Living with arthritis and rheumatism

Exercise

Many people believe that they should rest their arthritic joints and that this will prevent further damage. In fact, the right kind of exercise is not only beneficial but essential for keeping the joints mobile and the muscles strong. Prolonged rest, on the other hand, usually leads to more stiffness and to weakness and wasting of the muscles, while having no effect on the pain.

Nevertheless, the wrong kind of exercise is worse than none at all. For example, touching your toes and ‘sit-ups’ put an enormous strain on the lumbar region of the spine.

You should also avoid ‘the squat’ – bending your knees and hips from a standing position until your bottom touches your heels then standing up again. This exercise really punishes your knees. Do not rotate your head round like a windmill, hoping that this is a good exercise for your neck, because it can actually cause strain.

And lastly, never crack the joints in your fingers. What begins as a party trick can become a habit and can, over time, damage the joints. Aim to include three types of exercise in your programme:

• stretching exercises

• muscle-strengthening exercises

• general fitness or aerobic exercises.

The programme will also include a ‘weight-bearing’ element to help strengthen your bones and reduce your risk of developing osteoporosis. A good exercise programme should be part of your daily routine, whether or not you have arthritis.

Your exercise programme

Always start with gentle exercises and then build up gradually. The right sort of exercise should not cause pain, so listen to your body and adjust your activities accordingly.

Stretching

Stretching involves putting each of your joints through a full range of movement every day. Begin at the top of your body and work downwards so that no area is forgotten.

Neck

• Drop your head forwards on to your chest and let it hang there for a few seconds.

• Then straighten up and drop your head to the side, again letting it hang for a few seconds. Repeat, dropping your head to the other side.

• Turn round to look over your shoulder as far as you can and hold the position for a few seconds. Repeat, turning to the other side.

• Tip your head back as far as you can but do not force it, and this time do not hold the position for more than a second because you may feel dizzy.

Shoulders

• With your arms by your sides, rotate your shoulders in circles a few times, first forwards and then backwards.

• Lift your arms up above your head, bringing them in against your ears and pushing them backwards at the same time. Hold the position for a few seconds and then slowly bring them down sideways.

• Put your hands behind your back and clasp them. Then push your clasped hands backwards, away from your trunk and hold for a few seconds.

Elbows

• Straighten your elbows and then bend them up as far as they will go.

• Then, with your arms tucked into your sides and your elbows bent to 90 degrees, turn your forearms so that your palms are facing upwards and then downwards.

Wrists and hands

• Bend your wrists up and down as far as they will go.

• Spread your fingers out hard and then clench your fists. Do this several times. If your fingers do not straighten fully, put your hand on a flat surface palm downwards and very gently push the bent joints down with your other hand. Similarly, if your fingers do not close fully into a fist, very gently push them down with your other hand.

• Bring your thumb and index finger together in a pinch and then touch the tips of your other fingers in turn with your thumb. Repeat with your other hand.

• The muscles in your hands can be strengthened by repeatedly squashing a soft rubber ball into your palm, allowing it to inflate fully between squashes.

Upper back (thoracic spine)

• Stand with your back against a wall and straighten your back so that the back of your head touches the wall. Hold for a few seconds.

• Sit down and twist your trunk and shoulders round to one side as far as you can, hold for a few seconds and repeat to the other side.

• Take a deep breath in, expanding your chest as much as possible and hold for a few seconds.

Lower back (lumbar spine)

• Stand up straight and lean over to one side, running your hand down the side of your leg. Do not force the movement but just hang there for a few seconds. Repeat on the other side.

• Lie flat on the floor with your knees bent up. Lift your pelvis off the floor by tightening your stomach muscles and hold for a few seconds.

• Now straighten your legs out in front of you and push the small of your back against the floor, holding for a few seconds.

• Kneel on the floor on all fours. Make an arch of your back and then a hollow. Repeat several times (this exercise is known as ‘the cat’).

Hips

• Sit on the floor with your legs out in front of you and separate them out to the sides as far as they will go and hold for a few seconds.

• Then bring your legs together and bend your knees up to your chest, one at a time if this is more comfortable. Hug your knees to your chest with your arms and hold them there for a few seconds (this is also a good exercise for your knees).

• Stand up and hold on to a chair back or table for support. Lift one leg and swing it back behind you as far as it will go. Repeat with the other leg.

Knees

• Sit on a bed or on the floor with your back supported and your legs straight out in front of you. Push the backs of your knees hard against the surface, feeling the big quadriceps muscle in the front of your thigh tighten as you do so, and hold for a few seconds.

• Lift one leg up, keeping the knee straight, until your heel is about six inches above the surface. Once again, feel the quadriceps muscle working and hold for a few seconds. Repeat with the other leg.

• Find a low step and step on and off, alternating with each leg.

Ankles and feet

• Rotate your ankles in circles, first clockwise and then anti-clockwise.

• Bend your ankles up to bring your toes towards you and then bend them away from you, pointing your toes like a ballet dancer.

• Wiggle your toes.

Strengthening

Strengthening exercises work the muscles harder. Strong muscles are very important in helping to protect the joints from strain. Many of the exercises above will strengthen your muscles as well as stretching your joints.

More advanced muscle-strengthening exercises make the muscles work harder by lifting weights. The weights should be carefully chosen to suit you personally or the group of muscles being worked so try to get advice from a qualified person such as a physiotherapist or gym trainer. Weights that cause pain are too heavy.

Aerobic

Aerobic exercise works your heart and lungs as well as some of your joints and increases your stamina. Activities such as swimming, brisk walking and using an exercise bicycle are good examples. An exercise bicycle is particularly beneficial if you have arthritis in your hips or knees as the bicycle exercises these joints without them having to carry your weight at the same time. Swimming is a good choice if you are overweight because, again, the joints are exercised without having to support your body weight.

A moderate amount of exercise performed regularly, say two or three times a week, is much better for you than a blitz once a month, or only when you feel guilty. And even a small amount of exercise done regularly, such as a daily 10-minute walk, is much better than doing nothing.

Protecting your joints

Besides regular exercise, looking after your joints also involves protecting them from unnecessary strain in your everyday activities. People with arthritis can avoid pain and preserve their independence by making changes in the way that they do things. This is not ‘giving in to arthritis’ but simply good sense. Occupational therapists are experts in helping people to function as normally as possible, and advising on joint protection is one aspect of their work. They are based in hospitals and in social services departments and, if necessary, they will visit you at home to advise on aids, appliances and adaptations. Aids for every aspect of daily living are displayed in showrooms run by the Disabled Living Foundation (see Useful addresses).

People with healthy joints can also benefit from simple advice on joint protection. Avoiding unnecessary strain makes good sense for them too. It can make difficult or tiring tasks easier and it can help to avoid problems in the future. An obvious place to start easing the strain is in the kitchen.

It is much easier on the hips and knees to get up from a high-seated chair with arms and out of a bath with handles. Shoes with soft, rubber cushion soles act as shock absorbers and can protect the joints while walking. A walking stick can also be enormously helpful.

Tips in the kitchen

• A perching stool takes the weight off your legs when you are working at the sink, work-surface or ironing board.

• Steam irons are heavy and should be avoided if you have wrist, elbow or shoulder problems.

• Saucepans with two handles share the load between both hands.

• Eye-level shelves and cupboards are less tiring than floor cupboards, as reaching up causes less strain than bending.

Walking with a stick

If you have problems with your knees or hips, a walking stick can make a huge difference to your comfort, confidence and mobility. A walking stick, when used correctly, can take the load off an arthritic joint and help protect it from strain.

You can buy these walking sticks in chemists and elsewhere but there are many different types. It is best to get expert advice on the right one from a physio­therapist or occupational therapist who can assess your needs and help you to make the right choice.

Arthritis and the weather

At the first sign of cool, damp weather in the autumn, many people with arthritis and rheumatism find that their symptoms get worse. On the other hand, during the summer months or when they are on holiday, their arthritis is much less troublesome. Sometimes it can seem as if your joints are acting as a barometer. Although this experience is very common, we do not know why joint pain and stiffness are so sensitive to changes in the weather. But we do know that adverse weather conditions do not cause arthritis and they do not make existing arthritis worse.

Although people living in warm climates complain less of joint pain and stiffness, they develop the same forms of arthritis and often show abnormalities on their X-rays similar to those of people living in cool climates. Warmth is soothing and aids muscle relaxation and this is undoubtedly important in easing symptoms.

In warm weather and especially on holiday, people are often more active and the exercise is also beneficial to stiff, painful joints.

If you have arthritis, you should keep warm and try to maintain your levels of activity even when the weather is cold. A warm bath followed by a simple programme of exercises can help enormously to reduce the pain and stiffness of arthritic joints.

Diet and arthritis

People often wonder if their diet has anything to do with their arthritis. The answer is, ‘probably not’! The one exception is gout, where alcohol and foods containing large amounts of purines, such as liver, heart, kidney and fish roe, can make the condition worse. Food allergies as a cause of arthritis are highly individual, difficult to test for and probably very rare. However, if you feel that a certain food makes your symptoms worse, then you can do an experiment called an ‘exclusion diet’ to test this out.

There are lots of published ‘diets for arthritis’, supported by glowing testimonials from people who claim that their particular diet ‘cured’ their arthritis and will cure yours too! Unfortunately, glowing testimonials do not amount to scientific evidence and you may waste a lot of money following a diet that has no good evidence to support it.

The best diet for arthritis is a healthy diet – one with a balance of protein, carbohydrate and fat with plenty of fibre, vitamins, calcium, iron and other minerals. A good diet will also help you to keep close to your ideal weight – and keeping your weight down is one of the most important things that you can do to take the strain off your joints.

Exclusion diet

• Keep a diary of your joint pain and stiffness for six weeks.

• For the first two weeks, eat a normal diet, including the suspect food.

• For the second two weeks, cut the suspect food out of your diet completely.

• For the third two weeks, include the suspect food in your diet again.

• If your symptoms improve during the middle two weeks when you exclude the food, and then get worse again when you reintroduce it during the last two weeks, then it is reasonable to conclude that the suspect food is making your symptoms worse.

Arthritis and inheritance

Many people with arthritis want to know if the arthritis will ‘run in the family’. It is certainly true that almost all forms have an inherited element – that is, if you have arthritis then your first-degree relatives (children and siblings) have an increased chance of developing it too. But for most forms of arthritis, the increased risk is still very small indeed. And even if they do develop arthritis, it may still be mild, even if your arthritis is one of the severe forms. We cannot predict ahead of time who will and who won’t develop arthritis and, more importantly, we cannot prevent it. The best advice is to lead a healthy life, take regular exercise, don’t abuse your joints and don’t worry. Whatever form of arthritis you have, the chance that your child or grandchild will also have arthritis is very small.

Pain control

Pain should always be respected and constantly pushing yourself to continue activities that make it worse is counterproductive. On the other hand, too little activity is as bad as too much because it can leave you with weakened muscles and encourage joints to stiffen and lose flexibility. There are many techniques for reducing pain besides drugs, and some of them you can easily try for yourself at home.

The future

There are over 200 types of arthritis and, for many types, there is no single cause. Therefore, a single ‘cure for arthritis’ is very unlikely to be found! But for people with arthritis of all kinds, there is a great deal of help available and even people with severe arthritis can remain mobile and independent. In fact, most people with arthritis can lead normal lives.

On the other side of the coin is the fact that the population is living longer and people of all ages complain more about pain, stiffness and other locomotor problems. What is the cause of this? Certainly, it does not seem that the more serious forms of arthritis, such as rheumatoid arthritis, are becoming more common. Some of this increased stiffness, disability and pain is undoubtedly caused by osteoarthritis, which is more common in people who are older. But much is also the result of body abuse – lack of exercise, overweight, poor posture and overuse syndromes are the scourges of modern life in affluent societies. Abolishing these scourges would reduce not only locomotor problems but also diabetes, high blood pressure and heart disease.

The remedy is largely in our own hands. You will notice how much I have emphasised the importance of exercise throughout this book. Exercise, exercise and exercise are probably the three most important factors in keeping the joints healthy! Daily working lives are now much less active compared with 50 years ago. On the other hand, exercise classes, swimming pools and gyms for leisure time are now widely available, with activities to suit almost everyone of whatever age. Find out about them today!

Practical pain control

Ice packs: you can buy cold packs to keep in the home freezer and use when you need them. If you use a bag of ice or a pack of frozen peas instead, wrap it in a tea towel to protect your skin and apply it for no longer than 20 minutes. Cold packs are helpful for acute inflammation and swelling but avoid them if you have poor circulation or skin numbness.

Hot packs: these may be electric or ones that you heat yourself (including microwaveable types) and are used in the same way as cold packs. Heat lamps work in a similar way, and don’t neglect the traditional hot bath as a form of pain relief. Heat is good if you have deep aching pain, especially with muscle tension. Again, you shouldn’t use hot packs if you have poor circulation or skin numbness because of the danger of accidental burns.

TENS (transcutaneous electrical nerve stimulation): this method of pain relief uses simple equipment to deliver a mild electric current through pads attached to the skin over painful areas. Stimulating nerves in this way blocks the pain sensations and prevents them reaching the brain. The equipment is safe and easy to use and is often especially helpful for hip, shoulder and back pain. If you would like to try TENS then ask your physiotherapist.

Massage: if you have a partner, friend or relative who is willing to learn how to give you a simple oil massage, this traditional form of therapy can be a big help in relieving pain, especially in the muscles. Either ask an expert to demonstrate or buy one of the many excellent books on the topic.

KEY POINTS

• The right sort of exercise, performed regularly, is essential for keeping your locomotor system in the best possible condition

• The ideal is a balance of stretching for your joints, strengthening for your muscles and aerobic exercise for stamina