Controlling Arthritis

Whether you've been recently diagnosed or have been battling painful joints for years, you can learn to manage your arthritis and minimize the pain it can cause. There are no magic cures for arthritis — the key is to learn what works for you and to stick with it. Remember that everyone is different, so what helps someone else may not help you.

What will help you is to learn how to be a good self-manager of your arthritis. A good self-manager:

• Gathers information from family, friends, arthritis groups, or other sources.
• Consults with a professional or team of professionals such as a physician, occupational or physical therapist, pharmacist, and others.
• Follows through on the advice given by health professionals.
• Understands that arthritis self-management is a day-to-day task.

Exercise is a vital component for arthritis self-management. It reduces fatigue, builds stronger muscles and bones, gives more stamina, increases flexibility, and can improve your general health and sense of well-being. You should perform your exercise program on both good and bad days. You may need to modify your exercise on bad days, but don't quit. Exercise has been proven to break the cycle of chronic pain and depression when performed regularly. Consider these rules for exercise:

• Start with gentle stretches to loosen tight muscles and limber joints.
• Move slowly and gently without bouncing or jerking.
• Plan exercises to avoid getting up and down excessively.
• Perform the same number of exercises for the right side as for the left.
• Breathe naturally—try counting out loud to make sure you are breathing easily.
• Cut back on repetitions if you experience increased pain that lasts more than 2 hours after exercising—but never quit exercising.

Efficient use of your muscles will help you to reduce the stress, pain and fatigue arthritis can cause. Distribute the load over stronger joints and/or larger surface areas:

• Close a kitchen drawer with your hip, instead of your hand.
• Close plastic lids on containers with your elbow instead of your fingers.
• Hang heavy clothes in the closet by using both hands to hold the hanger and garment.

Use body leverage:

• Hold a brown paper grocery bag with both arms close to your body vs. holding a plastic grocery bag with one hand at your side.
• Avoid keeping joints in the same position for extended periods of time.
• Avoid holding a book or newspaper for a long period.
• Use a table or book stand to support reading material.

Reduce excess body weight to avoid strain on hips, knees and ankles. Use good posture when sitting, standing, lifting, and changing positions. To reduce stress to your joints learn to conserve your body energy by becoming more efficient:

• Plan tasks. Combine several errands around the house in one trip. Use a utility cart on wheels to transport items.
• Organize specific tasks. Store frequently used equipment and supplies between eye and hip level to decrease bending and stooping; store heavier items in easy to reach places; use dividers, special racks, turntables, and pull-out shelves.
• Balance work with rest. Allow for short but frequent rest breaks throughout the day. Alternate heavy and light work tasks during the day.

Utilize items that will help you in accomplishing tasks with less effort, such as:

• Wheels. Utility carts and garbage cans on wheels are helpful.
• Levers. Open flip-top cans with a table knife. Place keys on an extended holder or large key ring.
• Lightweight objects. Use Corelle-style dishes vs. heavy stoneware. Use lightweight pots vs. iron skillets. Use plastic bowls instead of heavy glass ones.
• Enlarged handles. Place foam padding around the handles of toothbrushes, pens, razors, and hairbrushes.
• Convenience items. Use food processors, microwaves, prepared foods, permanent press clothing, or anything else that will make daily tasks easier to perform.

Used by permission of
Baton Rouge Physical Therapy

Osteoporosis Not Limited to Senior Women

Often called “the silent thief” because there are no symptoms, osteoporosis is a disease in which once-strong bones become thin, brittle and more likely to break. Fractures—particularly in the hip and spine—can lead to permanent disability and possible life-threatening complications in men as well as women. Of the 44 million Americans over 50 at risk for osteoporosis, 30 million are women and 14 million are men, according to the National Osteoporosis Foundation. Although men typically have larger, stronger bones than women, one in eight men will suffer an osteoporosis-related fracture during his life, and one-third of all hip fractures occur in men. Factors contributing to risk for osteoporosis in younger people include: eating disorders, crash diets or diets low in calcium, side effects of certain medications, smoking, excessive alcohol and caffeine consumption, and early menopause.

A bone density test—the only way to determine bone mass—is crucial for early diagnosis of osteoporosis. Good nutrition including sufficient calcium and Vitamin D, various medications to prevent and treat bone loss, weight-bearing exercise, and strength training all play important roles in combating osteoporosis.

How Physical Therapy Can Help

The goal of physical therapy in treating osteoporosis is to restore mobility, function, strength, and confidence, and to enhance the safety and security of one’s everyday life, according to the American Physical Therapy Association (APTA.)

After performing a comprehensive musculoskeletal examination of the osteoporotic patient, Diane Hartley, PT, RCMT, (PTPN member, Hartley Health Care Services, Inc., Pinellas Park, Florida) develops an individualized program incorporating specific exercises for weaknesses and tightness as well as postural and weight-bearing exercises. “It’s important that patients find an 
 

exercise  hobby they enjoy, such as walking or swimming, that they’ll continue to do the rest of their lives,” says Hartley.

“If the patient is at risk for falls,” says Hartley, “a fall prevention program is incorporated with specific balance and strengthening exercises. We also analyze the patient’s habitual movement patterns and body mechanics and provide education for injury prevention.”

Another physical therapist that designs customized programs for patients with osteoporosis is Sylvia McCandless, MS, PT, (PTPN member, McCandless Physical Therapy, Flowood, Mississippi), who uses general weight training to stimulate bone mass and improve overall strength. “For some patients, aquatherapy, which uses the resistive force of water, is an effective way to do aerobic and strength exercises to stimulate the muscles around the spine.” To help relieve some of the pains and muscle spasms resulting from osteoporotic fractures, McCandless uses manual techniques, such as massage; therapeutic modalities, such as deep heat; and posture training. She also counsels patients on “energy conservation” to help them move efficiently around the house safely and without pain.

In the case of patients with significant osteoporosis, the APTA recommends avoiding activities that involve trunk rotation or forward bending and may cause vertebral fractures: golf, tennis, biking, bowling, and the use of rowing machines and cross-country ski machines.

With the goal of improving the quality of life for patients with osteoporosis, Hartley says, “Education is a big component in my program because if you increase a patient’s knowledge about the disease process, the importance of exercise, safe and proper body mechanics, and injury prevention techniques, he or she can avoid future problems for a lifetime.”

Suffering in Silence…  Help For Women With Urinary Incontinence

“The real shame is not that the person has this problem, but that the average woman waits eight years before seeking treatment,” says Kathryn Kassai, PT (PTPN member, Praxis Physical Therapy, San Pedro, California). The problem — urinary incontinence, the accidental leakage of urine — affects more than 13 million people in the United States, 85 percent of whom are women, and costs an estimated $16.4 billion annually, according to the Agency for Health Care Policy and Research (AHCPR).

Effects on Work Productivity, Quality of Life

Urinary incontinence can disrupt work and endanger job security for women perceived as “slacking” because of numerous bathroom breaks. In a study cited by the AHCPR, of 201 women aged 16 to 86 with urinary incontinence and other lower urinary tract symptoms, more than 50% said their symptoms were affecting their work. Chronic sleep deprivation from getting up several times during the night may cause inability to concentrate at work.

Without treatment, incontinence can consume a woman’s life with embarrassment and depression, limit her activities, and lead to secondary medical conditions such as recurrent bladder infections and possible surgery. Incontinence is one of the major reasons for admission to nursing homes, adding a substantial burden to medical systems. But the encouraging news is that physical therapy cures or reduces incontinence in the majority of women, and most insurance companies cover physical therapy for the problem. With physical therapy, the need for surgery and drugs is preventable in many cases. The results of a 1998 study in the Journal of the American Medical Association indicated that behavioral treatment using biofeedback (a physical therapy technique) should be offered routinely as an option for patients as a first-line treatment for urinary incontinence.

How Physical Therapy Can Help

Childbirth and pregnancy are leading causes of urinary incontinence because a woman’s pelvic floor muscles (PFM), which extend from the public bone to the tailbone, can become stretched and weakened, impairing bladder control. Those muscles can also be weakened by: hormonal changes of menopause, obesity, chronic constipation, chronic cough, aging, and improper lifting of heavy objects at work and at home. Other causes of urinary incontinence unrelated to the PFM may include: urinary tract infections, medication, neuromuscular disorders, caffeine intake, and stress.

The two types of urinary incontinence that benefit from physical therapy treatment are stress incontinence and urge incontinence. Stress incontinence is the sudden involuntary loss of urine when you
exercise or move in a certain way, e.g., jumping, coughing, sneezing, or laughing.

Urge incontinence is urine leakage that occurs as soon as you get the urge to go to the bathroom. The sensation is overwhelming, and your bladder muscle tightens at the wrong time, and you can’t control it. As a specialist in the treatment of urinary incontinence, Kassai uses a variety of techniques including a sophisticated computer technology with EMG (electromyographic) biofeedback, which “reads” activity in the PFM through an electrode placed over the muscle. The electrode is connected by a wire to a monitor, allowing patients to watch themselves contracting the muscles on a screen. They learn to contract the correct muscle, when to let go, and how many exercises to do. This builds strength, endurance and coordination in the PFM, which are all necessary to achieve urinary control. “The good news for millions of Americans is that Medicare,¹ after reviewing years of research, now covers biofeedback for treatment of urinary incontinence,” notes Kassai, who says treatment usually ranges from six to ten visits.

In addition to using biofeedback, Joan Dillon, PT (PTPN member, Star Clinic, Mountain View, California) prescribes abdominal exercises, Kegel exercises (developed in the 1940s by gynecologist Arnold Kegel), and vaginal weights to strengthen and retrain pelvic floor muscles and sphincter muscles. “Women need to understand the causes of pelvic floor weakness and become aware of what they’re doing that contributes to the problem. For example, a woman may leak urine when she goes from a sitting to a standing position because she’s bearing down — pushing the pelvic muscles out — instead of pulling up and in as she rises,” says Dillon.

Electrical stimulation is another treatment used by physical therapists to strengthen the PFM. Gentle electrical stimulation over the PFM helps the muscles to contract, and may also help the bladder to be less irritable. Bladder re-training is also necessary to reduce the voiding frequency.

An Ounce of Prevention

If pregnant women start doing pelvic floor exercises during pregnancy, studies show that they may suffer less urinary incontinence and pain after delivery. In fact, women may be able to avoid future bladder control problems if they start, as adolescents, or when they begin menstruating, to strengthen their pelvic floor muscles by including Kegel exercises as part of their regular health and fitness routine.


¹ Decision Memorandum on Pelvic Floor Electrical Stimulation for Treatment of Urinary Incontinence (CAG-00021) can be found at http://www.hcfa.gov/quality/8b.htm.

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