2009-08-28 / Columnists

Rockaway Walks Fitness Column

Intervention For Managing Arthritis
Commentary By Steven McCartney, IPO, HSW, MS

In America, one in three adults diagnosed with Arthritis reported activity limitation and one in four reported severe joint pains (CDC 2005). Arthritis is inflammation in one or more joints (when the ends of two or more bones meet). Usually, accompanied by pain, swelling and sometimes change in structure or a chronic widespread pain in muscles of soft tissue surrounding the joint throughout the body. Warning signs are swelling in one or more joints, early morning stiffness, recurring pain and tenderness in one or more joints, inability to move a joint normally (range of motion), redness, warmth in a joint, unexplained weight loss, fever, and weakness combined with joint pain. If you have any of these symptoms that lasts more than two weeks consult a doctor.

The third intervention for managing arthritis is to "Exercise Environmental Control Make Home User Friendly" (Ergonomics). Ergonomic derived from the Greek; the study or science of how people interact with their workstation (home, at work, traveling, and at play) body posture, and instrument positioning. Not to be confused with mere appearance, ergonomics design is a science devoted to helping productivity, more efficiently, comfortably and safely (this is not just your workplace). Furthermore, ergonomics is your interaction among the body, work-related task, and work tools. There are five aspects; safety, comfort, ease of use, productivity/ performances, and aesthetics (the look and feel of the object) your individual experience.

Our living environments (workstations) affect our body's musculoskeletal system (a complex system involving the joints, ligaments, tendons, and nerves). The workstation can cause poor posture or alignment creating aching pain in muscles in different parts of the body and limit your range of motion (the extent that a joint will move from full extension and full flexion contraction). If you have arthritis or know someone who does, it's important to be an active manager of your living environment. Practice good posture and alignment to improve circulation and reduce stress on joints. Remember—force, repetition and awkward posture are associated with an increase in risk factors for pain. In general the more a joint deviates from neutral (natural) position, the greater the pain. Serious faults in posture may lead to definite physical ailments. Backache, foot trouble, fatigue, and improper functioning of internal organs can be linked to poor posture.

Five good posture practices: (1) standing posture keep head high (look straight ahead), chin in (straighten your neck by moving horizontally back, do not allow your chin to drop to your chest or your head to tilt, ears directly over shoulders), shoulders the same height, relaxed in line with your hips, shoulders back, shoulder blade flat, chest up and forward, abdomen drawn up and in (stomach tucked), lower back flattened, hips (pelvis in line with knees and feet) tilted down in back (buttocks tight), knees straight but not stiff (soft), feet parallel (shoulder width), weight evenly balanced. Housework, as in ironing, cooking, or dishwashing: Stand erect with weight on both feet (avoid regularly wearing high heeled shoes, which can affect one's center of gravity, and place a rubber mat on the floor when standing for long periods to improve comfort). (2) Good walking posture keep the body erect, as while standing. Walk with a springy step, throwing more weight on the ball of the foot than on the heel; keep the feet close together and parallel. Maintain the pelvic tilt at all times. It will soon become habit (use a mirror to check your neck posture). (3) Good lifting position for a heavy object— bend the knees, keep the back straight (avoid by reducing weight). When carrying a heavy object, keep as erect as possible. Avoid slumping. This adds to the strain by destroying body balance. (4) When sitting, particularly in the case of a pregnant woman, place one foot in back of the other and bend the knee and slowly ease down into the chair. Sit well back so that the lower back is comfortably supported by the back of the chair. Sit with the spine erect and the upper body relaxed in good balance; keep both feet flat on the floor or foot rest, even weight on both hips (avoid unbalanced postures such as crossing legs unevenly while sitting, leaning to one side, hunching the shoulders forward or tilting the head). In an overstuffed chair, avoid slumping on the end of the spine with the lower back sagging. When leaning forward, bend from the hips, keeping the back straight. Good posture for desk work will help conserve energy and efficiency. Sit erect with lower back supported. Do not hunch. Chair should be adjusted to your proper height and feet flat on floor. As for driving, the jolting and swaying of a car add to the strain of poor posture. You will save yourself much fatigue by sitting erect. (5) One-third of our life is spent in bed. Sagging springs can cause serious trouble; one simple cure is putting a board (plywood) under the springs. The best type of bed is one that gives equal support to all parts of the body. Good joint care occurs when your joints are in good alignment; practice and exercise will help you form good habits. Remember that it is important to maintain an overall relaxed posture to avoid restricting movements by clenching muscles and adopting an unnatural, stiff posture. Our body is designed for movement and any limitation in motion over a long period of time can create more pain and a downward cycle of more pain.

Exercise environmental control by making your home user friendly (create ergonomic physical environments). This requires a small investment of time to personalize but the payoff will be well worth it. Increase your ergonomic technique by being aware of (warning signs) posture at home, at work, traveling, and at play—it is a vital stage in making a conscious connection between specific situations where poor posture or ergonomics are the root to your pain.

Stay prepared by starting a task before deadlines so you can pace yourself. Make entertaining easier. Spread a task over several days. Select foods that you can prepare ahead of time. Get help for heavy cleaning. Alternate heavy cooking such as cutting, chopping, and stirring to reduce stress on hands. Take short breaks when cooking large quantities: Alternate sitting and standing to reduce fatigue and joint stress. Buy vegetables already chopped to simplify cooking (salad bars). Create cleaning schedules that work for you. List your regular cleaning tasks. Consider spreading out light cleaning tasks over a week. Schedule one or two heavy cleaning tasks per month. Complete them on a good day.

Try to be organized by storing equipment and supplies that you use frequently between eye and hip level. This will minimize bending, stooping, and needless searching. Store the heavier items in easy-to-reach places, such as on countertops. Use kitchen and office organizers, such as bins, dividers, turntables, pull-out shelves, and spice racks, to locate items quickly. Store items where they are most frequently used. Eliminate clutter by removing unnecessary or infrequently used items from shelves. Put items in bins. If you have clutter areas, put away one item every time you pass by. Clutter does not have to be organized all at one time. Put duplicates of inexpensive items, such as cleaners, scissors, and cellophane tape, in all the places they are regularly used. Use special organizers in closets to maximize your use of space: Store seasonal items, such as winter hats and scarves, in clear plastic containers so they are easy to locate. Schedule frequent rest periods. One way of resting muscles is to use other ones. Longer work periods require longer recovery periods. Alternate posture to relieve overused joints and muscles (rest ten minutes for every hour instead of working for three hours straight); short breaks are better than none. Moving around at regular intervals keeps you more alert and energetic. Choose new products and evaluate those you already own—products with wheels, extended handles, lightweight objects, large handles; and use convenient items to decrease the length of time and number of steps needed to complete a task. This will reduce joint stress, pain and fatigue (expect results, but be patient).

Identify resources for support, information and adaptive equipment. Go online or contact the Arthritis Foundation. In review, Exercising Environmental Control is about energy conservation; structuring and simplifying work and daily tasks to decrease fatigue and maximize energy. 1. pacing

balance work with rest), 2. determining priorities, 3. positioning (correct body alignment requires less energy) For questions or concerns e-mail steven_ mccartney@walkprograms.com or come out to Beach 11 Street every Saturday at 8 a.m. through Sept. 12.

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