What is a joint and how does it work?
A joint is where two or more bones meet and is made up of a number of different parts that all work together so that we can bend, stretch, twist and turn easily – but within certain limits. Most of our joints are designed to allow bones to move only in certain directions.
The ends of your bones are covered in a thin layer of cartilage. This cushions the joint and helps to spread the load evenly when you put pressure on it. Its smooth, slippery surface allows your bones to move freely, without friction.
Surrounding the joint is a tough, fibrous sleeve called the capsule, which stops your bones from moving too much. The inner surface of the joint capsule (the synovium) produces a thick fluid that nourishes the cartilage and lubricates the joint.
Within or just outside the joint capsule are ligaments that help to hold the joint together and prevent it dislocating. The bursa helps to reduce friction in the joint.
At either side of the joint, your muscles are attached to the bones by tendons. As your muscles contract, they pull on the bones to make the joint bend, straighten or rotate.
Why do joints ache and hurt?
There are many reasons why your joints may ache and hurt, including:
Inflammation inside the joints
Inflammation irritates the nerve endings and causes pain.
Worn or damaged cartilage
Cartilage has no nerve endings so you may not know if it’s damaged. But if your cartilage is badly worn, the bone underneath may also begin to wear and change shape. This can be very painful because your bones do contain nerve endings.
Putting extra pressure on your joints
Not surprisingly, carrying heavy items can increase the pain in your hands, arms and shoulders, but you may also feel the effects in other joints. But being overweight will further increase the pressure on these joints.
Pushing yourself to complete a task can cause you more pain the next day. Arthritis can reduce your muscle stamina so you become tired more quickly. Arthritis can also cause your ligaments to become slack, which puts more strain on your muscles and joints.
Inflammation in the structures around your joint
Inflammation may occur:
- in a bursa, which normally allows your muscles and tendons to run smoothly over your joints – this often happens in your shoulder and hip joints
- in the ligaments that hold your joints together – this frequently happens around your knee joint.
Sometimes you may feel pain in one part of your body when the problem is somewhere else. An example of this is sciatica, where a nerve in your back is injured but you often feel the pain in your leg. Your doctor or therapist will try to work out the cause of the pain and help you decide which treatments will help to ease your symptoms and/or control the condition.
Aside from medical treatments, there are lots of things that you can do for yourself to reduce the pain and strain on your joints and to improve your muscle stamina.
Why do joints become damaged?
There are three main things that keep your joints stable. These are:
- the close fit of your bones
- the capsule and ligaments, which are like strong elastic and keep your bones together
- the muscles and tendons that make your joint move.
If you have arthritis, several parts of the joint can become damaged.
Your bones and cartilage may be damaged and your muscles may weaken, causing the joint to become unstable. This means that the joint may gradually change shape and deformities can develop.
Joint damage in rheumatoid arthritis
If you have rheumatoid arthritis your ligaments may become stretched and slack because of repeated swelling of the joint. These changes may start quite early in the condition.
The way you use your joints can contribute to the development of deformities. Your hands are particularly at risk because of their many small joints and constant use. These deformities can cause problems with activities that need a good grip. Common deformities in people with rheumatoid arthritis include:
- your wrist or knuckles slipping downwards so that they partially dislocate (subluxation)
- your fingers bending over towards your little finger (ulnar drift)
- your finger or thumb joints buckling (swan neck, boutonniere finger or z-shaped thumb deformities).
About half of all people who have rheumatoid arthritis will have developed some hand deformities after about five years, so have a look at your own hands carefully and see if any of them have started to happen.
Joint damage in osteoarthritis
If you have osteoarthritis, which is a wear and repair process, knobbly fingers (Heberden’s nodes and Bouchard’s nodes) are common types of deformity. You may also notice reduced movement and pain at the base of your thumb. This is often associated with buckling of the main thumb joint.
If you notice early that any of your joints are becoming deformed, whether you have rheumatoid arthritis or osteoarthritis, you can change the way you do things to reduce the strain on them.
Using joint protection techniques
The way you use your joints can increase the aches, pain and strain that you feel and, over time, it can increase any deformity. This is why you should take notice of pain. Listen to your body – if you’re still having pain an hour after an activity, try taking more short breaks next time.
Many people will give up an activity if it hurts (for example gardening), but it’s better to do a little at a time, with plenty of rests, rather than give up something you enjoy.
Try using some of the techniques below to help you to protect your joints.
Use splints and supports
Wearing splints can often help to ease the strain or pain in your joints. There are two types of hand and wrist splints.
- Working splints (elastic wrist and thumb splints) provide more flexible support to help reduce pain while you’re working.
- Resting splints consist of a custom-made cradle with straps to hold it in place. These can help if you have pain at night which affects your sleep or if you need to rest your hands for a short time during the day.
Some people find that compression (isotoner) gloves are also helpful in reducing pain and swelling and are easier to wear. These can be worn day or night, when working or resting.
A hand therapist can explore the options with you.
Following all the suggestions in this section would be a lot to change all at once, and changing the habits of a lifetime can be difficult to do.
It’s a good idea to change things bit by bit. You might find it helps to write down the benefit you’ll get from making the changes. You could set yourself a goal each week to change two or three things – start with something that’s causing you most pain and try following the steps:
- Work out another way of doing the task which causes less pulling or pain on your joints.
- Practise the new movements until you get them right and feel comfortable doing them.
- Keep practising until the new movements become automatic.
- If possible get a friend or a family member to remind you if you slip into bad habits.
Try some of the tips below to help you avoid tiredness.
Organise and pace yourself
To help you avoid tiredness, look at how you’re doing things and see if you can organise a job better. Ask yourself the following questions:
- Do you have everything you’ll need to use nearby before you start?
- Can you cut out any part of the job or do it more efficiently?
- Can you sit rather than stand to work?
- Can you slow down a bit?
Store things where you can reach them more easily. Organise your cupboards with the things you use most often at the front and get rid of things you don’t use.
Think also about pacing yourself. The best ways to do this are:
- taking a break for a few minutes every half hour
- changing activities regularly and switch between light and heavier jobs.
After vacuuming a room do some dusting, then sit down and have a rest. When mowing the lawn, take a break before you get tired, change to a lighter job and go back to mowing later when you feel rested. Use the same approach at work. Taking regular short breaks actually means you can keep going for longer.
Keeping fit and healthy
Keeping fit and healthy is an important part of looking after your joints. You can do this by exercising, eating a balanced diet and taking care of your body.
Exercising helps to keep your muscles strong and your joints moving. You can even exercise without putting strain on your joints.
Joint protection and exercise work together. Joint protection reduces strain on your joint capsule and ligament, which can become slack if you have arthritis, and straining them can make this worse. Exercise strengthens the muscles around your joint so that they can help to support it.
Being overweight puts an extra burden on your weight-bearing joints (your back, hips, knees, ankles and feet) when they’re already damaged or under strain.
Because of the way your joints work, the pressure in your knee joints is 5–6 times your body weight when you walk. For this reason, it’s important to maintain a healthy weight. You can do this by taking regular exercise, for example swimming, which is particularly good for people with arthritis because the water supports your joints.
Eating a Mediterranean-style diet is good for providing all the nutrients and vitamins you need. This includes:
- lots of fruit and vegetables
- oily fish
- nuts and seeds
- olive oil.
Generally speaking supplements are relatively well tolerated, but you should speak to your doctor about taking them because some can interfere with other medication, for example St John’s wort stops the contraceptive pill working properly.
If you decide to try any supplement, you should question what they’re doing for you, and base your decision to continue on whether you notice any improvement.
Having painful feet can limit you getting out of the house for work, leisure, shopping and exercise. Good shoes help to protect your feet in the long term.
Who else can help me to look after my joints?
You don't have to start using joint protection techniques on your own. Healthcare professionals, local groups, and friends and family can all help to provide support and encouragement.
The healthcare professionals attached to rheumatology units help support people in adapting their lifestyle. This can include:
Your occupational therapist can discuss the information in this section with you and suggest more ways you can reduce aches, pain and strain, which may help to slow down the development of joint deformities.
Joint protection programmes
Because changing the habits of a lifetime can be very difficult to do, many people find it helpful to get together with others who wish to do the same. Many occupational therapy departments offer joint protection programmes, where groups of people with arthritis support each other through learning and practising activities together. This may be part of an overall programme for people with arthritis.
If you find the self-help methods suggested here useful, you may like to join a local group. Take a look at our services and support information to check if we run a group in your area. The National Rheumatoid Arthritis Society (NRAS) run a programme for people with rheumatoid arthritis. There are similar programmes available locally for people with long-term medical conditions like arthritis.
Ask at your doctor’s surgery or rheumatology unit about the NHS Expert Patient Programme.
Friends and family
Learning about the things described here can help your family and carers to understand some of the problems you might face. Some people find it very helpful if their family or friends become involved as they practise some of the ideas mentioned in this section.
If they’re supportive, give you feedback on how you’re doing and help you to find solutions to problems, you may find you’re able to adopt the new movements or activities more quickly.