keep reaching beyond medication

As you've probably heard, exercise and staying active are not only good for your health, but they can also help relieve the symptoms of osteoarthritis.

Here, you can learn about different types of exercise and how you might start to make them a part of your lifestyle.

Be sure to check with your healthcare professional to see if these physical activities are right for you.

Exercise Overview

Exercise as Treatment for Arthritis*

Arthritis literally means "joint inflammation," but generally refers to the more than 100 rheumatic diseases and related conditions that can cause pain, stiffness and swelling in the joints and connective tissues. The condition also can deteriorate the joints' support systems, including muscles, tendons, ligaments and other parts of the body. About one in five American adults have been told by a doctor that they have arthritis.

While medication may be part of a recommended treatment plan for people with arthritis, a tailored exercise program can be beneficial to management of pain and fatigue and to preserve joint structure and function. Once you know what type of arthritis you have and understand what symptoms you can expect, you and your physician or physical therapist can develop a balanced program of physical activity to reduce the damaging affects of arthritis and promote overall good health.

Arthritis and exercise
Stiffness, pain and swelling associated with arthritis can severely reduce the range of motion in joints (the normal distance joints can move in certain directions). Avoiding physical activity because of pain or discomfort also can lead to significant muscle loss and excessive weight gain. Exercise, as part of a comprehensive arthritis treatment plan, can improve joint mobility, muscle strength, overall physical conditioning and help to maintain a healthy weight.

A tailored program that includes a balance of three types of exercises - range-of-motion, strengthening and endurance exercises - can relieve the symptoms of arthritis and protect joints from further damage.
Exercise also may:

  • Help maintain normal joint movement
  • Increase muscle flexibility and strength
  • Help maintain weight to reduce pressure on joints
  • Help keep bone and cartilage tissue strong and healthy
  • Improve endurance and cardiovascular fitness

Range-of-motion exercises
To help relieve pain, people with arthritis often keep affected joints bent - especially in the knees, hands and fingers - because it's more comfortable during the early stages of arthritis. While this may temporarily relieve discomfort, holding a joint in the same position for too long can cause permanent loss of mobility and hinder daily activities.

Range-of-motion exercises (also called stretching or flexibility exercises) help maintain normal joint function by increasing and preserving joint mobility and flexibility. In this group of exercises, affected joints are conditioned by gently straightening and bending the joints in a controlled manner as far as they comfortably will go. During the course of a range-of-motion exercise program, the joints are stretched progressively farther (maintaining comfort levels) until normal or near-normal range is achieved and maintained.

In addition to preserving joint function, range-of-motion exercises are an important form of warm-up and stretching, and should be done prior to performing strengthening or endurance exercises or engaging in any other physical activity. A physician or physical therapist can provide you with instructions on how to perform range-of-motion exercises for the fingers, shoulders and back, chin and neck, hips, knees and ankles.

Strengthening exercises
Strong muscles help keep weak joints stable and more comfortable and protected against further damage. A program of strength-conditioning exercises that target specific muscle groups can be beneficial as part of your arthritis treatment program. There are several types of strengthening exercises that, when performed properly, can maintain or increase supportive muscle tissue without aggravating affected joints.

Some people with arthritis avoid exercise because of joint pain. However, a group of exercises called isometrics are designed to strengthen targeted muscle groups without bending painful joints. Isometrics involve no joint movement, but rather strengthen muscle groups by using an alternating series of isolated muscle flexes and periods of relaxation.

Another group of exercises called isotonics are similar to range-of-motion exercises because they involve joint mobility. However, this group of exercises is more intensive, achieving strength development through increased repetitions or speed of repetitions, or by introducing light-weight resistance with small dumbbells or stretch bands.

A physical therapist or fitness instructor (preferably one with experience working with arthritis patients) can provide you with instruction on how to correctly and effectively perform isometric and isotonic exercises.

Hydrotherapy or aquatherapy (water therapy), is a program of exercises performed in a large pool. Aquatherapy may be easier on painful joints because the water takes some of the weight off of the affected areas while providing resistance training.

Endurance exercise
The foundation of endurance training is aerobic exercise, which includes any activity that uses large muscle groups, can be maintained continuously for a long period of time and is rhythmic in nature. Aerobic activity conditions the heart, lungs and cardiovascular system to:

  • Use oxygen more efficiently
  • Supply the entire body with larger amounts of oxygen-rich blood
  • Build stronger muscle tissue

When paired with a healthy diet, aerobic activity also is fundamental for weight control (which reduces excess pressure on affected joints) and improving overall general health.

Examples of aerobic activities include walking, swimming, low-impact aerobic dance, and biking, and may even include such daily activities as mowing the lawn, raking leaves or playing golf. Walking is one of the easiest aerobic exercise programs to begin because it requires no special skills or equipment other than a good pair of supportive walking shoes, and it's less stressful on joints than running or jogging. Biking also may be more beneficial to people with arthritis than other aerobic activities because it places less stress on knee, foot and ankle joints.

Appropriate recreational exercise, including sports, can be helpful to most people with arthritis, but only if it is preceded by a program of range-of-motion, strength and aerobic exercise to reduce the chance of injury.

Beginning a new exercise program
Regardless of your condition, discuss exercise options with a physician before beginning any new exercise program. Also, begin new exercise programs under the supervision of a physical or occupational therapist, preferably one with experience working with arthritis patients.

People with arthritis who are beginning a new exercise program should spend some time conditioning using a program that consists only of range-of-motion and strengthening exercises, depending on their physical and athletic condition. Endurance exercises should be added gradually, and only after you feel comfortable with your current fitness level.

As with any change in lifestyle, your body will have to take time to adapt to your new program. During the first few weeks, you may notice changes in the way your muscles feel, changes in your sleep patterns or different energy levels. These changes are to be expected with increased activity levels. However, improper exercise levels or programs may be harmful, making symptoms of arthritis worse. Consult your physician or therapist and adjust your program if you experience any of the following:

  • Unusual or persistent fatigue
  • Sharp or increased pain
  • Increased weakness
  • Decreased range of motion
  • Increased joint swelling
  • Continuing pain (lasting greater than 24 hours)

Effective treatment of arthritis should include a comfortable balance of range-of motion, strengthening and endurance exercises. But regardless of the exercise program you select, it's important to begin slowly and choose a program you enjoy so that you maintain it. Make exercise part of your weekly routine so that it becomes a lifetime commitment.

*Be sure to check with your healthcare professional to see if these physical activities are right for you. Copyright © 1995-2013 The Cleveland Clinic Foundation. All Rights Reserved. For more information on this topic visit www.clevelandclinic.org

Physical Activity for Arthritis*

What types of physical activity are appropriate for arthritis?

  • Low-impact aerobic activities including brisk walking, cycling, swimming, water aerobics, gardening, group exercise classes, and dancing.
  • Muscle-strengthening exercises including calisthenics, weight training, and working with resistance bands. These can be done at home, in an exercise class, or at a fitness center.
  • Balance exercises including walking backwards, standing on one foot, and tai chi. If you are at risk of falling, balance exercises are included in many group exercise programs.

Start low, and go slow
People with arthritis may take more time for their body to adjust to a new level of activity. Inactive people should start with a small amount of activity.

Modify activity when arthritis symptoms increase, try to stay active.
Arthritis symptoms come and go. Most people completely stop activity when their symptoms increase. It is better to first modify your activity by decreasing the frequency, duration, or intensity, or changing the type of activity to stay as active as possible without making your symptoms worse.

Activities should be "joint friendly."
Unsure of what types of activity are best for people with arthritis? A general rule is to choose activities that are easy on the joints like walking, bicycling, water aerobics, or dancing.

Recognize safe places and ways to be active.
Safety is important for starting and maintaining an activity plan. For inactive adults with arthritis or those who do not have confidence in planning their own physical activity, an exercise class designed just for people with arthritis may be a good option. For those who plan and direct their own activity, finding safe places to be active is important. For example, while walking in your neighborhood or at a local park, make sure the sidewalks or pathways are level and free of obstructions, are well-lighted, and are separated from heavy traffic.

Talk to a health professional or certified exercise specialist.
Many health professionals are a good source of information on what types and amounts of activity are appropriate for people with arthritis.

What should I do if I have pain when I exercise?
Here are some tips to help you manage pain during and after exercise:

  • Modify your exercise program by reducing the frequency (days per week) or duration (amount of time each session) until pain improves.
  • Changing the type of exercise to reduce impact on the joints – for example switch from walking to water aerobics.
  • Do proper warm-up and cool-down before and after exercise.
  • Exercise at a comfortable pace – you should be able to carry on a conversation while exercising.
  • Make sure you have good fitting, comfortable shoes.

*Be sure to check with your healthcare professional to see if these physical activities are right for you. Adapted from the CDC.gov factsheet, "Physical Activity for Arthritis" at www.cdc.gov

Flexibility Exercises

Exercises for Arthritis Management*

Exercise is one of the most powerful ways to challenge arthritis pain — and one of the most invigorating. That’s why sports doctors and the American Orthopedic Society for Sports Medicine developed the workout shown here.

Remember, a proper warm-up is key to avoiding injury. To increase your heart rate, always walk or march in place for at least five minutes before beginning these exercises.


Elongation Stretch: Lay with your back flat against mat, extending both arms and legs. Reach as far as is comfortable; point toes and extend fingers.


Elongation Diagonal: Turn on left side. Point toes of left foot and extend right arm. Stretching lengthwise as far as is comfortable.


Arm Stretch: Gently pull right elbow across the chest towards the opposite shoulder.


Shoulder Stretch: Interlace fingers so palms face outward. Slowly lift arms above head, pushing upward (stretch will be felt in arms, shoulders, and upper back).


Knee Chest Stretch: Lay with back flat against mat, pull right knee towards chest, keeping back of head on the floor.


Calf/Achilles Stretch: Hold chair with both hands, place right leg in front of left, bending the right knee while keeping left leg straight. Lower hips downward while continuing to slightly bend right knee.
Keep back straight and back foot toe facing straight-ahead, keeping heel down.


Quad Stretch: Hold chair with right hand while standing with weight on left foot. Hold top of right foot with left hand. Gently pull right heel toward buttocks.


Hamstring Stretch: Sit on mat and stretch both legs out in front of you. Grab towel at each end, placing it around the arches of your feet. Using straight arms, pull upper body down gently to stretch behind the legs.


Squat and Side Lift: With chair on right side for balance, stand with feet shoulder-width apart. Bend slowly at the knees and hips, and squat back as though sitting in a chair; stop when thighs are parallel to floor. Keep back flat, not allowing knees to extend past toes. Pause, then push up, lifting left leg off floor and to the side while beginning to stand. Pause and then return to starting position.


Knee Flexion: Stand up straight with head in line with spine, legs hip-width apart, and knees slightly bent while placing hands on back of chair for balance. Maintaining good posture, raise left heel toward buttocks until your calf is parallel to the floor. Make sure to keep thighs parallel to each other. Pause for 1 second. Lower left leg to the ground.


Calf Raises: Stand about one foot behind the back of the chair with feet hip-width apart and knees slightly bent. Keep back straight, head in line with spine, and shoulders back. Using chair for balance, raise heels off floor, pushing straight up onto balls of feet. Pause 1 second, then slowly lower heels to starting position.


Knee Extension: Sit in chair with back and hips against the chair back. Extend left leg out as straight as possible, pausing for 1 second when leg is parallel to the floor. Lower left leg back to starting position.

*Be sure to check with your healthcare professional to see if these physical activities are right for you. Copyright 2013 © The American Orthopedic Society for Sports Medicine. All Rights Reserved.

Strengthening Muscles

Muscle Strengthening Activities*

Muscle strengthening activities are especially important for people with arthritis because having strong muscles takes some of the pressure off the joints.

You can do muscle strengthening exercises in your home, at a gym, or at a community center. You can do exercises that work all the major muscle groups of the body (e.g., legs, hips, back, abdomen, chest, shoulders, and arms). There are many ways you can do muscle strengthening activities:

  • Lifting weights using machines, dumbbells, or weight cuffs.
  • Working with resistance bands.
  • Using your own bodyweight as resistance (e.g., push-ups, sit ups).
  • Heavy gardening (e.g., digging, shoveling).
  • Some group exercise classes.

Balance activities. Many older adults and some adults with arthritis may be prone to falling. If you are worried about falling or are at risk of falling, you should include activities that improve balance. Balance activities can be part of your aerobic or your muscle strengthening activities. Examples of activities that improve balance include the following

  • Tai Chi.
  • Backward walking, side stepping, heel and toe walking.
  • Standing on 1 foot.
  • Some group exercise classes.

*Be sure to check with your healthcare professional to see if these physical activities are right for you. Adapted from the Centers for Disease Control and Prevention. For more information on this topic visit www.cdc.gov

Resistance Exercise Helps Knee Osteoarthritis*

Resistance exercise can improve muscle strength and physical function in people with knee osteoarthritis. Many people with knee osteoarthritis also experience decreased pain with resistance exercise.

Resistance Exercise Defined
Resistance exercise is any exercise where muscles contract against an external resistance which can come from dumbbells, weight machines, elastic tubing or bands, soup cans, your own body weight, or any other object that forces your muscles to contract.

The goal of resistance exercise is to strengthen muscle groups around affected joints, stabilize and protect affected joints, and improve mechanics of the joints to reduce stress on the joints.

Arthritis Patients Need to Start Slowly
An arthritis patient, who is for the most part deconditioned, must begin a program of resistance exercise gradually. Many exercises may need to be modified to allow for physical limitations caused by arthritis. The exercise program must be designed for the individual after considering his strengths, weaknesses, and limitations.

What You Should Do
People with osteoarthritis are advised to talk to their doctor. Discuss your limitations and your expectations for resistance exercise. Be sure to ask your doctor if you can safely proceed.

If possible, consult with a physical therapist or personal trainer. Discuss which exercises may or may not be appropriate for you, because certain exercises may worsen your arthritis symptoms.

*Be sure to check with your healthcare professional to see if these physical activities are right for you. Copyright © 2013 About.com. All Rights Reserved. For more information on this topic visit www.about.com

Keep Moving with Aerobic Exercises

Walking Can Help if You Have Osteoarthritis*

You Set the Pace
You may not be inclined to lace up your walking shoes and head outside if your joints are aching, but regular walking can help if you have osteoarthritis. The most important thing is for you not to be discouraged because osteoarthritis pain is preventing you from walking a significant distance. Walk as much as you're able to at first; you can still benefit. Then, build on that at your own pace.

Improve Muscle Strength
It is essential for people with arthritis to stay active and to avoid a sedentary lifestyle. Walking is an activity that helps you build muscle strength. Strong muscles help support your joints and improve posture and balance. As you commit to a regular walking program, you can benefit from your efforts and may surprise yourself along the way.

Help to Maintain Your Ideal Weight
Regular walking burns calories to help you lose or maintain your ideal weight. Maintaining your ideal weight is an important aspect of managing osteoarthritis pain and symptoms. Carrying extra weight adds stress to joints affected by osteoarthritis.

Your Treadmill Is an Option
If you can't be convinced to go outside for a walk, consider indoor walking. Treadmills are an option -- you can still achieve the physical benefits of walking.

*Be sure to check with your healthcare professional to see if these physical activities are right for you. Copyright © 2013 About.com. All Rights Reserved. For more information on this topic visit www.about.com

Water Walking 101*

Reduce joint pain by taking your walking routine to the pool.
Like all water exercises, water walking is easy on the joints. The water’s buoyancy supports the body’s weight, which reduces stress on the joints. Water provides 12 times the resistance of air, so as you walk, you’re really strengthening and building muscle.

You can walk in either the shallow end of the pool or the deep end, using a flotation belt. The deeper the water, the more strenuous your workout. And if you fall in love with swimming and walking, you can keep going in cooler months – just switch to an indoor heated pool.

What you need: For deep-water walking, a flotation belt keeps you upright and floating at about shoulder height.

How it works: You’ll stand about waist- to chest-deep in water, unless you’re deep-water walking. You walk through the water the same way you would on the ground. Try walking backward and sideways to tone other muscles.

Try it: Stand upright, with shoulders back, chest lifted and arms bent slightly at your sides. Slowly stride forward, placing your whole foot on the bottom of the pool (instead of just your tiptoes), with your heel coming down first, then the ball of your foot. Avoid straining your back by keeping your core (stomach and back) muscles engaged as you walk.

Add intensity: Lifting your knees higher helps boost your workout.

Find a class: If you’re new to water exercises, an instructor can make sure your form is correct. Plus, it can be fun to walk with others. To find a class near you, call your local YMCA, fitness center or Arthritis Foundation office.

Don’t forget the water: When exercising in a pool during the hot months, you still need to drink water – even while keeping cool in the pool.

*Be sure to check with your healthcare professional to see if these physical activities are right for you. Article from Arthritis Today, the consumer health magazine published by the Arthritis Foundation. For more information from Arthritis Today visit www.ArthritisToday.org. Copyright © 2013 Arthritis Foundation. All Rights Reserved.

How Yoga May Help

If you’re living with arthritis, yoga may offer an effective way to increase physical activity. It can help build strength and endurance, and provide a range of motion that may be able to help reduce your joint pain and stress.

What is yoga exactly?
Yoga is a combination of exercises, breathing techniques and meditation that has been practiced in India for 5,000 years. The word yoga comes from a Sanskrit word meaning “to yoke” or “unite”—a way of uniting the mind, body and spirit. Today, the practice emphasizes postural alignment, strength, endurance and balance.

Getting started
There are a wide variety of public and private yoga classes available in communities across the country, as well as video instruction. If you have arthritis, it’s especially important to choose wisely because some forms of yoga may be more appropriate for you than others.

The first step is speaking to your primary care physician or rheumatologist to see if you are fit enough to begin an exercise program, and to see what style of yoga might be best for you. Also, discuss what activities might not be appropriate or what modifications you should take. If you are taking classes, look for a certified instructor who is familiar with the needs of students with arthritis. Be sure to discuss your condition and any limitations you may have with the teacher prior to hitting the mat.

If you haven’t done yoga before, it’s important to start slow. Even in a beginner class, some students will naturally be more flexible than others. Remember that yoga is not a competitive sport: it’s about the progress you can make as an individual. If you are having an arthritis flare up, don’t push yourself too hard, skip poses that are uncomfortable, and avoid excessive repetitions. The point is to go slow and steady, building your strength up gradually.

*Be sure to check with your healthcare professional to see if yoga is right for you.

Physical & Occupational Therapy

Occupational and Physical Therapy for Arthritis *

How is arthritis treated?
"Arthritis" means inflammation of the joints, and it might cause pain, swelling, and limited motion of one or many joints in the body. More than 100 different illnesses can cause arthritis.

Treatment begins after diagnosis by a doctor, who might prescribe medicine to reduce inflammation, pain, swelling, and loss of motion. As part of a comprehensive plan for arthritis treatment, your doctor might also prescribe occupational and physical therapy, which can provide additional help in your recovery.

How can occupational therapists help?
Occupational therapists can teach you how to reduce strain on your joints during daily activities. They can show you how to modify your home and workplace environments to reduce motions that might aggravate arthritis. Occupational therapists might also provide splints for your hands or wrists, and might recommend assistive devices to aid in driving, bathing, dressing, housekeeping, and other tasks.

How can physical therapists help?
Physical therapists can provide you exercises designed to preserve the mobility, strength, and use of your joints. Physical therapists can also teach you the proper body mechanics to move from one position to another and the proper mechanics during the performance of household activities. They can also teach you proper posture, such as while sitting, to protect the integrity of the joints. They can also educate you on the use of walking aids such as crutches, a walker, or a cane when needed.

What are the goals of treatment?
Your physical therapist will tailor a program to your specific needs, whether your arthritic problems are widespread or confined to one joint or body area.

The goals of treatment are to:

  • Prevent loss of use of the joints
  • Restore abilities that may have been lost
  • Help you adapt to new activity levels
  • Maintain your fitness
  • Maintain your ability to take part in the activities you choose with minimal help from others

Therapy should be started early in order to reduce painful symptoms of inflammation, prevent deformity and permanent joint stiffness, and maintain strength in the surrounding muscles. When pain and swelling are better controlled, treatment plans may include exercises to increase range of motion, and to improve muscle strength and endurance.

What are some benefits of occupational and physical therapy programs?
Physical therapy programs may provide:

  • Exercises aimed at restoring normal joint mobility or flexibility
  • Exercises aimed at restoring normal strength
  • Education on whether you are safe to walk with or without an assistive device
  • Postural education and activity modifications to relieve discomfort and improve performance

What are some therapeutic methods?
1. Exercise — This is an important part of arthritis treatment that is most effective when done properly every day. Your therapist will prescribe a program for you that will vary as your needs change.

  • Range of motion exercises. Gentle movements of specific joints through their normal range of motion will help relieve stiffness, improve and maintain joint movement, and increase flexibility. Your therapist will provide you with exercises that are specific for your needs.
  • Strengthening exercises. Strengthening exercises are aimed at preserving or increasing muscle strength. Isometric exercises tighten and strengthen the muscle without moving the joint and are most useful when joints are painful. Isotonic exercises strengthen the muscle by using it to move a weight.
  • Water exercise. Warm water helps relieve pain and relax muscles. Swimming is not necessary, as water exercises may be done while standing in shoulder-high water. Support by the water decreases body weight applied to the joints of the spine, legs, and feet. Water support of the arms and legs also helps joints move through range of motion exercises more easily.

2. Thermal modalities — Applying ice packs or heating pads can help relieve pain locally. Heat can help relax muscle spasms or taking a warm bath or shower before exercising might help you exercise more easily.

3. Therapy for joint surgery patients — Preoperative programs of education and exercise, started before surgery in the outpatient therapy department, are continued at home. They might be changed in the hospital after surgery to fit new needs in the rehabilitation period. These exercises might be added to your usual exercise regimen, and you might find your ability to exercise has improved after surgery.

4. Joint protection techniques — There are ways to reduce the stress on joints affected by arthritis while participating in daily activities. Some of these ways include:

  • Control your weight to avoid putting extra stress on weight-bearing joints such as your back, hips, knees, and feet.
  • Be aware of body position, using good posture to protect your back and the joints of your legs and feet. Change positions often, since staying in one position for a long time tends to increase stiffness and pain.
  • Conserve energy by allowing for rest periods, both during the day and during an activity.
  • Respect pain. It is a body signal that is telling you something is wrong. Don't try an activity that puts strain on joints that are already painful or stiff.

A therapist can show you ways to do everyday tasks without worsening pain or producing joint damage. Some joint protection techniques include:

  • Use proper body mechanics to get in and out of a car, chair or tub, as well as for lifting objects.
  • Use your strongest joints and muscles to reduce the stress on smaller joints. For example, carry a purse or briefcase with a shoulder strap rather than in your hand.
  • Distribute pressure to minimize stress on any one joint. Lift dishes with both palms rather than with your fingers, and carry heavy loads in your arms instead of with your hands.
  • If your hands are affected by arthritis, avoid tight gripping, pinching, squeezing, and twisting. Ways to accomplish the same tasks with alternate methods or tools can usually be found.

5. Assistive devices — Many assistive devices have been developed to make activities easier and less stressful for the joints and muscles. Your therapist will suggest devices that will be helpful for tasks you might have found difficult at home or work.

A few examples of helpful devices include a bath stool in the shower or tub; grab bars around the toilet or tub; and long-handled shoehorns and sock grippers. Your therapist can show you catalogs that have a wide variety of assistive devices you may order.

Summary
As the central member of your treatment team, you are the person responsible for following through with your therapy program. This includes continuing daily exercises and other suggestions made by your therapist. You should discuss questions and problems with your therapist as they come up so that the program can be adjusted to best meet your needs.
A positive attitude, patience, and persistence will help you to get the greatest benefit from your occupational and physical therapy activities, which are so important in meeting the challenges of arthritis.

* Be sure to check with your healthcare professional to see if occupational or physical therapy may be right for you. Copyright © 1995-2013 The Cleveland Clinic Foundation. All Rights Reserved. For more information on this topic, visit www.clevelandclinic.org

Choosing Your Own Physical Therapist *

You are the most important member of your own health care team, and you are entitled to choose the most appropriate health care professional to meet your goals. The American Physical Therapy Association (APTA) has provided the following guidelines for choosing a physical therapist for your care.

You have the freedom to choose your own physical therapist. Most states allow you to go directly to a physical therapist without getting a physician's referral first.

Keep in mind that your insurance policy may require a visit to the primary care physician first or may limit your access to preferred providers only.

Your physician may refer you for physical therapy that is to be provided in the physician's office, or to a facility in which the physician has a financial interest. If this is your situation, be aware that you have the right to choose your own physical therapist and that you are not obligated to receive physical therapy in any specific facility. Always insist that your physical therapy be provided by a licensed physical therapist.

How to Choose a Physical Therapist
Make sure that you receive physical therapy from a licensed physical therapist. Physical therapists are professional health care providers who are licensed by the state in which they practice. If you are receiving physical therapy from a physical therapist assistant, be sure that he or she is supervised by a licensed physical therapist.

Ask the physical therapist's clinic if it participates with your insurance company. Receiving care from a participating physical therapist should minimize your financial responsibility. There may be good reasons, however, to see a physical therapist who does not participate with your insurance plan. If you need a physical therapist who has special skills related to your particular condition-or if the location or other aspects of the care or the facility meet your needs-this may be a good choice for you.

Ask whether the physical therapist's clinic will submit claims on your behalf to your insurance company. Some policies require copayments for services, and the amount of the copayment will depend on whether the physical therapist is part of the insurer's provider network. You also will have to meet your deductible. Your physical therapist's clinic should be able to help you calculate an estimate of your financial responsibilities.

Your Appointment
Your first visit should include an evaluation by the physical therapist. Your physical therapist will perform an examination to identify current and potential problems. Based on the results of the examination, and considering your specific goals, your physical therapist will design a plan of care to include specific interventions and will propose a timetable to achieve these goals and optimize your movement and function. Your physical therapist will likely provide you with instructions to perform exercises at home to facilitate your recovery.

You should feel comfortable asking your physical therapist any questions regarding your course of care, including specifics regarding interventions and expectations.

* Be sure to check with your healthcare professional to see if physical therapy may be right for you.
Copyright © 2013 The American Physical Therapy Association. All Rights Reserved. For more information on this topic, visit www.moreforwardpt.com

Self-Help Arthritis Devices

There are a number of things you can do for yourself—at home, work or even in the car— that may help make your everyday activities a little easier.

Self-Help Arthritis Devices*

If you have arthritis, self-help devices can make tasks easier on your joints and more efficient for you. These products, which range from simple to elaborate, help keep joints in the best position for functioning, provide leverage when needed, and help extend your range of motion. Simple arthritis self-help devices, such as jar openers, reachers and easy-grip utensils can be purchased at many hardware or medical supply stores.

  • In the bedroom. When dressing, zipper pulls and buttoning aids can help you fasten clothing. Or you can choose to wear clothing with Velcro fasteners, if available. A long-handled shoehorn extends your reach without bending.
  • In the kitchen. In the kitchen, appliances such as electric can openers, food processors and mandolins (for slicing) make work easier. Reachers (long-handled tools with a gripping mechanism) can be used to retrieve items stored high or low. Built-up handles and grips make utensils easier to grasp and put less stress on finger joints. Install a fixed jar opener, or keep a rubber jar opener in the kitchen.
  • In the bathroom. Tub bars and handrails provide additional stability and security when you are getting into and out of the bath or shower. These are a must if you have problems with balance. Faucet levers or tap turners are available if your grip is weak. A raised toilet seat can make it easier to sit down and get up from the toilet.
  • In the office. In the work environment, many devices and modifications are available, from chairs and work surfaces with adjustable-height to telephones with large push buttons and hands-free headsets. If you are facing work modifications, you may want to see an occupational therapist about arthritis self-help tools. He or she can help you make changes and obtain the devices you need.
  • At play. Leisure activities can still be enjoyable through the use of assistive arthritis devices, such as kneelers and light-weight hoses for gardening, “no-hands” frames for quilting or embroidery, and card holders and shufflers for card games.
  • In the car. When driving, a wide key holder can make it much easier to turn on the ignition. A gas cap opener can help when filling the tank at the gas station.

*Be sure to check with your healthcare professional to see if these devices are right for you.
Article from Arthritis Today, the consumer health magazine published by the Arthritis Foundation. For more information from Arthritis Today visit www.ArthritisToday.org. Copyright © 2013 Arthritis Foundation. All Rights Reserved.

How to Choose the Right Cane & Use It Correctly*

The right cane can relieve pressure on sore knees, hips, ankles and feet, as well as improve balance.

Materials, colors and handle styles are a matter of preference. Cane type and size, however, are options that affect function and safety.

The right cane used correctly can improve balance and reduce risk of falling by widening the base of support, as well as decreasing weight on lower-body joints.

Choosing Type and Fit
The most common styles of canes are single point and quad or three-point canes.
When being fitted, wear your walking shoes and stand tall with your arms at your sides. The top or curve of the cane should hit at the crease in your wrist. “If the cane is too high, you won’t get the support you need. When the cane is too low, you slump.”

Correct Use When Walking
People often try to use a cane on their weak side. In fact, it goes on the strong side, but moves with the weak side.

Using the cane in the hand opposite your weakness shifts your body weight to the stronger side.

When walking, place it about 2 inches in front or to the side of you, not way out in front. Move the affected leg and the cane together, so that each side shares the load.

Correct Use on Stairs
To climb stairs, advance your good leg first. Follow with your affected leg and cane simultaneously. When descending, put your weak leg forward first, and then follow with the cane and your good leg.

*Be sure to check with your healthcare professional to see if a cane is right for you.
Article from Arthritis Today, the consumer health magazine published by the Arthritis Foundation. For more information from Arthritis Today visit www.ArthritisToday.org. Copyright © 2013 Arthritis Foundation. All Rights Reserved.