Joint protection principles are simple and effective tools you can use to decrease pain and increase the ease of doing everyday activities. Cynthia Hill, who is an occupational therapist, has personally used these joint protection principles with her clients for over 25 years with positive results.
The following joint protection principles are incredibly useful at minimizing hand pain caused by rheumatoid arthritis (RA).
1. Avoid Positions of Deformity
Some hand positions should be avoided at all costs. For example, don’t prop your chin on your hands or use fisted hands to push yourself up out of a chair. Activities that hold your MCP joints (at the base of your fingers) in flexion and the PIP and DIP joints (the other 2 joints) straight, such as holding books or magazines, can cause unnecessary stress on your hands, resulting in joint deformities. Prop books up on a pillow or use a book holder when reading instead.
Avoid activities that move the fingers in an ulnar direction (towards the little finger side). Instead, try turning your fingers towards the thumb side when opening jars or doorknobs. Better yet, use an under-cabinet jar opener with both hands, or an electric bottle opener.
Replacing knobs on doors and faucets with levers makes them easier to turn. Lever-type handles also enable you to minimize ulnar deviation stress on your hands. If you can’t replace knobs with levers, another option is to simply use the palms of your hands as an alternative. Try using the palms of both hands to turn doorknobs and faucets.
For more suggestions on the best hand positions to decrease pain caused by RA, check out Cynthia’s book The Hand Arthritis Manual – Simple Solutions to Manage Pain and Stiffness Without Drugs or Surgery.
2. Use Stable Joint Positions
First off, make sure you’re working at the proper height. Ideally, you should always try to work between waist and shoulder height. This can help you maintain good posture, which is important for people suffering from Rheumatoid Arthritis.
Avoid bending your elbows, knees, and back when you sleep. Instead, allow yourself to stretch out to minimize tightness in your joints. As far as sleeping positions go, try sleeping on your back rather than on your stomach or side.
Picking up household items such as cups, pitchers, and pans one-handed puts a lot of undue stress on the small joints in your fingers. When picking up items, try using both hands to disperse the weight more evenly and minimize joint strain.
If you need to stir something, avoid holding utensils in a thumb down position. Hold your thumb facing up instead. This places your wrist and your fingers in a much more stable position and minimizes joint strain.
3. Avoid Tight Grasps
Use large-handled utensils and tools as much as possible. If you don’t have access to large-handled utensils, including spoons, forks, knives, and toothbrushes, you can easily adapt them to fit your needs.
Pipe insulation works well to enlarge handles. It is relatively cheap and comes in a variety of sizes. Another option is to make a slit in both ends of a tennis ball and slide the ball over the handle.
Rather than wringing the water out of your kitchen sponge, use the palm of your hand to squeeze excess water out along the sidewall of the sink. Drape washcloths over the faucet and use both palms to squeeze out excess water.
Squeeze toothpaste using the palm of the hand, rather than using your fingers
4. Use Your Larger and Stronger Joints
Many simple modifications can be used to minimize the strain on the small joints in your hands. For example, you can slide heavy objects along countertops rather than carry them. Try using the palm of your hands, instead of your fingers, to lift or push objects.
Carry a backpack rather than a purse. Avoid holding handles of bags with your hands. Instead, place the handles on your forearm near the elbow. If the handles are large enough, try putting them on your shoulder.
Keep packages close to your body and use both hands to hug them against yourself. Push doors open with the side of the body rather than your hands.
Attach a belt or a hairband to the refrigerator, stove, and heavy drawer handles. Place your arm through the loop to open them.
Push, don’t pull, carts and chairs. This allows you to use your body weight as well as your larger joints and muscles to do the task.
5. Reduce Your Effort and Force
Carrying bags and boxes can put a lot of stress on your joints. Carts enable you to carry larger loads without putting so much stress on the joints in your arms and hands.
Use appliances and assistive devices whenever possible. For example, appliances like electric can openers and stand mixers can be lifesavers.
Keep items near where they are used and within easy reach. It’s okay to leave things you use on a regular basis on the counter.
Avoid sitting in low chairs whenever possible. It’s much easier to push up out of a chair that sits up higher. If all of your chairs sit low, try placing an extra cushion or a pillow in the seat to raise the seat height. Even a couple of inches can make a huge difference when it comes to getting up and down out of a chair.
Reduce the number of trips you take up and downstairs. Plan to do all the work on one floor before going to the next floor of the house. And, of course, don’t be afraid to ask for help.
6. Respect Your Pain
Pain is our body’s way of telling us that something is wrong, so it’s vitally important to respect that pain. As a result, activities that result in increased pain lasting more than 1 – 2 hours should be avoided whenever possible.
Additionally, try to stay away from activities that put a strain on painful or stiff joints. If you must engage in an activity, you should stop doing it before the point of discomfort.
You might also think about using extra equipment to help the pain. Wrist splints can help decrease pain for people with RA, while thumb splints may help people who have osteoarthritis (OA).
7. Balance Rest and Activity
It’s important to allow yourself to rest before you reach the point of exhaustion. Be sure to take frequent short breaks, especially when your inflammation is high.
When taking a break, alternate between heavy and light activities. If possible, eliminate any unnecessary activities. You should also try to avoid staying in one position for too long.
Planning your day ahead of time can help you feel balanced. Do your most strenuous chores at the time of day when you have the most energy and the least pain. If you know you are going to have a busy day, plan to have a light day before and after it. Don’t rush through anything either; budget extra time for activities that you know will take you longer.
8. Try Pain-Free Exercises
Combining joint protection principles and pain-free hand exercises are known to increase hand function. Low-impact exercises can increase aerobic capacity and decrease depression and anxiety symptoms in patients with arthritis.
Specific exercises can help maintain muscle strength and joint range of motion. For example, warm water pool exercises and workouts targeted specifically to each potential deformity are highly beneficial.
9. Keep a Journal
A journal can be extremely helpful in pinpointing causes of pain that you otherwise might not be able to figure out. Each day, write down what you did, what you ate, and how you felt. Then, when you go back and read your journal, you can try to find patterns.
You may find that every time you do a certain activity you have increased pain, stiffness, and/or fatigue that follows you to the next day. Or, certain foods may increase your inflammation. Even the weather might affect how you feel.
If you find that specific activities consistently cause an increase in pain symptoms, you have a couple of options. The first is to avoid doing that activity by delegating the task to someone else. The second option is to figure out a different way of doing the activity that minimizes the stress on your joints.
If you find that you have an increase in symptoms after eating certain foods, then it is best to avoid those foods.
You can’t control the weather, but at least you can know what weather changes affect you. When these weather changes occur hopefully you can allow yourself more time to rest.
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