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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 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

2. 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 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

3. 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 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 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

4. 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 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.

5. 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 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.

6. 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.
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.

7. The fingers may tend to 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 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

8. 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 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.).

9. 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 – 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.

10. 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 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.

11.  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
 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.