A wellness life-style is not just for people who are already healthy. It's also for people with chronic diseases and disabilities. Limitation is a fact of life and something each of us learn to live with at some level. Limitation makes it even more important to live in a way that maximises our potential for health and quality of life. The limitations imposed by arthritis provide an excellent illustration of this point.

There are over 100 different kinds of arthritis, and the disease affects one in seven people in the U.S. Except for infectious arthritis, which is caused by a specific disease agent, the causes of arthritis are not known. The symptoms vary in severity from day to day and even within a given day. People with arthritis often experience periods of remission. Since no cures are available, arthritis treatment means figuring out the best way to live with it. Education and self-care form the basis of arthritis treatment.

Self-care doesn't mean a person must "go it alone." On the contrary, selfcare means knowing when to get professional help and working with health-care professionals to understand the nature of arthritis and treatment methods. The earlier the arthritis diagnosis, the better, since although there is no cure, medical and life-style treatment can still significantly reduce or delay its progression. The goal of arthritis medical care is to relieve pain, reduce inflammation, and prevent deformity.

Self-care means following the recommendations of health-care professionals and adapting one's life-style to one's physical limitations. The life-style modifications required by people with arthritis vary with the severity of their condition. Many people with arthritis continue to lead very active lives. Billie jean King, the tennis player, is a good example. She has maintained a successful career as a professional player despite five bouts of knee surgery for osteoarthritis.

For people with more severe arthritis, coping with such simple tasks as preparing a meal or cleaning the house can provide real challenges. Some problems have simple solutions, like moving dishes to lower cupboards, using an electric can opener, and eating out more often. Relocating items and rearranging rooms can improve the comfort and safety of the home. People confined to a wheelchair will need to make more elaborate changes in their home environment. Self-care means managing one's resources in order to maximise quality of life.

Physical therapists play an important role in arthritis treatment. They educate the arthritis patient about various pain-relief techniques and therapeutic exercise programs.

Pain-relief techniques include hot and/or cold treatments, joint protection, and rest. Hot treatments include hot baths and showers, hot packs, heat lamps, electric heating pads and mitts, and paraffin wax. Cold treatments include ice packs and compresses. Both can decrease pain and improve joint mobility. Joint protection includes education about joint-sparing body mechanics. For example, people with arthritis in the wrist learn to push open doors with the side of their body, rather than the hand. Joint protection also includes appropriate use of orthopaedic devices such as splints, walkers, and canes to reduce joint stress.

Rest is an important component of arthritis self-care. Prescribed rest may include complete bedrest, or periodic resting of affected joints, and/or stress management relaxation techniques. Emotional rest includes participation in social groups and recreation. Arthritis can be a challenge to quality of life, and living with it requires a good attitude that can transform a potential invalid into an active family and community member.

Being overweight is a risk factor for the development of arthritis, and extra weight increases the stress on arthritic joints. Ten extra pounds on the torso translates into 40 extra pounds of force on the knee when standing. Weight control achieved through a well balanced diet and a moderate exercise program can significantly slow the development of arthritis. Good nutrition is also important for maintaining general good health and well-being, which is as vital for the person with arthritis as it is for anyone else.

For many years, medical scientists believed that osteoarthritis and other forms of arthritis were the result of "wear and tear" on joints and that exercise accelerated joint degeneration. Studies have shown that exercise does not appear to cause arthritis in healthy joints. Repetitive, high-impact movements such as running can speed the progression of arthritis in already damaged joints, however. Unfortunately, because of the confusion that has surrounded the arthritis-exercise issue, many people with arthritis have avoided all but the very mildest forms of exercise. Many people with less severe arthritis have unnecessarily restricted aerobic activity for fear it would worsen the disease. But a lack of physical activity actually accelerates joint degeneration and worsens arthritis symptoms. A sedentary life-style leads to loss of muscle strength and low fitness levels, which make movement even more painful and difficult, leading to further restrictions in activity, and an even greater decline in fitness. When muscles and joints atrophy, the resulting weakness makes joints even more unstable. Recent studies have demonstrated that aerobic activities, especially those that support body weight such as cycling and swimming, can be appropriate for people with osteoarthritis and rheumatoid arthritis who have fairly good joint mobility; can increase aerobic capacity, muscle strength, and functional status; and can improve pain tolerance, mood, and quality of life.

Physical therapists help educate arthritis patients about therapeutic exercises for the maintenance of joint function. These typically include range-of-motion (ROM) exercises to increase joint mobility and resistance exercises to increase the strength of muscles, tendons, ligaments, and other tissues that are part of the joint structure. Many physical therapists recommend exercises performed with elastic tubes to provide resistance. Flexibility and strength help protect joints from stress.

Arthritis self-care means learning to balance exercise and rest. Too much exercise can lead to pain and inflammation, while too much rest can cause joint stiffness. Exercise must often be done in very small amounts several times during the day if arthritis is severe. If pain persists for an hour or more after exercise, the patient has overdone it and must reduce activity to a lower level.