TEAM Physiotherapy

Which joints need protection?

People with local type of arthritis like osteoarthritis, need to pay attention to the joints that are involved with the arthritis. People with a systemic or whole body type of arthritis like rheumatoid arthritis, need to reduce the stress on all their joints.

​

JOINT PROTECTION PRINCIPLES :

​

1.    RESPECT PAIN

a.    It is important to distinguish between discomfort and pain.
b.    Pain that lasts for more than 1 or 2 hours after an activity indicates that the activity is too stressful and needed to be modified.
c.    If there is a sharp increase in pain during activity, stop and rest then modify the activity.
d.    If there is unusual pain or stiffness the next day, look back at the previous days activities to see if they were too strenuous.

​

2.    AVOID POSITIONS OF DEFORMITY

The foremost position of deformity for most joints is flexion, bending of the joint. Maintaining a bend position increases the possibility of deformity.

a.    Stand erect with weight evenly divided on both feet.
b.    Lay as flat as possible in bed , do not curl up or pop yourself up on several pillows.
c.    Work with your hands flat.
d.    Avoid tight grip and squeezing. 

​

​

3.    AVOID AWKWARD POSITIONS

Use each joint in its most stable and functional position : extra strain is placed on a joint when it is twisted or rotated.

 

a.    Rise straight up form sitting, rather than leaning to one side for support.
b.    Reposition feet rather than twisting trunk or knees.
c.    Stand on a stool to reach overhead.
d.    Reposition yourself closer to object rather than stretch your reach.
e.    Sit  to clean or garden, rather than squatting or kneeling down.
f.    Use good posture when you stand, sit and lie down.

​

4.    USE STRONGEST JOINTS OR DISTRIBUTE THE FORCES OVER SEVERAL JOINTS.

The stress on each individual is less if it is divided over several joints. The larger joints have greater muscles surrounding them to absorb the stress.

 

a.    Use two hands whenever possible.
b.    Carry packages in both arms rather that in one.
c.    Carry a shoulder purse, or purse handle over forearm rather that in fingers.
d.    Use knapsack to carry packages on back. 
e.    Lift objects from underneath using wrist and elbow, rather than pinch gripping the sides.
f.    Lift objects with your knees bent , your back straight.
g.    Move large objects with body weight behind it, the push coming from the the legs. 
h.    Push with open palm or forearm rather than fingers.

5.    USE ADAPTED EQUIPMENT 

Find equipment that will reduce stress on the joint or make the job easier.

​

a.    Equipment can be modified by:

1.    Building up the handle so it is easier to grasp.
2.    Extending the handle so it is easier to reach

b.    Equipment available.

1.    Walking aids
2.     self-care aids
3.    Bathroom safety
4.    Homemaking equipment 
5.    Job modification equipment.
 

ADDITIONAL REMINDERS FOR THE PROTECTION OF THE RHEUMATOID HAND

Through exercise, maintain wrist extension ( ability to pick hand up off table) to ensure power grip. 

Through exercise, maintain supination (ability to turn palm up) to ensure ability to hold and to carry objects.

Avoid positions of deformity. 

a.    Finger flexion 

1.    Avoid making fist or tight grip: use built up handles.
2.    Work with hand flat, use dust mitts, sponges.
3.    Avoid prolonged holding of objects: pen, book, pen , needle.

b.    Ulnar deviation ( tendency of fingers to slide towards little fingers side)

1.    Avoid pressure towards little finger of hand.
2.    Any twisting of hand, open door knobs jars etc. Should be turn towards thumb.
3.    Grip objects parallel across palm, not diagonal, for example, hold utensil like dagger to cut food, stir with wooden spoon.           
 

Avoid stress on small joints of hands.

Use two hands whenever possible.
Substitute larger stronger joints: for example lift or carry with palms or forearm, not small finger joints, not small finger joints; carry bag over elbow or shoulder, not in finger tips.
Avoid activities involving pinching motions.
Avoid twisting and squeezing motions with hands. 

​