Pain-Free Living

Working With an Occupational Therapist

by Nancy Callinan, M.A., O.T.R., C.H.T.

If stiff or painful joints, recent surgery, or illness or injuries prevent you from carrying out your day-to-day activities, you may be a candidate for occupational therapy. An occupational therapist (OT) is trained to assist you with your “occupation.” Occupation in this sense refers broadly to those duties and activities that you perform on a regular basis, at home, at work, and during your leisure and recreational time. You may be a homemaker, office worker, mother, musician, gardener, or cook. Pain or lack of strength or mobility may make it difficult or impossible for you to do seemingly simple tasks such as getting dressed, opening jars, holding tools, or reaching keys on a piano or a computer keyboard. Whatever the case, an OT is trained to address your particular needs and assist you in overcoming and adapting to physical limitations so that you can do things for yourself.

Who is an OT?

To become a registered occupational therapist (OTR), an individual must first complete a master’s or doctoral degree in occupational therapy. The specialized training includes study of anatomy, biomechanics, and disease processes. The individual must also have clinical experience — that is, experience working with patients — and must pass a national certification examination. An occupational therapist may also earn advanced certification in hand therapy (CHT).

How can an OT help someone with arthritis?

A systematic review of research on occupational therapy and rheumatoid arthritis (RA) conducted by the Cochrane Database in 2004 found that occupational therapy was effective in improving functional ability in people with RA. Other research shows benefits for individuals with osteoarthritis, fibromyalgia, and other forms of arthritis.

Specific services the occupational therapist may provide for individuals with arthritis include the following:

• Making custom hand splints to rest or support the hands and wrists;
• Designing a program of exercises to maximize strength and flexibility;
• Suggesting strategies to reduce pain, reduce stress on the joints, and prevent deformity;
• Designing or recommending assistive devices or suggesting modifications to tools and utensils that will make it easier to perform daily activities;
• Evaluating an individual’s home or workplace and making specific recommendations so that the individual can perform tasks more easily, maintain independence, and conserve energy;
• Training individuals in strategies that will help them cope with the chronic nature of arthritis well enough to function at a high level;
• Providing splints and a customized therapy program following hand surgery for arthritis.

Which of these services an OT provides for you depends on your needs and your goals. Before deciding on a particular treatment plan, the therapist will assess your physical condition, including which joints are affected and where and when you feel pain. The therapist will also ask you many questions about your daily activities in order to figure out particular problems and to understand what is important to you. To give you an idea of how all this works in practice, here are the stories of four people with arthritis who achieved their goals with the help of an occupational therapist. These resources might also help you find more information.

Mary

Mary is a 52-year-old nurse who works in a cardiac procedure room at a large metropolitan hospital. She has two active teenage boys at home, and she enjoys outdoor activities and gardening during her time off. For two years Mary had noticed increasing pain in her right thumb, especially when she was writing, using a syringe, or opening pill bottles at work. She had also noticed that she was feeling pain when she worked in the garden, especially when she was using her garden tools and pulling weeds. She was starting to avoid spending time in her garden. Mary reported the thumb pain to her family physician during her annual physical, x-rays were taken, and she was diagnosed with right thumb basal joint osteoarthritis.

Mary’s doctor referred her to an occupational therapist in a Hand Center affiliated with the hospital where Mary worked. After doing a thorough evaluation of Mary’s hand function, the occupational therapist gave her a custom-made thumb splint to use during painful activities. With the splint on, Mary was able to write and hold items at work with less pain. Because the splint was small and form-fitting, she was able to put sterile gloves on over the splint to use it at work, and she could wear it under gardening gloves at home.

During a second session with the OT, Mary was instructed in a comprehensive home exercise program, including isometric strengthening and mobility exercises for the thumb joint. (Isometric exercises tense the muscles against resistance without moving the joint. They are the best way to strengthen muscles without stressing the joints.) The therapist also had her try a paraffin bath — a small bowl containing a heated mixture of paraffin wax and mineral oil to dip the hand in — prior to exercises. Mary liked the heat of the paraffin bath and found it helped to relieve her hand pain and stiffness, making her hand exercises easier. She thought that the paraffin bath might be helpful to use in the morning before work.

The OT taught Mary some joint protection principles to apply to her job and home activities. Mary learned to respect pain in her thumb and to modify activities that caused her pain. Mary especially liked the pen grips and the built-up handles for gardening tools the OT showed her. Shears with a spring action for easy opening were much easier on her hands, and the padding added to her gardening tools reduced her pain.

After three sessions with the therapist, Mary felt ready to try the splint, exercises, and modifications on her own. She manages her symptoms independently and experiences fewer limitations when doing the activities she enjoys. As the pain in her thumb decreased, she gradually resumed gardening and is now able to enjoy her garden again.

Joe

Joe is a 65-year-old man looking forward to the joys of retirement from his job as a chemical engineer. Until 5 months ago, he was quite active, walking 3–5 miles daily. Then the pain in his left hip caught up with him. Joe had first noticed the pain three years ago. The diagnosis? Osteoarthritis of the left hip. He was hoping to renew his love of golf after his retirement, but the growing hip pain had him worried — he’d reached the point where he couldn’t even walk a block without significant pain.

A month ago, Joe underwent a total hip replacement, which relieved his hip pain considerably. Before his surgery, he attended a class where an occupational therapist taught him how to cope with daily activities following his surgery. (The recovery period after hip replacement surgery usually requires some changes to daily activities.) Following the surgery the OT reviewed dressing techniques with Joe, and within a few days, he was able to put on his pants, shoes, and socks with reaching aids. His son, Jake, came to a postsurgery occupational therapy session with Joe to learn techniques that would allow his dad to use the tub, the toilet, and the car seat and otherwise remain independent at home. The OT made recommendations for assistive devices they could purchase to make the transition easier. These included a raised toilet seat, a shower chair, and a grab bar in the bathroom. Joe left the hospital confident that he could safely manage his daily activities independently at home. He started a regular schedule of walking short distances, and he’s looking forward to the golf outings ahead now that he has his new hip.

Sarah

Sarah is a 29-year-old woman working as an attorney in a busy practice. She enjoys cooking with her husband and exploring new recipes in her free time. She had started working out at a health club after work but hadn’t stayed with it very long. Several months ago she noticed multiple areas of pain and tightness in the muscles of her neck, back, and arms. She had tender points all over her body and was having trouble sleeping. At first she attributed it to her busy schedule and overdoing it at the gym. But when the symptoms persisted after she stopped going to the gym, she saw a rheumatologist. The rheumatologist diagnosed fibromyalgia.

Sarah became so limited by her fatigue and pain that she reduced her hours at work and no longer enjoyed cooking when she came home in the evening. Even holding a knife to cut vegetables in the kitchen was too painful for her. Sarah was frustrated by her lack of energy and the effect it was having in her life. Her doctor referred her to an occupational therapist for help managing her symptoms so that she could resume her activities. The occupational therapist evaluated Sarah’s condition, including her mobility, pain, fatigue, and the difficulty she experienced in her daily activities. The OT designed an exercise program for Sarah. She started with warm-up activities to loosen muscles that were tight, advancing to gentle strengthening exercises Sarah could tolerate without increasing her pain. Sarah also did some aerobic activity every day, which included walking or biking with her husband. Besides teaching Sarah warm-up exercises to begin her exercise routine, the OT taught her how to do self-massage on her tight muscles.

During another session with the OT, Sarah learned strategies for conserving energy during cooking and homemaking activities. She developed a plan that she could use during the week to spread out the heavy and light tasks so she wouldn’t feel so overwhelmed with chores on the weekends. She also learned strategies for simplifying meal preparation and found some kitchen utensils that could reduce her hand pain when she cut vegetables. She especially liked the mandoline slicer that allowed her to cut healthy vegetables for her favorite stir-fry recipe without causing hand pain.

Sarah also learned about ergonomics — the practice of efficient movement — and she made some modifications at her work station by adding armrests on her chair and a wrist rest to make working at her desk more comfortable. The modifications reduced the pain in her neck and shoulders. She also started doing some simple stretches during the workday. Finally, Sarah worked with the OT on stress management strategies to reduce her stress and give her more energy during the day. By using strategies such as breathing techniques, Sarah was able, over time, to increase her hours at work without increasing her stress level. After her sessions with the occupational therapist, Sarah had the tools to independently and effectively manage her fibromyalgia.

Katie

Katie is an active 45-year-old mother of a teenage daughter. Katie works as a clerk at a large department store. Ten years ago, she was diagnosed with rheumatoid arthritis (RA). Recently, Katie developed wrist and hand pain that limited her ability to hang clothing at work and use the computer. She also had difficulty doing simple things like turning on the faucet and opening the gas cap on her car. She used to enjoy cooking and baking with her daughter, but now she had to rely on her daughter to help her with most things because the hand pain limited her ability to use utensils and open jars and packages. When she mentioned her frustrations to her rheumatologist, he referred her to an occupational therapist.

At her first visit, the OT gave Katie a thorough evaluation of her strength, mobility, hand and wrist pain, and function. The OT worked with Katie to identify her main goals in therapy and then developed a plan with Katie to achieve those goals. The OT gave Katie a wrist splint to use during the day and a resting splint for use at night. Katie used the wrist splint for heavy activities at work when she was doing stocking and heavy lifting. She used the resting splints at night to support her wrists and fingers and for additional pain relief.

To maximize Katie’s mobility and strength without causing a flare-up of her pain, the OT instructed Katie in a gentle exercise program. These exercises helped her to loosen up in the morning before starting her busy day. The therapist also taught Katie some strategies to protect her joints, especially during a flare-up. Katie learned to reduce the stress on the small joints of her hand by adapting the way she did things. At work, for example, she started using a rolling cart while putting away returned items, which helped her avoid heavy lifting and carrying. She also started using a reaching hook to hang items on higher hooks on the sales floor.

Katie’s home was another place for modifications recommended by the OT. A jar opener mounted under the kitchen cabinets helped Katie open jars with tight lids. The faucet turner and gas cap grip tool demonstrated by the OT gave Katie independence without hand pain. Using both hands to lift heavy pots and to slide heavy items along the kitchen countertop helped her avoid stress on her hands. The most important goal for Katie was to enjoy cooking and baking with her daughter again. By using the strategies and modifications she learned in occupational therapy, she has been able to resume these activities. Meal preparation is no longer a dreaded chore — it is a time to talk and laugh and connect with her daughter again.

Last Reviewed April 4, 2012

Nancy Callinan is Manager of Hand Therapy at TRIA Orthopaedic Center in Minneapolis, Minnesota.

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