Joint Protection Principles for Rheumatiod Arthritis

Joint stability is provided by the ligaments and capsule surrounding the structure. When a joint is swollen or inflamed, these structures can become stretched and this laxity or slackness often permits more movement than is normal. Due to this laxity, particularly during an RA flare up, it is not wise to put unnecessary pressure on the joints, however, it is important to maintain your range of movement through the safe exercise program that will be provided by your therapist. Continued and constant use of the hands in “natural” ways puts stress on arthritic joints and the tissues that support them. These forces and positions may contribute to the development of deformities, which in turn can lead to limitations in function and strength.

This handout will provide you with some general principles to help you think about how your daily activities apply forces to your joints, and how you can adapt the way you perform activities to minimize those forces and protect your joints.

Rheumatoid arthritis is a disease in which you have a lot of control over how the disease progresses. It is not a disease where it is best to “soldier on regardless” or “work through the pain” as that can cause a lot of damage. However, this does not mean giving up altogether, just rethinking the way you do something or the number of times you do it. It can help for you to share this information with family members and work colleagues so that they are aware of what you should and shouldn’t be doing!

Remember
Today’s over-enthusiasm is tomorrow’s ‘OUCH’!
Use your energy sensibly and keep a little in reserve.
Use your joints sensibly and with care.

Stresses to Avoid

  • Avoid using a tight grasp: This occurs when you carry heavy objects such as handbags, shopping bags, bucket, or baskets by their handles using your hands. It also occurs when you use screwdrivers, shears, and pliers. Try not to hold objects any tighter than absolutely necessary as tight grasp contributes to ulnar deviation (shifting of the fingers toward the little finger side of the hand) at the knuckle joints (MCPs), which can become permanent.
  • Avoid pressures against the lateral side (thumb side) of each finger: this tends to encourage ulnar deviation of the fingers. You contribute to this deformity when you prop your chin on the side of your fingers, when you push against the sides of your fingers to get up from a chair, and when you turn a key in a lock.
  • Avoid all pressures against the backs of your fingers: this type of pressure contributes to dislocation of the large joints between the palm and the fingers (metacarpal-phalangeal joints). You contribute to this dislocation if you push against the backs of your fingers when you arise from a chair and also if you prop your chin on them in the same way.
  • Avoid excessive and constant pressure against the pad of the thumb: this occurs when you pinch hard to manipulate small objects with force. Examples include: pressing to open a car door, sewing through tough fabric, and pushing against the thumb when arising to standing position. These pressures encourage subluxation and dislocation of the thumb joints; and the thumb is necessary for all skills of the hand.
  • Avoid prolonged periods of holding hands in the same position: Examples include: holding a book, crocheting, writing, and peeling potatoes. Sitting or standing for long periods of time should also be avoided.

Remember: always put weight on the palm of the hand when rising to standing – never on thumbs or fingers.

Keep these Principles in mind

  1. Always use the strongest and/or largest joint possible to do the task. This means instead of using your fingers, use your wrist; instead of using your wrist, use your elbow; instead of using your elbow, use your shoulder. For example – open a door by pushing with your shoulder instead of your hand; carry your shopping bag hung over your forearm instead of hooked over your fingers.
  2. When you lift an object, scoop it up in both hands with your palms upward. You will be lifting with your wrists instead of with your fingers. Examples include: handling dishes, coats, packages, books, laundry, etc.
  3. Slide all objects that slide and put whatever is practical on wheels. Examples: slide pots and pans across stove and counter to sink. Use a kitchen cart to carry foods and dishes and a laundry cart for laundry.
  4. Add leverage to appliances and fixtures to reduce the force to operate them, Example: lengthen the lever of the can opener, put an extension on the water faucet, etc.
  5. Hold all handles straight across the palm – never diagonally. Examples: hold your knife and fork for cutting in an overhand grasp and hold a mixing spoon the same way.

Consider Adaptive Equipment

Your therapist will show you examples of equipment that had been designed specifically to allow you to perform activities easily without damaging or hurting your joints.

Splints

Your therapist will possibly supply you with splints designed to rest, support, protect, and reposition the joints in your fingers, hand, and wrist. Splints can be soft or hard, static (immobile) or dynamic (allow the joint to move) and will be specifically fitted to your hand and designed to address your problem.

If you have any questions or concerns about taking care of your joints or have a specific task or activity that is difficult or painful to you, discuss them with your therapist.