Dealing With a Flare-up

For a person with arthritis, one of the most common problems that interferes with exercise is an arthritic flare-up. The stiffness, joint pain, and inflammation that are the hallmarks of arthritis can vary from day to day. When one or more of these symptoms increases significantly and quickly, you need to adapt your program. Furthermore, during flare-ups your immune system is compromised; if you put additional stress on the system by exercising, your symptoms may become worse or you may become ill.

The first and simplest adaptation is to decrease the intensity and frequency of your exercise regimen. Resistance training puts the greatest amount of stress on joints, so cut back on your strength-training routine. You should also reduce the intensity of your cardiovascular program; I suggest that you use perceived exertion as a way of determining how hard to work and that you exercise in the mild range.

While lowering the intensity of your exercise program, you also need to increase your rest. Earlier I discussed the importance of both general and joint-specific rest. Extended rest during a flare-up allows your body to direct extra energy toward healing, and you will feel better sooner. Eliminating joint-specific activity that increases your pain allows that joint to recover. Remember, the amount of rest you need depends on the severity of your illness. Usually you can continue to do some activity (at reduced intensity), since low-intensity activity helps the immune system and wards off excessive joint stiffness. Complete rest of either type should not last long, or you will lose mobility and strength very quickly.

In addition to modifying your exercise plan, consider using extra protection for your joints. During flare-ups, joints may be unstable, because the tissues surrounding the joints become inflamed. If you cannot modify an activity to decrease stress on the joint, it' s a good idea to splint or brace the joint to protect it from further injury. Chapter 7 discusses ideas for joint protection, ranging from simple devices (such as neoprene sleeves) to complex braces. If you are going to be putting a significant amount of stress on an involved joint, you should discuss options with your physician. A man I know insisted on continuing the downhill skiing season, even though his knee had become extremely swollen, painful, and unstable. Although the ideal solution would have been to give up skiing for the season, he was willing to wear a brace, which gave some protection and reminded him of his joint limitations. At the end of the season he had joint replacement surgery, so that his next ski season would not be affected.

Finally, you can use several modalities to decrease the swelling and pain associated with arthritis. Usually your physician will advise you to take an anti-inflammatory, especially during flare-ups. The use of cold or heat will alleviate some of the pain. In general, use cold when there is noticeable swelling, but it does increase tissue stiffness. Heat may increase inflammation, but it also increases tissue flexibility. Talk to your physician before you use either heat or cold; you should not use them if you have certain circulatory problems.