When people say they have arthritis, they are generally referring to problems with their joints. However, there are many different kinds of arthritis ranging from mild to serious. While they can also affect the soft tissue, including ligaments and muscle around the joints, not all types of arthritis get progressively worse.
The bones, joints and muscles of our body enable us to move around, and one of the main implications for people with arthritis is lack of mobility. Wear and tear arthritis of the hip, for example, can cause a limp and produce pain that makes walking difficult. Arthritis in the wrists and hands can make grasping simple household objects difficult, as it can seriously affect manual dexterity. Problems in the spine can significantly affect posture and produce long-standing and debilitating stiffness and pain. When more serious, it can even affect breathing by permanently bending the spine forward and compressing the lungs.
In turn, all of these things can reduce a person’s independence. Managing stairs, going out to the shops, going to visit friends and being as active as one used to be becomes a challenge. Some forms of arthritis affect other parts of the body, and general malaise and illness may accompany problems with the skeleton. Because of loss of mobility, it is easy to gain weight, which exacerbates strain on the already inflamed joints. Ongoing discomfort can impinge on a good night’s sleep and it can take much longer to get going in the morning. These kinds of frustrations can lead to stress, anxiety and depression. It is not much consolation for somebody with chronic discomfort and stiffness to hear that as many as 50 percent of people over 75 are in the same situation. Many people of this age and younger are mentally very agile and socially ambitious, and are very frustrated by the physical limitations that arthritis imposes.
Physical activity
Patients in my surgery with arthritis are often under the impression that they should always rest their arthritic joints and that this will help to limit any further damage. However, the correct type of exercise is not only helpful, but also vital for maintaining the mobility of joints and keeping muscles around them strong. If the muscles of the thighs for example are kept strong, then the knee joints are largely protected by that strength. Certain vigorous or weight-bearing types of exercises, however, can be worse than none at all. Old fashioned sit-ups, for example, put too much strain on your lower back and squatting down with your knees bent at more than a right angle can do harm to both knees and hips. Nor should the head be rotated around too vigorously as this can cause strain on the minor joints of the cervical spine.
Joints are designed to be moved. Even when the cartilage that covers the bone ends have become eroded over time, the joints will only become stiffer and more painful if they remain immobile. Putting the joints through a full range of movement but without jarring impact and weight-bearing is generally recommended. Gentle regular exercise can stretch out stiff muscles and frozen joints as well as strengthening the muscles around them. This will have a preventative effect on many forms of arthritis. The exception to this rule is in people who have an inflammatory arthritis such as rheumatoid arthritis where there is active swelling and increased circulation at certain times and where rest and the applications of ice packs is a better therapeutic option.
People with osteoarthritis, otherwise called ‘wear and tear’ arthritis, will often say that their joint pain is worse after strenuous exercise, and worst first thing in the morning when stiffness and aching is very noticeable. In fact any period of rest such as sitting in an armchair without the joints being supported can lead to this increased discomfort and stiffness. The correct kind of exercise will maintain mobility and strengthen the muscles around the joint. In turn this will stabilise the joint and protect it from further strain. Exercise also helps with losing weight, which can ease the pressure on the lower back, knees, hips ankles and feet.
Particular exercise
Whenever exercising, always begin with gentle exercises and build up gradually to more challenging ones. The correct type should not lead to any discomfort, so listen to your body and adjust your exercise levels accordingly.
Stretching – ideally you should try to put your joints through a full range of movement on a daily basis. Get into a routine and stick to it. You might like to start with your neck and work downwards through the body. With your neck, let your head fall forwards onto your chest and let it stay there for a few seconds. Then straighten up and drop your head to the left side for a few seconds before straightening up again and dropping it to the other side. Now, after looking straight ahead, turn to the right to look over your shoulder as far as you can, holding that posture for a few seconds. Then do this on the other side also. Finally tip your head back as far as is comfortable and then straightening up quickly so as to avoid any possible dizziness, which can sometimes occur with osteoarthritis of the neck.
Shoulders – with your arms by your side circle your shoulders forwards five times and then rotate them backwards five times also. Now lift your arms above your head pushing them backwards as much as possible. Keep your arms tight up against your ears, hold that position for a few seconds and then slowly bring them down sideways. Now hold your hands together behind your back and push them up towards the back of your head.
Elbows – start with your arms straight down by your sides. Now bend your elbows to a right angle with your palms facing downwards and rotate them upwards and downwards 10 times.
Wrists and hand – with your hands outstretched bend your wrists up and down to their full limit. Spread out your fingers and then make fists. Do this 10 times. Bring your thumb together with your index finger push them together then touch the tips of your other fingers with your thumb and repeat on both hands. Squeeze a tennis ball in your hands 10 times to strengthen your hand muscles.
Lower back – stand up straight with your feet shoulder width apart lean over to your left side and run your left hand down the side of your leg. Hold that for a few seconds and repeat on the right side. Now lie flat on the floor with your knees bent and lift your pelvis off the floor by tightening your tummy muscles and hold that for a few seconds. Next kneel on the floor on all fours first arching your back and then making a hollow. This position is known as the cat for obvious reasons and you should repeat it several times.
Hips – sitting on the floor with your legs out in front of you separate them to the sides as much as possible and hold that position for a few seconds. Next bring your legs together and bend your knees right up to your chest one at a time if this is easier. Hug your knees to your chest with your arms and maintain this position for a few seconds. Finally standing behind your arm chair lift first your left leg and swing it backwards behind you as far as it will go repeating this exercise with the right leg.
Knees – sit on your bed with your back supported with pillows behind you and your legs straight out in front of you. Push the backs of your knees down hard into the mattress feeling your thigh muscles tighten as you do this. Hold that position for a few seconds. In the same position, lift your left leg up keeping the knee entirely straight until your foot is about 6 inches above the bed. Once again you should feel the thigh muscles working hard. Hold this for a few seconds before repeating it on the other side. Finally, find a firm and stable box or low step and step up and down with one leg a few times before repeating on the other side.
Ankles and feet – lying flat, rotate your ankles in circles clockwise and anticlockwise. Now bend your toes up towards your knees and then bend them downwards as if you were on points like a ballet dancer.
Home adaptation
There are many ways to help and support somebody living with arthritis, and in mild cases the support of the GP together with the painkillers or anti-inflammatory medications he or she prescribes can be very helpful. More severe sufferers will be referred to a hospital specialist probably a consultant rheumatologist who works in conjunction with a rheumatology nurse specialist and a physiotherapist.
For people suffering from arthritis, the occupational therapist (OT) is another important healthcare professional. It is the job of the OT to keep you functioning as normally as possible and to guide you in maintaining the ability to carry out every day activities as efficiently as possible without straining your joints. The OT is the person who will advise you about aids and appliances that can be used to adapt your home to your specific individual needs. There are many and varied types of gadgets these days that make everyday tasks easier, both at home or work. There is an enormous range of aids or appliances from chunky grip pens to vegetable peelers and arm extensions with pincher grips. There are gadgets to help take the tight lids off jars, kettle tippers, bath seats, raised toilet seats and stair lifts. There are wheelchairs and ramps that can be installed. Alterations and adaptations can also be made to bathrooms to make showering easier rather than climbing into baths with high sides. Importantly, advice can be given on the procurement of the very best seating for the lounge or whatever room it is that the person with arthritis spends most time in. Sitting in a chair for many hours of the day may become inevitable for many people suffering from more severe forms of arthritis, but the important issue is that that chair must be as comfortable and as supportive as possible, helping each individual person with their individual requirements.
The following organisations are a very good source of information, counselling and support for anyone with arthritis or for relatives of people with arthritis.
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Arthritis Care
http://www.arthritiscare.org.uk
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Arthritis Research Campaign
http://www.arc.org.uk
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Assist UK (Disabled Living Centres Council)
http://www.assist-uk.org
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Back Care
http://www.backcare.org.uk
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Disabled Living Foundation
http://www.dlf.org.uk
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