ARTHRITISOTHER SELF CARE OTHER METHODS FOR ARTHRITIS METHODS ARTHRITIS Learn about Arthritis – internet, Arthritis Foundation, forums, literature (AARP) Consider life style change change– sedentary, social, intellectual pursuits Try to avoid Physician Fix St$dG - PowerPoint PPT Presentation


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ARTHRITISOTHER SELF CARE OTHER METHODS FOR ARTHRITIS METHODS ARTHRITIS Learn about Arthritis – internet, Arthritis Foundation, forums, literature (AARP) Consider life style change change– sedentary, social, intellectual pursuits Try to avoid Physician Fix St$dG


Examples of ROM Exercises Ankle Alphabet ... relieved by rest Changes in barometric pressure Joints in fingers are enlarged Pain upon palpation of the joint X-Ray ... – PowerPoint PPT presentation

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Title: ARTHRITISOTHER SELF CARE OTHER METHODS FOR ARTHRITIS METHODS ARTHRITIS Learn about Arthritis – internet, Arthritis Foundation, forums, literature (AARP) Consider life style change change– sedentary, social, intellectual pursuits Try to avoid Physician Fix St$dG

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Strategies for Managing Arthritis and Chronic Pain
  • By
  • Gina Tantalo, RMT
  • Dr. Tammy Langedyk, B.Sc., D.C., D.Acu.

Goals for today
  • Educate you about arthritis
  • Educate you about pain
  • Educate you about typical medical treatments
  • Educate you about complimentary treatments
  • Provide info on strategies to manage pain
  • Guide you through a typical exercise program,
    that you might use in the future

  • Arthro JOINT
  • Consists of more than 100 different conditions.
  • It leads to joint pain and impairment from loss
    of normal joint structure and function.

Types of Arthritis
  • Mild forms
  • Tendinitis
  • Bursitis
  • Mild-Moderate-Severe forms
  • OsteoarthritisMOST COMMON
  • Severe forms (inflammatory)
  • Rheumatoid arthritis
  • Gout
  • Lupus Erythematosus
  • Pain Syndromes
  • Fibromyalgia

What is Osteoarthritis?
  • The bones of joints are capped with cartilage.
    This is a tough elastic material that acts as a
    shock absorber and allows the joint to glide
    smoothly with low friction.
  • OA causes destruction of cartilage surfaces of
    the bone, where these boney ends grind together
    causing pain, loss of mobility, deformity and
  • In essenceOA is the inability of the body to
    repair the cartilage faster than it is degraded
    by a specific enzyme (metalloprotease, activated
    by IL-1, a pro-inflammatory product).

Other forms of Arthritis
  • In many forms of arthritis it is the joint lining
    or synovium that becomes inflammed and thickened,
    producing extra lubricating fluid, containing
    inflammatory cells.
  • These cells can damage the cartilage and the
    underlying bone

Normal vs Arthritic joint
Causes of Osteoarthritis (OA)
  • Obesity (thought to be the number one modifiable
    risk factor)
  • Age
  • Congenital or Developmental joint deformity
    (hip socket displaced)
  • Genetic / Gender (femalegtmale)
  • Traumatic (injury causes loss of normal joint
  • Occupation (repetitive stress ie lifting)
  • Sports/activities (wear and tear, if abnormal
    joints exposed to repetitive stress, or if normal
    joints subjected to high impact)
  • Muscle weakness / ligament laxity

Where is OA most common?
  • Hands (1st joints)
  • Spine
  • Knees
  • Hips
  • Thumb joint (1st MTP)

Did you knowThere are over 100 joints connecting
the bodys 206 bones
What are the Symptoms of Arthritis?
  • Physical Findings
  • Gradual onset of localized joint pain
  • Joint may lock or give way
  • Stiffness in the morning or after rest (rarely
    exceeds 30 minutes)
  • Decreased range of motion
  • Pain increases with motion, relieved by rest
  • Changes in barometric pressure
  • Joints in fingers are enlarged
  • Pain upon palpation of the joint
  • X-Ray findings
  • Decreased joint space
  • Osteophytes
  • Whitening or cysts on the surface of the bones

What is PAIN?
  • Cartilage has no blood or nerve supply. Thus, it
    does not feel pain, nor does it heal very well.
    The pain comes from the joint lining, surrounding
    muscles/ligaments/tendons and capsule.
  • Pain is a necessary warning that tells us
    something is wrongwe need to modify our
    behaviour or physiology
  • it is physiological or a physical response to an
  • It is also a pyschological response

Perception of Pain
How pain messages travel
  • Peripheral Nerves pain receptors pick up
    information from the skin, muscles, joints,
    bones, organs and travel to the spine
  • Spinal cord pain message enters the dorsal horn
    of the spinal cord and the message travels up to
    the brain
  • Brain thalamus (sorting/switching station),
    sends message to
  • Physical sensation area, to identify where the
    pain is
  • Emotional feeling region, experiences suffering
  • Thinking region, assigns meaning to the pain

PAIN, a unique experience
  • Affected by
  • Emotional and psychological state
  • Memories of past pain
  • Upbringing (taught to grin and bear it)
  • Age
  • Sex
  • Beliefs and values
  • Social and cultural influences (man on the hook)
  • Attitude
  • Expectations
  • FEAR and ANXIETY can increase intensity of pain
  • On the other hand, ATHLETES can condition to
    endure pain

Chronic Pain
  • PAIN becomes more of a learned experience and
    less of a physiological experience
  • Chronic Pain longer than 6 months
  • Can come/go, remain constant, can feel
  • Tingling, jolting, burning, dull, aching, sharp
  • Can be from painful inflammation of joints
  • Can be from damaged nerves
  • If you have a mood disorder ie. depression or
    anxiety, youre more likely to experience chronic
    pain- and to feel it more intensely. Ergo,
    treating mental health conditions can improve or
    eliminate chronic pain.

Osteoarthritis Pain Cycle
Managing Pain
  • Start with your doctor to properly diagnose
  • Immediate control may require use of NSAIDs or
  • See a therapist who can devise an exercise
    program specifically for you (muscle wasting,
    strengthening and ROM)
  • You might require a brace/orthotic to keep joints
    properly aligned
  • You may need to seek counseling
  • You become the master of your domain

  • Control the Symptoms (pain, stiffness swelling)
  • Painkillers NSAIDs
  • Take days to weeks to begin
  • Make one feel better, do not affect condition
  • Control the Disease
  • Primarily for inflammatory arthritis
  • Prevent joint damage that lead to deformities
  • Take six weeks to six months to work

Pain Reliever/NSAIDs
  • Pain Relieverthe goal is reduce your pain.
  • Tylenol (drug of choice 1000mg)
  • Anti-inflammatoryminimize day-to-day
    inflammation(which can damage cartilage/bone)
  • it may take up to 2 to 4 weeks
  • take even when you feel good
  • Cortisone
  • NSAIDs -Non-Steroidal Anti-inflammatory drugs
  • (ASA)Aspirin, (Ibuprofen)Advil, Motrin, Aleve
  • (Cox-2 Inhibitors) Celebrex
  • (meloxicam) Mobicox
  • Pennsaid - Topical NSAID
  • Linaments most try to distract the body
  • Tiger Balm - Capsaicin (effectively stops pain
    signals from being transmitted)

COX Inhibitors
Medication Side-Effects
  • Tylenol
  • liver
  • Clotting
  • NSAIDS gastrointestinal bleeding
  • Indigestion
  • Constipation
  • liver and kidney effect
  • Cox-2 Inhibitors (Celebrex)
  • Not recommended heart/stroke risk
  • Good NSAID for stomach /ulcers
  • Pennsaid
  • Topical NSAID for knees specifically

Medical Treatments
  • Injections
  • Corticosteroid Injections
  • Improve function
  • Decrease swelling
  • -ve weaken cartilage, deplete bone minerals
  • Hyalgan hyaluronic acid supplementation
    injection into the joint
  • Cochrane 2005 beneficial for knee in decrease of
    pain and increase of function
  • Surgical Techniques
  • Debridement (scraping)
  • Osteotomy (bone cut to change alignment)
  • Partial/Total joint replacement

Complimentary Techniquesto Relieve Pain
  • Rest
  • Energy conservation
  • Sleep
  • Relaxation
  • Exercise
  • If properly done, youll have more energy and
    less pain to do the things that are important to

Complimentary Treatmentof Chronic Pain
  • Persistent, severe pain from arthritis requires a
    combination of therapeutic strategies, no one
    pill or management technique is enough to provide
    non-stop pain relief safely.
  • Exercises (ROM, stretch, strength, endurance,
    body awareness)
  • Physical Therapy (chiropractic, massage, physio,
    TENS, heat/ice, acupuncture)
  • Sleep
  • Nutrition
  • Self Care
  • Dealing with Emotions

Why Exercise
  • POTENTIAL BENEFITS Randomized, controlled trials
    clearly show that regular moderate-level exercise
    does not exacerbate osteoarthritis pain or
    accelerate the pathological process of
    osteoarthritis. Furthermore, these studies
    strongly indicate that increasing the level of
    physical activity in osteoarthritis patients
    reduces pain and morbidity.

Why exercise
  • Osteoarthritis exercises can be an effective
    treatment for joint pain. Exercise can help
  • Control weight
  • Keep joints flexible
  • Increase muscle strength
  • Strengthen bones and ligaments
  • Improve mood and overall outlook

  • Absolute contraindications uncontrolled
    arrhythmias third degree heart block recent
    electrocardiographic changes unstable angina
    acute myocardial infarction acute congestive
    heart failure
  • Relative contraindications cardiomyopathy
    valvular heart disease poorly controlled blood
    pressure uncontrolled metabolic disease

Cross Training secret of champions
  • Range-of-Motion (ROM) Exercises
  • Maintain or restore normal joint movement and
    relieve stiffness
  • Stretching exercises
  • Help maintain or restore normal flexibility to
    joints muscles and tendons
  • Strengthening exercises
  • Increases the muscles ability to provide support
    and stability to a joint
  • Endurance exercises
  • Use large muscles of your body in rhythmic and
    continuous movement ie swim, bike, dancing,
  • Body awareness exercises
  • Help promote balance, posture and breathing ie
    yoga, tai chi

ROM Exercises
  • Do these at least once per day.
  • Do each exercise 3 to 10 times.
  • Move slowly. Do not bounce.
  • Breathe while you exercise. Count out loud.
  • Begin exercises slowly, doing each exercise a few
    times only and gradually build up to more.
  • Try to achieve full range of motion by moving
    until you feel a slight stretch, but don't force
    a movement.
  • Don't try to help others do their exercises by
    moving their arms or legs.
  • STOP exercising if you have severe pain.

Examples of ROM Exercises
  • Ankle Alphabet
  • Knee Raises
  • Neck Rotation
  • Finger Stretches

Stretching Exercises
  • Perform daily or every other day
  • Hold stretch position for 15 to 30 seconds
  • Exercise when pain and stiffness are minimal
    (i.e., prior to bedtime).
  • Warm up (shower or heating pad).
  • Relax prior to.
  • Perform movements slowly and within a comfortable
    zone. Breathe during each stretch.
  • Modify the stretching exercises to avoid pain or
    when the joint is inflamed

Examples of Stretching
  • Neck stretch
  • Wrist stretch
  • Knee to Chest
  • Knees
  • Back
  • Buttock
  • Hamstring Stretch

Strengthening Exercises
  • Perform 3 times per week
  • If the joint youre moving has arthritis but
    isnt painful, repeat the exercise 10 times.
  • If still pain-free gradually increase 3 sets of
  • If it is slightly swollen, mild pain 1 set of 15
  • If hot swollen, and painful STOP

Isometric Exercises
  • Contract the muscle without moving the joint

Isotonic Exercises
  • Contract muscle against mild resistance while
    moving the joint through its range of motion

Endurance Exercises
  • Helps us to increase circulation to our heart,
    lungs and blood vessels.

Body Awareness Exercises
  • as their name indicates, help promote balance,
    posture and breathing through a variety of
    therapeutic techniques and recreational
    activities, including yoga and tai chi.

Chiropractic/Physical Therapy
  • use a combination of non-invasive treatments.
    Including passive stretching, traction, use of
    TENS and ultrasound for pain control and
    inflammation. Recommend therapeutic exercise and
    provide nutritional, dietary and lifestyle
    counseling for long-term health.

Medical Acupuncture
  • Contemporary Medical Acupuncture is a medical
    adaptation of Chinese acupuncture methods, based
    on current concepts of nerves, muscles, joints
    and release of the bodys natural chemicals.
  • As in traditional acupuncture, it involves
    insertion of solid needles at relevant points on
    the body in combination with electrical
  • Acupuncture can be very effective for treating
    both acute injuries and chronic conditions.
  • Works by reducing inflammation, endorphin release
    (pain control) and re-programming pain.

Heat Ice
  • Heat recommended for muscle pain, promotes
    blood circulation, with nourishes and detoxifies
  • Moist heat towels, hot packs, bath or shower
  • 15-20 minutes
  • 3 times each day
  • Cold soothes excited nerve cells and reduces
    swelling in an inflammed joint be constricting
    blood flow
  • - Cold Therapy Ice packs, 2 lb bag of
    frozen peas
  • 10-10-10 RULE 10 min ice on -10 min ice off -10
    min ice on

Massage Therapy
  • Widely used for pain relief. Relieve muscle ache
    and tension by increasing blood flow.

  • Getting a good nights sleep can be almost
    impossible when youre in pain.
  • STEP 1 establish a new pattern (set alarm, wake
    up regardless)
  • STEP 2 dont go to bed until youre tired, if you
    cant fall asleep in 20 to 30 min, get up
  • Dont do anything that doesnt relax you ie TV
  • Good pillow and mattress
  • Keep heat at 64 to 66 degrees
  • Dont use medications
  • Satin sheets or pjs
  • Sleep on side
  • Keep room quiet

  • Weight control (burden on joints)
  • General sense of well-being
  • Avoid pro-inflammatory foods
  • red meat
  • night shade veggies (potatoes, tomatoes, egg
    plant, peppers)
  • Consume anti-inflammatory foods Omega 3 6
  • Fish oils (Salmon, trout), nuts (almond, walnut),
    flax and sunflower seeds and oil, soybeans
  • Consume Anti-oxidants
  • Fruits and veggies (especially high in Vit C
    bright colours)
  • Cherries, blueberries, apples, oranges, avocado,
    spinach, sweet potatoes, broccoli.

Natural SupplementationAnti-Inflammation
  • Aspirin and related drugs can have undesirable
    side effects such as stomach irritation,
    intestinal ulcers, intestinal bleeding
  • A number of herbal agents also block the
    production of PG-2 in the body, reducing the pain
    and inflammation, without the side effects.
  • Curcumin (derived from the spice turmeric) has
    been shown to be effective in clinical trials
    involving patients with rheumatoid arthritis.
  • Boswellia has been used successfully in studies
    with osteoarthritis and rheumatoid arthritis
  • White Willow Bark Extract has been shown to be
    effective in the management of various forms of
    arthritis, back pain and other joint inflammatory
  • Ginger ingredients have been shown to be helpful
    in various arthritic condition and muscle
    inflammatory states.
  • MSM (Methyl Sulfonyl Methane) helps control the
    low-grade background swelling and pain of

Natural SupplementationCartilage Health
  • Glucosamine Sulfate
  • Our bodies produce glucosamine sulfate naturally
    to make joint cartilage
  • As we age our body slows down its production of
    glucosamine sulfate
  • The good news is that studies conducted over the
    past 20 years have shown that supplementation
    with a pharmaceutical and pure grade of
    glucosamine sulfate can help the body rebuild and
    repair joint cartilage.
  • Clinical studies have proven that supplementation
    with glucosamine sulfate is an effective part of
    the management of osteo and degenerative
    arthritis, as well as in cartilage injuries,
    reducing pain and stiffness to a marked degree in
    many cases.
  • 2006 study in NEJM showed Glucosamine sulfate was
    better than hydrochloride
  • 1500mg/d for 6 to 8 weeks
  • Cautions
  • seafood allergy
  • diabetics

Natural Supplementation
  • Chondroitin (Shark cartilage)
  • chondroitin sulfate is too large a molecule to be
    absorbed from the intestinal tract to the
    bloodstream, showing only 0-13 bioavailability.
    Do not waste your money.
  • Calcium (1000-1200mg/day)
  • Vitamin D (200-400IU/day)
  • Evidence OA progresses faster in people with low
    Vit D
  • Milk has 100IU/glass

Effect of Mental State on Chronic Pain
  • Depression is very common in patients with
    chronic/recurring musculoskeletal pain
  • Depression is commonly misdiagnosed or never
  • Professional care required for diagnosis and
    treatment of Depression

Dealing with Emotions
  • Short of death, a diagnosis like chronic illness
    elicits a strong emotional response.
  • Depression
  • Anxiety
  • Feelings of helplessness and isolation

Stress and its Role in Pain
  • During periods of emotional stress naturally
    occurring predicaments of musculoskeletal
    symptoms can become highly magnified and
  • Attempt to avoid/minimize/escape emotionally
    stressful situations
  • Seek professional help to cope with stress if

Good Health Requires a Positive Attitude
  • Focus on abilities instead of disabilities
  • Focus on strengths instead of weaknesses
  • Modify activities into small manageable tasks
  • Make fitness and nutrition part of daily routine
  • Minimize and manage stress
  • Balance rest and activity

  • Pain is one of the hallmark symptoms of
  • We understand how pain works, but its never the
    same experience for any two people.
  • Relief requires a combination of strategies, not
    just one magic pill.
  • You need to empower yourself with all of the
    information and discover what works for you.
  • You are your own Arthritis Self-Manager.
  • Develop support system of family, friends, and
    health professionals.

Exercise Program
  • Warm up
  • Breathing
  • Neck circles
  • Shoulder circles
  • Reach up and out (sun salutations)
  • QL stretch
  • Seated flexion for LB
  • March on spot
  • Ankle circles/alphabet
  • Wrist/hand circles (squeeze and release)

Stretch Strength
  • AB hollow
  • Pelvic tilt
  • Hip flexion 3 above, sits bones
  • Foot dorsi/plantar flexion
  • Hip hikes
  • Lumbar rotation
  • Figure 4
  • Mid back reach
  • Pec stretch
  • Trap stretch
  • Levator stretch
  • Wrist flex/ext stretch

Resources for Arthritis
  • http//
  • http//
  • http//

Core Strength
List of Stretching/ROM for OA