Managing Daily Activities

If you have arthritis, you probably know by now even simple daily activities can become a lot harder. Arthritis can turn even the simplest tasks — dressing, washing or brushing your hair —into a real challenge. Feeling tired and drained of energy only makes things worse.

Fighting off Fatigue

Fatigue is often dubbed the 'silent symptom' of arthritis. It is important to determine the cause of your fatigue in order to fight it. Did you know that sometimes fatigue is caused by things other than your arthritis? Everyone experiences fatigue differently because its causes are usually a combination of physical and emotional factors like arthritis itself, inactivity, poor nutrition, insufficient or poor quality rest, emotional stress or anxiety, or a side effect of medication.

One of the best strategies to help look at factors that might be causing your fatigue and fight it is starting to bring what we call the “Four Ps” into your life:

Priorities

List all your activities for a typical week (don't forget to include your leisure activities and pastimes!) If you work, include the different work-related tasks you do on a given day. Now rearrange the list by placing all your activities in order of their importance in your life. We suggest that you may want to make several headings like, 'Work,' 'Home,' 'Play', and set priorities of your activities by category. Next, look at a calendar and note when you normally do your top-priority and daily activities.

After you’re done writing out all the things you do each day, think about these questions:

• Are your activities spread out over the week, or are they all bunched into a few days?
• Do you schedule your top priorities for when you're feeling the least joint pain and stiffness?
• Is there a balance between activities you have to do and those you like to do?
• Do you schedule rest breaks at home or at work?
• Do periods of increased pain and fatigue coincide with certain activities?

The goal is to simplify whatever you can, so as you examine your activities, think how you might approach tasks differently to conserve energy. What can be eliminated? Try letting the dishes drip dry, or hang dry clothing instead of ironing. Are there any tasks where you can delegate or get some help from your family, like working in the garden? Try doing things less often, like cooking two or three meals at once, or vacuum every other week,

Pacing

The next step is pacing your daily activities. Try these tips to help you pace:

• Use your morning range-of-motion and stretching exercises to gauge your energy levels and what you feel up to doing on a particular day.
• Alternate activities to prevent strain on certain muscle groups and joints
• Switch between standing, sitting & walking – use a timer if you find this useful!
• Spread heavy activities over the week e.g. don’t do vacuuming and grass cutting on the same day.
• Work at a moderate, reasonable pace. You can better accomplish tasks without draining your energy.
•  Don’t forget to take regular breaks, even for a few minutes.
• Observe the 'Two-Hour Pain Rule': If after an activity you feel pain for more than two hours, you did too much too fast.

Planning

Planning is key to ensuring your energy level allows you to do the things you want to do. Consider how these planning suggestions could work for you:

• Look back at your priorities in work, home and leisure activities. Schedule your activities throughout the week to ensure a balance of activity and rest, light and heavy tasks,
• If you have an intensive or important event coming up at work or socially, schedule enough rest before you need to use your energy.
• Most of us know when we are at our best and worst, so get the top priorities done when you are at your best, giving you time to do less demanding activities, or rest during your worst. Perform important duties at a time you feel most energetic – but don’t overdo it!
• If you’re having trouble balancing the demands of work and your personal life, you may be able to request reasonable accommodations to help you manage, such as flexible hours. If you have access to flex-time at work, use it if it helps – you may prefer working earlier or later in the day.

Posture

Did you know that proper posture distributes the work over larger muscle groups, helping to conserve your energy? The right work height promotes good posture and saves energy too.

If you must lift or carry, use proper techniques to make the work easier and safer for your joints and muscles:

• Store items you use the most in your home or at work between waist and shoulder height.
• Use the strongest and largest joints available to do the activity.
• Avoid staying in one position for a prolonged length of time.
• Alternate sitting and standing (sitting requires 25% less energy than standing!)

Sitting

• Good posture saves energy, even when sitting.
• The right work height promotes good posture and saves energy.

Driving

• Sit close to the wheel with your knees bent. 
• On long trips, stop frequently and walk to relieve tension, relax your muscles and prevent excessive stiffness. 
• A back support can be helpful in relieving your lower back pain.

Resting                                   

• Try using a cervical pillow or roll to support the curve of your neck.

A Good Night’s Sleep

Try some of these proven strategies that will help you to get a good night’s sleep:

• Invest in a mattress that provides firm yet comfortable support. Avoid waterbeds.
• Everyone has their own unique sleep cycle – think about yours: If sleeping longer and more soundly means going to bed later and waking up later, adjust your schedule to that rhythm if at all possible
• Stick to your schedule: Go to bed every night and get up every morning at the same times - even if at first you don't sleep very well - to establish a routine that accommodates your sleep cycle.
• If pain is keeping you from falling asleep, try taking a warm bath or shower before going to bed. That should help relax tense muscles and relieve your joint pain.
• If pain is waking you during the night, try some relaxation and distraction techniques before bed.
• If you're still waking during the night, ask your doctor to adjust your medication schedule so that your medications' pain-relieving component kicks in just before you're ready for sleep.
• Exercise regularly so that you feel pleasantly tired and relaxed at the end of the day.
• Is your bedroom too light or too dark, too noisy or too quiet? What about room temperature? Try adjusting your sleep environment so that there are no distractions that prevent you from sleeping.

Principles for Protecting Your Joints

Respect Your Pain

• Most people learn to live with some level of pain in their day-to-day lives. Learn to distinguish your “usual” vs. “not so usual” type or degree of pain.
• Activity causing pain that lasts longer than 2 hours should be stopped and/or changed. The concept of “no pain no gain” is not a strategy that works well for people living with arthritis.

Balance Work with Rest

• Give your joints and muscles a break and avoid staying in one position for too long!
• Tension can build around joints, and muscles can tire when held in a static position.
• Pay attention to your body’s signals and change position/stretch every 20-30 minutes.

Maintain Muscle Strength and Joint Range of Movement

• Strong muscles protect your joints from the stresses of movement. Find out more about exercising regularly.

Use Joints in their Most Stable and Functional Position

• Using joints in their most stable and functional position will allow you to perform activities with minimal stress on the involved joints, for example don’t lean on your knuckles - use the flat of your palm instead of your fingers when getting up.

Use Stronger and Larger Joints

• Larger and stronger joints can take more of a load than smaller joints. For example, instead of pushing open a door with your hand and wrist, lean against it with your shoulder or hip. And, instead of carrying a purse in your hand, sling it over your shoulder.

Reduce the Force

• Avoid excessive loads and heavy equipment by using adaptive methods or assistive devices
• Distribute the weight
• Use large grips

Using Helpful Tools and Devices

To protect your hands and wrists, and preserve your grip strength:

Choose tools with 'fat' handles 

• Large handles make joints work in a better position.
• Enlarge handles to make it easier to grip and reduce strain on the small joints of the hand.

The joints of the hand holding the enlarged pen  are working in a less bent position. This is better for the joints.	These large handled garden tools are sold in many department and hardware stores.	You can improve your own devices by adding foam tubing. Pipe insulation is useful and comes in many sizes.

Change the shape of the grip handle

• Some shapes are easier to get your hands around and allow you to use your hands in a position that gives you more strength and is better for your joints.
• There are many ways of using your hands and fingers to grasp objects. Grips using the whole hand are good. They spread the force that you use over many joints. The stress on each joint is lessened. Pain is decreased because less force is needed and joints stay in a better position.

Good shapes to grip.	This vegetable peeler has a large handle and a horizontal blade.	This angled knife has a handle which is vertical to the blade. This  makes it easier to grip and cut.
See how the handle design helps you change your grip.	All fingers are used to grip this turner. Retractable prongs grip many types of handles, faucets and knobs. Using this device can lessen the stress on your fingers.	A key ring through a zipper tab lets you hook one finger through the ring instead of pinching the tab, making the task easier and reducing strain on your thumb and index finger.

Choose tools with non-slip textured hand grips 

• Since textured and non-slip surfaces are easier to hold, you don't need to squeeze as hard to maintain your grip.

A doorknob cover converts a slippery handle into one that is easier to  hold and therefore needs less effort to turn.	A piece of non-slip plastic can help you open jars. It's also handy for turning doorknobs or taps when you are away from home. Keep a piece in your purse or pocket.

Use levers to reduce effort and increase strength

• Extend the length of handles to reduce the amount of effort required. The need for twisting motions can be reduced.

Lever taps and lever door handles can be purchased. You can see (right) how this tool can change your round tap	A key holder allows you to use all your fingers to turn the keys instead of just your thumb and first finger.
Levering a jar key against the lid releases the vacuum seal and makes opening jars easier	A knife attached by the tip to a cutting board is easier to use because it needs only a downward push with a flat palm instead of a sawing motion. This type of board (left) is available with stainless steel nails pointing upwards to allow you to cut or peel without holding.

Use tools that hold objects in place 

• Avoid gripping tightly or holding your joints in one position for long periods of time. Tools that help you anchor items in place make the job a lot easier on your hands.

Use a non-slip mat or suction cups under items.	Bookrests and card holders allow you to rest your hands while still taking part in the activity.

Support your wrist, finger and thumb joints with splints

• If you think a splint can be helpful, discuss it with your therapist or doctor.
• Wrist, thumb and/or finger splints can help reduce pain and protect joints from damage during daily activities. Therapists can help you choose the right one for you, or make one especially for you.

A thumb splint reduces pain by limiting movement.	Ring splints keep damaged joints in a better position.	Wrist splints support the wrist during heavy activities. When you take the splint off, be sure to stretch each joint completely so you don't stiffen up or lose movement.

To save energy and avoid hurting yourself:

Slide or roll objects, instead of lifting or carrying them

• By sliding or rolling items, you can avoid tight grips and heavy lifting, which can spare your joints.

When preparing meals, try sliding equipment on kitchen counters. A trolley on wheels or wagon can help transport items from one area to another, especially while making meals, putting away food, or working in the garden.	Many everyday items are designed with wheels, which removes the need for lifting and carrying and straining your whole body. Other items, such as planters, can be put on a wheeled base.

Use large joints to protect smaller, fragile joints 

• Your large joints are supported by bigger, stronger muscles and can handle mechanical stresses better than smaller, more delicate joints. 
• Keep things light. Use tools made of lightweight materials. When you buy in bulk, put small amounts into lightweight containers for easy use.
• Use electrical appliances. Household appliances such as can openers, food processors, or even toothbrushes, make life easier. Try them out first. Make sure they are easier to use and that you can take them back if you are not satisfied.

A briefcase with a shoulder strap allows you to use your body instead of your hands to carry heavy items	Putting a looped strap through the fridge door-handle allows you to open the door with your arm instead of your hand.	Use two hands instead of one. When you need to lift or carry, using two hands spreads the weight more evenly.

Keep items within easy reach

• Reduce pain and effort by keeping items at a height you can easily reach.
• Save energy by keeping items close to where they are being used.
• Use long handled devices to extend your reach if you have limited movement in your shoulders, elbows, hips or knees.

Slide-out shelves or drawers make items easier to reach. Department stores, kitchen stores and specialized shelving stores sell space-saving units for every room in the house.	See how little reach is needed when using a sling towel to wash your back.	A long-handled shoehorn lets you put your shoes on without bending. Elastic shoelaces let you slide your foot in and out of the shoe without bending to tie or untie them.
The special tool to the right can help you reach your feet to put on socks or stockings. Ask your vendor about stocking aids.	A long-handled dust pan and broom eliminate bending and decrease your risk of falling.	Use a reacher when you have joint pain or loss of movement. Remember to choose reachers that are easy to grip and squeeze and use your whole hand rather than putting strain on one or two fingers. There are some reachers that are meant to pick up lightweight items, such as a sock. Others can lift a heavy item such as a can of soup from the cupboard. Discuss with a vendor which model will best suit your needs.

To stay mobile and avoid stiffening up:

Raise seats to make sitting down and getting up easier

• Joint pain in your hips, knees, and ankles, as well as weak muscles, can make moving around difficult. Struggling to get up drains energy, strains joints and increases your risk of falling.
• Don't put extra strain on your shoulders and hands by pushing on the arm rests. Raise the height of your sitting surface to make getting up easier. This reduces the mechanical stresses on the hips, knees, and ankles. Remember, a firm surface is easier to get up from than a chair with a soft cushion seat.

A raised toilet seat comes in different heights. Make sure the seat is attached properly.	Raised blocks can be used under beds and stable chairs. Make sure the blocks are solid and stable on the floor or carpet.
Portable raised cushions come in many heights and sizes. Make sure the cushion material isn't slippery.	Make sure someone is nearby the first time you try this. This cushion has a built-in spring that helps you get up out of a chair. For those who cannot get up without help, power lift-chairs are an expensive but a good option. The chair lifts you from a sitting to a standing position at the push of a button.

Avoid standing for long periods of time 

• Sitting to work saves energy and decreases strain on joints.
• Learn to get up and stretch regularly to avoid increased pain and stiffness.

Use a high stool with back support when washing dishes, preparing meals, or washing at the bathroom sink. Open the lower cupboard to allow room for your feet.	Prevent joint strain by doing activities at a proper work height.

Use a cushion on the seat if the work surface is too high.

Place blocks under the table legs if the work surface is too low.

Make activities as safe as possible

• Joint pain, stiffness and fatigue can limit and slow your movements. You’re also at increased risk of falling. Some tools and equipment can reduce this risk and help you save energy at the same time. 
• Stair climbing requires good muscle strength, joint movement and balance. A railing on each side, set at a comfortable height offers you the best safety and support.   

Good shoes not only give you better balance, but also support your feet and ankles which helps reduce strain on your hips, knees and back. Laced shoes give more support than slip-ons. Low, wide heels are most stable and soles should have a good gripping surface.	Canes, walkers and other mobility tools help reduce joint stress and pain, lessen fatigue, as well as improve safety and balance. Ask a therapist to help you choose the best device.	Choose a cane that is lightweight with a moulded grip to give your hand and finger joints better support. Cushioned handles tend to be more comfortable than metal or wooden ones.
Walkers/rollators come in many types and sizes. Handles and brake controls vary, so choose one that is easy for you to use. Some have seats and trays. The seat allows you to rest in the middle of an activity.	Grab bars on the bathtub or tub wall give you extra support when stepping into or standing in the bath or shower. A 'knurled' (rough) finish on the bar prevents it from being slippery when wet or soapy. The clamp-on type lets you install it without drilling holes in the wall and it can be taken with you when you visit.	Make sure the screw is tight. Have a professional install it to a wall joist.
Instead of standing, use a shower chair to reduce your risk of falling. Adjustable legs let you raise the seat to a height that is right for you (easy to get on and off). Use a non-slip mat or strips on the tub floor. Use a rubber-backed mat on the floor outside the tub.	The bath seat (left) lets you swing your legs into the tub while sitting. Make sure this is safely installed