Living with the pain from arthritis can be tiring and frustrating, and its impact on your function and hobbies can really take a toll on your overall well-being. Educating yourself about the best ways to manage your condition is the first step to achieving less pain and greater freedom.

The Arthritis Foundation offers various books, videos, and publications that provide educational information about living with arthritis. Some people find it helpful to meet and talk with others also coping with arthritis in order to share experiences, vent, and gain valuable insight into ways to manage the condition. There are individual state chapters of the Arthritis Foundation that provide ways for people living with arthritis to find this support.

• In Massachusetts, for example, there is a young adult networking group designed for people between the ages of 18 and 44 to learn and share information.
• There are also groups that get together to exercise, which is one of the best ways to manage the pain of arthritis and optimize function and health.
• There are even “Joints in Motion” teams training to walk or run a marathon or half marathon to raise money for children with arthritis. Sometimes giving back to others is enough to ease some of the physical pain you experience on a daily basis.

To learn about the latest research, exercise guidelines, and find out what events and opportunities are available in your area, check out the Arthritis Foundation’s website.

“Too young to Feel Old: The Arthritis Doctor’s 28-Day Formula for Pain-Free Living,” was just released a few months ago. Written by rheumatologist, Dr. Richard Blau, this book offers recommendations and information regarding over the counter products, medications, exercise, alternative treatments, and diet. It also includes recipes designed to help improve overall health and arthritis symptoms.

The book can help to jump start you on a comprehensive way to manage your arthritis.

If you’ve never been to a massage therapist, I’d highly recommend it. Whether for relaxation, stress relief, or as part of an injury rehabilitation plan, massage therapy is extremely beneficial and enjoyable. Massage helps to decrease pain, improve circulation, reduce muscle spasm and increase flexibility. Just like any other type of treatment, it’s important to find a massage therapist that you feel comfortable with.

The American Massage Therapy Association (AMTA) has an information filled website with weekly tips, explanations of the benefits of massage, and resource finder to assist in locating a practitioner in your area. For more information about massage therapy, visit the AMTA website.

The large exercise balls have become popular at rehabilitation centers, gyms, and in peoples homes and offices. There are so many great exercises that can be done for the core, back, arms, and legs. It’s also a great tool to use for strengthening the neck muscles.

Unlike some of the other muscles in the body, you really can’t lift weights or use resistance bands for the neck. You can, however, use the ball (and gravity) in various positions to help strengthen the muscles in the front, back, and both sides of the neck.

To strengthen the front of the neck, you can perform any exercise where you lie on the ball on your back with the head unsupported. This requires the muscles on the front of the neck to work to support the weight of the head against gravity. An example of such an exercise is lying on your back and doing a chest press with the head off the ball. If this is too difficult, you can start out by sitting on the ball and slowly reclining back as far as you can, and gently returning to an upright position. This will allow the muscles to gradually develop strength without over-stressing them.

To strengthen the back of the neck, you can perform any exercises where you lay on your belly on the ball with the head unsupported. Doing back strengthening, such as rowing in this position is an excellent example of a way to strengthen the back of the neck as well as upper back muscles. In this position be sure to keep the neck in a neutral position, so you’re not straining to look up at the ceiling or down to the floor.

The side muscles of the neck can be targeted by doing exercises on the right and left side lying positions on the ball. For example, you could lie on your side with the head unsupported and perform side leg lifts to tone the outer thighs and train the side neck muscles at the same time. If it’s difficult to balance on your side, position your feet at a wall for added stability and safety.

The neck, as with any region of the body, is more susceptible to injury when there is an imbalance in terms of strength and flexibility. Finding creative ways to strengthen the neck can help with prevention as well as rehabilitation of neck injuries.

So we decided for the first time this year to forgo the flu shot. I’ve done it in years past when I worked in hospitals and then with young children we always opted for it. My kids are 4 and 5 this year and out of the high risk age range, so we skipped it since we’re generally healthy and I was feeling optimistic.

Well, live and learn. We got the flu (and I say this diagnosis with confidence because the pediatrician did a nasal swab on my daughter to confirm that it was in fact the flu) not once, but twice. Yes, we got two different strains of the virus this year, and it hit hard. High fevers, stomach upset, and a cough that was unlike any I’ve ever experienced. And this is how my injury came to be.

From my frequent, violent, coughing fits, I managed to send my entire neck into painful spasm, to the point where I couldn’t even turn my head. It was so excruciating and every time I coughed I had to brace myself and support my neck in anticipation of the pain.

Now, I’m an advocate of early access to treatment, so after unsuccessfully trying to treat myself (and actually making myself worse by trying to stretch the joints and muscles of my neck and upper back), I went to see a chiropractor and then a massage therapist. My pain gradually decreased as my motion also improved. I have regained almost full motion, and only have pain when I cough (which has lasted over 2 weeks now) and at the extremes of motion. Had I not sought immediate treatment, I don’t believe I would be feeling as well as I am today.

I can’t stress enough the importance of early access to treatment for any type of musculoskeletal pain. It helps to restore function and prevent secondary effects from stiffness and immobilization. Although waiting it out to see what happens is sometimes OK, in many cases, you will speed your recovery time and healing process by seeking out professional care from a doctor, chiropractor, physical therapist, and/or massage therapist within the first three days.

Within physical therapy and among physical therapists there is a a lot of variation in treatments that can be implemented. I’ve worked in hospitals and private clinics, and I have yet to meet 2 physical therapists who would approach a patient with low back pain in exactly the same way. A lot depends on the therapists level of experience, continuing education, and clinical training.

When I graduated with my master’s 10 years ago, I could treat a patient with low back pain in a very basic way. I had done one of my clinical rotations at an outpatient clinic in rural Iowa, and I learned entry-level techniques, without a lot of emphasis on manual therapy for the spine. With my low back patients, I would do some stretching, strengthening, modalities (like ultrasound and electric stimulation), and basic soft tissue and joint mobilization. The lower back was certainly not the area I was most comfortable treating.

Then I attended a seminar where I learned muscle energy techniques, and it changed my approach to back pain (and how quickly my patients felt better). A year or so later I learned another type of joint mobilization and again my experience, approach, and effectiveness improved. I also learned myofascial release, a type of soft tissue mobilization, which added another hands on tool for me to utilize. I wonder had I not taken these particular courses, would I still dread evaluating and treating lower back pain.

I recently read an article that talked about how the approach to care for low back pain patients varies greatly. Some practitioners take a very gentle approach to working with these patients, doing aquatic exercise, gentle stretching, heat, ultrasound, and ice. Others use McKenzie exercises, which encourage a lot of back bending type exercises. Some prefer to do all spinal stabilization. Some therapists use only hands on techniques to restore alignment and muscle balance. This is in high contrast to others, such as the New England Baptist Spine Program which takes a very aggressive approach to strengthening and does not use any modalities or hands on treatment (which has very good clinical results for decreasing pain and improving function for patients with chronic back pain.).

I feel very strongly that each patient is unique and their experience of pain must be looked at very individually. My experience has shown that a combination of some manual therapy, stretching, strengthening, and pain management modalities (all specific to the patient’s body and needs) if necessary provides relief for most patients. If you are working with a therapist and not seeing results, it may be that a different approach to your condition may be what you need. If you notice you are only doing exercises and the therapist doesn’t do any hands on work, you may need some specific joint stretching done. If your therapist is only doing hands on work and modalities, you probably need to do exercises to maintain the changes that their hands are invoking. It’s perfectly okay and appropriate to let your PT know that you are concerned about a lack of progress. You can also ask for a second opinion. You may not feel comfortable telling your provider that you want a different PT to see you, but a good therapist should be open to at least getting a colleague’s opinion and suggestions if you aren’t improving. You can always seek treatment at a different facility as well. If you take that route, be sure to communicate with your new therapist about the specifics of prior treatment that weren’t effective so you can start in the right direction. (You will also need to talk with your insurance company as they may not pay for a second evaluation and you may have partially exhausted your benefit.)

There are many options for back pain treatment within and aside from physical therapy. The same treatment doesn’t work for everybody; if it did, there wouldn’t be anybody living with chronic pain. If you can be open to trying new things, be consistent with the requirements of the treatment (if you don’t do any of your exercises and aren’t getting better, that may be the problem), and be proactive in finding the best solution for yourself, over time you should find relief from your pain.

My friend called the other day complaining of a sore back and said she had just taken Tylenol. She wanted to know if that was the right thing to take for her pain.

There are many over the counter pain relievers available, and it can be confusing to know which one to take. Two popular groups of pain medications are non-steroidal anti-inflammatories (NSAIDs) and salicylic acid based drugs. Drugs that are considered NSAIDs include the brand names Alleve, Motrin, and Ibuprofen, and the salicylic acids are drugs including Tylenol, Bayer, and aspirin.

For musculoskeletal conditions, which usually have a component of swelling, the NSAIDs can be more effective as they help reduce both pain and inflammation. They do need to be taken consistently as prescribed in order to have an anti-inflammatory benefit. That said, if your doctor prescribed 800mg Ibuprofen to be taken 2-3 times a day, you need to take it at that frequency to have the full benefit, though taken irregularly, you will still experience breakthrough pain relief. The aspirins do have an effect on pain relief, however they do not directly reduce inflammation. Given that, my first choice for an over the counter pain reliever for muculoskeletal-related pain is an NSAID, since swelling can be a significant contributor to overall pain and function.

Adequate hydration is important for all of the cells and tissues of the body that rely on water to function properly. Of relevance here, the discs of the spine contain water which aids in shock absorption and smooth gliding of the joints. Though it is known that with aging the discs become dehydrated, causing a decrease in disc height (Raj, et. al.) and often contributing to pain, I wasn’t able to find any scientific research that supports the theory that drinking more water may ward off back pain.

That said, it is still important to drink enough water each day. And I mean plain old water without added sugar, coffee/tea, or chemicals (though I know some disagree on this, I think plain water is the best for removing toxins and replenishing the body). There has been a lot of controversy recently about the recommendation for 8-10, 8 ounce glasses of water a day, as this doesn’t take into account the water that is consumed in foods. The amount you need to drink also depends on your health and how much you exercise. In general, a good way to know if you are drinking enough is to check that your urine is clear or pale yellow.

If you don’t drink any water during the day, start to add in a glass or two a day. You may or may not notice a change in back pain, but you will be doing your body a favor by supplying it with one of its main components. Always drink a glass of water after exercise, and if it’s a vigorous workout, you should drink before, during, and after to help prevent dehydration.

I think I’m getting thirsty…

P. Prithvi Raj MD, FIPP, ABIPP (2008) Intervertebral Disc: Anatomy-Physiology-Pathophysiology-Treatment
Pain Practice 8 (1) , 18–44

As I sat in the waiting room at my daughter’s yoga class, I watched as some of the mom’s read magazines with their heads down, the magazine on their lap. This position with the head down in a flexed position for a sustained period can be very taxing on the neck. It should be avoided during activities such as reading and when using a computer.

Try to keep your chin level, so the neck remains in it’s neutral, upright position. In order to do this, you may need to prop something on your lap to rest the book or magazine on, so the book is more upright and the eyes can gaze forward or slightly down without straining the neck.

If you look down at your laptop screen, you could invest in a lap tray that would raise the height of your computer allowing the eyes and head to stay more level. If you find you’re always looking down at a keyboard, you could consider taking a typing class so you are able to type comfortably and accurately without looking down. If you look down at papers while working at a computer, a document holder could be an excellent investment for the health of your neck. It brings your work closer to eye level and reduces the pull on the muscles and ligaments of the neck.

So remember, whether reading, writing, working, or playing, the more neutral you align your spine, the less likely you will develop muscle imbalances and pain.

According to the American Academy of Orthopedic Surgeons, 90% of hip fractures occur as a result of a fall. Women are 2-3 times more likely to sustain a hip fracture, and the morbidity and mortality rates are quite high, with only 25% of people making a full recovery, and almost 25% dying within a year due to complications. There are some basic steps to take to help prevent falls and likelihood of a hip fracture. test

1. Vision is a primary factor for balance, and it is important to optimize vision for fall prevention. Get annual eye exams and ensure there is adequate lighting in your home. If you wake at night to use the bathroom, keep a night light on to reduce the risk of falling.

2. Wear proper footwear. A low heeled, supportive shoe provides stability for the foot which improves balance.

3. Use an assistive device if necessary. Although you may feel too young to use a can or walker, it is much safer to use one than to walk holding onto walls or furniture. If you need a device, be sure to use it all the time to optimize safety.

4. If you experience dizziness, talk to your doctor right away. Many medications can cause dizziness as a side effect, and it may be that you need your dosages adjusted. It can also be a result of vertigo, low blood pressure, and other equilibrium problems.

5. Perform stretches to maintain the flexibility in the calf and hip muscles. If you start to lose your balance, the first receptors to respond are in the ankles. They try to shift the weight onto the heels to adjust for balance, but tight calf muscles will make this response ineffective. The second area to respond is the hips. Maintain good flexibility of the hamstrings and hip flexors to allow for better balance.

6. Maintain as upright a posture as you can. The taller you stand, the less likely you will fall.

7. Make safety modifications within your home. Remove scatter rugs, install grab bars in the shower area, and use a shower chair if necessary to prevent slips and falls. Be sure the railings at any stairways in and outside of your home are sturdy.

If you have even one fall, discuss it with your doctor. S/he may refer you to a physical therapist who can help design a specific exercise program to help improve your balance, strength, and flexibility, and reduce your risk for fall related fractures.