Protecting Your Joints

Normal movement places tremendous mechanical stresses on your joints. If they're structurally weakened by arthritis, even the simplest, everyday activities can expose them to risk of injury. Swollen, inflamed joints (particularly the small joints of your hands and feet) are especially vulnerable. For a full range of joint protection strategies, consult an occupational therapist (OT). OTs can prescribe custom orthotics and teach you the safe way to do things that might otherwise put you at risk.

Orthotics

These are usually custom-made appliances - such as splints, insoles and finger ring splints - which stabilize and protect fragile joints. An orthotic can also keep a joint properly aligned to improve functioning. Your OT will start with an in-depth assessment of your joints to see exactly how well they're working. If you have a joint that could be helped with an orthotic, the OT may recommend an orthotic device or splint. Wrist and hand splints are probably the most commonly prescribed orthotics, but a lot of people with arthritis also benefit from knee and neck braces.

For maximum effectiveness, you should probably have two types of splints: flexible splints for daytime activity and rigid ones to maintain joint alignment while you sleep.

Splints are especially important if your hands and wrists are affected by rheumatoid arthritis (RA) or lupus, since hands are prone to a deformity called 'ulnar drift,' where finger joints damaged by the disease start to slide toward the little finger and point away from the thumb. (The ulna is the large bone of your forearm on the side opposite to your thumb.) Splints can also help to prevent the wrist joints from becoming misaligned and preserve the best functioning possible.

Finger joints are particularly vulnerable to a variety of deformities. 'Swan neck' occurs when the finger's middle joint bends backward and the joint at the fingertip flexes forward, creating a shallow S-shape. 'Boutonnire' deformity describes when the middle joint remains fixed in a bent position, with the fingertip straight or bent backwards. To counter these specific problems and others, OTs prescribe metal ring-splints, which fit over each of the finger joints to provide stability and keep the finger bones properly aligned with one another.

People with osteoarthritis and RA commonly develop problems in the joints of their feet. Heel spurs, bunions, fallen arches, hammer toes and a host of other painful conditions can be helped immensely with inserts or custom-made orthotics.

Re-Education

Sometimes the old, familiar ways of doing a task are just too painful or can cause harm. Common sense suggests that if it hurts, don't do it. But what about all those chores - grooming, dressing, cooking and so on - that you simply must do regardless of the pain and risk of damage?

At first, it may seem a tedious process - relearning how to do tasks that you used to perform without thinking - but it's easy to get into the right frame of mind if you remember some basic concepts:

• Reduce mechanical forces: Observe energy conservation techniques, and use adaptive equipment, such as mobility aids, large-handled utensils or a raised toilet seat.
  
  
• Use large joints: Protect the smaller, more fragile joints in your fingers and wrists by using larger ones that can withstand mechanical forces more readily. 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.
  
  
• Change positions often: Avoid joint stiffness, muscle fatigue and pain by changing position or stretching every half-hour or so.
  
  
• Shift rather than lift: Nothing puts mechanical stress on joints like lifting heavy objects. Avoid such situations altogether by sliding objects along a surface to their destination or shifting them onto wheeled transport (such a tea trolley, mover's dolly or child's wagon) for longer distances. For example, if you have to move a pan full of boiling water, use oven mitts and try sliding it with both hands from the stove along the kitchen counter. If you have to cross the kitchen, shift the pan onto a trolley and roll it across.

This page was last reviewed/updated on : 05/30/2008