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Joint Protection for the
Person with Arthritis
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Introduction
This booklet is intended for someone
who has arthritis. It provides general
guidelines for limiting stress on your
joints and for protecting them from
damage or deformity. Specific
suggestions for modifying day-to-day
activities and for using adaptive
equipment are given to help you
manage your arthritis and allow you
to be as active and independent as
possible.
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What is Arthritis?
Most joint ailments caused by
inflammation are called arthritis, from
the Greek words arthron, for joint, and
itis, for inflammation. Osteoarthritis
and rheumatoid arthritis are two of
the most common joint ailments
afflicting people. Of these,
rheumatoid arthritis is the most
debilitating.
Osteoarthritis
Osteoarthritis, also called “wear-andtear arthritis” or degenerative joint
disease, develops as the natural result
of time and normal use. Thus, the
athlete who sustains joint injuries and
the laborer whose joints are
challenged every day by demanding
physical activity are at increased risk
of developing arthritic joints later in
life. People who develop
osteoarthritis experience pain and
aching in an affected joint during or
after use. When the afflicted joint
becomes swollen, it looses flexibility.
Discomfort in a joint before or during
a change in weather is also a common
occurrence.
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Rheumatoid
arthritis
Rheumatoid arthritis is thought to be
an autoimmune disease. An
autoimmune disease is a disease that
occurs when antibodies that are
normally formed by the body’s
immune system to fight infection,
react against the body’s normal
tissues. Unlike osteoarthritis which
affects only the muscles and bones,
rheumatoid arthritis is a systemic
disease. It can affect the entire body
including the muscles, bones and
organs such as the heart, lungs and
eyes. Rheumatoid arthritis tends to
affect more than one joint at a time,
particularly after sleeping or after
periods of limited movement, causing
stiffness and aching throughout the
body. It often has a symmetrical
impact; when it affects a joint on one
side of the body, it is likely to affect
the corresponding joint on the other
side of the body.
Rheumatoid arthritis is marked by
periods of flares and remissions.
During flares or “flare-ups” the
affected joints become swollen, stiff,
painful and warm to the touch. You
may experience morning stiffness, loss
of appetite, weight loss, fatigue and a
low grade fever. During periods of
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remission, symptoms may temporarily
disappear. Your lifestyle and the
medications you take influence the
length of your remission and
frequency of flares.
Contact the National Arthritis
Foundation at the address below for
more information. The national office
can inform you whether a local
chapter exists in your community.
Arthritis Foundation
1330 West Peachtree Street
Atlanta, GA 30309
(404) 872-7100
Web site: http://www.arthritis.org.
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Important Notes
People with osteoarthritis typically do
not acquire the same joint deformities
as people with rheumatoid arthritis.
However, the joint protection
principles described in this booklet
apply to people with both types of
arthritis.
The guidelines and exercises
suggested in this booklet are for use at
home following instruction by your
health-care provider. These exercises
and activities should not produce
pain. If you experience pain while
performing one of these exercises or
activities, stop immediately. Relax and
repeat the exercise or activity with
reduced speed and intensity. If pain
persists, stop the exercise or activity
and speak with your health-care
provider.
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General Principles of
Joint Protection
Following are general guidelines to
help you protect your joints from
injury as you perform daily activities:
1. Recognize and acknowledge your
pain.
• Learn to recognize the difference
between the general discomfort of
arthritis and the pain from
overuse of a joint.
• Modify your activity level or
method of doing a task to avoid
excessive pain. Pain that lasts
more than one hour after an
activity or includes joint swelling
indicates that the activity was too
stressful.
• Understand that painful, swollen
joints are more likely to be
damaged.
2. Avoid using your hands in ways
that may increase the potential for
deformities, such as those explained
to you by your physical or
occupational therapist.
• Avoid hand positions that push
fingers toward the little finger
(ulnar deviation) See figure 20 on
page 32. Motions of your fingers
should be in the direction of your
thumb whenever possible.
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• Avoid making a tight fist or tightly
pinching an object against your
index finger. This position
increases the likelihood of ulnar
deviation. Large-circumference or
built-up handles can help you to
grasp an object more easily while
reducing the amount of ulnar
deviation (see figures 1 and 2).
Figure 1. Large
circumference
handle
Figure 2.
Built-up
handle
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• Hold an object with an open hand
and curved fingers (see figure 3).
Don’t use a “tabletop grip” with
bent base joints and straight end
joints.
Figure 3. Open hand position
• Avoid resting your head on your
knuckles.
• Modify activities that require
excessive pressure, such as
holding a pen or turning a water
faucet on and off. Write with a
large barrel pen or pen to which a
grip has been added. Use an easy
glide pen with a roller ball or gel
ink.
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• Use a sponge in an open hand
when washing dishes, your car
and wiping counters and
windows. Press out water using
an open hand or your fist.
• When shaking hands, let the
person you are greeting extend
their hand first, then grasp the
person’s fingertips, thumb or
forearm or take their hand
between both of yours.
• When turning a round door knob,
hold your arm parallel to the door
and use a wrist or forearm motion
(see figure 4).
Figure 4. Opening round doorknob
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• Install lever door handles to
reduce stress to hand joints (see
figure 5).
Figure 5. Lever doorknob extension
• When traveling, transport your
luggage with a lightweight
luggage cart with wheels, or
luggage or backpack with wheels
and extended handles. Avoid
carrying your luggage.
3. Use correct body mechanics to
protect your joints.
• When standing, use work
surfaces that allow you to work
comfortably without stooping or
elevating your shoulders.
• Increase the height of your chair
and toilet seat to decrease stress
on your hips and knees as you sit
and stand.
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• To reach a lower surface, sit on a
chair and bend over. To pick up
items from the floor or a low
shelf, bend at your knees and
hips, if you are able, to minimize
stress on back. Bending from the
waist will increase the stress on
your back.
• Slide objects along a counter or
workbench rather than lift them.
• Hold bulky or heavy objects close
to your body when carrying them
so you can support the weight on
your forearms (see figure 6 ).
Figure 6. Carrying an object
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• Divide groceries into several bags
to distribute the weight.
• Move from a sitting to a standing
position by sliding your body
forward in your chair. Do not
move your feet forward. Lean
forward so that your weight is
more directly over the balls of
your feet and use your legs to
stand up. If necessary, use your
forearms or palms to push up on
the arms of your chair or a nearby
table (see figure 7). Do not push
with your fingers.
Figure 7. Moving from sitting to standing
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4. Use the strongest joint available for
a job.
• Support carried items with your
forearms, distributing the weight
equally between your arms and
body.
• Carry groceries in a paper bag
against your body rather than in a
plastic bag hanging from your
fingers.
• Open cabinets with a wrist or
forearm loop to decrease stress on
your fingers (see figure 8).
Figure 8. Forearm loop
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• Place a shoulder strap purse over
your head with the strap lying
diagonally across your back and
chest.
5. Change position often.
• When driving, writing or doing
handwork, release your grip
every 10 to 15 minutes.
• On long car trips, get out of the
car to stretch and walk at least
every hour.
• While watching television, get up
and move around every 30
minutes.
6. Conserve energy.
• Balance periods of rest and
activity during the day. Spread
chores such as cleaning and yard
work throughout the week rather
than try to finish chores in one
day.
• Work at a steady, moderate rate
and avoid rushing.
• Rest before you become fatigued
or sore.
• Alternate light and moderate
activities throughout the day.
• Alternate sitting and standing.
• Get assistance.
• Delegate strenuous work to
others.
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• Allow yourself adequate time.
Avoid the stress of rushing.
• Transport heavy items with a
utility cart to avoid extra trips
when setting a table or unloading
groceries or household items.
Use a wheel barrel or garden cart
to move lawn supplies.
• During any activity, sit rather
than stand to reduce stress on the
hips, knees and back.
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Joint Protection When
Dressing, Grooming and
Bathing
Follow these guidelines to help protect
your joints when dressing, grooming
and bathing:
1. Plan extra time so that you are not
rushed.
2. Choose loose-fitting clothes that are
comfortable and easy to manage.
• Wear clothing with front openings
and easy-to-handle fasteners such
as zippers with large tabs, large
buttons, Velcro™ or large hooks.
• Use a button aid to fasten small
buttons on clothing (see figure 9).
Figure 9. Button aid
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• To eliminate buttoning, use
Velcro™ tabs or attach cuff
buttons with elasticized thread to
allow your cuff to stretch so you
can slip your hand through
without unbuttoning it.
• Do not pinch tightly when you
grasp a zipper tab. Instead, use a
zipper pull (see figure 10), key
ring, large zipper ring or a loop of
invisible fish line at the end of a
zipper so you will not need to
pinch the tab.
Figure 10. Zipper pull
• Avoid tight collars. Necklines
with V-necks, scoop necks and
boat necks are easiest to manage.
• Select clothing made from stretch
fabrics.
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• Wear slip-on shoes or use elastic
shoelaces or shoes with Velcro™
closures.
• Wear lightweight jackets or
lightweight, down or fiber-filled
coats in the winter. Velcro™
closures are easiest to manage.
• If your range of motion is limited
and pulling clothing over your
head is difficult, step into garments
or try wrap-around garments. Your
therapist may be able to suggest
other helpful dressing techniques.
• When inserting arms into sleeves,
first insert your weakest arm or
the arm with the least range of
motion. Undress that arm last.
• If slipping your arms into coat
sleeves is difficult, try a cape or
poncho.
• Fasten back-closing bras in the
front at your waist, then turn
around and pull into place. Using
a bra extender, which can be
purchased at a fabric store, will aid
in sliding your bra into position.
Women may find that frontclosing bras or sports bras are
easier to manage than back-closing
bras. When dressing after a bath
or shower, powder applied on and
under your breasts will allow your
bra to slide into place more easily.
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• Avoid wearing girdles and garter
belts because pulling them on
and off strains the fingers.
• Thread your belt through the belt
loops before putting on pants.
• Wear a clip-on tie or leave the
knot loosely tied and slip the tie
over your head if tying a necktie
is difficult.
3. Select hair styles that require
minimal care.
• Use lightweight electrical
appliances for hair care.
• Rest your elbow on a counter or
table to comb your hair.
• Use long-handled brushes and
combs with adjustable handles
(see figure 11).
Figure 11. Long-handled brush
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4. Use built-up (large circumference)
or lengthened handles with surfaces
made of rubberized material to
improve your grasp and to make up
for the decreased range of motion in
your joints.
• Use built-up handles on makeup
applicators and lipstick tubes to
simplify makeup application.
Built-up handles also may be
added to toothbrushes and eating
utensils (see figure 12).
Figure 12. Built-up handle
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• Use a long-handled shoehorn or a
small footstool to help you reach
your feet (see figure 13).
Figure 13. Long-handled shoehorn
• Use a stocking aid to put on your
socks if you have difficulty
reaching your feet (see figure 14).
Figure 14. Stocking aid
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5. Use bath benches, grab bars and
toilet seat risers for bathing and
caring for your personal hygiene
with greater ease, safety and
independence. This equipment can
be purchased from a medical supply
store.
• Bathing aids such as longhandled sponges and brushes can
help you reach your feet and
parts of your body that might
otherwise require stretching.
• Bathing with a nylon mesh body
sponge will help you to relax
your grasp.
• Use pump containers for soap,
shampoo and toothpaste.
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Joint Protection When
Working in Your Kitchen
or Storage Areas
Follow these guidelines to help protect
your joints when working in your
kitchen or storage areas:
• Organize your work areas so that
items are easy to reach. Dispose of
items that are seldom used.
• Hang utensils, tools, pots and pans
on pegboards.
• Install turntables and pullout
shelves in your cabinets to help you
avoid unnecessary lifting.
• Store frequently-used heavy items
in cabinets that are located between
your hip and shoulder height.
• Locate tools, cookware and
appliances near the area where you
will use them.
• Cook with lightweight non-stick
pans.
• Choose prepared food and
convenience items whenever
possible. For example, purchase
chopped walnuts rather than whole
nuts you must chop.
• Hold a knife like a dagger and use a
sawing motion and gentle pressure
to cut. Electric knives and knives
with offset hand grips and serrated
edges are especially effective (see
figure 15).
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• A cutting board with a nail can help
to hold food while cutting or
peeling (see figure 15).
Figure 15. Knife with offset hand grip; cutting
board with nail
• Use electric appliances and tools
such as food processors, blenders,
electric knives and can openers in
the kitchen. Use electric drills,
power saws and automatic garage
door openers in the garage.
• Use a peeler with a largecircumference handle rather than a
knife when preparing fruit and
vegetables.
• When rolling out pie crust or cookie
dough, place your hands flat on the
rolling pin to move the pin rather
than grasping the handles.
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• Install a jar opener in the kitchen to
assist you in opening tight screw-on
covers (see figure 16).
Figure 16. Jar opener
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Joint Protection When
Working at Your Desk
Follow these guidelines to help protect
your joints when working at your desk:
• When writing, use adequate lighting
and correct posture. Adjust your
chair height so you can sit
comfortably without elevating your
shoulders when resting your arms on
the table. Writing materials should be
pushed forward or placed on the table
so that you can work comfortably
without bending your neck.
• Relax your hand and neck muscles
every 20 to 30 minutes.
• If holding a pen is painful, you may
lessen your discomfort by writing
with a larger barrel pen or using a
pen grip or sponge roller to enlarge
the barrel (see figure 17). Nylon tip,
felt tip, rolling ball or gel ink pens
permit easier gliding and require
less pressure than do pencils and
ballpoint pens.
Figure 17. Wide barrel pen
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• When reading, use open hands or a
bookholder to support your book
(see figure 18). You may also place
your book on a lapboard or table to
avoid prolonged holding.
Figure 18. Bookholder
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Joint Protection When
Cleaning
Follow these guidelines to help protect
your joints when cleaning:
• Clean one area or floor level at a
time to reduce the number of trips
from room to room and up and
down stairs.
• Store cleaning supplies in areas that
you use them.
• Avoid unnecessary bending and
stooping: use long-handled mops,
dustpans and brooms and, if
possible, raise your front-loading
washer and dryer by placing them
on blocks for easier access.
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Joint Protection When
Exercising
Follow these guidelines to help protect
your joints when exercising:
• To maintain flexibility without
damaging your joints, move each
joint through its full pain-free range
of motion at least once daily. This
pain-free range may vary from day
to day.
• Do the exercises your physician and
occupational or physical therapist
recommend. Do not overexercise or
push yourself when your joints are
painful or swollen.
• Incorporate tasks of daily living into
your exercise program. For
example, pick up light objects from
the floor or from the highest shelf
you can reach comfortably.
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Joint Protection When
Taking Part in Hobbies,
Leisure and Recreation
Follow these guidelines to help protect
your joints when taking part in
hobbies, leisure and recreational
activities. Limit participation in
activities that stress the joints such as
knitting, crocheting, needlepoint,
bowling and sports such as tennis and
football. Consider these activities:
• Garden with plants that require
minimal care, such as indoor or
patio plants. When weeding,
position yourself comfortably on a
stool and use long-handled tools.
Weed after a rain, or water your
garden the night before weeding to
simplify weed removal.
• Paint, create ceramics and draw
using paint brushes and pencils
with built-up handles.
• Play an instrument. However, limit
the length of playing time to protect
your joints from stress or injury.
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• When playing card games, use a
card holder and a card shuffler for
assistance (see figure 19).
Figure 19. Card holder
• When fishing, use a rod holder or
built-up handle on your reel and
wear a light-weight life vest.
• When golfing, use a golf cart and
golf clubs with enlarged grips to
minimize discomfort. A golf ball
caddy and golf tee placer will
extend your reach when placing
your ball and tee.
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Splinting for Joint
Projection
To help manage arthritis that has
affected your hand, your physician
may prescribe a splint. The splint will
help to rest your joints and reduce
inflammation. Your therapist can
provide you with the specific reasons
for your splint and instruct you in its
wearing schedule and care.
Prolonged inflammation or
inflammation that does not respond to
treatment may damage bones, cartilage,
tendons and ligaments and increase the
potential of joint deformity for people
who are affected by rheumatoid
arthritis. Splints help slow the formation
of joint deformities that people with
rheumatoid arthritis may develop.
People with osteoarthritis typically do
not develop these same joint deformities.
Joint deformity that occurs in the hand
can include the following:
• Ulnar deviation — the fingers “drift”
toward the little finger (see figure 20)
Figure 20. Ulnar deviation
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• Swan neck — the middle finger
joints collapse and the end joints
flex or straighten unnaturally (see
figure 21). This deformity can
interfere with ability to grasp an
object.
Swan neck
deformity
Figure 21. Swan neck
• Subluxation — when a joint or bone
is no longer in alignment with a
corresponding joint or bone (see
figure 22).
Subluxation
deformity
Figure 22. Subluxation
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• Boutonniere — flexion of the middle
joints of the fingers and the
extension of the end joints (see
figure 23). This deformity can
become fused and prevent you from
straightening your fingers.
Boutonniere
deformity
Figure 23. Boutonniere
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Hand Exercises for Joint
Projection
When performed as directed, these
exercises may maintain or increase the
range of motion of the joints in your
hand. Repeat each exercise ________
times, ________times a day.
Do each of the following exercises
slowly and smoothly:
1. Bend and straighten the end and
middle joints of your fingers while
keeping the knuckles straight (see
figure 24).
Hold this position for ________
seconds.
Relax and repeat.
Figure 24. Hand exercise 1
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2. Make a gentle fist by touching your
finger tips to your palm or to the
base of your thumb (see figure 25).
Hold this position for ____ seconds.
Relax by straightening your fingers
without spreading them.
Repeat.
Figure 25. Hand exercise 2
3. Straighten your fingers without
spreading them apart (see figure 26).
Hold this position for ____ seconds.
Relax and repeat.
Figure 26. Hand exercise 3
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4. Make an “O” by touching your thumb
to each fingertip (see figure 27).
Hold each position for ____ seconds.
Relax and repeat.
Figure 27. Hand exercise 4
5. Rest your hand on a table with your
palm down. Move your thumb
away from your hand. Move each
finger, one at a time, toward your
thumb (see figure 28).
Hold each position for ____ seconds.
Relax and repeat.
3
4
2
5
1
Figure 28. Hand exercise 5
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Contrast Baths for the
Hands and Feet for Joint
Protection
Contrast baths alternate using hot and
cold water to help prevent swelling in
your hands or feet that may occur if
you were to soak them in only hot
water. When performed as directed,
these baths may help you relax and
reduce pain in your hands or feet.
Important: These baths should not
produce pain. If you experience
pain at any time, stop the bath
immediately and, depending on
which part of the bath is painful,
either cool the hot water or warm
the cool water by several degrees
and continue. If pain persists, stop
doing the baths and speak with
your healthcare provider.
To prevent burns, use a thermometer
to measure the temperature of the
water before placing your hands or
feet in the bath. Use the temperatures
as prescribed on page 39 to prepare
the water for contrast baths.
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Fill one large basin or container with
hot water at:
_________ degrees Fahrenheit
_________ degrees Centigrade
Fill another large basin or container
with cold water at:
_________ degrees Fahrenheit
_________ degrees Centigrade
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Schedule
Begin and end baths in hot water.
Place your hands or feet in the hot
water and then the cold water,
according to the following schedule.
HOT
COLD
10 Min.
1 min.
4 min.
1 min.
4 min.
1 min.
4 min.
1 min.
4 min.
Contrast baths should be taken once
or twice daily.
You may need to refresh the water
toward the end of the baths to
maintain the proper temperatures.
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BARBARA WOODWARD LIPS PATIENT EDUCATION CENTER
Mrs. Lips, a resident of San Antonio, Texas, was a loyal patient of Mayo Clinic for more than 40 years.
She was a self-made business leader who significantly expanded her family’s activities in oil, gas and
ranching, even as she assembled a museum-quality collection of antiques and fine art. She was best
known by Mayo staff for her patient advocacy and support.
Upon her death in 1995, Mrs. Lips paid the ultimate compliment by leaving her entire estate to Mayo
Clinic. Mrs. Lips had a profound appreciation for the care she received at Mayo Clinic. By naming the
Barbara Woodward Lips Patient Education Center, Mayo honors her generosity, her love of learning, her
belief in patient empowerment and her dedication to high-quality care.
©2001
MC1837rev0301