By Chris Cunningham
Alternative ways of working, and devices that help you develop those alternatives, can have a double benefit. They may help prevent a fibro-flare now-and they may lay the groundwork for feeling better long-term.
PEOPLE WHO SUFFER FROM FM and other chronic pain conditions are more easily fatigued by housekeeping, yard work, and driving, even the smallest of modifications can reduce fatigue. Switching to half-gallon containers of milk or dragging the vacuum cleaner backwards, rather than pushing it, save energy and prevent strain, says Allison Green, an occupational therapist with the University of Michigan Health System. “People in chronic pain don’t have the luxury of pushing beyond their limits.”
As Green puts it, seemingly modest adaptations, in conjunction with muscle rebalancing and problem solving, “will usually go a long way to improve the way patients manage their symptoms.”
Any little change that lessens the impact on the body will make a big difference over time.
Then the trauma will start to heal in that area.
During an evaluation, Green observes the patient’s movements and assesses the reaction of the musculoskeletal structure. For example, she says, A forward shoulder position like that used to push a grocery cart will put pressure on the nerves, in which case, the patient’s reaching patterns will need retraining to reduce the pain.
Next time you go to the grocery store, “think big” before pushing the shopping cart and picking up that bag of groceries, she suggests. Rather than using your hands, “try to use bigger (arm muscle) areas when you can. This protects the joints.”
Green says that if patients’ “reach patterns” are not healthy, adding an adaptive device into their routine may not necessarily correct the problem. “We’re looking at [healthy] responses that will last a lifetime,” she says. “Adaptive devices cannot make up for good body mechanics.”
But they can help, and they don’t have to be “strictly medical,” either. “Soft touch scissors and electric can openers [can] make a big difference,” she remarks.
FORGET, NO PAIN NO GAIN: Aaron Shaw, OTR, a Certified Hand Therapist in Harborview Medical System’s Hand Therapy Clinic in Seattle, Wash., stresses the importance of exercise in maintaining one’s ability to perform chores. He says that slowly moving each joint through a comfortable range of motion nourishes the joints and maintains elasticity in the muscles, ligaments, and tendons. But he also cautions that trying to push through the pain “to get a ‘good stretch,’ will likely cause a pain response that will, in turn, increase stiffness and loss of function.”
He gives three examples of good body mechanics: “Keeping items close to your body while carrying them will reduce the strain on your back and arms. [Similarly,] squatting down by bending your knees will be less stressful on the back than bending at the waist and keeping the legs straight. And keeping the feet far enough apart to be slightly greater than shoulder width will provide a good base of support while lifting.”
When gardening, Shaw encourages sitting instead of standing, and pushing instead of carrying. “If something needs to be moved, consider whether it can be pushed on a cart or slid along the counter or table. Incorporating these energy conservation techniques across as many activities as possible will reduce the physical stress that can lead to increased pain.”
Keeping a daily diary, noting the pain caused by different activities, will show people with FM which actions increase pain and therefore require physical modifications, adaptive tools, or more frequent breaks. Resting frequently throughout activities, Shaw adds, will “enable a person to work longer with less pain.”
And since those in chronic pain can only do so much without increasing that pain, Shaw says, “Ask yourself if you need to save that energy for cooking, cleaning, or working in the garden, or if you need a full day to rest in preparation for tomorrow’s plans.”
Rona Silverstein, OTR, with the Outpatient Rehabilitation Service Department at the University of California, Los Angeles, work with adults who experience neurological and rheumatological conditions and low vision problems.
Like Shaw, Silverstein is a strong proponent of energy-saving tactics, recommending four general strategies for maintaining the home and the yard: planning, pacing, prioritizing, and organizing.
Consider your energy reserves and be careful not to “over-spend,” she suggests. For example, a “morning person probably shouldn’t plan to do chores late in the day. Do the chores that take lots of energy when you have the most energy reserves available.”
EVEN THE SMALLEST OF MODIFICATION CAN HELP FATIGUE: People with FM should pace themselves “by alternating activity with rest periods, and dividing large tasks into smaller, more manageable ones,” she says. “Cleaning the kitchen may be a huge task, but cleaning out a couple of cabinet shelves may be more manageable.”
Silverstein says, “Prioritize at the start of each day. See what needs your attention, and what can be delayed until the next day, if necessary.”
Organizing helps reduce the amount of energy spent. Keep the cleaning supplies for the kitchen in the kitchen and bathroom cleansers in the bathroom to help eliminate walking back and forth to gather items. Toss out or recycle junk mail immediately to eliminate the stacks of papers that tend to accumulate inside the home.”
For outdoor chores, Silverstein adds, good body mechanics–particularly for the back–can diminish the pain . Some tried-and-true ways for reducing back pain include: holding heavy objects close to the body, bending at the knees, and avoiding twisting.
Occupational therapists look at activities from an ergonomic viewpoint too, Silverstein says. “For example, keeping one’s wrists in a more comfortable grips is easier on the joints and muscles and can reduce the strain on the body.”
MAKING ADAPTATION SMALL AND LARGE: Silverstein says OTs understand that people with fibromyalgia and chronic pain must contend with both physical pain and the way the physical pain affects their mental and emotional health. Along with “having to manage their own thoughts and beliefs about their condition, they also are dealing with the attitude of others. It is a tremendous burden at times.”
She says OTs can provide specific therapy and exercises to help ameliorate hand, shoulder, and neck pain problems. They can also create custom splints to reduce stress on tendons. “If your job or home activities are increasing neck, back, or arm pain, an occupational therapist can watch you at work and make specific recommendations for reducing the strain on your body. “She adds that anyone seeking the services of an OT must first obtain a prescription from a physician.
Just as important, OTs can teach their patients strategies to cope with stress and pain management. “The better the coping skills are, the better the attitude,” Silverstein says.
Green adds that OTs are every bit as concerned about the patient’s emotional health as physical health. “There’s the psychological piece [of asking], ‘How is she dealing with the [pain]?'” Green explains. On the other hand, she finds that patients benefit immensely from looking outside rather than inside to remove impediments that might be contributing to their pain. So, Green continues, “There’s the other piece: ‘I’m in charge, [and] I can make this work for me.'”
And as Green has observed time and again, “Just knowing there is the possibility of improving will change the way the person looks at pain.”
* DEVICES CAN MAKE A DIFFERENCE
- Try these OT-recommended products and tips around the house and garden.
- Kitchen gadgets and utensils with built-up handles.
- Wheeled trivets for sliding heavy pots or dishes along the counter
- Kitchen carts to move items around
- Stools in the kitchen to sit on while cooking
- Electric jar openers
- Reacher’s” to retrieve items above and below the counter
- Milk cartons with holders and handles
- Long-handled dustpans eliminate bending
- Shopping carts decrease the need for carrying packages
- Electric can-openers, blenders, and food processors reduce strain on hands and arms
- Dishwashers reduce effort of washing dishes by hand
- Dishpans to soak dirty dishes and help eliminate scrubbing
- Seat positioning devices, such as swivel car seat or a lumber back support, diminish strain
- Seat belt handles make fastening easier
- Key turners and gas cap turners reduce wrist action
- Small pushcarts lessen the pain and strain caused by heavy lifting
- Padded kneelers and seats in the garden offer extra protection
- Garden tools with ergonomic handles reduce need for gripping
- Stools on same ground-level as plants reduce bending
- Long-handled pruners prevent over-reaching
- Rolling cart to move heavy items decreases need for lifting
- Work areas where all tools are within reach reduce walking