MSK articles - Musculoskeletal Health Australia (MHA)

20/Sep/2022

Is there anything better than pulling on your comfy trainers and heading outdoors for a walk? With the first breath of fresh air and the sun on your face, you feel better. Your muscles warm up, your joints loosen, and you settle into a comfortable stride. The rhythmic movement helps you relax and boosts your mood.

I love going for a walk. It’s such a great exercise.

It costs nothing, is suitable for most people, and gets you out of the house. You can walk at a leisurely pace or take it up a notch and increase the speed and intensity of your workout. Or do a combination of both for some interval walking.

If you don’t exercise much, it’s an ideal way to build up your activity levels. Be sure to talk with your doctor first to get the all-clear, especially if you’ve recently had surgery or have other health conditions. Then start slow and gradually increase your distances and times.

Try walking 30 minutes a day on most days of the week, and you’ll definitely notice the health benefits. Walking regularly can help you manage your pain, maintain a healthy weight, lift your mood, get a good night’s sleep, improve your muscle and joint health and increase heart and lung fitness.

If you can’t walk 30 minutes at a time, you can easily break the walking up over your day. You don’t have to do it all in one go to reap the benefits. So during your day, you can do three 10 minute walks, two 15 minutes walks or six 5 minute walks, whatever works for you. It all adds up 😊.

And if 30 minutes most days isn’t realistic for you at the moment, set yourself a goal so that it becomes achievable. Think about your daily commitments, your level of fitness, your pain/fatigue levels and all the other things that affect you daily. Now create a SMART goal. That’s a goal that is Specific, Measurable, Achievable, Realistic and has a Time-frame that works for you. It will help you set a practical plan for achieving your goal. Read our blog about goal setting for more info.

14 tips for better walking

Dress the part

Let’s start with the most important element of your walking outfit – your shoes. They need to be comfortable, fit properly, and support your feet. Look for light, flexible shoes with thick, non-slip soles. Avoid slip-on shoes, and if laces are difficult to fasten due to arthritis in your hands, Velcro or elastic laces might be an option.

Your clothes should be loose and/or stretchy enough to allow you to walk without restrictions. Make sure you wear a hat and sunglasses on sunny days. And grab any mobility aids you use before you head out.

Warm up and cool down to prevent injuries or pain

While you might be eager just to get out there, it’s important to take the time to let your muscles and joints warm up. So start your walk slowly, and gradually increase your pace. And when you’re close to finishing your walk, take the time to slow it down and give your body the chance to cool down. You can also incorporate some basic stretches to warm-up and cool down. Check out these stretches from the Arthritis Foundation (USA).

Walk briskly

Did you know that 10 minutes of brisk walking is classified as cardio as long as you’re slightly out of breath? Brisk walking at a moderate intensity provides more health benefits than a simple stroll. How fast you need to walk for it to be moderate intensity will depend on your age and fitness level. So it differs from person to person. You can tell if you’re walking at a brisk, moderate-intensity pace if you’re breathing heavier than usual but can still have a conversation. But if you can walk and sing (which is a little unusual) 😉, you need to kick the intensity up a notch.

Make walking a part of your routine

To make walking a daily activity, you need to build it into your routine. Go at the same time each day – e.g. before/after work, before breakfast/after lunch. Whatever time suits you best and allows you the space to commit to it. Before long, when that time arrives each day, you’ll find yourself automatically reaching for your walking shoes. 👟👟

Listen to music, audiobooks, podcasts

Going for a walk by yourself gives you space for some alone time. Listen to something that interests or relaxes you as you exercise. There are many entertaining podcasts and audiobooks you can access free online. Or you can borrow audiobooks from your public library and download them to your phone.

You can also make yourself a walking playlist featuring your favourite music that starts slower (for your warm-up), gets faster (for your main workout) and slows down again towards the end of your walk (for a cool down).

Make it social

At other times, it’s nice to walk with others. It’s fun and will help keep you motivated. You can chat, shoot the breeze, catch up and just be social 😊. So walk with friends or your family. And if you have a dog, bring it along! They need the exercise too. And dog owners are always up for a chat 🐶!

Explore new places

As many of us discovered during past lockdowns, walking the same paths day after day can become a little tedious. Mixing it up will make your walks more enjoyable. So look at your maps and discover new walking trails, parklands and suburbs.

Or try a variation of this idea. Comedian and radio host Tony Martin and his partner have spent more than ten years exploring the streets of Melbourne, with the goal to walk every street! While you may not want to go that extreme, you could start smaller and check out different streets of your neighbourhood. Or pull out the old Melways or use your GPS to discover new and interesting places to walk.

Take a water bottle

Walking can be thirsty work, so you may need to take some water to remain hydrated. And depending on how far you’re walking, consider taking a small backpack for your water bottle and any other supplies you think you may need, such as snacks, sunscreen, a map, band-aids (just in case) and your phone.

Be mindful while you’re walking

Take time to be in the moment and experience the walk. How do your feet feel as they connect with the ground? What can you smell? How does the wind feel on your face? What can you see around you? Take the time and opportunity to really connect with what you’re doing and savour every moment.

Track your walking with a pedometer or fitness activity tracker

This’s a great way to see how you’ve progressed over time. And many of the walking apps allow you to challenge others, so if you can’t physically walk together, you can in spirit. And a little healthy competition can help you push yourself to achieve more 😉.

Increase the distance and intensity of your walks over time

To see the health benefits from your walking, you need to push yourself to go further and harder. Just be mindful that you don’t push too hard, too soon. Especially if you’ve been unwell, had surgery, or you’re having a flare. Listen to what your body is telling you. A physiotherapist, exercise physiologist or fitness instructor can provide tips and guidance if you need help.

Walk indoors

If it’s raining or just too hot or cold to take your walk outdoors, stay in! There are many ways you can walk indoors. For example, you can walk around your home if you have the space. Or you can follow an online video of walking exercises (there are many available to suit your specific needs and fitness level). Or you can take your walk to the shopping centre. They have lots of open areas to walk and places to rest and hydrate when you need to. Just try not to get distracted and slow down to shop! 😂 You can also take your walk to the local fitness centre or gym. Many have indoor walking tracks you can use for free if you’re a member or for a small fee if you’re not.

Be aware of walking surfaces

They’re not all equal. Natural surfaces such as grass, fine gravel, dirt and woodchip are softer and generally easier on your joints. However, they’re not always even surfaces, so you need to be aware of potential trip hazards. Manmade surfaces such as asphalt and concrete can be more jarring on sore joints. However, they’re generally smoother. So factor walking surfaces into your plans. If your hips, knees, ankles or feet are particularly sore, go for the softer, more natural surfaces. If you’re concerned about falling or bad weather, manmade surfaces may be your best option.

Join others

Consider joining a walking or bushwalking group. You’ll meet other people who love walking, explore new places together and get lots of tips and advice to make walking more enjoyable and challenging.

Another option is parkruns. They’re free, weekly community events with 5km walks and runs in parks and open spaces on Saturday mornings. Everyone is welcome, there are no time limits, and best of all, no one finishes last! 😊
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So what are you waiting for? Pull on your walking shoes, grab a friend or your headphones, and as the INXS song goes, just keep walking !

Contact our free national Helpline

Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, telehealth, or accessing services. They’re available Monday to Thursday between 9am-5pm on 1800 263 265; email (helpline@muscha.org) or via Messenger.

More to explore

12 tips for walking when you have sensitive knees
Verywell Fit
Building a walking workout
Arthritis Foundation
Nordic walking Is an ideal low impact exercise, especially with arthritis
Healthline
Top tips for walking with arthritis
Versus Arthritis
Walking towards healthier knees
Science Daily
Walking with arthritis: benefits, tips, how to prevent pain
Creaky Joints

Walks in your state or territory

Lisa Bywaters

31/Aug/2022

Written by hand therapist Catherine Reid, B.App. Sci, (OT), M.Sci (H&UL rehab), MAHTA (As awarded by the AHTA), CHT(USA)

It’s no secret I love hands! They’re amazing, complex and delicate structures. They help us connect with the world and each other. They allow us to touch, feel, carry objects, pick up kids and perform all kinds of everyday tasks.

That’s why I’m passionate about people being proactive and looking after them.

As an Accredited Hand Therapist* I’m often asked about the things people can do to look after their hands. Here are my top five tips.

1. Look after the skin on your hands

Your skin protects your hands from the outside world. It’s constantly renewing itself. Every time you wash your hands, you rub away dead skin cells. It’s important to look after your skin by keeping it as clean as possible and using a gentle hand wash. In some cases, gloves might be a good idea, for example if you’re using chemicals to clean your shower, or work in a café washing dishes.

Keeping your hands clean isn’t just about them looking good. It’s also about avoiding infections. Anyone who’s had an infection in their hand will tell you it‘s very painful. This is due to the many nerve endings you have in your fingertips. And because you use your hands so often, it’s hard to avoid banging or knocking an infected or injured hand.

An infection can also limit your hand’s movement, which, if left untreated, can become permanent.

Obviously, keeping your hands clean is impossible with some jobs, so keeping the skin in good shape is essential. Using a good moisturiser or barrier cream after washing is recommended to avoid small cracks developing in the skin. These cracks allow dirt and germs to enter your body, increasing your risk of infection.

Keeping your skin hydrated and moist helps keep your skin supple and leads to faster healing.

2. Stay strong

Many people don’t realise they’re losing strength in their hands until they have a functional problem, such as pain when opening a jar or difficulty gripping a doorknob.

That’s why I recommend exercises to strengthen your hands when you start to notice a problem. Many people strengthen their hands by squeezing a ball; if this is the case, I recommend a softer ball so your fingers can move through a greater range when squeezing. A cheap alternative to squeezing a ball is squeezing plumbing insulation. You can buy it by the metre at hardware stores for a few dollars and in different diameters to suit your hand size.

Accredited Hand Therapists can provide you with exercises for specific muscles or to deal with particular issues you’re having. They may use strengthening tools, exercise putty, and/or exercise bands.

3. Keep your joints moving

As the saying goes, ‘motion is lotion’ as far as your joints are concerned, so don’t let them stiffen up!

At the ends of the bones in your joints, you have a layer of cartilage. Cartilage is a firm cushion that absorbs shock and enables the bones to glide smoothly over each other. The joint is wrapped inside a tough capsule filled with synovial fluid. This fluid is the oil in your joints. It provides nutrition for the cartilage and helps provide a cushion between the cartilage. It moves across the joint’s surfaces like a drop of oil on a door hinge. When you move your hands, the synovial fluid is spread around the joint. So tasks that have you holding something for a long period without changing grip aren’t good for the joints. It’s not allowing the synovial fluid to lubricate the joint. Rather than not perform the activity, take frequent breaks and move your fingers. And try to avoid activities that push your fingers into extremes of range, for example, lifting items that are too large using only one hand.

Similarly, use bigger, stronger joints where possible. For example, carry shopping bags on your forearm rather than with your fingers.

Accredited Hand Therapists can instruct you in exercises for specific joints, such as the joint at the base of the thumb. To maintain good movement, moving your joints through the full range of movement and stretching out to the ends of the range is important. Tendon gliding exercises are often used for this purpose as they glide one set of tendons over the other and move each joint through its full range. Click here for examples of tendon glide exercises.

4. Use the right tool for the job.

We often force our hands into extreme positions or keep going with a task until our hands are aching, especially if we’re in a rush or just want to get a job done.

But using the right tools can be gentler on your hands. For example, large or fat handles can spread loads more evenly or over several joints. Tools that use a lever to reduce the required force are also preferable; for example this tool (see image) helps open ring-pull cans.

There are also many electric tools for use in and around the home, reducing the required force. For example, instead of hand pruning a hedge, you can use electric shears. I know which I’d prefer!

You can buy aids and other tools from supermarkets, chemists, hardware stores, and home health care stores. Musculoskeletal Australia also has a range of tools available through their online shop.

5. Seek professional help

If pain or inflammation persists for more than a few days, seek professional help. Pain can be a warning sign that your joints are being overworked. Inflammation can be due to joints, muscles and/or tendons being overused or other health issues such as diabetes or heart disease. Prolonged inflammation can make it difficult to move your fingers. It may be that the structures in your hand need a rest to allow them to heal.

Your GP or a practitioner in hand therapy can help diagnose the problem and provide you with techniques to manage the pain or prevent the problem from becoming worse.

Accredited Hand Therapists can be located via the Australian Hand Therapy Association’s web page under the “Find an Accredited Hand therapist” section.

And check out my other article, ‘Can a hand therapist help you?’.

*As awarded by the Australian Hand Therapy Association

Contact our free national Help Line

Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, COVID-19, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

Lisa Bywaters

10/Aug/2022

Although it sounds like it, a Baker’s cyst isn’t named after an occupation like housemaid’s knee (prepatellar bursitis), policeman’s heel (plantar calcaneal bursitis) or writer’s cramp (hand dystonia). It has nothing to do with the act of making delicious, delicious bread 🍞 or other baked goods 😋.

Baker’s cysts are named after Dr W.M Baker, the 19th-century surgeon who first described cysts that form on the back of the knee. Their clinical name is popliteal cyst. Often people don’t know they have a Baker’s cyst, especially if it’s not causing pain. However, sometimes they can cause problems.

Your knee – a complex joint

To understand how a Baker’s cyst affects your knee, it’s helpful to know a little about your knee joint.

Your knee is a large and complex joint where three bones meet: your thighbone (femur), shinbone (tibia) and kneecap (patella). Covering the ends of your bones is a thin layer of tissue called cartilage. It provides a slippery cushion that absorbs shocks, helps your joints move smoothly and prevents bones from rubbing against each other.

Surrounding the joint is a tough capsule filled with a lubricating fluid (synovial fluid). This fluid allows your knee to move freely.

A Baker’s cyst can form when an injury or arthritis causes your knee to produce too much synovial fluid. This excess fluid bulges from the joint capsule behind the knee as a protruding sac (see image).

Cysts can vary in size and cause symptoms such as pain or stiffness in the knee joint.

Baker’s cysts may not require treatment, but if they do, they can be treated effectively with self-care and medical treatment.

Causes

Some of the common causes of Baker’s cyst include:

trauma or injury to the knee
torn cartilage
osteoarthritis, rheumatoid arthritis and gout.

Symptoms

Often, there are no symptoms, and you may not even know you have a cyst. If symptoms do occur, they can include:

a lump or swelling behind the knee
knee pain
stiffness or tightness of the knee
limited range of knee movement (if the cyst is large).

Diagnosis

Many people don’t know they have a Baker’s cyst as it may be small and painless.

However, you should see your doctor if you notice a painful lump in the space behind your knee.

Your doctor will ask about your symptoms and medical history and examine your knee. They’re usually able to diagnose a Baker’s cyst based on this.

Sometimes a doctor may organise scans of the joint, usually an ultrasound, or if the diagnosis is uncertain, possibly an MRI (magnetic resonance imaging). This is to rule out other rare causes of the lump, such as a popliteal aneurysm, blood clot or tumour.

Complications

The symptoms of a Baker’s cyst are usually mild; however, in rare cases, the cyst may burst, leaking fluid into the calf region. This can cause increased pain in the knee and swelling or redness in the calf.

If you experience swelling or warmth in your calf, you should seek medical advice quickly.

It can be difficult to tell the difference between the complications of Baker’s cyst and more serious but less common problems such as a blood clot in a vein in your leg. So it’s better to be safe and get it checked out.

Treatment

You probably won’t need treatment if you have no symptoms or only mild pain.

However, if it is causing you pain, your doctor will develop a treatment plan that may include:

Self-care. You can reduce the pain and swelling by using an ice pack on your knee for short periods. Make sure to wrap it in a cloth so the pack doesn’t come into direct contact with your skin. You should also protect and rest the joint. Elevate your knee while resting it, and avoid activities that strain your knee (e.g. jogging). You may also find it helpful to use a cane or crutches for a short period or wear a knee support.
Medicines such as paracetamol or non-steroidal anti-inflammatory medicines (e.g. ibuprofen) may provide temporary pain relief. These medicines are available over-the-counter or with a prescription, depending on their dosage and other ingredients.
A corticosteroid (steroid) injection may be helpful for people who haven’t found relief from other treatments or if they have severe pain.
Treating the underlying condition (e.g. arthritis) is also important, so your doctor may discuss other medicines and treatment options.
Seeing a physiotherapist or exercise physiologist for gentle strengthening and range of movement exercises to reduce symptoms and maintain knee function.
Draining the cyst by inserting a needle into it (needle aspiration) and removing the fluid. This may be done under ultrasound.
Surgery is rarely needed to treat a Baker’s cyst. However, it may be an option in some cases to treat the cause of the cyst (e.g. an injury) or to remove the cyst if all other treatments haven’t provided relief.

Contact our free national Help Line

More to explore

Baker’s cyst
Mayo Clinic
Baker’s cyst
NHS
Baker’s cyst
Cleveland Clinic
Baker’s cyst (popliteal cyst)
OrthoInfo
Baker’s cyst
Patient
What is a Baker’s cyst (popliteal cyst)?
Medical News Today

Lisa Bywaters

10/Aug/2022

Written by hand therapist Catherine Reid, B.App. Sci, (OT), M.Sci (H&UL rehab), MAHTA (As awarded by the AHTA), CHT(USA)

A surgeon once told me that the human body’s most elegant anatomy was in the hand. I might be slightly biased, but I had to agree! The hand is amazing and complex in the way it’s structured and works.

There are 27 bones in your hand compared with just 3 in your leg. These bones are moved by over 30 muscles, all working in unison to provide smooth, coordinated movements. Your nerves help you control these movements enabling you to adjust your strength or fine coordination to suit the task.

Your hands can convey your feelings through touch and gesture and help to communicate your thoughts. In fact, some people will tell you they can’t talk without using their hands!

Your wrists, elbows and shoulders work together to position your hands in space. Any problem along the chain of your upper limbs affects your ability to fully function. Imagine how difficult it would be to reach up to do your hair if your shoulder was stiff, or to do downward dog in yoga with a painful wrist!

We connect with the world through our hands, performing everyday activities, and many of us earn our living with our hands. That’s why it’s essential that we take good care of our hands.

For some people, this may include seeing a professional.

What is hand therapy?

Considering the importance of our hands, it should be no surprise that there are professionals devoted solely to their rehabilitation.

Hand surgeons are either orthopaedic or plastic surgeons who’ve undergone additional training and study to specialise in treating problems of the hands, wrists and arms. They may use surgical and/or non-surgical treatments.

Hand therapy practitioners are qualified physiotherapists or occupational therapists registered with the Allied Health Practitioner Regulation Agency (AHPRA). They have extensive knowledge and skill in understanding and treating problems with the fingers, wrists, elbows and shoulders. The Australian Hand Therapy Association (AHTA) defines hand therapy as “the art and science of rehabilitation of the upper limb – shoulder to fingertip”.

What is an Accredited Hand Therapist (AHT)?

In 2017, the Australian Hand Therapy Association implemented a credentialing program to ensure accredited therapists offer a high standard of practice. All Accredited Hand Therapists have undertaken advanced education and assessment of the upper limb and have had over 3,600 hours of hand therapy clinical practice. After they’re assessed as competent to provide safe, evidence-based diagnosis, advice, and treatment, they’re awarded the credential of Accredited Hand Therapist by the Australian Hand Therapy Association Credentialing Council.

What conditions are treated?

Accredited Hand Therapists diagnose and treat a large variety of musculoskeletal conditions of the upper limb. They include:

arthritis
nerve compressions (e.g. carpal tunnel syndrome)
fractures, joint injuries and dislocations
tendinopathies (e.g. tennis elbow) and other soft tissue injuries
pain conditions
nerve and tendon injuries
burns and scar management
sporting injuries
work-related injuries
post-surgical conditions.

What happens at an appointment?

When you meet with an Accredited Hand Therapist, you’ll work together to develop a treatment plan. It will take into consideration your specific situation, symptoms, and the environment in which you live and work.

Some treatments aim to resolve a problem, for example, improving muscle strength or range of motion after a fracture. Some treatments may be preventive and involve teaching you to manage symptoms like pain or swelling in response to an injury or illness.

Assessments may involve specific measurements; for example, the therapist measures your wrist’s range of movement or grip strength. Assessments also include your experience of the problem, for example, when you describe the location of the problem, how your symptoms feel and affect you, and the things you noticed or experienced when you first noticed your symptoms.

Treatments often use heat, ice or electrotherapy to improve healing, orthoses (splints) to rest soft tissues (e.g. muscles, tendons, ligaments), and specifically targeted exercises to improve movement and strength.

You’ll be encouraged to complete a home program when possible, so education will also be a large part of your treatment.

To achieve the best outcomes, therapists may collaborate with other health professionals such as hand surgeons, rehabilitation consultants or GPs.

Where do I find an Accredited Hand Therapist?

Accredited Hand Therapists can be found throughout Australia in private practice (sometimes co-located with hand surgeons), in public hospitals and in community settings. In Australia, there are over 400 Accredited Hand Therapists in metropolitan, rural and remote locations. You can contact a hand therapist through the AHTA “Find an Accredited Hand therapist” web page or email the AHTA at enquire@ahta.com.au.

You use your hands all day long, so receiving the best care to recover after surgery, injury, or a medical condition is essential. Your hands deserve the best, and so do you!

Contact our free national Help Line

Lisa Bywaters

10/Aug/2022

Creams, sprays, liniments, ointments, patches, rubs & gels

If you open most medicine cabinets or bathroom cupboards, you’ll more than likely find a tube or jar of a pain-relieving rub. With varying degrees of smelliness!!😱

Many of us turn to these products when we wake up with a stiff neck or overdo it in the garden. The soothing ointments, creams, sprays, liniments, patches, rubs and gels that we apply directly to our skin (topically).

But what are they? How do they work? Are they effective? And are they safe?

First, there’s a vast array of topical products available in many forms and using different ingredients. Many are available to buy over-the-counter from your chemist or supermarket. However, some require a prescription.

Let’s look at some of the more common varieties.

Counterirritants

These products use ingredients such as menthol, methyl salicylate, eucalyptus oil and camphor. They’re called counterirritants because they create a burning, cooling or ‘tingling’ sensation in the area where they’re applied that distracts you from your pain.

Medicated products

Many topical products contain non-steroidal anti-inflammatory drugs (or NSAIDs) such as ibuprofen, diclofenac or piroxicam. NSAIDs block the action of specific enzymes (cyclooxygenase or COX) that are involved in inflammation.

Topical NSAIDs may be an option for you if you can’t take oral NSAIDs due to other health issues (e.g. high blood pressure) or the risk of complications (e.g. stomach problems), as less medication is absorbed into the bloodstream.

If you’re using a topical NSAID, you should avoid taking NSAIDs orally (pills or tablets) unless you’ve discussed this with your doctor. Although the amount of medicine that enters your body through the skin is less than when taking them orally, there’s still the risk of getting too much when using both forms.

Corticosteroids, or steroids, simulate the naturally occurring hormone cortisol. One of the many functions of cortisol is to suppress or reduce inflammation. Steroid creams come in varying strengths. They rarely have serious side effects if used correctly, so it’s essential that you follow the instructions carefully. If you have any concerns, discuss these with your doctor or pharmacist.

Capsaicin

Capsaicin is the substance found in chilli peppers that gives them their heat and spicy kick, making your mouth tingle and burn. Applied to the skin as a cream, it works by interfering with the pain signals between your nerve endings and brain.

Benefits of using topicals

Most topicals, when used correctly, provide quick, temporary pain relief and have fewer potential side effects than oral pain-relieving medicines.

They may be a good option if you only have pain in a few joints or muscles, as they work in the immediate area you apply it to, rather than affecting your whole body.

Topicals also provide the soothing benefit of a mini-massage when you apply them to your skin. Seriously, how good does it feel when you rub the cream into your sore neck, and you feel the muscles loosening? Or when you apply a warm gel to your stiff, aching knee? Bliss. 😊

Another benefit of topicals is that they’re very portable; you can have some at home, in your drawer at work, in your handbag or gym locker, and use them as needed.

Do they work?

Many people swear by these products for quick pain relief. And there’s solid evidence that they can provide pain relief for acute pain, such as strains and sprains. However, research shows only modest benefits for chronic pain. But, if you feel better when using these products, and you’ve discussed it with your doctor, they’re safe to use and are better tolerated than oral medicines.

Potential side effects

Topicals, both medicated and non-medicated varieties, can cause side effects. They include skin irritation, redness, rash, or a burning, stinging or itchy sensation in the area it’s been applied.

Very rarely, some people may experience nausea, breathlessness, indigestion or an allergic reaction to the topical. If you experience any of these symptoms, stop using the topical and talk with your doctor or pharmacist for advice.

Cautions

As with any medication, there are things you need to be aware of to prevent any problems from occurring:

Taking oral and topical medicines containing the same ingredients (e.g. NSAIDs) at the same time may increase the risk of side effects. Talk with your doctor about this risk.
Always read the consumer medicine information carefully and follow the instructions. Take note of how to apply the topical, how often and how much. Don’t go overboard and slather it on. You can get too much of a good thing!!
Wash your hands thoroughly after applying.
Be careful to avoid contact with your eyes or other sensitive areas 😖.
Don’t use these products on wounds or damaged skin.
Don’t use with heat packs as this may cause burns.
Only use one topical medicine at a time.
Check the use-by-date and discard any out-of-date products.

Contact our free national Help Line

More to explore

Arthritis pain: Treatments absorbed through your skin
Mayo Clinic
Capsaicin
Versus Arthritis
Topical analgesics for acute and chronic pain in adults ‐ an overview of Cochrane Reviews
Cochrane Library
Topical anti-inflammatory painkillers
Arthritis Foundation
Topical anti-inflammatory painkillers
Patient
Topical medicines for musculoskeletal pain
NPS Medicinewise

Lisa Bywaters

21/Jul/2022

COVID numbers are up and masks are back. The stupid virus and its many variants just keep on giving 😥.

We’ve dealt with isolations, lockdowns, and massive life changes in the past few years. We’ve made sourdough bread, completed countless jigsaws, consumed gallons of quarantinis (or was that just me? 😉🍸) and given online yoga a go.

But now what? Yoga has become a source of calm and relaxation, but we’re sick of sourdough, can’t bear to see another jigsaw, and for the sake of our livers, we’ve moved on to non-alcoholic mocktails (again, maybe just me? 🍹).

It’s time to cast aside the things that make us unhappy or trigger feelings of lockdown anxiety. It’s time to embrace the things we love, that make us fulfilled and satisfied. The things that feed our curiosity and creativity. And the things that support self-care.

Here are some simple things you can add to your routine to boost your happiness. Hopefully, one or two of them will strike a chord with you 😊.

Give thanks

Sometimes we can be consumed with what we don’t have or what others have… money, good health, the latest gadget, a great job, travel opportunities… Unfortunately, all this does is create feelings of envy or dissatisfaction – and that’s no way to live.

When I find these feelings creeping in, I stop myself. I think of three things I love about my life and make me grateful for the life I’m living. And there’s so much to choose from! My partner, the absolute love of my life 😍. Having a nice place to live in the green outer suburbs. A fabulous collection of shoes that I’m rediscovering after years of lockdown slippers and runners 😁 Psychotic balls of fluff (aka two cats) that rule my home and make me laugh. The fact that I live in a country where I can attend a non-violent protest for women’s rights. The chilli plant I bought as a small seedling that now produces deliciously hot chillies 🌶🌶 A library within walking distance. Without even breaking a sweat, that’s seven things I could list in a few short minutes!

We have lots to be thankful for in our lives – we just need to take a moment to think about and value them.

Learn new things

Nerd alert! For me, there’s nothing like watching a documentary, learning a new skill, attending a webinar/seminar/class, reading an article or talking with someone with unique experiences and knowledge. It always inspires me to discover more and delve deeper into a subject.

Learning new things challenges us and fires our curiosity and imagination. And that’s not only good for our mental health and satisfaction with life in general, but it’s also excellent for our brain health. I’m currently messing around with learning to play the guitar. I’m not sure if you could call the sound I create music, but it’s a lot of fun! If there’s something you’ve been wanting to learn, don’t put it off any longer. Book that class, take that online course, speak with people in the know – you won’t be disappointed!

Enjoy the company of friends and family

Seeing our important people face-to-face is all the sweeter when we remember the restrictions we endured in 2020 and 2021. It’s hard to imagine that there were periods when we could only connect via phone or video. So cherish the time you have together.

Do things for others

I find being useful and helping others a rewarding experience.

It doesn’t matter if it’s something small, e.g. letting a car into traffic in front of me, or something big, e.g. helping an aunt move into a retirement village, then out of a retirement village, and later relocate 500 kilometres away in the space of 18 months (true story 😝). To me, if it helps make someone’s life a little easier, it’s worth it.

There are many ways you can help out or do things for others, including volunteer work, mowing your neighbour’s nature strip, being kind to your barista, cooking a meal for a sick friend. Whatever you do, you’re sure to feel warm and fuzzy inside, and make your corner of the world that much brighter.

Laugh

Having a good laugh, chuckle or giggle is the best 😂😆🤣. Everything seems so much better, you feel happier, and you can’t wait to do it again.

Laughter releases the ‘feel-good’ hormones – endorphins, serotonin and dopamine. They boost your mood and make you feel more positive. And endorphins are your body’s natural pain reliever and can reduce your feelings of pain. Yay!

So next time you feel a little down, or you’re in pain, watch funny cat/dog/panda videos (I’ve heard there are a couple on the internet 😉), talk with a friend about a silly experience you had together, watch a comedy, listen to an entertaining podcast. Do whatever makes you laugh and enjoy those happy vibes.

Get out into nature

Whether it’s the local park, a walk on the beach or bushwalking through the hills, just getting out into nature makes me feel happy 🍁🍂. We’re surrounded by so much beauty.

When you head outdoors, keep your phone in your pocket and look around. Listen to the birds in the trees, notice how the trees sway in the wind, enjoy the dogs playing in the park, and appreciate the scenery around you. Take the time to pay attention and be mindful, and you’ll immediately feel a boost in your mood.

Discover new places

This often goes hand in hand with the previous one. And it’s something that kept me sane during lockdowns. I’d look at maps of my local area and the radius in which I was allowed to travel. I’d then look for all the green spaces – and it’s amazing how many parks, reserves, playgrounds, and abandoned golf courses I could find. When I visited them, I’d discover new, interesting things – a pretty creek alongside the path, a group of goats brought in to deal with the weeds, a flock of cockies gathered in a tree throwing seedpods at the people walking below 😆. Discovering new places brings out the intrepid explorer in me and I feel like I’m seeing so much more of the world.

Stay active

Activities that exercise your body and mind in challenging, new ways are great for your physical, mental and emotional wellbeing. And choosing activities that you enjoy will ensure you do them regularly.

For example, I’ve recently rejoined the gym because my strength and stamina have declined due to my sedentary COVID life. So I’m combining my usual walking and hiking with strength training, yoga and Pilates to increase my fitness, take some weight off my joints and help me sleep better. It’s early days, but I’ve already noticed a difference.

Like millions of others, I’ve also been enjoying the daily mental challenge of Wordle. It stimulates the brain and provides social competitiveness as we compare our wins and losses 😃. And I’m trying to learn to do cryptic crossword puzzles, though that’s proving more difficult!

The important thing is that I’m engaging both body and mind in demanding activities. They’re pushing me out of my comfortable status quo and making me grow.

Hug your people

Physical distancing and being unable to get close to others for fear of germs is a lonely experience. And it can leave us feeling sad at the lack of closeness. So the people I can touch, I touch a lot! Not in a creepy, unwelcome way 😄 but in a caring, loving way.

Being able to touch or hug others reduces stress, anxiety, and depression and makes us feel good. And here’s a tip from me to you: don’t save your hugs for when you’re feeling down. Hug each other when you feel happy, excited, or just because it’s Thursday.

Clean and declutter

Ooh, I did a lot of this during the first few lockdowns. And I know many of you did the same. Op shops were bursting at the seams with our discarded books, clothes, jigsaws and appliances. There’s nothing like decluttering and cleaning your home and work spaces to make you feel satisfied and in control. And your new tidy rooms will hopefully have the added benefits of preventing falls as trip hazards are moved or given away. Just be careful while doing your big clean not to overdo it physically. Take your time and pace yourself.

Try new recipes and new ingredients

Full disclosure, I’m a terrible cook. But I’ve been trying a new recipe and/or ingredient at least once a week. It gets me out of my ‘Tuesday night stir-fry’ rut. It helps to have tasty recipes from our talented volunteers, Lauren and Kitty. I’m also blessed that my partner is a great cook and has introduced me to spices and condiments I’ve never used before. There have been many, many disasters in the kitchen (and a trip to the hospital for a deep cut from slicing capsicums 😫), but there have also been successes. And that’s incredibly satisfying.

Acknowledge it’s been hard

So far, the things I’ve listed have been light and happy. But we should acknowledge that there have been dark, traumatic times without fun, joy or happiness. There have been tears, arguments, and moments of intense anxiety and stress. And before this pandemic is done, we’ll likely experience more of these moments. So it’s important to remember that we’re not going through this alone. We have people who love and care for us. We also have access to professional support if we need it to get through. We just need to ask.

The COVID-19 pandemic will pass. It’ll take some more time, but we can adapt. We’ve been doing it for years, and even though we’re weary, we can continue to do it. And finding the things that make you feel happy, strong, and in control of your world will help you get through.

Contact our free national Help Line

Contact Lifeline Australia

13 11 14 for 24 hour crisis support and suicide prevention.

More to explore

Action for Happiness and Happify
These websites and apps provide tools and programs to help you live a happier life and take control of your emotional wellbeing.
How to be happier
NHS
How to figure out what makes you happy (so you can do more of it)
Yes & Yes
Some inspiration for isolation
Musculoskeletal Australia
We asked how you are finding joy in the pandemic. Here are 12 surprising ideas
NPR

Lisa Bywaters

21/Jul/2022

Looking for ways to put more ‘care’ into your self-care game? We’ve got 21 tips to help you!

1. There’s no perfect or right way to practise self-care

The first tip, and I can’t stress this enough, is there’s no perfect or right way to practise self-care. Sure, we can talk about the International Self-Care Foundation’s seven pillars, and we can push exercise, healthy eating and hand washing until the cows come home 🐄 🐄 🐄. But, if those things don’t resonate with you, or you have other pressing issues vying for your attention (e.g. dealing with a case of painsomnia), you’re not going to care about our messaging on those topics. Or, at least not at the moment.

2. Choose your own adventure

This leads us to tip number two. Self-care is like a ‘choose your own adventure’ story. It’s unique to you, your life, your specific set of circumstances and your choices.

3. Create your toolbox

Knowing the basic elements or tools of self-care (see the seven pillars) means you can choose what you need to help you manage at specific times. It’s like having a trusty toolbox filled to the brim with info about exercise, smoking cessation, healthy recipes, pain management strategies, guided imagery scripts and massage oil. You can pick and choose what you want or need. The key is knowing what’s available and how they can help you.

So far, we’ve been talking broadly about self-care. Now let’s look at some more specific tips our consumers and staff recommend.

4. Drink water

It lubricates and cushions your joints, aids digestion, prevents constipation, keeps your temperature normal and helps maintain your blood pressure. The amount of water you need varies from person to person and from day to day. There’s no ‘one size fits all’, but “as a general rule, men need about 10 cups of fluids every day and women need about 8 cups (add another cup a day if you are pregnant or breastfeeding)”. (1)

5. Plan your menu

You can take a lot of the stress out of your day if you sit and plan your week’s meals and snacks. Check what ingredients you have in your pantry, fridge and freezer, work out what you need to buy, and write it all down. Then all you hopefully need is one trip to the shops, and you’re sorted! No more – ‘what’s for dinner’ angst. 😐 Eatforhealth.gov.au has some info on meal planning and sample plans for men, women and children.

6. Get excited about exercise

Mix up your exercise routine with something fun and enjoyable to get you out of your exercise rut. Try Zumba, cardio, low-impact exercises, tennis, dancing, skipping, cycling, or trampolining. Head to your local fitness centre or gym, try an online class or download an app like Get Active Victoria. There’s something for everyone!

7. Just breathe

Our breathing can become shallow when we feel stressed, anxious, upset or in pain. This, in turn, can elevate blood pressure and increase the heart rate. It can also cause more tension. When you notice this happening, take some time to decompress. Relax your body. Focus on your breathing. Slowly take a deep breath in. Fill your lungs to a capacity that’s comfortable for you. Then slowly release this breath. Don’t release it in a sudden exhale, but control it, so it’s slow and smooth. Continue this deep breathing, and you’ll feel your muscles relax, and your mind calm.

8. Write it down

Write about the things that make you happy and grateful. Write about the things that went well in your day.

And write about the bad things. Not so you’ll continue to obsess about them, but so you can process your feelings and actions. This reflection allows you to devise strategies to prevent the bad thing from happening again, or ways to handle it differently in the future.

9. Fill your home with plants

Bring the outdoors in and enjoy the health benefits. Having plants in your indoor spaces can help relieve stress, improve mood, lower blood pressure and improve air quality. Just be sure to check that they’re not toxic for you, your family or your furry housemates. 🌼

10. Have a regular date night

Whether with your significant other or a bestie, having a regular date night scheduled gives you something to look forward to. It also means there’s less chance that other commitments get in the way of you spending dedicated time with that person, which is essential for nurturing your relationship. 🧡💚💛

11. Say no

We all want to please others, so saying no can be challenging. But you need to weigh up everything you have going on and decide whether you can take on something else. If you can’t, then say no. And don’t feel you have to apologise for doing so.

12. Discover new places

Embrace your inner adventurer and explore new places. Far or near – it doesn’t matter. The point is to get out in the world and experience new sights, sounds, smells and tastes. Immerse yourself in new experiences.

13. Listen to music

Music is a powerful force we often don’t think about – or at least not too deeply. It’s always there, often in the background. But music can improve your mood, help you focus, get motivated and even ease your pain. Find out more about the power of music.

14. Pat your pets

Spending time with your pets is a wonderful tonic. It can decrease blood pressure, reduce feelings of loneliness, reduce stress, improve your mood and increase opportunities for exercise and outdoor activities. And they’re so much fun! 🐶😺

15. Get tidy and organised

Nothing can make you frazzled faster than not being able to find that ‘thing’ you’re looking for. So taking time to put things away in their place after you’ve used them, or reorganising your cupboard/pantry/child’s room, so that things are orderly and easy to find can bring a lot of calm to your life. The level of order you want to achieve is up to you. Although there are MANY social posts about the perfectly organised home, don’t fall down that rabbit hole. All you need to achieve is a space that makes you feel good and suits your lifestyle.

16. Eat mindfully

How often have you eaten dinner but can’t remember what it tasted like because you were watching TV? Or wondered how on earth you ate a whole packet of potato chips while scrolling through Insta? If this sounds familiar, try some mindfulness. You may have tried mindfulness meditation, but you can also be mindful when you do other activities, like eating. It simply means that you focus on the moment and the activity without being distracted. So when you’re eating, really take time to focus on the textures, smells and flavours and how the food makes you feel.

17. Get your meds sorted

Medicines are an important part of our self-care, but it’s easy to miss doses, get them mixed up with others meds or take them at the wrong time. So have a chat with your pharmacist. Ask questions about your medicines and supplements, so you’re fully informed about each one.

Many pharmacies have apps you can download that alert you when you need a new script, or you can download the MedicineWise app from NPS. If you take lots of medicines, or you find it hard to keep track of whether you’ve taken them or not, consider using a pill dispenser. You can buy one and fill it yourself, or your pharmacist can do this for you.

18. Listen to your body

Living with a chronic condition means that you need to be self-aware of how you’re feeling. If you’re exhausted, rest. If your back’s stiff, move. If you’re feeling sluggish, get some fresh air. If you’re feeling full, stop eating. Whatever your body is telling you, listen and take action.

19. Treat yourself

Many self-care posts we see on socials are very much of the ‘treat yo’ self’ variety. Going to a day spa, enjoying decadent foods, doing some online shopping, getting a pedicure, binging a favourite TV series, or travelling to exotic places. And why not? Why not indulge in pleasurable things that make you happy every now and again? As long as you’re not overindulging, overspending or overeating. Find the right balance and treat yourself. 😍

20. Stand up

We spend so much of our time sitting. In the car, on the couch, at the office, in waiting rooms. But we know that too much sitting can be bad for our health. It increases the risk of developing heart disease, type 2 diabetes and some forms of cancer. It also makes us feel tired, and our muscles and joints become stiff and sore from inactivity. So stand up and move regularly. Set alerts on your phone to remind you. Or download the Baker Heart and Diabetes Institute Rise & Recharge app, which helps reduce sitting time and encourages regular movement.

21. Play

We loved to play when we were kids. Chasing each other, making up games, not overthinking things and just having fun. But as adults, we become too busy for play. Or we feel silly or self-conscious about how we might appear when we play. But playing is fun! It helps us forget about our work and commitments. It lets us be in the moment and let our inhibitions go. Play relieves stress and allows us to be creative and imaginative. So rediscover playing – with your kids, pets, partner, and friends. Let your inner child loose, play and have fun! Rediscover chasey (the dogs love that one), play hide and seek, build a blanket fort in your lounge, throw a Frisbee, play charades, the floor is lava, or a video game tournament. There are no rules – just have fun!

Contact our free national Help Line

More to explore

Breathing to reduce stress
Better Health Channel
Get a houseplant, reap the health rewards
The Sydney Morning Herald
How to add more play to your grown-up life, even now
New York Times
How to treat yo’ self and others, too
University of Colorado Boulder
Self-love and self-care: What chronic illness taught me about both
Creaky Joints
Why you should add writing to your self-care routine
American College of Healthcare Sciences

Reference

(1) Drinking water and your health, Healthdirect

Lisa Bywaters

07/Jul/2022

Pilates, yoga, and tai chi

How’s your exercise routine going? Are you doing the amount of activity recommended in the Australian physical activity and exercise guidelines?

As a reminder, the guidelines say that adults should be active most days, preferably every day.

Each week, adults should do either:

2.5 to 5 hours of moderate-intensity physical activity – e.g. a brisk walk, golf, mowing the lawn or swimming
1.25 to 2.5 hours of vigorous-intensity physical activity – e.g. jogging, aerobics, fast cycling, soccer or netball
an equivalent combination of moderate and vigorous activities.(1)

I know I’m meeting these recommendations, but like me, are you finding that exercise has become a little dull? Has your exercise routine been reduced (because of COVID fears and restrictions 😷) to simply walking? Lots and lots of walking 🚶 🚶 🚶?

Although I love a good walk, it isn’t working my body as much as it needs to be worked for optimal health and wellbeing. So while I’ll continue doing it, it’s time to add something new … something that will also improve my fitness, stamina, balance and flexibility.

And now’s the perfect time. Even though it’s cold and wintery, many of these exercises can be done indoors, where it’s cosy and warm.

Before we go any further, what are low-impact cardio exercises?

Simply put, low-impact exercises or activities are easy on your joints. They put little or no impact on them – hence ‘low-impact’. Examples include swimming, cycling, tai chi and yoga. While doing these exercises, you’re putting minimal stress, weight, or pressure on your joints.

Compare these activities to more intense ones such as running, basketball or tennis. They aren’t low-impact because your joints are being jarred or impacted by the activity. For example, your hips, knees and feet feel the impact when you run, and your arm, shoulder and wrist feel the jarring as your return a tennis volley.

The ‘cardio’ aspect means that while you’re being kind to your joints, you’re still getting a workout. Cardio exercises increase your heart rate and improve the health of your heart and lungs (or your cardiovascular system).

What are the benefits of low-impact cardio exercises?

These exercises allow you to stretch and strengthen your muscles without putting your joints through too much stress. They’re also a great place to start if you’re a beginner, haven’t exercised in a while, or you’re recovering from an injury.

Low-impact exercises can also improve flexibility, mobility and help relieve joint pain and stiffness. Because you’re getting a solid workout, the exercise builds endurance and stamina, aids weight loss, helps reduce your risk of other health problems (e.g. diabetes) and can improve your sleep quality.

Regular exercise improves your mood and mental health. It also improves your balance and can reduce your risk of falls, which is essential if you have osteoporosis or are at risk of poor bone health.

Let’s look at a few low-impact exercises that will provide a good workout but, when performed correctly, won’t aggravate musculoskeletal conditions.

Tai chi

Tai chi is an ancient form of martial art originating in China. It’s evolved over centuries into what’s been called ‘moving meditation’ because it combines gentle, flowing movements with mindfulness and deep breathing.
It’s a low-impact, slow-motion exercise with specific controlled movements. When doing tai chi, your muscles are relaxed rather than tensed, and your joints aren’t fully extended or bent.

There are many forms of tai chi, and some have been modified to suit people with various health conditions, including arthritis and osteoporosis.

Tai chi promotes correct body posture and balance, improves flexibility and integrates the body and mind. It’s practised by people of all ages and fitness levels.

You can learn tai chi online or from books or DVDs, but most people find it easier to learn from a qualified instructor. They’ll ensure you’re performing the movements correctly and safely.

The Tai Chi for Health website has a search function to help you find a qualified tai chi instructor in your area.

Online recordings, books and DVDs are useful to help you practice between classes. Your instructor will be able to recommend some websites and titles.

Yoga

Like tai chi, yoga incorporates mind, body and breath. Yoga originated in India over 5,000 years ago. Since then, it’s become incredibly popular around the globe.

It’s so popular that it’s all over Insta, TikTok, Facebook and YouTube. But take what you see on these platforms with a grain of salt. They often show us the extremes of yoga – fit and flexible people bent and twisted into challenging poses. This can be a little off-putting 😮!

The good news is there are many different types of yoga to suit all needs and interests. There are even types of yoga that have been modified so that you can use a chair, a block or other aids to help you do the postures without straining your joints or aggravating your condition. So if you’re interested in trying yoga, you’re sure to find a type that suits you.

Search the Yoga Australia website for a qualified yoga teacher. When making contact with them, ask about the type of yoga they teach, whether it’s suitable for people with your condition (and any other health conditions you have) and if they’ve successfully taught people with your condition before.

Pilates

Pilates was developed in the 1920s by German physical trainer Joseph Pilates. It focuses on postural alignment, strengthening the trunk (your abdominals, hips, inner and outer thighs, and back), body awareness and breath control. Initially, it was dancers, athletes and soldiers who used Pilates to strengthen their bodies and recover from injury.

However, it didn’t take long for Pilates to become popular amongst the wider community. Pilates’ slow, controlled movements are suitable for people of all ages, fitness levels and abilities.

Pilates can be performed on a mat or using special equipment (e.g. the Reformer) in a Pilates studio. The difference is that mat Pilates uses only your body weight and gravity as resistance, whereas the equipment involves springs, ropes, and straps for added resistance. Depending on your needs and preferences, you can choose to do Pilates on a mat at home or in a class environment, or in a studio using equipment. Or you can do both, as Joseph Pilates intended.

Ensure you see a qualified instructor who can teach you how to perform each exercise correctly and safely.

You can find a Pilates instructor via the Pilates Alliance Australasia or the Australian Pilates Method Association.

Health insurance

In 2019, the Australian Government made changes to private health insurance. Many natural therapies are no longer covered by your extras, including Pilates*, tai chi, and yoga.

With no rebate available, this will affect your out-of-pocket costs, so when making inquiries about classes or sessions, ask for prices 💰.

*Note: Clinical Pilates, delivered by a physiotherapist, is covered under physiotherapy care as part of your extras cover without any changes.

Starting classes

If you decide to try Pilates, yoga and/or tai chi, there are a few things you should do:

Talk with your doctor about whether these exercises are suitable for you. Discuss any potential benefits and risks.
When inquiring about classes, ask if your instructor is qualified and if they’ve worked with people with musculoskeletal conditions.
Ask how much the classes/sessions cost and how often you need to attend.
Don’t rush through the warm-up and cool-down – they’re important for preventing injury and pain.
Focus on your movements and technique to ensure you’re exercising correctly and safely.
Listen to your body. Some pain is expected when you begin exercising your body in a new way, but it shouldn’t be severe. Stop the exercise and discuss it with your instructor if you feel unusual pain. You may be performing the exercise incorrectly, or need to modify it to suit you.

Contact our free national Help Line

More to explore

Arthritis Pilates video workout
National Health Service (NHS)
How can strengthening and stretching help your arthritis?
Versus Arthritis
Meditation, t’ai chi and yoga
Versus Arthritis
Tai chi: What you need to know
National Center for Complementary and Integrative Health, National Institutes of Health
The right exercise mix
Arthritis Society
Why are yoga and tai chi beneficial for our bodies and minds?
Versus Arthritis
Yoga and pain
painHEALTH
Yoga benefits for arthritis
Arthritis Foundation

Reference

(1) Physical activity and exercise guidelines for all Australians: For adults (18 to 64 years)
Australian Government, Department of Health and Aged Care

Lisa Bywaters

07/Jul/2022

Guest blog by hand therapist Catherine Reid, B.App. Sci, (OT), M.Sci (H&UL rehab), MAHTA (As awarded by the AHTA), CHT

The advent of COVID has seen many more people riding their bikes, either for exercise or for their daily commute. It’s a great exercise for the heart and lungs and a low-impact exercise for people with musculoskeletal conditions.

In recognition of the health and environmental benefits of riding a bike, the United Nations declared June 3rd to be World Bicycle Day. Unfortunately, as a hand therapist, I frequently hear patients complain that hand and upper limb pain or weakness limits their ability to ride.

Hand therapists are experts in rehabilitating the upper limb. We understand anatomy and how it relates to everyday activities. We can help determine what’s causing the problem, if it’s due to an injury, illness or activity, and provide appropriate treatment.

Some pain experienced when riding a bike may be due to vibration transmitted up through the bike into the arms or due to the prolonged time or force with which the handlebars are gripped.

If you love to ride but find it a bit painful, here are my top 10 tips for protecting your hands and upper limbs while riding. The best place to start is from the ground up.

1. Tyres

If you’ve ever ridden a bike or billy cart with solids tyres rather than rubber, air-filled, pneumatic tyres, you know what a difference a little air and rubber can make!

Yet even with pneumatic tyres, vibrations or jolting through the handlebars can be painful for people with arthritis or joint injury. Ensuring the tyres on your bike are properly inflated can help reduce stress going up through the arms and into your body. The current thinking in the biking world is that wider tyres with less pressure offer better rolling resistance and comfort.

Wheels for bikes can also vary in stiffness depending on the design and the material they’re made from, so some are better at absorbing shock than others.

2. The frame

If you plan to explore the world and take your bike with you, you need to consider the weight of your bike. Is the weight manageable for you?

And when choosing a bike rack, one mounted on the back of the car might be an easier option than lifting your bike over your head onto the roof of a car. Lower lifts reduce the strain on sore or stiff shoulders.

Carbon fibre and titanium bikes are much lighter than traditional steel-framed bikes but come at a cost.

Another consideration is that the further away your seat is from the handlebars, the more of your weight your arms will be supporting.

3. Shock absorbers

The front fork of a bike can have shock absorbers that reduce the force going up into your arms from uneven terrain while keeping the tyres in contact with the ground for better control. They can be easily adjusted to provide more or less bounce.

4. Stem flexibility

The stem attaches the handlebars to the bike, and the modern stems have pivots, elastomers and moving parts to provide suspension. They may be as effective at smoothing the force from rough terrain as the fork suspension but may be a cheaper option to retrofit to a bike.

5. Handlebar shape

There’s a huge variety of handlebar shapes, which roughly fall into three categories: swept back, drop or flat handlebars. Some of the handlebars offer several different grip positions enabling the rider to vary their grip.

For example, the drop bars enable the rider to use three different positions

the hooks, the part that curves or drops down, taking most of the weight through the hand;
the hoods are the rubber covers around the hinges of the levers. For smaller hands, it might be more comfortable holding the levers here, but there’s some loss of strength as the grip is near the hinge and not the end of the lever;
the third place you can hold a drop bar is on the top of the bar. This gives the rider a more upright position and places the hands in a palm down position, but this is a less anatomically friendly position for the wrist. Placing hands in a palm down position also puts pressure on the nerves in the palm of the hand, which can cause compression neuropathies such as carpal tunnel syndrome or cyclist’s palsy. Carpal tunnel syndrome affects the thumb side of the hand, while Bicycler’s neuropathy affects the little finger side; both conditions cause numbness and tingling in the hand.

6. Handlebar rise and sweep

Handlebar rise is the vertical rise measured from the centre of the bar to the bar end. The handlebar height can be adjusted by raising the stem or by increasing the rise of the handlebars. Increasing the rise changes the body position of the rider to a more upright position, meaning more weight is placed through the saddle, and less weight is placed through the shoulders, wrists and hands. Handlebars can have an upsweep and a backsweep. Sweep is the angle from the stem to the end of the bar either in an upward angle (upsweep) or in a backward angle (backsweep). More upsweep generally places more pressure on the hands, wrist and shoulders, whereas more backsweep places the wrists in a more natural (palms facing) position.

7. Handlebar material

The material the handlebars are made of can affect their ability to reduce or dampen the forces going through them. Carbon fibre and aluminium dampen vibrations better; however, steel and titanium flex. A little bit of flex in a handlebar is a good thing as it absorbs some of the force from bumps in the road.

There’s also a line of handlebars that have a foam-filled core to deaden the vibration through the core.

8. Grips and tapes

Larger grips generally distribute the weight more evenly through the hand. There are lots of commercially available grips, and many can be retrofitted to your bike.

Some change a flat handlebar to provide a vertical grip as well, allowing for a change of hand, wrist and elbow position. This can help reduce hand stiffness and provide rest from pressure on a particular joint or nerve. Tapes can either be gel or cork. The advantage of cork tapes over gel is that they don’t compress over high-pressure areas and are generally more durable.

9. Gloves

Gloves offer added protection from blisters and falls and improve grip. Glove fit should be firm so they don’t bunch up and cause pressure areas. They should also fit firmly around the cuff so water can’t leak in when it’s raining.

Keeping hands warm with waterproof or thermal gloves helps maintain hand dexterity, especially for arthritic hands. Lightweight, breathable summer gloves with wicking ability may be helpful to reduce sweaty palms, which reduce grip.

Some gloves have padding to reduce vibration, which irritates the nerves of the hand, or silicon tips or open tips to improve touch.

Gloves can provide skin protection in the case of a fall or protection for mountain bikers with inbuilt carbon fibre inserts to protect the backs of the hands from trees.

10. Gears and brakes

Traditionally gears fall into 3 categories:

Twist or grip shifters,
Trigger shifters, or
Shimano Total Integration (STI) brake lever shifters.

More recently, digital computerised gear mechanisms have been introduced. They require very little resistance to use, but unfortunately, they’re expensive to retrofit to your bike.

Twist shifters can only be fitted onto straight handlebars and are controlled by rotating the wrist. They’re easier on the fingers and the thumb as wrist motion is used to control the gears. So if you have painful fingers or reduced dexterity, twist gears might be advisable. Twist shifters are known to become stiffer over time, which might put undue strain on the wrist. They also require frequent repositioning of the wrist.

Trigger shifters generally require little force and can be activated with different fingers. To shift gears, the top lever is moved with the fingers, and the bottom lever is moved with the thumb. The benefit of trigger shifters is that the wrist stays in a neutral position. This is helpful if you have tennis elbow as it reduces strain in the muscles at the elbow joint.

STI Brake lever shifters are a combination of the gear shifter and the brake lever on the one fitting. This allows the rider to shift gears without moving their hand from the bars. They’re generally found on touring or racing bikes and can be activated while holding the hoods. They require minimal force to use.

Brakes can either be hydraulic or cable brakes.

Hydraulic brakes are preferable if you have upper limb problems as they take far less force to use. The back pedal (coaster) brakes are less common these days and are generally found on cruiser bikes or kids bikes. They’re worth considering if you have poor eye-hand coordination or poor hand strength. If the levers are too far out from the bars, people with smaller hands have difficulty reaching their fingers around the brake levers, making it difficult to grip forcefully. This can be adjusted with small rubber inserts placed at the hinge end of the brake lever.

Getting your bike tailored to meet your specific needs may just require some minor changes to your existing bike. But sometimes, purchasing a new bike can be more cost-effective. Remember, changing any part of your bike will affect your bike’s fit and may affect your bike’s handling. It’s worth getting your existing bike correctly fitted to you before making too many expensive changes.

If changing your bike isn’t helping, then you need to see a hand therapist to evaluate the cause of the pain and, if needed, provide upper limb exercises, treatments or supportive splints to enable you to keep riding. A hand therapist in your local area can be found on the Australian Hand Therapy website.

Our guest blogger Catherine Reid is an occupational therapist with a Master of Science in Hand and Upper Limb Rehabilitation. She’s a full member of the Australian Hand Therapy Association and works in her private practice Western District Hand Therapy, in Warrnambool, Victoria.

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More to explore

The joy of cycling
Musculoskeletal Australia

Lisa Bywaters

07/Jul/2022

It’s definitely a mouthful, but what is axial spondyloarthritis?

Axial spondyloarthritis (axSpA) is the umbrella term for two different types of inflammatory arthritis that affect the spine: ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA)

Ankylosing spondylitis (AS) affects the spine and the joints that connect the lower spine to the pelvis (sacroiliac joints). These changes are visible on x-ray.

In non-radiographic axial spondyloarthritis (nr-axSpA), these changes aren’t yet visible on an x-ray but may be seen on an MRI. For some people, nr-axSpA will never progress to the stage where joint changes are seen on x-ray. For others, these changes will eventually be seen on an x-ray, and their diagnosis will be changed to AS.

These conditions cause pain, stiffness and reduced mobility in your spine. They can also cause symptoms including inflammation of tendons and ligaments, inflammatory bowel disease, psoriasis and inflammation of the eye.

The good news is that axSpA can be treated effectively with medicine and self-care.

Q. What are the signs that I may have axial spondyloarthritis?
A. The signs or symptoms of axial spondyloarthritis vary from person to person. The most common symptoms are pain and stiffness in the back, often the lower back and into the buttocks that:

comes on gradually over weeks or months
is worse in the second half of the night and wakes you up
is worse first thing in the morning, with early morning stiffness that lasts 30 minutes or more
is worse after rest and feels better after activity and exercise
has been present for 3 months or more
may involve pain deep in the buttock that can swap from one side to the other over time, especially in the early stages (doctors call this ‘alternating buttock pain’).

Other symptoms can include:

fatigue (extreme tiredness)
inflammation and pain in tendons (which connect muscles to bones) and ligaments (which connect bones to each other), which you may feel as pain in the front of your chest, back of your heel or underneath your foot
arthritis in one or more of your peripheral joints – such as the joints in your hands, feet, arms or legs
inflammation in your eye (uveitis)
inflammatory bowel disease
psoriasis
feeling feverish and having night sweats
losing your appetite and losing weight.

Symptoms may change from day to day. At times your symptoms (e.g. pain, fatigue, inflammation) can become more intense. This is a flare. Flares are unpredictable and can seem to come out of nowhere.

Q. What causes axial spondyloarthritis?
A. Axial spondyloarthritis is an autoimmune disease. That means it occurs as a result of a faulty immune system.

Instead of identifying foreign bodies (e.g. bacteria, viruses) and attacking them to keep you healthy, your immune system mistakenly targets healthy tissue in and around your joints, causing inflammation and pain.

We don’t know why this happens. Genes are thought to play a role. You’re more likely to get axSpA if you have a history of it in your family. Most people with axSpA have the gene called HLA-B27; however, this gene can also be found in people who don’t have axSpA.

Since this gene doesn’t automatically lead to the development of axSpA, other factors are thought to be involved.

We used to think axSpA affected more men than women, but recent research suggests men and women are affected relatively equally.

Q. How do I know if I have axial spondyloarthritis?
A. If you have ongoing back pain and stiffness or other symptoms of axSpA, it’s essential that you see your GP. Getting a diagnosis as soon as possible means that treatment can start quickly. This will give you the best possible outcomes.

No one test can diagnose axSpA, so your doctor will use a combination of tests to confirm your diagnosis. They may include:

Your medical history. Your doctor will ask about your symptoms, family history and other health issues.
A physical examination to assess joint tenderness, flexibility, and stiffness.
Blood tests to check for inflammation associated with axSpA.
Genetic testing to look for the HLA-B27 gene, which is present in most people with axSpA.
Scans such as an x-ray and MRI (magnetic resonance imaging) to look for joint inflammation and damage.

Your GP will refer you to a rheumatologist if they think you have, or have diagnosed you with axSpA. Rheumatologists are doctors who specialise in diagnosing and treating problems with joints, muscles, bones and the immune system.

Q. How is axial spondyloarthritis treated?
A. Your rheumatologist will recommend and prescribe medicines for your axSpA.

The two main types of medicines used to treat axSpA and help manage its symptoms are NSAIDs and targeted therapies:

Non-steroidal anti-inflammatory drugs (NSAIDs) are nearly always used as the first medicine to treat the pain, inflammation and stiffness of axSpA unless there’s a reason that you can’t take them. Research shows that NSAIDs are very effective in managing symptoms of axSpA. Some people may need to take them regularly, while others will only take them as needed. This will depend on your symptoms and how you respond to the NSAID. Your rheumatologist will talk with you about how often you should take NSAIDs and the long-term benefits and risks of using them. There are many different types and brands; some are available over-the-counter, while others are only available on prescription.
Targeted therapies are medicines that ‘target’ specific proteins in the immune system that produce inflammation. They include biological disease-modifying anti-rheumatic drugs (biologics), biosimilars and targeted synthetic disease-modifying anti-rheumatic drugs. These targeted treatments have dramatically improved the quality of life for people with axSpA who need more than NSAIDs to manage their condition. They work to control your immune system in a targeted way, slowing down the attack on your spine and joints. Your rheumatologist will talk to you about using these medicines if you need more than NSAIDs to manage your axSpA or you’re unable to take NSAIDs.

Q. What can I do to control my symptoms?
A. As well as taking your medicines as prescribed, there are things you can do.

Learn about your condition. Understanding axSpA allows you to make informed decisions about your healthcare and actively manage it.
Exercise regularly. This is the most important thing you can do to help manage your axSpA. Exercise can improve symptoms including stiffness, pain, fatigue, breathing capacity and posture. It helps increase your flexibility and range of movement, so it’s easier to do many everyday tasks. As soon as possible after receiving your diagnosis, you should ideally begin a personalised exercise program developed by a physio or exercise physiologist (EP) and aim to do some exercise every day. Being active is also essential for your overall health and wellbeing. It helps keep your muscles, bones and joints strong so that you can keep moving. It reduces your risk of developing other conditions such as heart disease, osteoporosis, diabetes and some forms of cancer. It boosts your mood, benefits your mental health, helps with weight control and improves sleep.
Manage your weight. Being overweight or obese increases inflammation throughout your body. This inflammation affects not only your joints but also blood vessels and insulin levels. This can increase your risk of chronic health conditions such as heart disease and diabetes. Losing weight is an important thing you can do to reduce your risk of these conditions and to reduce your axSpA symptoms. Being overweight or obese also limits the effectiveness of some medicines used to treat axSpA. Losing weight can be challenging, so if you need to lose weight or advice on healthy eating, talk with your doctor or dietitian.
Learn ways to manage your pain. Pain is the most common symptom of axSpA, so learning to manage it effectively is crucial. Read our A-Z guide for managing pain for more information.
Work closely with your healthcare team. The best way to live well with axSpA is by working closely with the people in your healthcare team (e.g. GP, rheumatologist, physio). Keep them informed about how you’re doing and if you’ve experienced any changes in your symptoms or tried new medicines, complementary therapies, supplements or other treatments.
Use aids and equipment. Supports such as long-handled shoehorns, reachers and canes can reduce joint strain and make life easier, especially if your condition has reduced your flexibility and mobility. An occupational therapist can advise you on aids, equipment and home modifications. You can also check out our range of aids in our online shop.
Sleep well. Not getting enough quality sleep can worsen your symptoms; however, getting a good night’s sleep when you have axSpA and chronic pain can be difficult. If you’re having problems sleeping, talk with your doctor about ways you can address this.
Manage stress. Stress can also aggravate your symptoms, so learning to deal with stress is extremely helpful. Things you can do to manage stress include planning your day and setting priorities, using relaxation techniques such as going for a walk, getting a massage or listening to music, and, where possible, avoiding people and situations that cause you stress.
Practise mindfulness. Regularly practising mindfulness meditation can improve your mood, relieve stress, improve sleep, improve mental health and reduce pain.
Eat a healthy, balanced diet. While there’s no specific diet for axSpA, it’s important to have a healthy, balanced diet to maintain general health and prevent weight gain and other health problems, such as diabetes and heart disease.
Quit smoking. Smoking cigarettes is not only bad for your general health but also negatively affects your bone health and increases inflammation.
Seek support from others. You might find it helpful to contact Ankylosing Spondylitis Australia or the Ankylosing Spondylitis Group of Victoria and speak to others who have axSpA and know what you’re going through.

Q. Are there any complications I should be aware of?
A. Some people living with axSpA develop an eye problem called uveitis, which causes a painful red eye with blurred vision and sensitivity to light.

If you develop eye symptoms, you’ll need to quickly get your eye checked and treated by an ophthalmologist. Treatment is usually with prescription eye drops, which reduce the chance of permanent eye damage.

By understanding this risk and knowing what signs to be alert for, you can reduce the risk of damage to your eyes.
Ask your GP or rheumatologist what you should do if you develop any eye symptoms.

Q. What about surgery?
A. Most people with axSpA can manage their condition using a combination of exercise, medicines and self-care.

However, surgery may be considered in some cases if treatments haven’t provided relief from symptoms or if you have a spinal fracture or dislocation. Surgery that may be considered includes:

hip arthroplasty (replacement) surgery if you have severe and persistent hip pain
cervical fusion, where bones in the cervical (upper) spine are fused together to treat a fracture or dislocation
wedge osteotomy removes a wedge-shaped piece of bone from a vertebra to allow the spine to be realigned.

If your doctor thinks surgery might be an option, they’ll refer you to an orthopaedic surgeon. Together, you can discuss the benefits and risks of surgery and decide if it’s right for you. If you’re unsure about surgery or don’t feel comfortable with the information from the surgeon, ask your doctor to refer you to another surgeon for a second opinion.