Coping with arthritis
What to do and what not to do
The amount of available information for managing arthritis may be a little on the overwhelming side at first. There are plenty of references offering up the best ways to manage this condition. It may be difficult at first to feel settled in your normal lifestyle with so much to take into consideration or even try out for effective symptom relief. Everything you do or don’t do will have some influence on your condition. It is often a good idea to make changes slowly, one at a time, keeping a journal of how these influence your condition.
So, how do you know what will best work for you? Your doctor is the best person to guide you, as can a team of physical therapists and a nutritionist (if you’d like to have one). When it comes to medication usage – whether in pill, patch, injection or cream form, it is advisable to use these as per your doctor’s recommended instructions. Overall, however, finding a comfortable balance in managing a chronic condition such as arthritis may take a little time, but it is doable.
Here are a few tips and things to consider:
1. The basics of everyday lifestyle:
- Do keep the lines of communication open with your doctor to better understand your overall condition and monitor treatment. Sometimes another physical concern that arises may not be entirely unrelated to the effects of arthritis. When in doubt, talk to your doctor and allow him or her the opportunity to best assist with adapting treatment for the best possible results.
- Do engage in gentle movements throughout the day, including evenings to alleviate morning stiffness. Movement can alleviate pain. Simple ways to do this include pacing your movements and taking adequate breaks to ensure that you do not overuse a particular joint, adjusting your positions frequently (standing, sitting, walking, laying down), tilting your neck periodically (side to side), stretching your legs, standing or walking every half-hour or so and changing the position of your hands. Regular or routine check-ups are also important to stick to, so as to monitor the progression of arthritis and keep it under better control.
2. Exercise activity:
- Do get into the habit of exercising, as well as being mindful of gentle movement, as this helps to improve your motion range abilities, strengthen muscles in the body and also increase your levels of endurance. Exercise can boost endorphins (chemicals in the brain) and have the double bonus of not only enhancing your mood, but also blocking pain signals in the brain.
- Do work with your physical or occupational therapist to incorporate exercise activities that will best suit you and help decrease painful flares. Along with exercise, stretching and gradual strength training is also important. The added benefit is that exercise activity will also help to maintain your weight and improve your overall mood.
- Don’t engage in high impact repetitive motion activities such as tennis (especially a tennis serve), high-impact aerobics or running.
- Do balance out activity with adequate rest. Allowing the body time to recuperate is just as important as maintaining enough movement. Allowing fatigue to set in can aggravate pain symptoms which will cause you to backtrack and not make sufficient progress in achieving your treatment goals.
3. Medication use:
- Do double check with your doctor when adding over-the-counter medications to your treatment programme that may not have originally been recommended. This will ensure that you avoid experiencing unnecessary side-effects or adverse interactions when taking other medications for pain and inflammation management. No medication (prescription or over-the-counter) is entirely free of side-effects.
- Don’t over use medications or under treat your symptoms by allowing prolonged periods of arthritis pain. Rather use medications as directed for optimum treatment.
4. Emotional / mental wellbeing:
- Do pay attention to your mental or emotional wellbeing. Persistent pain can take a toll and leave a person feeling discouraged from time to time. Depression and anxiety are not uncommon in chronic arthritis sufferers and can be effectively managed alongside the physical effects of the condition. Some antidepressants have been known to help treat symptoms of depression as well as physical pain. A doctor may recommend specific therapy types to help better manage the emotional effects of living with arthritis. Therapy options include cognitive behavioural therapy, relaxation therapy, and deep breathing exercises . Whatever helps you to reduce levels of stress, ensure that you take measures that work for you. It can be as simple as listening to soothing music or heading out to a favourite location that provides a mental escape. Stress can aggravate or intensify physical pain. Whatever healthy activity or treatment works for you to alleviate stress, will be the best option.
Other self-care management tips for managing pain and discomfort:
- Restrict alcohol consumption or cut out altogether: Alcohol will affect your ability to sleep comfortably which can in turn worsen physical symptoms of pain.
- Avoid smoking: Smoking can worsen symptoms of chronic pain, adding to your woes by worsening problems with circulation as well. It can also increase your risk of developing other medical conditions such as heart disease or cancer.
- Pain level tracking: It may be useful to keep a journal or logbook of pain on a daily basis. This may be most helpful in the early days following diagnosis. Keeping a daily pain score may help to distinguish patterns for both yourself and your doctor. You may find that certain activity habits aggravate your condition, or improve it. Having a logbook can help to see these patterns easily and find ways to improve your physical functioning abilities.
How to stay active when you have arthritis
There’s no good reason to feel incapable of living independently just because of the potential debilitating effects of a progressive physical condition. There are plenty of things you can actively do during each and every day to benefit your body and manage your condition. While it can sometimes feel like the symptoms of arthritis are ‘encouraging you to be immobile’, participating in moderate exercise actually works to alleviate pain and stiffness (not aggravate it). A lack of exercise actually weakens the muscles and tissues surrounding affected joints, resulting in added pressure and physical strain where it is least needed.
Continued physical activity has been shown to work best when it comes to managing arthritis symptoms in the long-term. Initially, pain may increase in the short-term when first getting into an exercise routine. This is normal, but it’s important to soldier on appropriately to gain any benefit at all.
It’s also important to listen to your body and know your limits. You don’t need to overdo it. Moderate exercise is usually best. You will soon work out what level of activity gives you the most effective results once you get going.
Benefits of exercise include:
- Maintaining bone strength
- Strengthening the muscles and tissues around the joints
- Providing an energy boost through the day
- Promoting better rest and a good night’s sleep
- Maintaining a healthy weight (or lose excess weight)
- Improving your balance
- Enhancing your mood and overall quality of life
Exercise activity types which are more joint-friendly include:
- Range of motion: Moderate exercise movements (through a full range of motion) can help to alleviate stiffness and improve your ability to move affected joints. Exercises which may prove beneficial include slowly raising your arms above your head and rolling your shoulders (forwards and backwards).
- Exercises for strength: To build strong muscles to better support and protect your joints, exercises for strength will be recommended. Exercises with weights can be performed regularly with rest days in between workouts, especially if joints are swollen or painful during flare-ups. You will likely be advised to take care not to exercise the same muscle groups over two or more consecutive days to avoid overworking sensitive areas. A workout programme of 2 to 3 days a week should be sufficient for adequate strength training.
- Aerobic exercise: This is important for building up endurance in the body and improving overall fitness levels, stamina (energy levels) and cardiovascular health. Aerobic exercise also aids in maintaining a healthier weight. Walking, biking (or cycling), swimming and water aerobics (the most ideal pool temperature for water activity is 28.3 degrees Celsius or 83 degrees Fahrenheit), or using an elliptical machine are great, joint-friendly means of exercise to participate in. You may be encouraged to work your way up to approximately 150 minutes of moderate aerobic exercise a week, which can be split any which way is most comfortable for you to achieve.
- Other: If walking bores you, there’s no reason why you can’t get creative and participate in different activities that boost your mood as well as benefit your body. Play video games (Nintendo or Wii sports games can help you achieve moderate exercise activity in just the same way a brisk walk can), rope in some company on walks (family, the dog or a group of friends can make a walk more pleasurable and feel a little less like treatment for your condition), hand wash your car (for a little moderate activity working multiple muscle groups and encouraging range of motion), carry your groceries (the weight of your shopping will add some intensity to your walk and help strengthen your upper body), do some housework (it can be a good workout that increases your heart rate and encourages you to alternate motion, using different areas, muscles and joints in your body. But be mindful of overdoing things and overextending your reach), dancing or tending a garden (you can have fun while working up a little bit of a sweat as well as improve your flexibility and strengthen muscle groups), suggest active social meetups (sometimes meeting up with friends or family in settings that promote physical activity, such as a hike or a walk in the park, or volunteering at a local animal shelter can help to keep you moving and socialising too), or use the stairs or strategically park your car in a spot further away (where you have an opportunity to encourage additional activity, make the most of it).
*It is best to involve your doctor when deciding on activity types. Some exercise activities are better for certain forms of arthritis than others, and will also depend on the nature and severity of your condition.
What are the best ways to protect your joints while participating in activity?
If you are new to regular exercise, the best way to start is gradually. Ease your joints into exercise activity and be mindful about over-exerting yourself. If you over-work your muscles, you will place additional pressure and strain on your joints and worsen your symptoms.
Some tips to keep in mind are:
- Opt for low impact activity: Stationary or recumbent bicycles, water activity / exercises and elliptical machines are great ways to ease into activity while keeping strain on the joints low.
- Heat treatments: Warm (not hot) towels, a shower or hot pack and compresses can help to relax the muscles and joints, as well as alleviate pain and stiffness, when applied for about 20 minutes before exercise activity.
- Warm up gently: A good warm-up of movement for between 5 and 10 minutes before any strength or aerobic work-outs will place less strain on muscles and joints.
- Slow and steady wins the race: Your exercise regime is not a competition. Slow and easy movements as you exercise are best. If you notice any unusual sensations or feel any sharp pain, take a break. If you note any swelling or redness near your joints, slow down a little. Pace yourself and increase your efforts as your intensity tolerance levels improve. A little movement at regular intervals can go a long way in promoting long-term improvement, but over-exertion will compromise your efforts.
- Ice and cold compresses: Following activity, you can apply cloth-wrapped ice to your joints for up to 20 minutes to help alleviate swelling. It is normal to experience some pain after activity if your fitness levels are particularly low. If you experience pain for more than 2 hours post-workout, you may have over-worked your muscles and joints. When in doubt about what level of pain is normal or not, talk to your doctor for advice and guidance.
Many who suffer from arthritis experience discomfort in the hand joints. There are a few simple exercises you can do to alleviate pain and stiffness in the hands and fingers:
- Hold your hand in a relaxed and neutral position (palm up) with straightened fingers. Then slowly bend your thumb inwards, across the palm of your hand until you can touch the base of your small finger with the tip. If this is somewhat difficult, move your thumb as far across your palm as you can and repeat the exercise multiple times on each hand.
- Hold your hand in a straight position with fingers closed together and thumb relaxed (palm up). Now bend the middle and end joints of your fingers towards your open palm, while keeping the knuckles straight. With slow and smooth movements, extend your fingers to a straight position and repeat multiple times on each hand.
- Hold your hand in a straight position with fingers closed together and thumb relaxed (palm up). Now close your fingers into a fist and wrap your thumb around the outside of your fingers and knuckles. This is a gentle exercise, so you should be mindful not to squeeze the fingers in this position. Slowly release the fingers from the fist and return to the starting position. Repeat the exercise multiple times on both hands.
- Hold your hand in a straight position with fingers closed together and thumb relaxed (palm up). Now, gently curve your fingers into a C shape. Slowly return the fingers to their straight position, and repeat the exercise multiple times on each hand.
- Hold your hand in a straight position with fingers closed together and thumb relaxed (palm up). With each fingertip (individually), form an O shape by touching your thumb, one finger at a time. Start with your index finger, then the middle, ring and small fingers before returning to the start position. Repeat multiple times on each hand.
- Place your hand on a flat surface, palm facing downwards and fingers stretched out. Relax your thumb away from your index finger / hand. Now move your index finger towards your thumb, followed by your middle, ring and small fingers independently (one at a time). Repeat the exercise multiple times on each hand.
What to eat
Food can be a trigger for inflammatory flare-ups, but there is no dedicated diet for arthritis sufferers. Knowing what to eat and what to avoid, however, is an important part of managing your condition. What you put into your body is going to have some influence on your overall condition, including symptoms of arthritis.
There are some foods which can provide an adequate amount of nutrients to improve overall joint health and alleviate inflammation. Some swear by a Mediterranean diet which includes a fair amount of fish, seeds, nuts, fruits, vegetables, olive oil, whole grains, and beans. Others focus on incorporating more fibre, or vegetarian diets only.
For the most part, diet can play a role when it comes to precipitating or aggravating symptoms but not to any great extent. In general, for most forms of the disease, foods with anti-inflammatory properties have shown some positive effect.
Key foods which can help promote joint health include:
- Fish: A minimum of 85 – 113 grams (3 to 4 ounces) twice a week may provide a good source of imega-3 fatty acids which can help to fend off inflammation in the body. Higher levels of omega-3 fatty acids in the body can help to lower C-reactive proteins and interleukin-6 (inflammatory proteins) which can be problematic for inflammatory variations of arthritis. Fish oil supplements (about 600 to 1 000 mg a day) can help to alleviate joint swelling, pain and lingering stiffness, especially those who have RA. Good sources of fish to include in your diet are tuna, salmon, sardines, anchovies, herring, scallops and other col-water fish.
- Seeds and nuts: A daily helping of about 42 grams (or 1.5 ounces) of nuts is a good addition to your diet for anti-inflammatory benefits. Studies have shown that over the long-term this can help to reduce inflammation in the body by up to 51%. Vitamin B-6 content in many nuts have high levels of inflammatory markers and monounsaturated fats which fend off inflammation in the body. The fat and calorie content may be higher, but the protein, fibre and monounsaturated fats in many nut variations can be quite satiating (meaning that you’re unlikely to reach for unhealthier snack options). One helping a day is sufficient – more will not always be better for you. Good sources to stock up on are almonds, walnuts, pistachios and pine nuts, as well as flaxseed.
- Olive oil: Adding a little olive oil (2 to 3 tablespoons) to your diet may also be beneficial for lowering inflammation. The oleocanthal content in olive oil has been found to have similar properties to anti-inflammatory, nonsteroidal medications which inhibit COX enzyme activity (Cyclooxygenase, also known as prostaglandin-endoperoxide synthase / PTGS which contribute to inflammatory responses in the body). The effect is a considerable reduction to pain sensitivity. The best option is extra virgin olive oil as this typically is not as processed and contains more nutrients than many other more refined products. Other good oil options are avocado, safflower or walnut varieties.
- Fruits and vegetables: Daily servings of about nine or more can help fuel the body with plenty of antioxidants that will fend off symptoms of arthritis. One serving equates to 1 cup of fruit and most veggies or 2 cups of raw leafy greens. Antioxidants are potent chemicals that help to stimulate the body’s natural defence system, neutralising cell-damaging free radicals. Red and purple fruits contain anthocyanins which have an anti-inflammatory effect on the body. Vitamin C-rich fruits and vegetables high in vitamin-K can also aid in alleviating inflammation. Good sources include raspberries, cherries, strawberries, blueberries, blackberries, grapefruit, oranges, limes, broccoli, spinach, kale, lettuce, and cabbage. Generally, the more colourful (darker and more brilliant) the fruits and veggies, the more antioxidant content they have.
- Beans: At least twice a week, one cup of beans add a healthy helping of fibre and phytonutrients which can help to lower C-reactive protein levels. Many bean varieties are high in antioxidants, a good source of protein and contain a host of anti-inflammatory compounds. Good sources include red kidney beans, small red beans or pinto beans. The protein content also promotes good muscle health too.
- Whole grains: About 85 to 170 grams (or 3 to 6 ounces) of grains per day contain plenty of fibre which reduces inflammatory C-reactive proteins in the body. The best sources are foods with the entire grain kernel, such as whole wheat flour, bulgur, oatmeal, brown rice and quinoa. Consuming too much gluten in these whole grains, however, can counteract anti-inflammatory benefits for some people.
What foods should you be more mindful of?
There are certain vegetables you may want to avoid or limit to avoid painful arthritic flare-ups. Nightshade vegetables, such as tomatoes, goji berries, okra, red bell peppers, eggplant (aubergine) and white potatoes (not sweet potatoes) contain the chemical compound solanine, which can aggravate pain in an arthritic body.
Not everyone with arthritis will notice symptom aggravation when consuming these vegetables. Scientifically speaking, nightshade vegetables have not been conclusively proven as arthritis triggers, but many have found that limiting or avoiding them provides a little more symptom relief.
For the most part, doctors will agree that if you find that nightshade vegetables aggravate your symptoms, limiting consumption or avoiding these altogether is not necessarily a bad thing. If these vegetables don’t appear to aggravate symptoms, they’re not likely doing you any more harm.
Other foods which have been found to aggravate symptoms of arthritis, particularly inflammation, include:
- Alcohol (especially beer)
- Fructose, sucrose and other refined or processed sugar foodstuffs (soft drinks and corn syrup)
- Aspartame (artificial sweetener)
- Refined carbohydrates (white flour products, white rice and cereals which have a high-glycaemic index)
- Gluten and casein-containing foodstuffs (barley, rye and wheat or whey protein products)
- Saturated fats (such as cheese, red meat, organ meat, full-fat dairy, pasta and grains)
- Trans fats (found in most fast foods, fried foodstuffs, processed and frozen foods)
- Omega-6 fatty acids (mayonnaise, salad dressings and oils such as corn, grapeseed, soy, vegetable and peanut)
- MSG / mono-sodium glutamate additives (often found in pre-packaged foods to enhance flavour)
- Excess salt