Should Rheumatoid Arthritis Patients Exercise, Part 2

Should Rheumatoid Arthritis patients exercise or not?

There was a bit of a backlash to the Part 1 blog post to this series on exercise and Rheumatoid Arthritis. A few people even unsubscribed. But, staying out of trouble is not a goal of this blog. Truth-telling is.

Specifically, what I have challenged is the kneejerk “Use it or lose it” approach to exercise and Rheumatoid Arthritis. It is simply ironic when joint protection is considered. As I explained in Should Rheumatoid Arthritis Patients Exercise, Part 1, I do not oppose exercise generally.

Recently, I wrote that “Use it or lose it” should be re-written. It ought to be: If you can exercise, you should; If you can’t, you should not.

Logic

Let me paint a picture for you: massage is a good thing, right? Everyone knows it can be very beneficial in the right context. However, imagine massaging a sunburned back.

Doesn’t work, does it?

That’s the same thing as prescribing exercise for Rheumatoid Arthritis patients who are damaged, inflamed, or barely able to move.

Are people saying that the crutches, canes, wheelchairs, and braces of many RA’ers are just props and that they need to cast them aside and rise up and walk? Or are they implying that those with Rheumatoid Arthritis are in this condition because they were too inactive to begin with? We just need common sense on this issue.

It’s one of those things that does not need to be explained to those of us who know. The problem is, it is nearly impossible to explain it to those who don’t know. How can they know what they cannot experience?

Bluntly, if you are still able to view exercise as helpful to you, then you can probably still exercise. And you probably should – whether you have Rheumatoid Arthritis or not. If you are not sure, it’s easy enough to find out.

Experiments

Several months ago, I could not resist the draw of my kids and the tennis rackets. I determined to hit a few with my 12 year old. I could barely hold onto the lightweight racket. But, my willpower is iron.

I managed to force my wrist to awkwardly hold out that racket. I thought: I WILL do this! And then my child tapped a ball in my direction. It felt like a cannonball hit my racket. The shock of that ball sent pain through my hand and arm that did not fade in a few moments.

I did not give up. Over and over, I tried to ignore the pain. I missed more and more balls because my hips would not let me move sideways. I did not want to, but eventually I had to quit, of course.

I did not complain. I had done this voluntarily. I just had to know whether I could hit the ball. It looks so easy…

For several days, my hand and wrist were useless. Was it worth it to play a bit of really crummy tennis? No.

However, I am hoping it was worthwhile for another reason. It was a useful experiment. Think of it as a research trial.

Tomorrow in Rheumatoid Arthritis and Exercise, Part 3: more homemade RA research trials and a piece of exciting news on this topic.

Recommended reading: How Rheumatoid Arthritis Creates Makeovers and Bag Ladies

Stunning video: How Rheumatoid Arthritis Impacts Lives

24 for Rheumatoid Arthritis Warriors

We Live With Rheumatoid Arthritis 24 / 7

I wanted to do a" 24" segment on RA to show what it’s like to live with it 24 / 7. I wrote this down a couple months ago, but I saved it for today because I wanted to post it right after the joint protection article.

Here is one hour in the life of an RA-er delivered in three minutes.

Warning: This will be annoying journey into Life with Rheumatoid Arthritis.

Think of it as an amusement park ride which you want to try, but you know will probably also exasperate you. If you choose to board this ride, please be aware that nausea is a strong possibility. Stay inside the vehicle until it comes to a complete stop. That will be in approximately 3 minutes. Enjoy the ride.

Last night I was awakened several times by noises in the house. It was not an intruder. It was my knees. I turned to my right side; neck clicking. I turned to my left; shoulder grinding. Back on my back to for deep breathing; no way to keep my elbow from touching the bed.

Anyway, I’m tired today. I feel like slept on the tracks while trains ran over me all night long.

Ouch. My knees are screaming. It breaks into my thoughts.

I am not hungry, but I will eat breakfast soon so I can take meds. That’ll help. And vitamins. Yeah, my cure. Just eat right and I’ll be fine…

Laundry left that I could not finish last night. After six p.m. I can barely move. Bending to open the dryer: POP! That was my hip. Opening the washer lid with the sides of my hands; my fingers are too weak. It pulls them out of place. Wet laundry is heavy. When I try to pull out one piece, the washer seems to pull it back. Oh my gosh! My big toe is screaming. Pulling the laundry with all my might, I’m dropping it down to the dryer door.

Starting a new load means soap. I got a little bottle, but it still weighs 40 pounds, to me anyway. I reach up to open the cupboard and my shoulder grinds loudly. I call out to my daughter in the next room: Did you hear that? I do my drop / fly trick: I get a hold of the handle on the soap bottle and let it drop down to the washer top: bang. It is falling by gravity and I just have to stop it from going all the way to the floor.

Grabbing the bottle lid with the whole hand, I ease it off. It’s not tight because no one else touches it besides me. I do my spill-pour trick: I put the lid low inside the machine and I spill down into it so I don’t have to lift the bottle to pour.

Drag up a load I sorted yesterday and push it into the washer. I turn the dials with my special technique using four fingers as if they were one; hoping to prevent ulnar deviation (turning toward the outside of the hand). I turn and bump my shoulder on the cupboard as I close it. It will not stop hurting in a few moments like it did once upon a time when RA was not 24/7. It will hurt more and be sore for a couple of hours.

There are laundry baskets between me and the door. I can’t step over them because of my hips, so I just step into them.

My toddler needs help to get dressed and make his bed. Slowly, I bend and pick up toys as I talk to him cheerfully about our day. I cannot fluff his pillow because my fingers are not able. I smooth the sheet the best I can and lay the quilt on top.

It hurts my fingers to use the drawer pulls. It’s as if the drawer pulls back, trying to separate my fingers from my hands. I get his clothes and sit down in the chair. My wrists are killing me as I hold out his pants for him to step in. Hurry up! I can’t keep my hands in this position for long. He wants juice.

I shuffle to the kitchen. Both hands grab the fridge door handle. I bend my knees and pull with all my might. It won’t come. OOf. Finally, it pops open. The orange juice is full. I cannot reach up and take it with a hand. I move whatever is in the way and reach up with both full hands and tip it into my arms. I hug the juice to the counter. I plop the bottle down.

Cups: Reach up or bend down? Up for a glass which seems to weigh 10 pounds or down to get a plastic cup. I always pick cup. Pop goes my hip and my knee. The sounds are usually accompanied by pain. The cups are stuck together and I cannot get one apart. One of my kids runs to the rescue. I could do the spill / pour with the OJ into the sink, but I have help and I gladly accept it.

My daughter pours some milk into a cup so I can add what I want to my cereal. I cannot pour from the gallon. She takes good care of me.

If you have RA, you may have nodded along with me. If not, try to imagine how annoying it would be to not only READ it, but to LIVE it 24/7.

This has been the beginning of a typical morning in the life of a Rheumatoid Arthritis patient. Many RA-ers are worse. Some are much better. I would have liked to bring you more of this morning, but no sponsors would agree to broadcast such dismal programming. As a matter of fact, this “half hour in the life” segment has been brought to you solely by Rheumatoid Arthritis Warrior.

What Is Joint Protection for Rheumatoid Arthritis

How can we protect our joints?

As soon as the initial shock of a Rheumatoid Arthritis diagnosis wore off, I began to search for ways to make my life as good as it could be. I was ready to fight. One of the things that we fight off is the deformity that is part of the RA package. We have talked about fighting medically. But I also learned very early in my searching that we can do other things to protect and preserve our joints.

I was so glad that I found an article on the Mayo Clinic’s web site about joint protection techniques. That led me to search for even more on the subject. I was shocked that my doctor had not told me that there were actually things that I could do that might help avoid some deformities caused by Rheumatoid Arthritis.

Many of the things on the list are actually things to avoid doing. I remember my own grandfather’s hands. He also had the RA genes. He is the reason that I understood easily what was meant when I read about “ulnar deviation.” I remember how his fingers all leaned out toward the ulnar / pinky side. What’s more, I even remember him doing some of the motions that are warned against in the articles I read!

When Granddaddy stood up, he pushed off using the backs of his fingers. That is a big no-no! He broke 2 rules at once:

(1) Don’t ever use small joints when you can use large ones. For example, he could use an elbow. Or better yet, a forearm and no joint at all.

(2) Don’t ever use the backs of the fingers to push because it drives them in the ulnar direction, encouraging that deformity.

I get plenty of funny looks, but when I stand up, I push off with my arms and let my fragile little hands and wrists alone.

Another one that has been a life saver for me is this: Never tightly grip anything. Do not pinch or squeeze or twist. Ever. Use a light touch. I use all my fingers together as one, avoiding any twisting motion whenever possible. This might mean I get a tool or get help. Often, it just means I’m slow and funny-looking. Whatever it takes.

Here is another basic principle that you can apply lots of ways: Use the largest joint you can to do any motion or no joint at all if possible. Sometimes, I will also go to a lesser used joint or one that does not hurt. You might use your whole hand or arm instead of fingers to carry something, for example. All of this requires that you think before you move. At first this seems awkward, but you can develop your own joint protecting habits pretty quickly and then it becomes more routine.


Here is one more technique I figured out: In describing ulnar deviation, an article stated that the movement to avoid is the motion that is like turning a key. I determined never to do that. At times, my hand was unable to turn a key anyway, so I had my kids turn the key in the car ignition – big thrill for them. Here is what I did: I got a huge key. (You can also get yours wrapped in rubber bands or tape.)Then, I grasp the key like an overhand baseball grip only more relaxed. I use my whole hand to turn the car key away from me. It does not use my fingers at all.

I recommend that you read the whole Mayo guide to joint protection, and Cleveland Clinic’s joint protection strategies for Rheumatoid Arthritis, too.

PS: If you are a “no pain no gain” advocate or believe in “use it or lose it,” you may be in for a surprise. The Mayo Clinic regards pain as a warning for Rheumatoid Arthritis patients to use caution and protect their joints: “Though you may want to work through your rheumatoid arthritis pain, doing so can aggravate the situation.” Similarly, Cleveland Clinic’s article states: “Respect pain. It is a body signal that is telling you something is wrong. Don't try an activity that puts strain on joints that are already painful or stiff.”

Tomorrow, see me in action doing joint protection 24/7.