Joint Protection Techniques

Joint Protection Techniques

Sayali Manjrekar
4th BPT, Seth GSMC & KEMH Mumbai
December 2016

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Joint Protection Techniques

Definition:
Joint Protection Technique is a self-management technique which aims to
enable patients with Rheumatoid Arthritis to reduce pain, inflammation,
joint stress and reduce the risk of deformity by using assistive devices and
alternative movement patterns of affected joints to perform everyday
activities.

Why is Joint Protection Important?

A normal joint is protected by the muscles around it which absorb the

forces on the joint, preventing undue strain on the tendons, ligaments
and cartilage.

A diseased joint is mechanically weak and poorly stabilized. So, this may
overstretch the tendons, ligaments and damage the cartilage.
Hence, Joint protection is important to prevent progressive
deterioration of the joints and its surrounding tissues.

Which joints need protection?

Patients with local type of arthritis, like osteoarthritis, need to pay close
attention to joints which are involved with arthritis.
In patients with systemic or whole body type of arthritis, like rheumatoid
arthritis, need to reduce the stress on their small joints like joints of hand,
wrist joint etc.

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Joint Protection Techniques

Join Protection Principles

 Respect Pain

o Distinguish between Pain and Discomfort

o Modify the activity if pain lasts for more than 1-2 hours after an
activity
o Stop and Rest, if there is a sharp increase in pain during an activity

 Avoid Positions of Deformity

o Stand erect with weight evenly divide on both feet

o Do not curl up or prop yourself up in bed
o Work with your hands flat and avoid prolonged flexed postures
o Avoid tight grip or squeezing

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Joint Protection Techniques

 Avoid Awkward Positions

o Stand on a stool to reach overhead objects

o Reposition yourself closer to the object rather than stretch your
reach
o Sit to clean or garden rather than squatting or kneeling down
o Use neutral spine posture when you stand, sit or lie down

 Use Large and Strong Joints

o Use two hands whenever possible

o Carry a shoulder purse rather than holding a clutch in hand
o Lift objects from underneath, using wrist and forearm rather than
pinch gripping the sides
o Lift objects with your knees bent and back straight
o Prefer pushing heavy objects over pulling them
o Push with open palm or forearm rather than fingers

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Joint Protection Techniques

 Use Adaptive Equipment

o Modify the equipment by:

- Building up the handle so it is easier to grasp
- Extending the handle so it is easier to reach

o Equipment available:
- Walking aids
- Self-care aids
- Home-making equipment
- Job modification equipment

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Joint Protection Techniques

Example:
Rheumatoid Arthritis (RA) is a chronic systemic inflammatory disorder
that primarily affects the joints. It may result in deformed and painful
joints, which may lead to loss of function. The most common joints affected
in RA are small joints of hand and foot. A deformed hand in RA is an
intrinsic plus hand in which all the small joints are affected and deformed
but the muscle strength is maintained. A deformed hand affects pinch and
grip leading to slow and clumsy hand function.

Protection of the Rheumatoid Hand:

1) Through exercise, maintain wrist extension to ensure power grip

2) Through exercise, maintain supination of the elbow joint to ensure the
ability to hold and carry objects
3) Avoid positions of deformity:

a) Finger Flexion
i) Avoid prolonged holding of objects
ii) Avoid pressure on bent knuckles

b) Ulnar deviation
i) Avoid pressure towards the ulnar side of the hand
ii) Any twisting of the hand, open door knobs, jars, etc. should be
turned towards thumb
iii) Grip objects parallel across palm and not diagonal

4) Avoid stress on small joints of hand:

i) Use two hands whenever possible
ii) Substitute larger and stronger joints whenever while lifting or
carrying
iii) Avoid activities involving pinching motions
iv) Avoid twisting and squeezing motions with hands

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Joint Protection Techniques

Thus, Joint Protection Techniques can help to achieve reduction in pain and
reduce further possible damage to the joints, prevent joint deformities,
help increase and maintain functional ability and patient’s functional
independence. Also, a regular follow-up in Physiotherapy OPD will help
patient to have better Quality of Life.

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Joint Protection Techniques

References
1) http://search.pedro.org.au/search-results/record-detail/11260
2) Physical rehabilitation, 5th edition – O’Sullivan, Schmitz.

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Joint Protection Techniques

About the Author

Sayali Manjrekar
4th Year Physiotherapy Student,
Seth GS Medical College, Mumbai

PlexusMD Management Intern

Connect at: https://www.plexusmd.com/msSayaliManjrekar

Email: sayalee.mj11@gmail.com

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Joint Protection Techniques

About the Reviewer

Dr Joshua Samuel

Manager - Research and Development and Consultant Physiotherapist

at RECOUP Hospital, Bangalore

Editor at PlexusMD

Dr. Joshua Samuel holds a Graduation and Post Graduation Degree in

Physiotherapy, specialized in Neurology from Dr. M.G.R. Medical
University, Chennai. He has more than 50 scientific publications and
conference presentations at State, National and International level to
his credit. He has around 5 years of Clinical experience in Paediatric
and Adult Rehabilitation.

Connect at: https://www.plexusmd.com/drjoshua

Email: joshua.physio@hotmail.com

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Joint Protection Techniques

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