had a very good chance of becoming my patient in time. At the time I was doing many things that were hurting my hands and I knew I had to stop.
I wish I could tell you that from that day forward I religiously practiced joint protection, but I can’t. Feeling rushed, stressed, or wanting to “push through” pain has at times made taking care of my joints difficult. What I can say is that I have done my best, and I know that my joints are a lot more strong and stable as a result.
Joint protection is a strategy, or plan of action that helps a person to maintain healthy joints, decrease joint pain, and improve function. The basics of joint protection are the same for all, but it is important to know your specific limitations and challenges, and consult with your MD or occupational/physical therapist to develop your unique plan.
With that in mind let’s learn about keeping your joints strong and stable.
As you have probably experienced, RA causes joints to become swollen and inflamed. The swelling and heat you feel in your joints is a result of extra fluid that is caused by an overactive, confused immune system. When joints are swollen the tendons and ligaments that support and help them to move have to stretch and pull over a much larger area. Over time all of this stretching and pulling can cause tendons to rupture or slip, which results in changes to the joints. Once this happens, it is very difficult and often impossible to correct without surgery.
With this in mind, here are the most important things to remember as you go through your day.
You can make small changes for big results. Here’s How:
Try to only do activities that put pressure on the pinky side of your hand when you absolutely have to. This will help you avoid putting strain on the tendons and ligaments that keep your fingers straight, and avoid the possibility of tendon rupture.
Some ways to do this are:
- When grocery shopping, pack lighter bags and carry them with your forearm instead of your hand.
- Open jars with your right hand and close them with your left. Depending on your hand strength you may want to ask family/friends for help with opening jars as much as possible.
- Install lever style door handles in your house, focusing on the doors you use the most. Install easy to use handles in your shower as well.
- Use lightweight cups and mugs.
Avoid tight gripping. You can do this by:
- Using pens that have a large circumference or build them up yourself with pen grips or cylindrical foam.
- Use two hands to pick up heavier objects so you can distribute the force you are placing on any one hand.
- Use spring-loaded scissors.
- Invest in an automatic can opener.
- Think about daily tasks that put strain on your hands and do them differently. For example, I add cylindrical foam to my toothbrushes, and when I buy large bottles of lotion, shampoo, etc. I empty them into a smaller bottle that I can pour instead of squeeze.
Use larger, stronger joints whenever possible during daily tasks.
- Carry items with your forearms, close to your body so you won’t have to strain your hands and elbows.
- Use backpacks or fanny packs instead of heavy purses or bags that strap across one shoulder to avoid putting pressure unevenly on your shoulders.
- Close dresser drawers and doors, with your hip or forearm instead of your hand. This may look funny but it sure does hurt less!
Learn to pace yourself throughout the day.
- When planning your day alternate more physically demanding tasks with easier ones and make sure you rest in between. Do this in your weekly planning as well. Alternate harder physical days with more restful ones. This will help you if you have insomnia as well!
- Try to avoid activities that you can’t safely stop if it gets too painful.
- Respect your pain and instead of trying to push through it when your pain level is rising significantly during a task. If you are doing something that you know is difficult, such as gardening, use a timer and every ten to fifteen minutes take a stretch break. This will help you to tune in to your body and notice earlier if you are over-doing it.
Avoid staying in one position for too long.
- Alternate sitting and standing. Sitting will require less energy and may be less painful but standing will help to keep the muscles surrounding your joints strong. Short walks to keep joints limber are also really helpful.
- Learn to “fidget” when sitting. This will help you from getting stiff when you have to stand. I love doing my ankle “alphabet” exercise my Physical Therapist gave me when watching movies or in long meetings.
Move your joints through their full range of motion every day and stay active.
- Start at your neck and shoulders and work down to your toes, slowly and gently moving each joint throughout their range of motion without straining or causing increased pain.
- It is best to consult an occupational or physical therapist to learn safe and effective exercises specifically for you. By keeping you body strong you will be better able to compensate for swollen, painful joints. My motto is to “move my body every day.” Some days this is a short walk and others a long bike ride, depending on how my body feels.
Learn about Body Mechanics.
- Body mechanics is a term that is used to describe the healthiest way to sit, stand, lift, and move. I’ve mentioned a few pointers in this article but there are other websites that explain them more fully I’ve referred to below.
Remember that you don’t have to make all your changes at once, habits are always hard to break, and these are habits you’ve had for a lifetime. Use these ideas, work with your health care team, and know that even small changes can help to keep your joints strong and stable.
For a full description of body mechanics from The Colorado Spine Institute:
For helpful gadgets in the home including pen grips, scissors, doorknob adaptors:
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