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Joint Protection & Arthritis

Stay Safe With These Fall-prevention GuidelinesThe American Geriatrics Society and the British Geriatric Society have issued updated guidelines for preventing falls.

The American Geriatrics Society and the British Geriatric Society have issued updated guidelines for preventing falls in older people. It is the first such update in over 10 years.

"There is always evidence that is coming out and in area like falling, we are learning more about it every day," says Mary Tinetti, MD, a professor of medicine at Yale University School of Medicine, New Have, Ct., and a co-chair of the panel that came up with the guidelines. "We want to make sure the guidelines are as timely and accurate as possible."

While the guidelines, which appear in the January 2011 issue of the Journal of the American Geriatrics Society, target older patients, they apply to patients of any age with rheumatic disease involving gait.

"It relates to all of our patients who have lower extremity disorders," says Nortin M. Hadler, MD, attending rheumatologist at UNC Hospitals and professor of medicine and microbiology/immunology at University of North Carolina at Chapel Hill.

"Gait is quite remarkable. It's a highly integrated biological function that requires heel strike and push off of toes, knees that are supple and hips with reasonable range of motion," says Dr. Hadler. "All of these things we take for granted, but if anyone has any impairment, they don't take it for granted." Dr. Hadler notes that patients with rheumatic disease also fall "less well" because they are less able to brace themselves when they do fall.

The new guidelines call for a complete risk assessment for patients who simply report difficulties with gait or balance in addition to those who have a history of falling. The assessment should include evaluation for muscle weakness, balance problems, orthostatic hypotension (a fall in blood pressure when a person stands up from a sitting or lying down position), as well as an examination of the feet and footwear, and an evaluation of both daily living skills and the use of adaptive equipment and mobility aids. Health care professionals should also ask patients about the fear of falling.

"Falls are a very serious problem and they often have a complex set of causes that can be a challenge to sort out. One of those things is that we are fearful," says Sharon Brangman, MD, president of the American Geriatric Society. "Patients can be so fearful that it limits mobility, which sets up a vicious cycle: We are fearful, so we restrict our activities, and our muscles get weaker and so we are more likely to fall."

The guidelines were developed by a panel including members from previous panels, as well as experts in areas such as geriatrics, physical therapy, orthopedics, emergency medicine, occupational therapy, nursing and pharmacy. To come up with the new guidelines panelists reviewed the medical literature on fall prevention published between May 2001 and July 2009.

"The main thing is that these guidelines were developed by a panel of experts who scoured the literature and scientific information to find guidelines based in science," says Dr. Brangman. "We knew things anecdotally, but these guidelines have evidence behind them."

Within the new guidelines are recommendations for intervention that include:

  • an exercise component that combines balance and strength training, such as tai chi or physical therapy.
  • cataract surgery when needed (but only in conjunction with other interventions).
  • medication reduction or withdrawal, especially drugs that affect the central nervous system, such as sleep medications and antidepressants.
  • appropriate management of heart rate and rhythm abnormalities, and orthostatic hypotension.
  • a daily 800 IU vitamin D supplement.

"The new guidelines are not all doctor-oriented," says Dr. Brangman. "They have practical pieces that people can carry out on own: finding safer shoes, removing clutter in your home, clearing off stairs and installing handrails in bathrooms and on steps."

But the interventions must be followed. "It really made a difference in how carefully all the interventions were carried out," says Dr. Tinetti. "It's important not just to say that something needed to be done, but to do it."

51 Ways to Be Good to Your Joints

Follow these simple steps to preserve joint health.

Avoid a pain in the neck. Document holders attached to computer monitors and positioned at eye-level, along with hands-free telephone headsets, can reduce neck strain.

Compute comfortably. Your upper body should be spaced 20 to 26 inches from your computer monitor, the top of which should be at an even line with the top of your head when your head is in neutral position. Your arms should hang comfortably at your sides, elbows at a right angle, with your wrists relaxed while typing.

Ditch the high heels.
Unless you're a fashion model, chances are you can live without high heels. Experts say a three-inch heel stresses your foot seven times more than a one-inch heel. In addition, heels put extra stress on your knees and may increase your risk of developing osteoarthritis.

Sit and stand. Neither sitting nor standing on your feet all day is good for you. When possible, alternate between the two to prevent locking yourself in one position. If your job primarily involves sitting, take a break and stand up every 30 minutes or so.

Rest your wrists. Purchase a wrist rest for your computer or make your own with two strips of bubble-wrap packing material taped together. Make the bottom strip wider than the top one, and tape the excess width to the bottom of your keyboard so the wrist rest extends outward.

Handle heavy loads. To make heavy loads easier to handle, use your largest, strongest joints and muscles to take stress off smaller hand joints and to spread the load over large surface areas. When you lift or carry items, use the palms of both hands or use your arms instead of your hands. Hold items close to your body, which is less stressful for your joints. For joint safety, slide objects whenever possible rather than lift them.

Resolve to reduce. Lose weight. You won't just look better – you’ll feel better, too. Every extra pound you gain puts four times the stress on your knees. The flip side is that even a small amount of weight loss will give your knees relief. Research has shown that losing as little as 11 pounds may improve your joint health and cut your risk of osteoarthritis of the knee by 50 percent.

Picture portion sizes. Eating proper portions is key to losing and maintaining a healthy weight and, in turn, lightening the load on your joints. Brush up on proper portion sizes and picture visual comparisons. For instance: One serving of meat –  3 ounces – is the size of the palm of your hand; one serving of dairy – say 2 ounces of cheese – is the size of a pair of dominoes; one serving of vegetables – 1 cup – is the size of your fist.

Turn off the tube. Television not only keeps you sedentary, which slows your metabolism, it also makes you prone to overeating. Read a good book instead, or better yet, pop on those cross trainers and hit the road.

Build strong bones. Boost your calcium intake, because a diet rich in this important mineral helps to keep your bones sturdy and can lower your risk of osteoporosis (the brittle bone disease). There are plenty of sources besides milk, including yogurt, broccoli, kale, figs, salmon and calcium supplements.   

Ditch the drive thru. Avoid eating at fast food restaurants. But if you must, try to make the healthiest choices. Opt for grilled meat instead of fried meat. Add lettuce and tomato to your sandwich. Hold the mayo. Substitute a side salad for french fries. Drink water or juice instead of soft drinks.

Pick, pour or peel. If you are looking for a tasty treat, reach for an orange – or a tall glass of orange juice. Why? Recent research points to the importance of vitamin C and other antioxidants in reducing your risk of osteoarthritis.

Add color to your diet.
Choose fruits and veggies in a wide range of color to get maximum nutrients, such as fiber, disease-fighting antioxidants and an abundance of phytochemicals.

Hang out at the bar. Eating the veggies typically found in a plain tossed salad from a salad bar – romaine and Bibb lettuces, broccoli, spinach, kale or parsley – can lessen the amount of bone loss that occurs with age, research says, thanks to their high calcium count. But remember to go easy on the dressing.

Be supplement savvy. Glucosamine, a supplement made from the shells of crab, lobster and shrimp, has been shown to ease joint pain and stiffness, particularly in people with osteoarthritis of the knee. Some studies suggest that it may contribute to cartilage repair.

Throw some fish on the grill.
Omega-3 fatty acids, found in cold-water fish, such as salmon and mackerel, can help keep your joints healthy. In fact, studies show omega-3s can reduce the pain and inflammation of stiff joints in people with arthritis. Because you probably don't have time to grill fish every night, consider supplementing your diet with fish oil capsules.

Sneak in healthy food
. Keep precut veggies and fruits – like celery and carrot sticks, broccoli florets, pepper slices and melon cubes – in the front door of your refrigerator so you'll reach for them at snack time.

Keep a food journal.
Increase the odds that you'll stick to your plan for eating better by putting your nutritional goals in writing. Record what you eat daily to keep track of your progress.

Break it up.
Instead of eating two or three big meals each day, try spreading out your munching into a number of smaller meals throughout the day. Research shows that grazing throughout the day boosts your metabolism, helping your body run more efficiently (and keeping the pounds off).

Curtail your caffeine intake. While you may need that extra burst of energy in the morning, try and resist those second and third cups of coffee. Studies show that the extra caffeine can weaken your bones.

Take your vitamins. Supplementing your diet with a multivitamin is a good way to get the vitamins and minerals you may lack by eating too much junk food. Strong bodies (and overall joint health) will benefit from bone-building calcium and vitamin K, tissue-repairing vitamin C, pain-relieving vitamin E, folic acid and more.

Visit the great outdoors. Besides the soothing, relaxing benefits of breathing fresh air and observing nature, the great outdoors provides many opportunities for burning extra calories while having fun. Gardening and other yard work is just one way to firm up your arms and legs, while being productive, too.

Take the plunge.
From strength training to jogging to aerobic classes (and let’s not forget the plain old swim), aquatic exercises allow you to keep doing many of the exercises you love, while taking a load off your joints.

Take a hike. Choose your favorite spots and walk them at least once a week. Hiking burns calories, strengthens muscles and builds denser bones, while providing interesting scenery and a chance to get in touch with Mother Nature.

Warm up. Don't think about hitting the gym, the pool or the trails (or any exercise for that matter) before warming up. Warming up your body before exercise is like warming your car up in the winter. To keep it running smoothly and for optimal joint safety, start slowly and get up to speed only after your muscles and joints have at least five minutes prep time.

Go for function not fashion.
Shoes shouldn't just look good, they should work well, too. Look for flexible, supportive shoes that are squared or rounded at the toe so your toes can move around. A shoe with a rubber sole will give you more cushion. Make sure your shoe is flexible at the ball of your foot, where you push off.

Check in with yourself.
Monitor how you're feeling after exercise. Joints still aching two hours after your workout are telling you something. Listen to them and lighten your routine next time.

Stretching isn't just for workouts anymore. Take breaks throughout the day, including at your office, to get re-energized and help keep your muscles and ligaments flexible and strong.

See a yogi.
Yoga hasn't been the hottest trend (for the last 5,000 years) for nothing. Yoga and other forms of gentle exercise like Pilates and Tai Chi strengthen the mind-body connection, allowing you to get your body fit while you get your mind in shape. These exercises keep joints strong and muscles limber while erasing stress.

Bulk up. Strength training is the best way to boost your metabolism (and get a sleeker bod, too). Research also shows lifting weights creates denser bones and builds stronger muscles that help stabilize and protect joints.

Develop abs of steel. Strong abs are essential to creating overall core strength and balance. Studies show that improving strength and balance are key to preventing falls and protecting joints from damage.   

Walk Fido. Pets don't just help your mental health, they also help your physical health. Walking your dog is a great excuse for getting yourself into shape. Use a sturdy leash that is easy to grip, such as a thick leash with a loop handle.

Brace yourself.
Elbow, wrist and joint braces, or guards, not only prevent injury but also reduce the load on joints. Ask your doctor if braces may alleviate some of your joint stress and, who knows, perhaps improve your game.

Get a trainer.
Sign up for a consultation with a trainer who can help show you the right way to exercise to prevent injury and avoid undue joint stress. Doing an exercise wrong is often worse than not exercising at all. Think joint safety!

Don't stomp your feet.
Research shows pounding exercises like kickboxing, step aerobics and more can be tough on joints. Switch to low-impact activities like biking and swimming that offer the same calorie-burning benefits without the painful pounding.

Buddy up. Working out with friends is one of the easiest ways to keep your exercise program on track. Try walking with a friend after work.

Increase your range.
Range-of-motion exercises (such as stretching) are a good way to keep your muscles and ligaments flexible and strong. Add weights to your workout and you'll tone up, too.

Soak it up. There's nothing like a warm bath to soothe aching muscles and joints after a workout. So go ahead and pamper yourself without guilt – how you treat yourself after exercise is as critical as how you treat yourself during a workout.

Do the write thing. Keeping a journal can be fun and therapeutic. Writing about your deepest fears, feelings and frustrations can help you put everything in perspective. It also helps you easily look back over your victories and successes. Some people with pain have found a measure of relief from writing down their feelings.

Enjoy a massage. Massage can relieve muscle tension and help reduce fatigue. Invest in a professional massage or research information on do-it-yourself tips. Go ahead and treat yourself to a soothing massage after a busy period at work or stressful time. Certain forms of massage, such as Swedish, focus on muscles and joints to improve function.

Let yourself go.
On vacation, that is. Find time to take a break away from your routine – even if you are a stay-at-home mom or you work from home. Don't get caught up in trying to plan an expensive weeklong trip to an island, either. A day or two off to enjoy your favorite activity counts as vacation, too. Experts continue to emphasize the connection between stress and pain.   

Say no. It may be tough at first, but after awhile you'll get the hang of it. Saying no to others and to activities lets you say yes to extra time for yourself. It also allows you to say yes to exercise, healthy eating and stress reduction – three power-packed methods of improving your health.

Sit, soak and soothe.
A warm bath before bed can relieve muscle tension, ease aching joints and help you get a good night's sleep.

Pack some heat.
To relieve pain and stiffness, try heat therapies, such as heated pools, whirlpools, warm showers, warm compresses or microwaveable heat packs.

Chill out. Applying cold to sore spots can also help reduce pain and swelling. Use a cold pack, a bag of ice wrapped in a towel or a bag of frozen vegetables for a quick and easy cold treatment. You can also try an "ice massage" and rub ice directly on a painful joint.

Rub out pain.
If you have mild pain, you may find a topical analgesic, such as capsaicin, counter-irritants or salicylates, helpful.

Make a date with your doctor. See your physician for a routine check-up at least once a year. Request an examination of your joints – from head to toe – and ask for tips on protecting your joints from daily wear and tear. It's never too soon to learn self-management techniques. 

Fess up. Be sure to tell your doctor about medications you are taking, both prescription and over the counter. Don't forget to mention any nutritional supplements you're taking, too. All medications – even natural ones – have the potential to cause side effects or to react adversely with each other.

Tell your doctor about joint pain.
Take the Arthritis Foundation joint health quiz. If you have signs of arthritis, see your doctor to get a full exam and diagnosis.

Play 20 questions. Well, maybe not 20, but write down questions related to your health as you think of them. Prioritize them and slip them into your purse or wallet before your next doctor's visit. That way, you'll have your top concerns at your fingertips.

Kick butt.
People who smoke have a greater risk of fracture than nonsmokers. In fact, smoking can reduce bone mass, which can lead to osteoporosis. Kick the habit to keep your body strong and healthy. Plus, just think of all the money you'll save by going smoke-free.

Self-help Arthritis DevicesThese tools can make life with arthritis a little easier.

If you have arthritis, self-help devices can make tasks easier on your joints and more efficient for you. These products, which range from simple to elaborate, help keep joints in the best position for functioning, provide leverage when needed, and extend your range of motion. Simple arthritis self-help devices, such as jar openers, reachers and easy-grip utensils can be purchased at many hardware or medical supply stores.

In the bedroom. When dressing, zipper pulls and buttoning aids can help you fasten clothing. Or you can choose to wear clothing with Velcro fasteners, if available. A long-handled shoehorn extends your reach without bending.

In the kitchen. In the kitchen, appliances such as electric can openers, food processors and mandolins (for slicing) make work easier. Reachers (long-handled tools with a gripping mechanism) can be used to retrieve items stored high or low. Built-up handles and grips make utensils easier to grasp and put less stress on finger joints. Install a fixed jar opener, or keep a rubber jar opener in the kitchen.

In the bathroom. Tub bars and handrails provide additional stability and security when you are getting into and out of the bath or shower. These are a must if you have problems with balance. Faucet levers or tap turners are available if your grip is weak. A raised toilet seat can make it easier to sit down and get up from the toilet.

In the office. In the work environment, many devices and modifications are available, from chairs and work surfaces with adjustable-height to telephones with large push buttons and hands-free headsets. If you are facing work modifications, you may want to see an occupational therapist about arthritis self-help tools. He or she can help you make changes and obtain the devices you need.

At play. Leisure activities can still be enjoyable through the use of assistive arthritis devices, such as kneelers and light-weight hoses for gardening, “no-hands” frames for quilting or embroidery, and card holders and shufflers for card games.

In the car. When driving, a wide key holder can make it much easier to turn on the ignition. A gas cap opener can help when filling the tank at the gas station. 

How to Choose the Right Cane The correct cane can relieve pressure on sore knees, hips, ankles and feet, as well as improve balance. | By Heather Larson

Walking canes come in even more varieties than candy canes. Materials, colors and handle styles are a matter of preference. With cane type and size, however, there are options that affect function and safety.

When used correctly, the right cane improves balance and reduces the risk of falling by widening the base of support, as well as decreasing weight on lower-body joints, says Lori Ramage, a physical therapist and the Joint Club Coordinator at Banner Boswell Medical Center in Sun City, Ariz.

Choosing Type and Fit

The most common styles of canes are single point, and quad or three-point canes. Ramage says most people with arthritis need only single-point canes, and those with a neurological impairment are best suited to quad canes, because they can put more weight on them.

When being fitted, wear your walking shoes and stand tall with your arms at your sides. The top or curve of the cane should hit at the crease in your wrist. “If the cane is too high, you won’t get the support you need,” says Ramage. “When the cane is too low, you slump.”

Correct Use When Walking

People often try to use a cane on their weak side. In fact, it goes on the strong side, but moves with the weak side.

“Using the cane in the hand opposite your weakness shifts your body weight to the stronger side,” says Brian Benjamin, a physical therapist and owner of ProActive Physical Therapy and Exercise Center in Fort Collins, Colo.

When walking, he says, place it about 2 inches in front or to the side of you, not way out in front. Move the affected leg and the cane together, so that each side shares the load.

Correct Use on Stairs

To climb stairs, move your good leg first. Follow with your affected leg and cane simultaneously. When going down stairs, start with the cane, then put your weak leg forward, and follow with your good leg. “Up with the good, down with the bad” makes this easy to remember, says Ramage.

How to Climb Stairs With a CaneLet your strong leg take the lead.| By Sean Kelley

If joint pain or recent surgery makes taking the stairs daunting, the right techniques – unaided or with a cane, crutches* or handrail – can make it easier and reduce your risk of falls. Here’s how.

Go up with the good, down with the bad. When going up, lead with your strongest leg. When going down, lead with the weaker one.

Always face forward. You’re much less stable when you’re turned sideways, especially if the staircase has no handrail, says Joseph Zeni, PhD, assistant professor of physical therapy at the University of Delaware.

Using a cane with a handrail. Use the cane on your side opposite the handrail. When going up, put your stronger leg on the next step first, followed by the cane and then your weaker leg. Going down, lead with the cane, followed by your weaker leg and then your stronger leg.

Using a cane without a handrail. Keep your cane on the side you would normally use it, and follow the same procedure as without a cane: good leg, cane, bad leg going up; cane, bad leg, good leg going down.

Using crutches without a handrail. Use crutches under both arms and go up with your stronger leg first, then the crutches, then your weaker leg. When going down, lead with crutches, then your weaker and then your stronger leg.

Using crutches with a handrail. Grasp the handrail with one hand and put both crutches under the opposite arm. Follow the strategy for climbing stairs with a cane.

* If you are on crutches and cannot put any weight on your weaker leg, avoid stairs.

How to Avoid Back InjuryReduce the risk of back pain and injury by following these smart tips. | By Terrie Heinrich Rizzo

Twisting at the waist, especially when bending or carrying something, is a prime cause of back injury. Reduce the risk of injury and pain by making sure your hips, knees and shoulders always move in the same direction.

Here are a few other tips to keep in mind during daily activities:

Getting out of bed:

  • Roll on your side and bend both knees toward your chest in a loose fetal position.
  • Push your upper body into a sitting position, legs over the edge of the bed.
  • Stand up, keeping your back straight.

Loading and unloading:

  • Keep loads small and close to you.
  • Keep a straight back, and use your leg muscles to do most of the work.
  • Pivot on your feet to turn around, instead of twisting your upper body.

Shoveling and sweeping:

  • Make sure your feet and the buckle on your belt face your shovel or broom.
  • Keep your feet moving, and stretch with your arms and back.

How to Pick Up Your GrandkidsLifting grandkids can hurt joints. Here’s how to do it safely.

  • To pick up a child from the floor, lower yourself onto one knee, tighten your stomach muscles and lift, putting the stress on your legs instead of your back. To lift a child from a crib, lower the side of the crib so that you can comfortably reach the child.
  • Pull the child close the center of your body, cradling her against your chest. Don’t sling the child onto your hip and hold her with one arm.
  • To put the child back down on the ground, return to the half-kneel position, make sure the child is balanced on her feet or sitting down and release her. To return the child to a crib, bend from the waist instead of stooping your shoulders.
  • Adding exercises to strengthen your back, arms and shoulders to your daily fitness routine will make picking up the kids a little easier.

How to Squat CorrectlyAvoid adding pain to already sore knees by learning how to properly squat. | By Donna Rae Siegfried

Squatting is a functional move – helping you do the activities of daily living, such as getting pots out of a bottom cabinet or picking up shoes off the floor. Squatting also helps build strength in the legs and hips, and stronger muscles mean more stable joints. But if you don’t squat correctly, it can be painful to sore knees. Too many people compensate for sore knees by bending over at the waist, which can lead to a sore back, says Cynthia Harrell, physical therapist and clinical coordinator of the arthritis and osteoporosis programs at the Duke Center for Living at Duke University in Durham, N.C. You need to know the right way to squat.

When you go to reach into a low cabinet, Harrell says, hold on to the countertop and “sit” down, using the muscles in your arms and buttocks for lowering and pulling yourself up. If squatting this way is still painful, place a chair in front of the cabinet. “Reaching to the floor from a seated position is much less stressful on the knees,” says Harrell.

Wall Squats Build Strength

The ability to squat correctly without pain can be improved by doing these “wall squat” exercises. Start with 10 of them three times per week, says Harrell.

Stop at the point where you feel muscle pain, but continue to perform the exercise regularly, so that the non-painful range will increase as thigh and core muscles become stronger. “If done correctly, squatting is well tolerated by people with osteoarthritis of the knees,” says Harrell.

1. Stand with back against a wall, feet shoulder-width apart, heels 18 inches away from wall. Keep knees in line with heels, not out in front of toes.

2. Breathe in and exhale as you squat by “sitting down” as far as you can go comfortably, without dropping buttocks lower than knees and keeping knees in line with heels.

3. Tighten abdominal muscles and flatten back against wall, or place a ball behind your back to keep you from moving too far forward. Inhale as you return to standing position, pushing up through heels (not off the balls of the feet) and working the muscles in the back of your legs and buttocks.

Go easy on your knees the next time you need to pick something up – remember the right way to squat.

Feet Hurt? Slip in Some Relief With Shoe InsertsCustom-made orthotics may help stamp out foot pain. | By Emily Delzell

When your feet hurt, it’s hardto think about anything else, and everyday activities that involve standing or walking for more than a few minutes can become too daunting to attempt. Making good shoe choices can prevent problems, but for many of those who are already suffering, orthotics – shoe inserts designed to ease foot pain and correct structural issues – may provide much-needed relief.

Foot pain is common. One in four adults have some problem with their feet, and among people with certain types of arthritis, including rheumatoid arthritis (RA) and osteoarthritis (OA) of the knee, hip, ankle or foot, it’s even more prevalent.

Foot discomfort and structural problems such as the hammertoes and bunions caused by the inflammation of RA and lupus also can spread beyond the feet, leading to shin pain, knee pain and lower back pain.

Orthotics redistribute weight and relieve pressure on sensitive areas of the feet, provide cushioning that reduces stress, or biomechanical load, on the lower body, and correct gait and structural abnormalities, says Marian Hannan, associate professor of medicine at Harvard Medical School and co-director of Musculoskeletal Research at the Harvard-affiliated Institute for Aging in Boston.

“The best evidence of benefits with orthotics is for reducing foot pain in people with RA and lower extremity OA, Hannan says, noting, “The right insert may also help slow damage caused by knee OA.”

Research on orthotics and the course of knee OA are mixed. Although most studies find that people who wear orthotics have less foot pain and need fewer pain-relieving medications, some also suggest custom-made inserts can lead to long-term changes in biomechanics that may slow or prevent the progression of arthritis, says Hannan. 

“It’s not entirely clear how orthotics work to cause these positive changes, but data suggests the inserts affect the foot’s very fine, or micro-, control of gait, subtly altering muscle activity and reducing stress on the lower extremity,” she says.

A Cochrane Review, a systematic analysis of a number of randomized-control trials, found gold- and silver-level evidence that custom-made orthotics reduce foot pain in people with:

  • Rheumatoid arthritis
  • Bunions
  • Painful high arches
  • Juvenile idiopathic arthritis 
  • Plantar fasciitis, or heel pain

More research needs to be done to tease out specific benefits, including how long different people need to wear orthotics before feeling improvements, Hannan says. She notes that, anecdotally, “We can tell by the prevalence of people who continue to wear orthotics months and years after filling their prescription that they feel that the inserts are helping.”

Your doctor can determine whether orthotics could be a good option for you and refer you to a podiatrist who will examine your feet, ankles and hips and evaluate your gait by observing your body in motion.

Custom inserts, which last about five years, can cost between $400 and $800 a pair, and not all insurance plans cover them. As a less-expensive option, some podiatrists may customize off-the-shelf inserts to address your specific issues.

When Knees Need SupportDon’t let a knee injury or arthritis keep you sidelined. A brace may help you get back in the game. | By Mary Anne Dunkin

When Rex Benham's doctor told him he needed a total knee replacement, he feared his days as a competitive racquetball player were over. Five years later, Benham, 76, competed in the National USA Racquetball Tournament – and never had the surgery. "I am almost always pain-free and walk and play without a limp," he says.

He credits his success to a rigorous quadriceps-strengthening routine, glucosamine, and a knee brace to relieve the pain of his osteoarthritis (OA).

The best documented benefits of knee braces for OA are in cases like Benham's, in which the cartilage damage is confined to the medial, or inside, compartment of the knee, says J. Martin Leland III, MD, an orthopedic surgeon and assistant professor in the Department of Surgery at the University of Chicago

"The unloader brace pushes the knee back into normal alignment and puts more of the force to the outside compartment and less on the damaged inside compartment so the knee feels better," he says.

Here are three more ways a brace might help people who have knee arthritis:

Allowing ligaments to heal. For medial collateral ligament (MCL) injuries, a hinged knee brace prescribed by your doctor provides the support to allow healing. Anterior collateral ligament (ACL) tears often require surgical repair, and in those cases, a drop lock hinged brace prescribed by your doctor or physical therapist may be locked to immobilize the knee or unlocked to allow the knee to bend during healing after surgery.

Relieving kneecap pain. When weakness or softness of cartilage under the kneecap causes pain, a Neoprene brace with a cutout for the kneecap can help keep the bone in place and ease pain. It should enable you to more comfortably do exercises to strengthen the quadriceps, says Matt Holland, manager of physical therapy for the Methodist Center for Sports Medicine in Houston. You can find these braces at pharmacies and sporting goods stores.

Boosting confidence. Many people report relief from knee pain with a neoprene sleeve-type brace, also available at pharmacies and sporting goods stores. Experts believe these may help by providing warmth and compression, which may relieve swelling. The main benefit, however, may be psychological, says Holland. "It gives you a feeling of support and a reminder to be more careful of that knee when you're physically active."

Finger Joint SupportRing splints offer a fashionable way to improve finger function and provide joint support. | By Holly Welling and Donna Rae Siegfried

Remember when you were a kid and after you jammed a finger catching a ball, your dad would tape two fingers together or use a Popsicle stick to keep it straight? That same concept appplies today. Stabilizing finger joints can help align joints, improve function and keep deformities caused by arthritis, loose ligaments or injury from getting worse.

Some people with osteoarthritis (OA) or rheumatoid arthritis (RA) may not be able to straighten a finger joint, which can make opening the hand wide enough to grasp an object difficult or make putting on a glove downright impossible. In others with OA or RA, an inflamed tendon may cause a finger to feel locked in a bent position, causing pain and reducing function. Ring splints can be worn on any of the fingers to help these problems and other deformities, such as joints that become “stuck” in a hyperextended position or instability at the knuckles, which lets fingers cross under or over each other.

A study published in the journal Arthritis Care and Research shows that metal ring splints may help people with arthritis regain some function in their fingers. In the study, 17 people who had finger deformities caused by RA volunteered to wear metal splints on their affected finger joints. In the 17 people, 72 silver ring splints were used on joints that were not actively inflamed. Results show that after one year of use, dexterity increased significantly from a score of 71 at the beginning to 85 at one year.

Combining the concepts of therapy and style, silver ring splints can help fingers with damaged joints and provide a benefit that few other medical devices can boast.

“I have a patient who says that people are always coming up and asking her where she gets her ‘cool rings,’” says Melissa Peavey, a Dallas-based occupational therapist and certified hand therapist.

These custom-fitted double-loops of flexible metal are less bulky and more durable than foam or plastic ring splints, so patients are more likely to wear them regularly and benefit from treatment, Peavey explains.

Ring splints most commonly fall into two categories: swan neck splints, which are used to prevent hyperextension of joints beyond the neutral position; and boutonniere splints, which help straighten a joint that cannot be actively extended.

Ring splints are available in plastic, if you want to try them temporarily, as well as silver and gold, for more long-term use. If you plan on using them for years, you can have them crafted to look even more like jewelry by adding decorative bands and precious or semi-precious stones.

According to Cynthia Garris, an occupational therapist and inventor of silver ring splints, joint instability is caused by changes in the alignment of ligaments due to disease or joint destruction. This changes the mechanics of the joint and creates a loss of support and decrease in power. Ring splints stabilize the finger and control the movement of the joint in its normal range.

“Swelling and pain are precursors to joint instability, so if you notice you’re starting to have these symptoms in your hands, tell your doctor you’d like to have an occupational therapist or certified hand therapist evaluate your hands and advise you about the benefits of a ring splint,” says Garris. “Once a joint becomes fused splints are no longer useful.” Garris says that one splint can last more than 10 years.

Osteoarthritis and FallsHaving OA may make you more likely to suffer falls and fractures. Here’s what the research shows and what you should do to reduce your risk. | By Mary Anne Dunkin

For an older person who falls, the pain can go far beyond the impact of the fall or the immediate injuries resulting from it.  A broken hip, for example, may necessitate the surgery with all its inherent risks in addition to the risks related to immobility including blood clots and muscle atrophy.  A fractured wrist may permanently interfere with the ability to perform daily tasks such as carrying heavy items, turning door knobs or keys, cutting food or pouring a drink.

While fractures have long been attributed to the brittle bone disease, osteoporosis, increasingly scientists are considering the role that osteoarthritis may play in the risk of falling and/or the type and severity of resulting injuries. 

For example, an analysis of the 51,386 women in the Global Longitudinal Study of Osteoporosis in Women (GLOW), a large international study designed to improve care of patients who are at risk of osteoporosis-related fractures, revealed those who had osteoarthritis (about 40 percent of the study population) experienced 30 percent more falls and had a 20 percent greater risk of facture than those without OA.

While it is not completely understood why people with OA would be more likely to fall or experience more fractures, new research is providing some clues. Here’s what doctors are learning about how and why OA may affect falls and fracture risk—and what you can do to reduce that risk.

The Problem with Pain

Several studies have shown an association between pain and fall risk.  One 2009 study of 749 adults aged 70 years and older, for example, found that those who reported two or more locations of musculoskeletal pain, severe pain or pain that interfered with their ability to perform daily activities were significantly more likely to fall than those with no pain or low levels of pain. The study was published in the Journal of the American Medical Association.

A separate study of 6,641 men and women 75 or older who participated in a three-year trial of intramuscular vitamin D therapy found that those who reported prevalent knee pain had a 25 percent increased risk of falls and almost twice the risk of hip fractures compared to those without prevalent pain. Increasing severity of knee pain was associated with a greater risk of falls and hip fracture. Authors of the study, which was published in Arthritis & Rheumatism, say the increased risk of fractures could not be explained by the increased risk of falls, but was likely due to the severity of the falls suffered by those with knee OA. 

Decreased Function

Another explanation for the OA-fall connection is that people with OA have risk factors such as decreased function, muscle weakness and impaired balance that make them more likely to fall, says Catherine Arnold, professor of physical therapy at the University of Saskatchewan, Canada. “Those are all very common in individuals that have arthritis in their lower extremities like their hips and knees.” 

Adding to the problem is that OA makes exercise difficult, she says, so that many people with OA tend to be less active. “They are not as engaged in physical activity and therefore that is a bit of a spiral in terms of their confidence in their ability to balance, says Arnold, whose research expertise is focused on educational and exercise programs to decrease fall risk in the older and other vulnerable populations. “Their balance deteriorates more and puts them at higher risk. ”

In a cross-sectional, population-based study published in Osteoarthritis and Cartilage, researchers used several tools including the Western Ontario McMasters Osteoarthritis Index (WOMAC) to measure pain, stiffness and functional ability of 850 randomly selected men and women aged 50 to 80. WOMAC is a score derived from patients’ answers to a questionnaire concerning arthritis symptoms, including pain and stiffness, and how those symptoms affect their ability to function. While the group as a whole had a low risk of falls, those who had higher WOMAC scores – which significantly associated with factors such as reaction time, balance, proprioception (the ability to sense the position and location and orientation and movement of the body and its parts) – had a greater risk of falling compared to those with lower scores.

Pain Medications

Some researchers believe the risk of falls and fractures in patients with OA may have less to do with the arthritis itself than the medications used for pain relief, citing an increase in falls and fractures among OA patients since the COX-2 inhibitor rofecoxib (Vioxx) was taken off the market in 2004 and the discovery of cardiovascular risks associated with NSAID use prompted the prescription of narcotic analgesics instead.

In a study presented at the 2011 scientific meeting of the American College of Rheumatology, researchers at New York University (NYU) reviewed the medical records of 10,000 patients diagnosed with osteoarthritis between 2001 and 2009, and found that the percentage of study patients who received prescriptions for narcotic analgesics increased from 8 percent in 2002 to 40 percent in 2009. During the same time frame, the incidence of falls and fractures more than quadrupled.

Specifically the researchers found the prescription narcotic analgesics was associated with a 3.7-times greater risk for falls and fractures than he prescription off COX-2 inhibitors and a 4.4-times greater risk than non-COX-2 inhibitor NSAIDs from 2005 to 2009.

“We couldn’t prove cause and effect,” says Lydia Rolita, MD a geriatric researcher at NYU and the study’s lead author.  “We couldn’t prove that people were actually taking what was prescribed to them, but it’s reasonable to guess that’s what was going on.”

In a separate large study of Medicare beneficiaries in Pennsylvania and New Jersey, investigators at Brigham and Women’s Hospital in Boston identified those with rheumatoid arthritis or osteoarthritis who were started on a nonselective NSAID, a COX-2-selective NSAID, or a narcotic analgesic during 1999-2005 and then calculated the fracture risk. The composite incidence of nonvertebral fracture – those of the hip, pelvis, humerus (upper arm bone) or wrist -- 26 per 1,000 person-years among patients on nonselective NSAIDs, 19 with COX-2-selective NSAIDs, and 101 with narcotic analgesics.    

While Brigham and Women’s study, like the NYU study, clearly showed a connection between the prescription of narcotic analgesics and fall risk, the study was not designed to explain the connection. 

Preventing Falls

Regardless of the cause of falls and fractures, research points to the need to more efforts to prevent them. A study by Arnold published in the Journal of Aging and Physical Activity suggests an aquatic exercise and education program can help. In the study, 79 adults age 65 and older with hip OA and at least one other fall risk factor were randomly assigned into one of three groups: aquatic exercise twice a week plus a once weekly education; aquatic exercise twice weekly or a usual activity control group. Factors like balance, falls efficacy (the feeling of confidence that you are able to move better), walking performance and functional performance were measured before and after the study. The combination of aquatic exercise and education was more effective in improving fall risk factors than exercise alone, says Arnold.

To reduce your risk of falling, Arnold recommends taking an exercise class such as those offered by the Arthritis Foundation with an educational aspect to it. “Look for a program that teaches how to use good biomechanics when doing activities at home and talks a bit about falls education,” she says.  “Certainly individual attention and getting that advice from a physical therapist would be helpful as well.”

Taking another look at medications, too, could help reduce fall risk, says Dr. Rolita. “I think we need to think more carefully about pain medication regiments and take into consideration people’s risk factors,” she says.

For example, if someone doesn’t have significant cardiovascular risk factors that might make an NSAID inadvisable, their doctors might do well to pay a little more attention to fall risk, she says. “I think it’s important to just kind of weigh the risks and benefits on a more individual level.”