Using Joints Wisely.

Basic principles

Respect pain

Pain is one of your body's signals that something is wrong. Pain may be caused by swelling, joint damage, muscle tightness, or spasm. If you place your joints under harmful stress, you almost certainly will feel pain. Don't take the attitude that you can "tough it out." If you do, you may experience more pain later.

Be alert for pain that lasts more than two hours after completing a task. If this occurs, try doing the task differently the next time. Either take breaks during the activity, use less effort, or work for shorter time periods. For example, if you wash and wax your car and find that your joints hurt two hours later, then next time take breaks between washing, waxing, and polishing. This applies to your exercise program as well.

Also, don't try any activity that puts a strain on joints where you have pain or stiffness. For example, if your wrist is sore, you shouldn't play tennis. However, you might be able to swim instead.

Become aware of body positions

Avoid activities that involve a tight grip. If your hands are affected by arthritis, holding an object tightly can harm the weakened joints. You can buy items with enlarged handles to lessen the strain on your hands. You can also build up the handles on pens, eating utensils, tools, or brushes by taping a layer or two of thin foam rubber around the handles (or by using a foam rubber hair curler or pipe insulation).

Avoid activities that put too much direct pressure on your fingers or thumbs. Pushing down on your dinner knife with your finger when cutting meat is an example of direct pressure. Instead, try holding the knife like a dagger or using a pizza cutter. Use a knife to open a milk carton or a box, instead of pushing with your thumb. To avoid opening push-button car doors with your thumb, use a door opener aid with a lever handle.

Avoid tight pinching, squeezing, or twisting motions. Spread your hand flat over a sponge or rag, instead of squeezing. To open a screw-top jar, lean on the jar lid with the palm of your hand and turn the lid with a shoulder motion to reduce stress to your fingers. Use a rubber gripper, or use a drawer to hold the jar while you twist the cap. You can also purchase a jar opener that allows you to hold the jar with two hands while turning it. Remind the family not to close jar lids so tightly the next time! Use push type ratchet or power screwdrivers, instead of twisting the standard type handles.

Use good posture to protect your neck, back, hips, and knees. When you have pain or stiffness in any of these areas, you need to pay special attention. Use a book rack, so you don't have to strain your neck looking down.

Whether you sit or stand to work surfaces should be at a correct height. Your elbows should be at right angles and your shoulders should be relaxed when you work. To make it easier to get out of a chair, use pillows to make a seat higher. Learn proper body mechanics for lifting, bending, reaching, and rising from a chair.

Control your weight

Avoid staying in one position for a long time

Use your strongest joints and muscles

Remember to use the strongest joints and muscles whenever possible. By using larger joints or your whole body, you can reduce the stress on smaller joints. Here are some examples:

• Carry a purse with a shoulder strap, rather than holding it in your hand, or use a backpack or fanny pack.
• Push open a heavy door with the side of your arm, not with your hand, or lean into it using your body or hip.
• Add cloth loops to drawer pulls and the refrigerator door handle so they can be opened using your forearm.
• When using stairs, go up with your stronger leg first and go down using your weaker leg first. Always use a hand rail if available.

Pay attention to body mechanics

• When lifting something that is low or on the ground, bend your knees and lift by straightening your legs. Try to keep your back straight.
• Use reachers instead of bending to get something from the floor or cupboards.
• If you have to bend, try to keep your back straight.
• To get up from a chair, slide forward to the edge of the chair. Keep your feet flat on the floor. Lean forward, then push down with your palms-not your fingers-on the arms or seat of the chair. If you have wrist pain, you can push off with your forearms against the top of your thighs. Stand up by straightening your hips and knees.

Distribute weight

Balance rest and activity

Both work and leisure activities are important for people with arthritis, but you can overdo them. It is wise to take short breaks and alternate heavy and light activities throughout the day. Learn to balance periods of work with rest breaks, so you don't place too much stress on your joints or get too tired. You may need to take longer and perhaps more frequent rest breaks when your disease is more active.

Part of this balancing includes pacing yourself during the day, and also from day to day. Allow plenty of time to finish the things you start, so you won't feel rushed. Don't try to do too much at one time. Pacing also includes doing the hardest things when you're feeling your best.

Plan ahead

You can make your life easier by planning ahead. Perhaps each night you could prepare a written schedule of the next day's tasks. Think about what the tasks involve--the amount of time they require and how tiring they are. Remember to build in rest periods, and to alternate heavier with lighter tasks.

Be realistic. Look at all of the activities you do in a normal day and week, and eliminate the ones that are not necessary. Delegate some of the others. Set priorities for the remaining tasks, but remember that you can change your priorities if needed.

Organize your tasks. Combine steps and find shortcuts. For example, you can save time and energy by fixing simple meals that require little preparation. If you want to serve more complex dishes, choose a day when you have more time. Cook extra portions and freeze them to use on days when you don't feel like cooking.

If you have a basement laundry area, bag your laundry and drop or drag it down the steps to avoid carrying heavy loads and making several trips. Plan to stay there until the laundry is finished. Have a place to relax while waiting, or use the time to catch up on reading or letter writing.

Organize work and storage areas: Keep all the equipment necessary for any task together in one area, within easy reach. For example:

• Keep your baking equipment in one place.
• Keep pots by the stove.
• Keep the same cleaning supplies in several places: kitchen and bathrooms, both upstairs and downstairs.
• Store heavy jars and boxes at elbow level.
• If you must store objects up high, be sure they are lightweight. Use a long-handled reacher or tongs to get them down.
• Keep appliances that you use most often (such as a toaster) out on the counter.
• Keep shelves shallow (preferably only one row deep), or use space savers, such as Lazy Susans and pullout shelves.
• Use a pegboard at the workbench for easy access to tools.

Sit to work

Use labor-saving devices

Many different devices have been developed to make tasks easier and more efficient. You can find these in local hardware and variety stores, pharmacies, and medical supply shops. Check with an occupational therapist who can answer your questions and help you choose the best device for you. It can be costly to order from catalogues and find the item doesn't work for you.

These devices can:

• provide leverage to give you more force
• keep joints in the best position for function
• extend your reach when range of motion is limited
• help you avoid strain on joints

Ask for help

While it may be hard to admit that some things are more difficult to do than before, it is important to get help when needed, especially for activities that are particularly stressful to your joints. Your family and friends will understand you better if you share your feelings with them and let them know how they can best help you. You might try telling them on a scale of one to ten (with "ten" being the worst}, how much pain or fatigue you're having.

You may even find that your family and friends have some of the same emotional reactions to your arthritis as you do. They may feel shut out or frustrated when they aren't able to help. Tell them that the amount of pain and stiffness you feel varies throughout the day and from day to day. Try to involve your family in decisions about sharing chores and making new arrangements of shelves and furniture. Ask your friends for their understanding if you have to change or postpone plans you've made.

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