1. Injection therapy is intended to be a means to an end. The goal is to provide the patient
with enough pain relief to bridge from inactivity to physical therapy, where orthopedic
problems can be better treated with special exercises. For years, physicians have used cortisone
injections, steroid injections, trigger point injections and nerve blocks to relieve pain caused by
osteoarthritis, rheumatoid arthritis, sports injury and more.
Cortisone steroid injections into a joint can help in quickly reducing joint pain while at the same
time restoring function to the part of the body affected by inflammation. Addtionally, when the
corticosteroids are absorbed from the joint into the circulation, cortisone injections can help to
decrease the inflammation in diseased joints throughout the body. Examples of orthopedics
problems that may benefit from steroid injections include a knee, elbow or shoulder affected by
osteoarthritis or rheumatoid arthritis. Long term relief for more advanced osteoarthritis is less
likely because of the existing problem and the weight bearing nature of these joints. Short-term
relief of pain and swelling should occur and may help patients waiting on a total joint
replacement. While there are potential and infrequent adverse reactions to steroid injections,
there is little risk of significant side effects.
Steroid injections. Steroid injections can be used to help relieve pain and restore function in
many types of orthopedic conditions such as tendinitis, bursitis, fibrositis, fasciitis, arthritis,
ligament injuries and more. Corticosteroids are hormones made naturally from cholesterol in the
adrenal glands. When our system naturally produces corticosteroids, they affect most of the
tissues in the body either directly or indirectly. This steroid directly effects the production of
important enzymes in the body. Steroid injections can produce strong anti-inflammatory results.
Visco Supplements. When treating osteoarthritis of the knee one of the first goals is to relieve
pain. Common treatments include pain relievers such as ibuprofen or nonsteroidal anti-
inflammatory drugs (NSAIDs), physical therapy, and corticosteroid injections. Some patients do
not respond well to NSAIDs and may only feel temporary pain relief. A procedure in which a
dose of hyaluronic acid is injected into the knee joint is known as viscosupplementation.
Hyaluronic acid occurs naturally and is found in synovial (joint) fluid. Hyaluronic acid serves as
a lubricant to enable bones to move smoothly over each other and as a shock absorber for joints.
Patients with osteoarthritis, arthritis caused by "wear-and-tear", have a below normal
concentration of hyaluronic acid in their joints. Viscosupplementation may be a non-surgical
treatment for people diagnosed with osteoarthritis of the knee. Viscosupplementation does not
provide immediate pain relief. Commonly, during the course of the injections, patients may
notice less pain in the knee due to the fact that hyaluronic acid has anti-inflammatory and pain-
relieving properties. Injections can also help stimulate the body to produce more of its own
hyaluronic acid. Effects of viscosupplementation treatment can last for several months.
Physically active individuals are healthier, happier and live longer than those who are inactive
and unfit. This is especially true for people with arthritis. Yet, arthritis is one of the most
common reasons people give for limiting physical activity and recreational pursuits. Inactivity, in
addition to arthritis-related problems, can result in a variety of health risks, including Type II
diabetes, cardiovascular disease and osteoporosis. In addition, decreased pain tolerance, weak
muscles, stiff joints and poor balance common to many forms of arthritis can be made worse by

2. inactivity. For many older people with arthritis, joint and muscle changes due to aging can make
matters worse. Therefore, for the person with arthritis, the right kind of exercise is very
important.
What exercises are helpful and safe?
Aquatic exercise is a safe form of aerobic exercise. The three main levels of exercise are 1)
therapeutic/rehabilitative; 2) recreational/leisure; and 3) competitive/elite. Finding the right
balance is key. Therapeutic exercises, prescribed by health professionals, address specific joints
or body parts affected by the arthritis or arthritis-related surgery. A therapeutic exercise program
is often a necessary first step for individuals who have been inactive, have restricted joint motion
or muscle strength, are experiencing joint paint or are recovering from surgery such as a joint
replacement.Recreational or leisure activities can range from walking and swimming to cross
country skiing and running. Appropriate forms are those that can be done in a controlled and safe
manner, have little risk of injury, and place little stress and loads on affected joints. In most
cases, participating in recreational exercise does not do away with the need for therapeutic
exercises. Competitive or elite level activities are performed at higher intensities, for longer
durations and require greater skill and training. There are limited reports of people with arthritis
continuing or returning to a competitive level of sport participation. However, as a general rule,
exercising at this level is not recommended for individuals with inflammatory arthritis or with
joint problems that may be adversely affected by the sporting activity (e.g. marathon running
with hip or knee arthritis). If you have mild or early arthritis and wish to continue exercising at
this level, first talk to your rheumatologist or a physical therapist who has experience in arthritis
and knowledge of the specific sport.
Who should exercise? Everyone! Research shows that people with many forms of arthritis can
participate safely in appropriate, regular exercise. Long-term studies have shown that even
people with inflammatory arthritis such as rheumatoid arthritis (RA) can benefit from moderate
intensity, weight-bearing activity. Other benefits include less bone loss and small-joint damage
associated with RA and no increase in pain or disease activity. For individuals with osteoarthritis
(OA) in the knee or elsewhere, research suggests programs that combine strengthening and
aerobic exercise, reduce symptoms, improve joint motion and function, enhance coordination
and balance, and control body weight. Regular moderate exercise even has been found to
improve cartilage health in individuals at risk for developing knee OA. Having weak thigh
muscles (quadriceps) is a risk factor for both developing OA in the knee and having greater
disability.
What exercises are best? There are four major types of exercise that make up all exercise
programs, regardless of the level of participation. Each can have a positive effect on reducing
arthritis-related pain and disability. Flexibility exercises: Both range-of-motion (ROM) and
stretching exercises help to maintain or improve the flexibility in affected joints and surrounding
muscles. This contributes to better posture, reduced risk of injuries and improved function. ROM
exercises usually are performed 5-10 times on a daily basis. People with RA may find doing
ROM exercises in the evening helps reduce joint stiffness the next morning. It is recommended
that stretching exercises be done at least 3 days a week with each stretch being held for about 30
seconds. While ROM exercises are more common in therapeutic programs, stretching activities
are important in all levels of exercise. Recreational activities such as yoga incorporate both ROM

3. and stretching movements into their routines. Strengthening exercises: These more vigorous
exercises are designed to work muscles a bit harder. As the muscle becomes stronger, it provides
greater joint support and helps reduce loading and stress through the painful joint. Strong
muscles, which also contribute to better function, help reduce bone loss related to inactivity,
some forms of inflammatory arthritis and the use of certain medications (corticosteroids). One
set of 8-10 exercises for the major muscle groups of the body 2-3 times a week is recommended.
Most persons should complete 8-12 repetitions of each exercise. Older individuals may find that
10-15 repetitions with less resistance are more appropriate. The resistance or weight needs to be
of sufficient intensity to challenge the muscles without increasing joint pain. Resistance can take
the form of lifting a limb against gravity, using hand-held weights or elastic bands, or
pushing/pulling against resistance using a weight machine. Even movement against water can
provide resistance when done at faster speeds. Gradually increase the amount or form of
resistance for ongoing improvements in strength. Aerobic exercises: Also referred to as
cardiorespiratory conditioning, these exercises include activities that use the large muscles of the
body in a repetitive and rhythmic manner. Aerobic exercise improves heart, lung and muscle
function. For people with arthritis, this type of exercise has benefits for weight control, mood,
sleep and general health. Safe forms of aerobic exercise include walking, aerobic dance, aquatic
exercise, bicycling or exercising on equipment such as stationary bikes, treadmills or elliptical
trainers. Daily tasks and leisure activities such as mowing the lawn, raking leaves, playing golf
or walking the dog also are aerobic if carried out at a moderate intensity level. Current
recommendations for aerobic activity are to do 150 minutes of moderate intensity exercise a
week, preferably spread out over several days. You can accumulate this amount of exercise in
several 10-minute bouts over the course of the day or week for similar health benefits as
sustained exercise sessions. This provides greater options in scheduling aerobic exercise
sessions, and allows those individuals with greater pain and fatigue to do shorter sessions within
their personal tolerance level. Moderate intensity is the safest and most effective exertion level
for aerobic exercise. This means the exerciser can speak normally (Talk Test), doesn't get short
of breath or over-heated, and can carry on the activity for a sustained period of time in comfort.
Body awareness exercises: A fourth—and less recognized, though very important—group of
exercises is referred to together as body awareness exercises. These include activities to improve
posture, balance, joint position sense (proprioception), coordination and relaxation. While some
of these improvements can be achieved through the first 3 types of exercise, problems in these
areas often require different exercises. Tai chi and yoga are examples of recreational exercises
that incorporate elements of body awareness. When a joint and its surrounding muscles are
affected by arthritis, or if a joint has been replaced, the result is often impaired coordination,
position awareness, balance and an increased risk of falling. A health professional experienced in
arthritis exercise prescription can determine which of these exercises will help improve your
overall functioning and reduce the risk of injury. Tai chi and yoga are examples of a recreational
exercise that incorporates elements of body awareness.
When to exercise? Finding the right time of day to exercise will help you establish a routine and
obtain the greatest benefits. For those with a lot of morning stiffness, gentle ROM exercises may
be helpful, but getting to a fitness class may be too difficult. If fatigue is a problem, breaking up
the exercise program into several short bouts during the day may be more manageable. Trouble
sleeping at night? Avoid doing aerobic exercises within 2 hours of bedtime; however, stretching
and relaxation exercises may help with sleep. It is important to be aware of any changes in your

4. arthritis symptoms such as periods of more joint pain and stiffness. You may need more rest and
less exercise during these times.
Where to exercise? The best place to exercise is a personal choice. Some people prefer to
exercise in the comfort, convenience and privacy of their own home with an exercise DVD or
video such as the Arthritis Foundation’s Take Control with Exercise. Others enjoy the social
aspect of getting out of the house and attending a class or gym in the community. A community-
based program offers greater options than exercising at home and, for some people, the support
and guidance offered by an instructor or fitness trainer provides the needed motivation to stick
with a program. Aquatic or pool-based exercise is another good option for people with arthritis.
The buoyancy effects of water result in less stress on the weight-bearing joints and marked pain
relief for many people with arthritis. The Arthritis Foundation’s Aquatic Program is a good
starting point to learn appropriate exercises in the pool. [Check with your local Arthritis
Foundation chapter for arthritis exercise programs in your community.]
How to get started? Starting a regular exercise program can be very challenging. Understanding
the benefits of exercise for people with arthritis and having the support and guidance from your
rheumatologist will help. Physical and occupational therapists can suggest exercises that are safe
and customized to your specific needs, teach you how to monitor your body’s response to
exercise, and modify your exercise routine as needed. Make an exercise plan or contract
including when, how often and for how long you will exercise. Other tips to help you stay
motivated are:
 Set realistic short and long term goals, and reward yourself when you have achieved them
 Exercise with a friend or family member
 Keep an exercise log or chart your progress on a calendar
 Identify problems or obstacles that are likely to get in the way of your exercise program
and plan ahead how you will deal with them
 Choose activities that are convenient, relatively inexpensive and fun!
Discuss your exercise program and any concerns you have with your rheumatologist and/or other
arthritis health professionals on a regular basis. With their support and guidance, you will be able
to build regular physical activity and exercise into your daily routine and reap the benefits of an
active and healthy lifestyle.
Points to remember
 Having several exercise options and locations keeps you from becoming bored and
provides alternatives on those days when getting out of the house seems impossible.
 Recent American College of Rheumatology (ACR) guidelines suggest that exercise
should be one of the mainstays of treatment for OA of the hip and knee.
5 Steps to Make Physical Therapy Work for Your RA
Doing physical therapy exercises can help your RA by making you stronger and more flexible.
That can help you feel better. "When you get up and move, you'll actually have less pain and

5. more energy," says Brett Cook, a physical therapist at Independence Rehab in Sandy, Utah.
Cook knows what he's talking about, and not just because of his medical background. At the age
of 1, he was diagnosed with juvenile rheumatoid arthritis. "I understand the pain and fatigue of
living with RA," Cook says. "I also know firsthand that physical therapy for RA vastly improves
one's quality of life." Follow these five suggestions from Cook and other RA experts to make
physical therapy a successful part of your rheumatoid arthritis treatment.
1. Work With a Pro
Ask your rheumatologist to recommend a physical therapist who has experience working with
people with rheumatoid arthritis. "We can create an individualized physical therapy program
based on your RA symptoms and disease progression," says Jim Long, senior physical therapist
at Cleveland Clinic's Lutheran Hospital. A physical therapist can also make sure you're doing the
exercises correctly and show you new ones to try, so you'll be less likely to get frustrated and
give up.
2. Adopt a "No Excuses" Policy for Physical Therapy
If you're tempted to say, "I hurt too much today. I'll do my exercises tomorrow," don't give up.
Instead, work a different, less painful part of your body. For instance, if your knees are your
most painful joint, "do some seated wrist and arm exercises like bicep curls," Cook says. Warm-
water exercises are also good because the water's buoyancy relieves pressure on your joints, and
the warmth is soothing. As with any kind of exercise program, you're more likely to do it if you
make a habit of doing it at the same time every day. Schedule your workout time on a calendar
and treat it just like you would a doctor's appointment. Don't cancel!
3. Stiff Joints? Turn Up the Heat
Mornings can be tough since joints get stiff overnight. A warm shower does more than wake you
up -- it also serves as your therapeutic warm-up. Moist heat increases muscle relaxation, boosts
blood supply to the painful area, and relieves muscle spasms. "I'm more likely to follow through
on my physical therapy exercises once the water's soothed me," says Audrey Sawyer Mills, who
has RA. Her home in Houston is equipped with a hot tub, whirlpool sauna, and a shower rail.
4. Include Aerobic Exercise
Aerobic exercise is an essential part of physical therapy for RA. "Weight-bearing activities build
and strengthen bone while reducing your risk of other health problems like heart disease and
diabetes that often accompany rheumatoid arthritis," Long says. Pair up with a walking partner
or sign up for a class for people with arthritis. "You're less likely to bail on an activity if you
know others are counting on you to show up," Long says. Check with your local Arthritis
Foundation office to find a health club near you that offers arthritis-friendly exercise programs
including aquatic, tai chi, yoga, and walking activities.

6. 6 Hand Exercises for Rheumatoid Arthritis
Maintaining range of motion and developing realistic expectations of your hand strength
are two good reasons for doing these rheumatoid arthritis exercises for your hands.
Rheumatoid Arthritis Content from Dr. Sanjay Gupta:
Losing hand strength and mobility is a scary prospect for people with rheumatoid arthritis. For
many, rheumatoid arthritis treatment includes hand exercises to help maintain range of motion.
There are many reasons to do rheumatoid arthritis exercise routines for your hands. "It's a nice
way to get a little strengthening going and lets patients sense what their level of activity might
be," explains certified hand therapist Alice Pena, PT, DPT, director of operations for Home Care
of Rochester in Rochester, N.Y. and spokesperson for the American Physical Therapy
Association. In general you can repeat the following exercises up to five times per session, once
or twice a day. Talk to your doctor about the best number of reps for you.
1. Flat-Hand Finger Lifts
For a simple rheumatoid arthritis exercise, start by placing your hands flat on a table, says Pena.
"Try to raise each finger individually off the table." Work gently and take your time with this
type of rheumatoid arthritis treatment. "Generally [there] is not a lot of strain to the joint,
providing you don't have a significant amount of deformity," says Pena, adding, "I usually ask
patients not to force bending."
2. Folding Fingers
Another great hand exercise for rheumatoid arthritis is drawing your fingers down into the center
of your palm to make a loose fist. Then open your hand slowly and repeat a few times. Pena
offers this tip for easing the difficulty of some rheumatoid arthritis exercise: Try moist heat to
make motion easier. Practice hand exercises such as this one while taking a warm shower. Other
options are to use warm paraffin wax or place a warm, moist washcloth over your hand.
3. Walking Fingers
Place a hand towel or kitchen towel flat on a table to do this rheumatoid arthritis exercise. With
your hand lightly cupped and supported by your fingertips and thumb, "walk" your fingertips
toward you in order to pull the towel up into the palm of your hand. "Get as much towel into
your fist as you can and gently squeeze," says Pena. This keeps you aware of how rheumatoid
arthritis might be affecting your grip and how strong your grip is, she explains.
4. Finger Pinches
Rheumatoid arthritis exercises for hands are intended to support daily activities — such as tying
shoelaces or doing up buttons — that become harder as you experience more symptoms of
rheumatoid arthritis. Pinching your thumb to the tip of each of your fingers, one at a time and in

7. order is an effective exercise. Take your thumb and touch it your index finger and pinch, says
Pena. Thumb to index finger, thumb to long finger, plus thumb to the side of index finger are the
three key pinches of this rheumatoid arthritis exercise, she adds.
5. Thumb to Base of Fingers
One of the goals of rheumatoid arthritis exercise is to preserve all the motions available to any
specific joint, says Pena. Focusing on your thumb is necessary because it is so important to so
many different hand motions, which may become progressively more difficult as rheumatoid
arthritis progresses. A key exercise for the thumb is to try to touch the base of the little finger.
This kind of motion can help you grip circular objects, such as hairbrushes.
6. Spread Fingers
When you have rheumatoid arthritis, just as you need to practice bringing your fingers and
thumb close together, you also need to work on spreading them apart — a motion needed when
you are putting on gloves, for example. So this rheumatoid arthritis exercise is to simply spread
your fingers apart, slowly and gently. While you have your hand flat, you can also exercise your
thumb by separating it gently from the other fingers.
Taking a Break From Rheumatoid Arthritis Exercise
Succeeding with rheumatoid arthritis treatment means knowing when to take a break. Pena
emphasizes that there are times, especially during flares or a worsening of the symptoms of
rheumatoid arthritis, when it might be best to wear a supportive brace or a splint and go easy
with any exercise program that you have planned. This is to avoid additional damage to your
joints during that period of time. Working with a hand therapist on rheumatoid arthritis treatment
can help you learn when to rest and when to keep going.
So You're a Caregiver... Now What? Caregivers provide a wide range of nursing, homemaking,
social, emotional, and financial services on a daily or intermittent basis. Whether you were thrust
into the role of caregiver rather suddenly or gradually over time, you may feel unprepared, alone,
and overwhelmed by what is expected of you.
While each caregiving circumstance is challenging and unique, your individual experience can
greatly improve with the practice of a few general strategies. Through our caregivers site, the
Arthritis Foundation addresses the common needs, concerns, and struggles of family caregivers.
Let us help you help your loved one.
Providing Care for Your Parents
Caring for a parent suffering from arthritis is a tough responsibility -- one which carries a host of
difficult decisions and issues with which you may have little or no experience. Too often,
caregivers feel overwhelmed, isolated, and trapped. Let Arthritis Foundation help. We'll share
some strategies to care for your parent, help you identify potential problems, and point out some
workable solutions.

8. Rheumatoid arthritis is an inflammatory arthritis in which joints, usually including those of
the hands and feet, are inflamed, resulting in swelling, pain, and often destruction of joints.
 The immune system damages the joints and connective tissues.
 Joints (typically the small joints of the limbs) become painful and have stiffness that
persists for more than 60 minutes on awakening and after inactivity.
 Fever, weakness, and damage to other organs may occur.
 Diagnosis is based mainly on symptoms but also on blood tests for rheumatoid factor
and on x-rays.
 Treatment can include exercises and splinting, drugs (nonsteroidal anti-inflammatory
drugs, disease-modifying antirheumatic drugs, and immunosuppressive drugs), and
sometimes surgery.
Worldwide, rheumatoid arthritis develops in about 1% of the population, regardless of race
or country of origin, affecting women 2 to 3 times more often than men. Usually,
rheumatoid arthritis first appears between 35 years and 50 years of age, but it may occur at
any age. A disorder similar to rheumatoid arthritis can occur in children. The disease is then
called juvenile idiopathic arthritis, and the symptoms and prognosis are often somewhat
different (see see Juvenile Idiopathic Arthritis (JIA)).
The exact cause of rheumatoid arthritis is not known. It is considered an autoimmune
disease (see see Autoimmune Disorders). Components of the immune system attack the soft
tissue that lines the joints (synovial tissue) and can also attack connective tissue in many
other parts of the body, such as the blood vessels and lungs. Eventually, the cartilage, bone,
and ligaments of the joint erode, causing deformity, instability, and scarring within the joint.
The joints deteriorate at a variable rate. Many factors, including genetic predisposition, may
influence the pattern of the disease. Unknown environmental factors (such as viral
infections and cigarette smoking) are thought to play a role.
Symptoms
People with rheumatoid arthritis may have a mild course, occasional flare-ups with long
periods of remission (in which the disease is inactive), or a steadily progressive disease,
which may be slow or rapid. Rheumatoid arthritis may start suddenly, with many joints
becoming inflamed at the same time. More often, it starts subtly, gradually affecting
different joints. Usually, the inflammation is symmetric, with joints on both sides of the
body affected about equally. Rheumatoid arthritis can affect any joint, but most often the
small joints in the fingers, toes, hands, feet, wrists, elbows, and ankles become inflamed
first. Other commonly affected joints include the hips, knees, and shoulders. The inflamed
joints are usually painful and often stiff, especially just after awakening (such stiffness
generally lasts for more than 60 minutes) or after prolonged inactivity. Some people feel
tired and weak, especially in the early afternoon. Rheumatoid arthritis may cause a loss of
appetite with weight loss and a low-grade fever. Affected joints are often tender, warm, red,
and enlarged because of swelling of the soft tissue and sometimes fluid within the joint.
Joints can quickly become deformed. Joints may freeze in one position so that they cannot
bend or open fully, which leads to a limited range of motion. The fingers may tend to

9. dislocate slightly from their normal position toward the little finger on each hand, causing
tendons in the fingers to slip out of place, or may develop other deformities (see Fig. 1:
When the Fingers Are Abnormally Bent ). Swollen wrists can pinch a nerve and result in
numbness or tingling due to carpal tunnel syndrome (see see Carpal Tunnel Syndrome).
Cysts, which may develop behind affected knees, can rupture, causing pain and swelling in
the lower legs. Up to 30% of people with rheumatoid arthritis have hard bumps (called
rheumatoid nodules) just under the skin, usually near sites of pressure (such as the back of
the forearm near the elbow). Rarely, rheumatoid arthritis causes an inflammation of blood
vessels (vasculitis—see see Overview of Vasculitis). Vasculitis reduces the blood supply to
tissues and may cause nerve damage or leg sores (ulcers). Inflammation of the membranes
that cover the lungs (pleura) or of the sac surrounding the heart (pericardium) or
inflammation and scarring of the lungs or heart can lead to chest pain or shortness of breath.
Some people develop swollen lymph nodes (lymphadenopathy), Felty syndrome (a low
white blood cell count and an enlarged spleen), Sjögren syndrome (see see Sjögren
Syndrome), thinning of the white of the eye (sclera), or red, irritated eyes caused by
inflammation (episcleritis). Rheumatoid arthritis can also affect the neck, making the bones
unstable and creating risk of compression of the spinal cord.
Rest and nutrition:
Severely inflamed joints should be rested, because using them can aggravate the
inflammation. Regular rest periods often help relieve pain, and sometimes a short period of
bed rest helps relieve a severe flare-up in its most active, painful stage. Splints can be used
to immobilize and rest one or several joints, but some systematic movement of the joints is
needed to prevent nearby muscles from weakening and joints from freezing in place. A
regular, healthy diet is generally appropriate. A diet rich in fish (omega-3 fatty acids) and
plant oils but low in red meat can partially relieve symptoms in some people. Some people
have flare-ups after eating certain foods, and if so, these foods should be avoided, but this
occurs rarely. No specific foods have been proved to cause flare-ups. Many diets have been
proposed but have not proved helpful. Fad diets should be avoided.
Physical treatments:
Along with drugs to reduce joint inflammation, a treatment plan for rheumatoid arthritis
should include nondrug therapies, such as exercise, physical therapy (which includes
massage, traction, and deep heat treatments), occupational therapy (which includes self-help
devices), and sometimes surgical treatment. Inflamed joints should be gently stretched so
they do not freeze in one position. Heat therapy can be helpful because heat improves
muscle function by reducing stiffness and muscle spasm. As the inflammation subsides,
regular, active exercises can help, although a person should not exercise to the point of
excessive fatigue. For many people, exercise in warm water may be easier. Treatment of
tight joints consists of intensive exercises and occasionally the use of splints to gradually
extend the joint. Cold may be applied to reduce pain caused by temporary worsening in one
joint. People who are disabled by rheumatoid arthritis can use several aids to accomplish
daily tasks. For example, specially modified orthopedic or athletic shoes can make walking

10. less painful, and self-help devices such as grippers reduce the need to squeeze the hand
forcefully.risk factors for heart attack and stroke.
8 Arthritis Exercise Tips
For the 21 million American adults suffering from arthritis, stiff, painful joints can make
even an easy exercise program feel impossible. But, with countless research studies backing
up the benefits of working out, can your loved one really afford to forgo their daily cardio?
The experts don't think so. Neil Roth, M.D., an orthopedic and sports medicine specialist at
Lenox Hill Hospital in New York, says, "there is nothing better," than exercise when it
comes to managing pain in people with arthritis. Though, he does admit that it can be hard
for people who are in pain to stick to an exercise routine. "It is a catch 22, because arthritis
pain can prevent a person from exercising, but it is actually one of the most beneficial ways
to alleviate arthritis pain," he says.
Thankfully, there are ways to make an exercise regimen more arthritis-friendly:
1. Prioritize pain management: According to Stephen Soloway, M.D., a
rheumatologist, the key to a successful exercise program for people with arthritis is
making sure their pain is under control before they start working out. This will
involve a trip to your loved one's doctor to diagnose which type of arthritis they
have, and prescribe any necessary anti-inflammatory medications or therapies. Once
their pain and inflammation are under control, Soloway says a senior should be able
to do most types of exercise without aggravating their condition. A doctor can also
advise an arthritis sufferer on which kinds of exercises would be good to do, as well
as which ones could be harmful.
2. Start slow: Warm-up is an often overlooked (yet integral) element of a workout—
especially when a senior's joints are sore and stiff due to their arthritis. Before your
loved one hops on a bike or picks up dumb bells, they should do some gentle range-
of-motion exercises (generally prescribed by their doctor or physical therapist), such
as arm circles, hip lifts, and toe touches. Roth says it might also be beneficial for a
senior to put a heat pack on their most painful areas prior to starting a workout. Heat
can help relax and loosen up their muscles and joints.
3. Reduce your impact: When it comes to exercising with arthritis, low-impact is the
way to go, according to Roth. He cites swimming, water aerobics, stationary cycling,
and elliptical machines as great low-impact forms of cardiovascular training.
Soloway also suggests practicing Tai Chi as a way to help a senior increase their
balance and flexibility. Studies have shown that this ancient Chinese martial art can
help reduce pain and increase mobility in people with different types of arthritis. It's
generally safe for an arthritis sufferer to lift weights, just be sure to check with your
loved one's doctor before encouraging them to begin a weight training program.
4. Mix it up: Switching up an exercise regimen can be extremely beneficial for a
senior who is suffering from arthritis, according to Soloway. "Workouts should be
varied—not stagnant," he says. There are numerous benefits to mixing it up in the

11. gym, not the least of which is that your loved one is less likely to become bored and
uninterested in working out. Soloway says that it's important to consult with your
loved one's doctor to come up with a workout plan that focuses on safely developing
their cardiovascular capacity as well was their all-around strength and flexibility.
5. In pain, no gain: Both Roth and Soloway warn arthritis-suffers to avoid workouts
that cause them pain. "You should exercise up to a point where you are tired, but it is
not good to push through pain," Roth says. Soloway adds that pain is your body's
way of telling you that something is wrong. Especially if your loved one suffers
from rheumatoid arthritis, Soloway says that they need to go to the doctor to make
sure their inflammation is under control before they start an exercise program.
6. Work on weaknesses: When it comes to strength training, a senior might want to
stick with the exercises that they're good at. But Soloway says it's equally (if not
more) important for your elderly loved one to work on increasing strength in their
weaker areas. Roth says that some of the most beneficial types of exercises a senior
can do are those that strengthen the muscles that support their arthritic joints. A
doctor or physical therapist can help your loved one come up with a set of exercises
geared towards strengthening the areas around their pain points.
7. Recover well: According to Roth, stretching before and after a workout can help a
senior's muscles recover more quickly. If your loved one is particularly sore in
certain areas, it may be beneficial for them to ice those parts of their body. When
icing, make sure the ice pack is wrapped in a thin towel and don't leave it on a
senior's skin for longer than 30 minutes.
8. Don't forget to eat (right): There's no magical diet that can take away aches and
pains, but eating healthy can beneficial for seniors who have arthritis. Soloway
suggests tailoring your loved one's diet to fit their exercise regimen. For example, if
a senior is engaging in a good amount of strength-building exercises to build up the
muscles around their joints, make sure they're getting enough healthy protein (egg
whites, almonds, chicken, salmon, etc.) to help fuel muscle growth. If they're doing a
good amount of cardio, make sure they're eating high-quality carbohydrates (fruit,
whole grain pasta and bread, brown rice, etc.).
Physical Therapy for Arthritis Pain Relief
Did you know that the joints of most adults over the age of 18 would show arthritic changes? Of
course most teenagers are not complaining about joint pain. However, it is no surprise that as
time passes, and the joints undergo more wear and tear, those changes cause the symptoms that
most people associate with arthritis, the most common forms of which is osteoarthritis (OA) or
degenerative joint disease (DJD). Arthritis most commonly affects the large weight-bearing
joints, such as the hips and knees, as well as the hands, feet and spine. Arthritis can be a natural
result of aging, as cartilage – the springy material that cushions against friction in the joints –

12. begins to degenerate. It can also be caused or accelerated by other factors, such as obesity,
trauma or surgery to the joint, gout or diabetes.
When treating arthritis, the goals are to reduce joint pain and inflammation, while improving and
maintaining joint function. Physical therapists can offer many effective interventions to
accomplish these goals.
Arthritis pain relief: Physical therapists can provide several means of reducing joint
discomfort. At a basic level, some people can benefit from application of heat or cold. Which of
these modalities is chosen may depend on whether inflammation is apparent in the joint. A
combination of heat application prior to exercise, and cold packs after exercise, may also be
beneficial. Gentle, low-grade mobilizations, which are gentle passive movements of the joint by
the therapist, may also decrease pain, while also improving joint mobility.
Arthritis joint protection: Exercise is key to physical therapy for seniors with arthritis.
Strengthening and stretching will improve range of motion and help protect the joint. Many
elders with joint pain are afraid that exercise will make their pain worse; however, a properly
designed exercise program will use appropriate exercise intensity, frequency, and duration to get
positive results without exacerbating pain. Aquatic physical therapy, which is performed in a
pool, can be particularly effective for those with painful arthritis, since it allows movement with
the partial weight-bearing support and gentle resistance of the water. An exercise program will
also include stretching to help increase range of motion in effective joints. Yoga is a great form
of exercise that can combine strengthening and stretching.
Physical therapists have the knowledge and training to safely progress seniors’ therapeutic
exercise programs to improve joint strength and mobility and maximize their function, as well as
design a home exercise program to insure that the improvement is maintained after discharge
from skilled therapy. As an added bonus, a regular exercise program can assist with weight loss,
which can also decrease the symptoms of arthritis and offer many oter health benefits!
What Types of Exercise Are Most Suitable for Someone With Arthritis?
Three types of exercise are best for people with arthritis:
 Range-of-motion exercises (e.g., dance) help maintain normal joint movement and
relieve stiffness. This type of exercise helps maintain or increase flexibility.
 Strengthening exercises (e.g., weight training) help keep or increase muscle strength.
Strong muscles help support and protect joints affected by arthritis.
 Aerobic or endurance exercises (e.g., bicycle riding) improve cardiovascular fitness,
help control weight, and improve overall function. Weight control can be important to
people who have arthritis because extra weight puts extra pressure on many joints. Some
studies show that aerobic exercise can reduce inflammation in some joints.
Most health clubs and community centers offer exercise programs for people with physical
limitations.

13. How Does a Person With Arthritis Start an Exercise Program?
People with arthritis should discuss exercise options with their doctors and other health care
providers. Most doctors recommend exercise for their patients. Many people with arthritis begin
with easy, range-of-motion exercises and low-impact aerobics. People with arthritis can
participate in a variety of, but not all, sports and exercise programs. The doctor will know which,
if any, sports are off-limits.
The doctor may have suggestions about how to get started or may refer the patient to a physical
therapist. It is best to find a physical therapist who has experience working with people who have
arthritis. The therapist will design an appropriate home exercise program and teach clients about
pain-relief methods, proper body mechanics (placement of the body for a given task, such as
lifting a heavy box), joint protection, and conserving energy.
Pain Relief Methods for People With Arthritis
There are known methods to help stop pain for short periods of time. This temporary relief can
make it easier for people who have arthritis to exercise. The doctor or physical therapist can
suggest a method that is best for each patient. The following methods have worked for many
people:
 Moist heat supplied by warm towels, hot packs, a bath, or a shower can be used at home
for 15 to 20 minutes three times a day to relieve symptoms. A health professional can use
short waves, microwaves, and ultrasound to deliver deep heat to noninflamed joint areas.
Deep heat is not recommended for patients with acutely inflamed joints. Deep heat is
often used around the shoulder to relax tight tendons prior to stretching exercises.
 Cold supplied by a bag of ice or frozen vegetables wrapped in a towel helps to stop pain
and reduce swelling when used for 10 to 15 minutes at a time. It is often used for acutely
inflamed joints. People who have Raynaud’s phenomenon should not use this method.
 Hydrotherapy (water therapy) can decrease pain and stiffness. Exercising in a large pool
may be easier because water takes some weight off painful joints. Community centers,
YMCAs, and YWCAs have water exercise classes developed for people with arthritis.
Some patients also find relief from the heat and movement provided by a whirlpool.
 Mobilization therapies include traction (gentle, steady pulling), massage, and
manipulation (using the hands to restore normal movement to stiff joints). When done by
a trained professional, these methods can help control pain and increase joint motion and
muscle and tendon flexibility.
 TENS (transcutaneous electrical nerve stimulation) and biofeedback are two additional
methods that may provide some pain relief, but many patients find that they cost too
much money and take too much time. In TENS, an electrical shock is transmitted through
electrodes placed on the skin’s surface. TENS machines cost between $80 and $800. The
inexpensive units are fine. Patients can wear them during the day and turn them off and
on as needed for pain control.
 Relaxation therapy also helps reduce pain. Patients can learn to release the tension in
their muscles to relieve pain. Physical therapists may be able to teach relaxation

14. techniques. The Arthritis Foundation has a self-help course that includes relaxation
therapy. Health spas and vacation resorts sometimes have special relaxation courses.
 Acupuncture is a traditional Chinese method of pain relief. A medically qualified
acupuncturist places needles in certain sites. Researchers believe that the needles
stimulate deep sensory nerves that tell the brain to release natural painkillers
(endorphins).
 Acupressure is similar to acupuncture, but pressure is applied to the acupuncture sites
instead of using needles.
How Often Should People With Arthritis Exercise?
 Range-of-motion exercises can be done daily and should be done at least every other
day.
 Strengthening exercises should be done every other day unless you have severe pain or
swelling in your joints.
 Endurance exercises should be done for 20 to 30 minutes three times a week unless you
have severe pain or swelling in your joints. According to the American College of
Rheumatology, 20- to 30-minute exercise routines can be performed in increments of 10
minutes over the course of a day.
What Type of Strengthening Program Is Best?
This varies depending on personal preference, the type of arthritis involved, and how active the
inflammation is. Strengthening one’s muscles can help take the burden off painful joints.
Strength training can be done with small free weights, exercise machines, isometrics, elastic
bands, and resistive water exercises. Correct positioning is critical, because if done incorrectly,
strengthening exercises can cause muscle tears, more pain, and more joint swelling.
Are There Different Exercises for People With Different Types of Arthritis?
There are many types of arthritis. Experienced doctors, physical therapists, and occupational
therapists can recommend exercises that are particularly helpful for a specific type of arthritis.
Doctors and therapists also know specific exercises for particularly painful joints. There may be
exercises that are off-limits for people with a particular type of arthritis or when joints are
swollen and inflamed. People with arthritis should discuss their exercise plans with a doctor.
Doctors who treat people with arthritis include rheumatologists, orthopaedic surgeons, general
practitioners, family doctors, internists, and rehabilitation specialists (physiatrists).
How Much Exercise Is Too Much?
Most experts agree that if exercise causes pain that lasts for more than 1 hour, it is too strenuous.
People with arthritis should work with their physical therapist or doctor to adjust their exercise
program when they notice any of the following signs of strenuous exercise:
 Unusual or persistent fatigue
 Increased weakness

15.  Decreased range of motion
 Increased joint swelling
 Continuing pain (pain that lasts more than 1 hour after exercising)
Should Someone With Rheumatoid Arthritis Continue To Exercise During a General Flare? How
About During a Local Joint Flare? It is appropriate to put joints gently through their full range of
motion once a day, with periods of rest, during acute systemic flares or local joint flares. Patients
can talk to their doctor about how much rest is best during general or joint flares.
Are Researchers Studying Arthritis and Exercise?
Researchers are looking at the effects of exercise and sports on the development of
musculoskeletal disabilities, including arthritis. They have found that people who do moderate,
regular running have low, if any, risk of developing osteoarthritis. However, studies show that
people who participate in sports with high-intensity, direct joint impact are at risk for the disease.
Examples are football and soccer. Sports involving repeated joint impact and twisting (such as
baseball and soccer) also increase osteoarthritis risk. Early diagnosis and effective treatment of
sports injuries and complete rehabilitation should decrease the risk of osteoarthritis from these
injuries. Researchers also are looking at the effects of muscle strength on the development of
osteoarthritis. Studies show, for example, that strengthening the quadriceps muscles can reduce
knee pain and disability associated with osteoarthritis. One study shows that a relatively small
increase in strength (20-25 percent) can lead to a 20-30 percent decrease in the chance of
developing knee osteoarthritis. Other researchers continue to look for and find benefits from
exercise to patients with rheumatoid arthritis, spondyloarthropathies, systemic lupus
erythematosus, and fibromyalgia. They are also studying the benefits of short- and long-term
exercise in older populations.