When you're living with RA, you know all too well the joint pain common in hands, feet, toes, and ankles. Whether the hallmark symptoms strikes your hands or feet— or both — you could turn to any number of solutions for relief. For many, the first line of defense is medications, to fight the inflammation or to ease the pain. Others may rely on heat or ice, while some may give dietary fixes (such as adding omega-3 fats to the menu) a shot.

All of these are viable choices, but there’s still another effective yet underused option: Exercise.

“Stretching and strengthening exercises are very important in maintaining range of motion of joints and keeping surrounding muscles strong, which also protects the joints,” says Kelly Weselman, MD, a rheumatologist with WellStar Medical Group in Smyrna, Georgia.“I frequently advise patients to pursue such programs.”

And research backs it up as well. A review published in 2016 in the British Medical Bulletin found that resistance exercises improved hand function, pain, grip strength and range of motion in people with rheumatoid arthritis. Better yet, combine exercise with another powerful pain-relieving technique — massage — to get the benefits of both: the stretching and strengthening advantages of exercise with the soothing relief of massage.

In fact, one study published in May 2013 in the journal Complementary Therapies in Clinical Practice found that people with rheumatoid arthritis who were placed in a moderate pressure massage group (given by a massage therapist once a week for four weeks in addition to performing self-massage daily) had less pain, greater grip strength and greater range of motion in their wrist, elbow, and shoulders than those in light massage group.

Perhaps you’ve heard of the benefits of self-massage for hand and wrist arthritis pain, exercises that target connective tissue, hand stretching routines, or programs like The Melt Method, which uses small soft balls and a foam roller to gently massage tight areas in the muscles and connective tissue called fascia to help ease pain. If you’re interested in creating your own soothing and strengthening exercise plan, consider these key points before you begin:

1. Check in with your rheumatologist.

Discuss your plans to start an at-home plan with your rheumatologist before you do anything. “Rheumatoid arthritis is a chronic disease, so make sure everyone on your treatment team is on board, staring with your rheumatologist” says Mary Ann Wilmarth, D.P.T., of Back 2 Back Physical Therapy, located outside of Boston. Do not start when your disease is not in a flare.

2. Get a referral.

Ask your rheumatologist or primary care physician for a referral. “If you’re seeing your primary care physician on a regular basis, you can certainly ask him or her as opposed to waiting to see your rheumatologist, as long as everyone is communicating with each other,” says Wilmarth, who is a media spokesperson for the American Physical Therapy Association (APTA). You’ll need to see a physical therapist, occupational therapist, or certified hand therapist, who can be either a PT or OT (this certification signifies that the provider has five years of clinical experience, including at least 4,000 hours of direct hand therapy). Your health insurance may cover some visits. According to APTA spokeswoman Carmen Elliott, vice president of payment & policy management, most plans pay for physical therapy services that are medically necessary and that are provided by or under the direction and supervision of a physical therapist.

You can find a PT, OT, or hand therapist in your area by going to each groups’ website (American Physical Therapy Association; American Occupational Therapy Organization; Hand Therapy Certification Commission) and searching by city or zip code. These specialists can help you create an at-home program that’s both safe and effective based on your needs and personal medical history.

3. Ask for recommendations.

“Many people with RA are involved with other groups and foundations, like CreakyJoints, an online patient community. Feel free to get recommendations from fellow patients whom you’ve become close. Word of mouth is a powerful thing,” Wilmarth adds.

4. Leave with handouts.

Feel free to ask for handouts or email copies of moves so you can refer back to them. “When I had shoulder pain, I was given handouts of moves on a 3 x 5 ring,” says Cheryl Crow, who has rheumatoid arthritis and who works as an occupational therapist in the Seattle area and teaches at an Occupational Therapy Assistant Program at the Lake Washington Institute of Technology. “Home Exercise Programs, or HEPs, are a standard part of general outpatient PT and OT clinics.” Another option? Ask your OT or PT if they know of any reputable apps you can download on your smart phone.

5. Start slowly.

“The most important thing when you first begin is not to go too fast,” says Wilmarth. “Even one or two or three repetitions is great. Start with whatever you can tolerate and build gradually. Focus on slowly improving and maintaining your range of motion. Get into a routine and get yourself moving without hurting yourself.”

6. Don’t compare yourself to others.

No two people are alike, and no two cases of RA are the same, so don’t expect the same results as someone else. “You may have similarities to others with RA, but what works for someone else might not work for you,” Wilmarth says. “Go at your own pace.”

7. Break it up

There’s no need to get the entire program done in one shot. “Your body wants to keep moving all day long — that’s what makes it feel best,” Wilmarth explains. “So try to find small chunks of time throughout the day. Do some exercises when you wake up in the a.m. Do some at midday during your lunch break. Do some in the afternoon during a break. Do some at night while standing making dinner or and again while watching before bed.”

8. Pinpoint the cause of pain.

There are different types of pain, and figuring out the cause can help you determine whether you should back off versus push through. Pain from overdoing it is more muscular in nature, versus joint pain. “This is called delayed onset muscle soreness and is often caused by doing a little more than you’re used to. You can back off a little in this case, and then start back up soon after,” says Wilmarth. On the other hand, constant chronic pain that’s there all the time can be more serious. “It doesn’t change or go away when you switch positions or ice the area.” This type of pain often requires you to take a break and let the area heal before returning to activity again. Otherwise, you risk inflaming the joint and causing further damage. If you’re ever unsure, check in with your PT, OT, or doctor.

9. Don’t be afraid to follow up. 

When you’re at your initial appointment with your PT or OT, inquire about how you should follow up.  “Ask if it’s better to call or email with questions,” suggests Crow. Because you are going to have questions. For instance, what happens if I have more pain than I expected? Or what should I do if a move is harder or easier than I expect? “Always be on top of anything out of the ordinary. Don’t be shy and think, oh, it’s ok, I’ll just push through.  This is your body, and it’s the only one you get. It’s worth being proactive with anything that comes up.” And any increased swelling within a day or two of doing an exercise should prompt discussion with your rheum or PT, Dr. Weselman, who chairs the ACR Committee on Communications and Marketing, says.

Related: Ease RA Hand and Wrist Pain With These Moves

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