Travel and Arthritis

For up-to-date and comprehensive resources on shoulder arthritis, please visit our new online Shoulder Arthritis Book and Rotator Cuff Tear Book!

In this article

Is traveling difficult for people with arthritis?

While traveling and commuting with arthritis is second nature for many people" for others the thought of traveling may bring to mind additional pain, inconvenience and frustration.

This article on travel contains commuting and long-distance travel tips for people with arthritis whether they are seasoned or infrequent travelers. Whether traveling by plane,  car,  train,  bus or ship there are many ways to make traveling more comfortable.

Additional travel tips have been included for people with arthritis who have difficulty walking and may also require the use of a wheelchair cane or crutches.

Commuting

Tips for commuting

The following suggestions may be of help for people with arthritis who have difficulty getting to and from work or walking long distances.

  • Consider carpooling. Employee bulletin boards may help you find drivers.
  • Consider using public transportation. Under the Americans with Disabilities Act all public transportation is required to be accessible to people with disabilities.
  • Consider having adaptive equipment installed in your car to make driving easier. The "Big Three" American car makers all offer rebates to assist customers to install adaptive equipment in new cars and provide lists of companies that do the work.
  • Ask your employer to provide reserved or accessible parking spaces near building entrances.
  • Obtain an accessible parking sticker or license plate for the disabled through your State Transportation Department so you can park closer to the building.
  • If necessary request a ramp leading to the building entrance.
  • Request an office space near the entrance.

Planning long-distance travel

Make realistic plans

The key to successful travel is advance planning.

The first step includes making realistic plans--ones that fit your capabilities and interests. For example a hiking trip may be unreasonable for a person with hip and knee limitations; instead a week at the beach may be a better choice. Plans must also be flexible allowing people with arthritis to set their own pace. You might consider spending one or two days or afternoons alone if other family or group members plan more strenuous activities or extensive sightseeing. While alone occupy your time with a good book craft item letter writing or better yet use that time to catch up on your rest. Frequent rest periods may be the most important ingredient for an enjoyable trip.

Travel agents

Some people prefer to make all their travel arrangements themselves while others find it more convenient to work with a travel agent. Travel agents can often save you money as well as time.

To select a good travel agent ask for referrals from friends and relatives or call various agencies and ask about their experience arranging trips for people with illnesses or physical limitations. Be sure to select an agent with whom you feel comfortable discussing your special needs and make sure he or she is willing to spend the extra time necessary to work out your particular arrangements.

Don't assume anything. For example not all travel agents are familiar with the terms "accessible" or "handicapped accommodations." Be specific about your requirements. Keep in mind that the travel agent cannot and should not make all the decisions for you. You will be more satisfied if you work with the agent to select the arrangements that suit your needs and interests.

Travel plans should be made at least four to six months in advance especially for trips to popular holiday spots. The more time you give an agent the better the chances he or she will be able to make any special arrangements for you.

Group tours

Group tours may not be for everyone although many people find them an enjoyable way to travel. Either you or your travel agent can reserve space on a group tour. Be careful however about joining "budget" tours. They may not provide arrangements for special access or accommodations. They also work on a tight fast-paced schedule which may not be appropriate for you.

Tours for people with limited mobility may be more suited to your needs. These are moderately paced and designed to meet the special requirements of the group. They include hotel lodging transportation sights and restaurants that are suitable and accessible for people with limited mobility. Individuals are generally expected to make their own arrangements for nursing or attendant care if needed. If provided by the tour agency additional payment is required for the attendant's travel costs and escort services. Most often families and friends are also welcome to join these tours.

Many travel agents and tour agencies also arrange special tours for senior citizens. These tours are generally slower-paced and provide luggage-carrying assistance. Tours for senior citizens are often advertised in the travel section of newspapers or as part of senior citizen clubs' membership activities.

You might consider arranging your own tour with a group of friends or members from your arthritis club or self-help group. Whichever tour you select study the details carefully.

Commuting

General tips

  • Begin a trip or outing well rested.
  • Set aside time to rest at your destination before beginning activities.
  • Prevent stiffness with simple range-of-motion exercises such as ankle circles shoulder circles wrist and hand exercises leg lifts moving legs in a jogging or walking motion to stimulate circulation getting up and moving around if possible.
  • Accept help and special services when needed.
  • Ask tour guides how much walking is required.
  • If walking is difficult for you or if you tend to tire easily consider requesting a wheelchair or motorized cart even if you usually do not require one. It may allow you to enjoy activities which might otherwise be painful or impossible (some recreational facilities provide wheelchairs).
  • Don't let yourself get overtired.
  • Set priorities for activities.
  • Don't expect to do everything--especially in one day.
  • Alternate active periods with restful ones.
  • Schedule rest periods for yourself as well as your family. Traveling may be tiring for them also.
  • Anticipate how you will spend time by yourself in case you are unable to join or keep up with the group's activities (for example browse through a book store or enjoy a snack at a corner cafe while others shop more extensively).

Hotels

Hotel arrangements can make your trip pleasant and enjoyable or totally unbearable. Therefore keep your needs in mind when selecting hotels. Many of the better hotel chains have specially designed rooms for people who have disabilities available at no extra charge. Make sure to specify in advance any special arrangements you will need and get written confirmation of any guaranteed accommodations.

Organizations such as the Society for Accessible Travel and Hospitality (SATH) and the Association for Specialized Services Involving Special Travelers (ASSIST) provide hotel and other travel information for people with disabilities.

Before making hotel reservations ask about any of the following accommodations that pertain to you.

  • Walking distance and amount of stairs to the room restaurant pool beach gift shop or other areas of interest.
  • Whether telephones are placed conveniently beside the bed and in the bathroom.
  • Location of the elevators.
  • Availability of hotel-provided transportation to and from the airport which can easily be used by someone with mobility limitations or a wheelchair.
  • Accessibility and availability of heated pools for exercise and relaxation.
  • Whether hand rails are located beside toilet and tub.
  • Availability of levers instead of round knobs for doors faucets and shower/ bathtub controls.
  • Availability of room service where food and laundry services are inaccessible.
  • Distance from the lobby to your room.
  • Lowered light and thermostat switches or closet bars.
  • Low pile carpet.
  • Raised toilet seat.
  • Sinks and vanity tops which allow space for wheelchairs.
  • Trapeze bar above the bed to aid with transfer to and from the wheelchair. (Consider bringing your own trapeze bar.)
  • Ramp to entrance door.
  • Handicapped parking.
  • Fire exits for the handicapped or first floor rooms in case of fire.

Travel insurance

Illness of any kind can interrupt travel plans yet most airline and hotel reservations are made well in advance. While some deposits are refundable others are not. You may receive full or partial refunds if cancellations are due to illness and if refund requests are accompanied by a doctor's statement. Nonetheless some people prefer to purchase trip cancellation insurance which reimburses portions of your deposit for hotel holiday package and airfare. It can be purchased from a travel or insurance agent.

In addition some people purchase medical insurance for travelers called "trip or travel insurance." This type of insurance provides payment for medical services received during a trip. Some policies have a clause that exempts coverage of any pre-existing condition (treated 60-90 days prior to purchase or travel date) so be sure to understand the policy and what it covers. Also find out about the policy's maximum payouts age restrictions and types of services covered. Before purchasing medical trip insurance find out what provisions your own health insurance has for covering medical care during travel.

Medical care

Discuss your travel plans with your doctor. Ask if you need any special tests treatment or travel precautions. Also ask your doctor what to do in case symptoms worsen during the trip.

Wear a medic-alert bracelet at all times to get appropriate medical care in case of an emergency. This is especially important for people who take steroids or who have allergies heart disease diabetes or other special medical conditions or requirements.

Other tips:

  • Complete any necessary lab studies or medication injections before you leave.
  • If you anticipate stomach or motion sickness ask your doctor to recommend appropriate medication.
  • Eat lightly before and during travel.
  • Obtain the name of a physician or clinic at your destination from your doctor or someone familiar with your destination. Bring along a summary of your medical history.
  • If you have arthritis in your neck or neck pain support your neck in an upright position with a soft cervical collar or horseshoe pillow. This will protect your head from bobbing if you should fall asleep.
  • Should you become ill most hotels employ a doctor or can refer you to a clinic

Medications

Always carry medications with you in your carry-on bag or purse; luggage may get lost or over-heated.

Other tips:

  • Take medications with you when sightseeing so you can stay on schedule. You never know when you may be delayed.
  • Bring enough medications to last the length of the trip plus an extra refill in case of spills or delays.
  • Take along current prescriptions in case medications get lost.
  • Keep medications in labeled plastic containers.
  • Containers with liquid medications should only be 3/4 full. Keep these in plastic bags in case of leakage.
  • Carry snacks with you if you need to take food with your medications.

Planning long-distance travel

What to pack

  • Name and phone number of your doctor
  • Prescriptions
  • Insurance forms and insurance group or policy number
  • Sunblock for people whose medications promote burning
  • Sunscreen hat and protective clothing if you have lupus
  • Any arthritis aids you absolutely need such as:
    1. built-up eating utensils
    2. rubber lever door handle for hotel rooms
    3. portable raised toilet seat
    4. long-handled comb or brush
    5. special pillows for neck or back
    6. device for manipulating hotel key
    7. reacher for picking up items
    8. heating pad
    9. folding cane

Luggage and packing tips

  • Use light-weight luggage with shoulder straps or wheels.
  • Ask porters to carry your luggage whenever possible.
  • Use luggage carts when assistance is unavailable.
  • Carry dollar bills for tips--a few extra dollars spent for luggage assistance may be well worth the cost.
  • Pack lightly--most hotels have laundry facilities.
  • Take comfortable clothing that is easy to get on.
  • Check weather conditions ahead of time to decide what type of clothing to bring. Clothes that can be layered allow you to adapt more easily to changes in the weather.
  • Bring a sweater for air conditioned buildings transportation or cooler days.
  • Travel in low-heeled shoes with good support.
  • Always carry medications with you in your carry-on bag or purse; luggage may get lost or over-heated.

Tips for long-distance travel

Air Travel

Tips for air travel

Air travel is often the fastest way to get to your destination.

A non-stop direct flight avoids the inconvenience of having to transfer airplanes. Find out which airlines fly directly to your destination. If non-stop flights are unavailable the next best choice is a direct flight with a stop. If you must make connections with another flight schedule ample time between flights. Keep in mind that distances between boarding gates may be very long and flights may not always arrive on schedule.

Air travel is usually less crowded during the week than on weekends or holidays making weekday travel easier and less hectic. Reservation clerks can recommend flights that are less crowded. When making your reservation inform ticket agents of any special assistance you will need. Special diet meals such as low sodium diabetic low calorie or vegetarian can also be requested in advance.

In airport terminals

Individuals having difficulty walking should request a wheelchair or motorized cart for use within the airport terminal. Airline personnel will meet passengers and assist them (with a wheelchair if necessary) to get to scheduled flights baggage claim or outside transportation. Most terminals allow use of their elevators if escalators or stairs present a problem. Wheelchair arrangements must be made in advance preferably at the time you make your ticket reservation. Ask how far it is from one gate to another. If you have difficulty walking request a wheelchair for each f light. Flight changes between airlines may also mean changing to another terminal. Ask whether transportation is provided between terminals and whether it is wheelchair accessible.

If transportation between terminals is not wheelchair accessible find out in advance from reservation clerks the best way to arrange for your own transportation.

Boarding and leaving the plane

Airplane boarding procedures may vary but most airlines provide boarding deplaning and escort assistance. Assisted passengers are boarded first and escorted off the plane last. Some aircraft board by stairs. If you anticipate difficulty with stairs ask whether ramps or lifts will be provided to assist you. Consider requesting an aisle or bulkhead seat because they are easier to get into and out of. Flight attendants are required by law not to seat handicapped individuals or persons with walking aids near an emergency exit for easier access to the exit.

The requirement that all walking aids be stored is also a Federal Aviation Administration (FAA) regulation for the safety of all passengers during the flight. Therefore flight attendants will store canes and crutches after passengers reach their seats. Individuals who plan to take their own wheelchair on a trip should tag it with their name address phone number and destination. Most airlines will not transport liquid acid battery chairs because of potential acid spills or leaks but will store dry battery operated chairs. Personal wheelchairs are stored with other baggage while passengers are escorted to the plane in airport wheelchairs. Also request that an airport wheelchair be waiting for you at the door of the plane upon arrival.

Wheelchairs on aircraft

Most airlines restrict the number of wheelchair passengers per flight in case evacuation is necessary. This is determined by the size of the aircraft number of exits and number of flight attendants. An airline can refuse to transport any passengers whose condition in the airline's opinion would jeopardize the well-being of other passengers. Therefore when you make your reservation describe your needs and ask whether the airline will accept you as a passenger and provide any needed assistance. Some airlines require a doctor's letter stating either your ability to travel alone or your need to be accompanied.

The FAA requires each U.S. airline to have a national company policy regarding handicapped travelers which must be approved by the FAA. Since these policies vary from airline to airline find out about each airline's policy in advance.

More tips

  • Request any special services at the time you book your reservation.
  • Reserve seats ahead of time to avoid standing in lines.
  • If you will need special assistance arrive at least one hour before the normal check-in time and allow extra time to get to the airport and through the terminal to the departing gate.
  • If you have difficulty walking request an airport wheelchair or motorized cart to save energy. Such requests should be made in advance.
  • Ask skycaps to carry your luggage.
  • Curbside check-in saves on luggage carrying and standing in lines.
  • Check all luggage through to your final destination especially if you have connecting flights.
  • Prevent stiffness during a flight with simple range-of-motion exercises or by getting up and moving around if possible.

Car travel

Tips for car travel

Car travel allows you more freedom than any other form of transportation.

You can design your own schedule and plan convenient rest stops. You'll have more room to stretch out or to bring along special devices. Auto clubs can design maps for you which chart the smoothest shortest or most scenic route depending on your interests. Information about each state's policy regarding "disabled placards" is available by contacting the state's department of transportation.

Stop often to get out and move around to prevent stiffness. You can also do range-of-motion exercises in the car and at rest stops. Make hotel/motel reservations in advance or stop early in the evening to find a motel or campsite. Don't wait until you are overtired or until the motels are full. Most rest areas and fast food restaurants are wheelchair accessible.

Car rental

When renting a car request those features that would make driving more comfortable for you such as:

  • Power steering brakes windows and seats
  • Tilted steering wheel
  • Passive restraint seat belts
  • Cruise control
  • Four-door car with light-weight doors
  • Lift-up door handles
  • Easily reached and managed ignition controls
  • Side-view mirrors on both the driver and passenger side
  • Hand controls if necessary.

Rental car reservations for special features should be made 4-6 weeks in advance. Get written confirmation of reservations and guaranteed features. Before driving the car make sure it has the features you requested and is in excellent working order.

Rental vans modified for disabled drivers and passengers are available in some cities. These vans are equipped with wheelchair lifts tie-downs raised roofs and raised door openings.

More tips

Keep the following items in the car:

  • All medications (if left in the trunk they may spoil from the heat).
  • Snacks and beverages (especially if you need to eat when taking your medications).
  • Hand-held lighted magnifying glass for reading detailed maps.
  • Emergency kit (including tire pump jumper cable jug of water for radiator leaks flashlight emergency flares change for phone calls)
  • First aid kit (including bandages and tape bandaids bee sting ointment mosquito repellent and salve burn/sunburn cream tweezers alcohol pads chemically activated ice packs antiseptic cream).
  • Consider installing a CB radio to obtain current traffic or weather conditions or to secure help in an emergency.

Joint protection devices for a more comfortable ride include:

  • Special inflatable horseshoe pillow for head and neck support.
  • Cervical collar for neck pain.
  • Cushioned seat belt to minimize shoulder discomfort.
  • Back cushion to provide additional back support.
  • Sheepskin steering wheel cover to protect hand joints by allowing a looser grip and also protecting hands from a hot or cold steering wheel.
  • Wide-angled side and rear-view mirrors.

Train travel

Tips for train travel

Most American trains are barrier-free.

Amtrak

Amtrak the largest passenger service line in the U.S offers special assistance and reduced fares for disabled passengers. For more information about Amtrak call 1-800-USA-RAIL or visit www.amtrak.com.

When making reservations with Amtrak ask for the "special service desk." Most train stations have personnel to provide baggage assistance and to help passengers from the station entrance onto the train. They may also be able to provide medical aides to accompany passengers if needed (payment is required for the aide's services and transportation costs). Individuals using a cane or walker or having difficulty walking should consider requesting an Amtrak wheelchair. Passengers should find out whether needed assistance will be available at all scheduled stops. At most Amtrak stations there is about a four-step climb to board the train. With advance notice Amtrak personnel can assist or even lift passengers onto the train. Passengers who find it difficult to walk through a moving train may prefer to sit in the food service car or have meals served to them at their seat. You can request that any medication needing refrigeration be stored in an Amtrak refrigerator but bring a cooler to store medication in your room if needed between the hours of midnight and 6:00 a.m. (Amtrak will provide the ice).

Wheelchairs on trains

Standard battery-operated wheelchairs are usually allowed on passenger cars but full-powered or extra-large wheelchairs must be transported in the baggage car. Train employees are generally available to help wheelchair passengers get on and off the train. Some trains will allow wheelchairs to be used as a passenger seat. However it may be more convenient and comfortable to sit in the special swivel seat provided for wheelchair travelers. This seat has a fold-down armrest and storage space beside it for one wheelchair. It is located in the food service car and is across the aisle from an accessible restroom. Some Amtrak trains also have special bedrooms with room enough for a wheelchair traveler and a traveling companion ample space for wheelchairs and a specially designed toilet facility.

More tips

  • Make reservations early.
  • Request assistance with the special service desk.
  • Request a wheelchair if you anticipate difficulty walking.
  • Reserve a seat in the food service car if you anticipate difficulty walking through the train.
  • Find out whether train personnel will be available to accompany wheelchair passengers to and from the train and assist with boarding and exiting.
  • Make advance reservations for the special swivel seat for wheelchair travelers.
  • Request that a wheelchair be available at each scheduled stop.
  • Ask whether restrooms bedrooms and train aisles are accessible.

Bus travel

Tips for bus travel

The two major U.S. bus companies, Greyhound and Trailways,  offer special services for people with limited mobility.

Both companies have attempted to make many but not all of their terminals more accessible by providing wider doorways handrails ramps convenient restrooms and telephones at wheelchair level. Reduced fares are available for senior citizens. Aides or companions can travel free of charge as long as passengers present a doctor's written statement certifying that the assistance of an aide is necessary.

If the bus schedule includes an overnight stay most bus companies can recommend hotels motels and restaurants that are near the bus terminal but these may not be accessible. If possible obtain the bus schedule ahead of time and make your own hotel reservations. Also request any special assistance at the time you reserve your tickets and confirm assistance a day or two before the trip.

Most bus aisles are not wide enough for wheelchairs. If you use a wheelchair or have trouble using stairs make arrangements with customer service for assistance in getting on and off the bus. Bus personnel can also meet wheelchair travelers at the curb and take them to the bus. Most likely you will be boarded first and have a choice of the front seats. If you need your wheelchair at rest stops ask the driver to unload it for you. Non-motorized wheelchairs walkers canes and other aids can be stored in the baggage area at no extra cost and are not counted as part of your luggage allotment. Some bus companies require that wheelchairs be collapsible.

Questions to think about

Before taking a bus trip consider the following questions:

  • How long will you be traveling?
  • Are you able to sit comfortably for hours at a time?
  • Will you need to change buses? If so will you need help?
  • How frequently will the bus stop for restroom and restaurant needs?
  • Can you get on and off a bus easily?
  • What requirements do you have for food and restroom facilities?
  • Are the bus terminals easily accessible?

More tips

  • Ask what kind of assistance is available.
  • Take snacks or lunch on board if you anticipate difficulty getting on and off the bus at food stops or if you will need food with your medications.
  • Try to schedule your trip during midweek and non-holiday times when fewer people are traveling.
  • Avoid too many bus or terminal transfers.
  • Bring a small pillow or cervical collar for naps.
  • Do range-of-motion exercises on the bus and at rest stops to prevent stiffness.
  • If traveling with an aide ask about the two-for-one fare. Present the necessary doctor's statement when you purchase your ticket.
  • Determine services and accessibility at each scheduled stop.
  • Ask whether wheelchairs must be collapsible for storage.
  • Obtain an advance travel schedule and make any necessary hotel accommodations.

Ship travel

Tips for ship travel

Many people with arthritis have found cruise ship travel to be both enjoyable and relaxing.

In recent years ships have made design changes specifically for people with limited mobility such as extra-wide passageways doorways and elevators and specially designed bedrooms for wheelchair passengers. A few ships will even build ramps where needed and assist people in difficult areas. Some ships may require a doctor's letter stating that a disabled passenger is physically able to travel by cruise ship.

Medical assistance

Most cruise ships employ doctors on board in case passengers become ill. Direct payment for any medical services is required. Individual health insurance may not be accepted for medical expenses incurred on cruises. Check with your insurance provider. Although you can obtain motion sickness medication from the ship clinic it is advisable to bring medication prescribed by your own doctor.

Getting on and off ships

Anyone anticipating difficulty getting on and off a ship should choose a cruise with fewer stops. If using a wheelchair be sure to lock the wheelchair brakes when you're not moving; even slight rocking of the ship can cause wheelchairs to roll. (Some people use blocks in addition to the brakes.)

More tips

  • Choose a cabin near the elevator and reserve a table near the entrance of the dining room if you anticipate difficulty walking.
  • Confirm that special requests have been passed on to the crew.
  • Choose a cruise with fewer stops if you anticipate difficulty getting on or off the ship.
  • Take along motion sickness medication prescribed by your doctor.
  • Make sure the ship is accessible to wheelchairs.
  • Ask whether it is necessary to bring a ramp or wheelchair narrowing device.
  • Be sure wheelchair brakes are in good working order
  • Determine in advance whether any ports of call will require a license for a motorized wheelchair.
  • If required present a medical statement stating that the disabled person is physically able to travel by cruise.

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 a pamphlet originally prepared for the Arthritis Foundation.This material is protected by copyright.