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Overview of joint protection

Maureen R Gecht-Silver, OTD, MPH, OTR/L
Alison M Duncombe, PT, DPT, OCS, FAAOMPT
Section Editor
Zacharia Isaac, MD
Deputy Editor
Monica Ramirez Curtis, MD, MPH


Patients with unstable or painful joints may have a limited understanding of activities that increase the risk of further joint damage or that promote inflammation. This topic will review the concept of joint protection and will suggest approaches to evaluation and interventions that may promote joint health.

Specific applications of joint protection to particular sites are presented separately. (See "Joint protection program for the upper limb" and "Joint protection program for the lower limb" and "Joint protection program for the neck".)

What is joint protection? — Joint protection is a process that includes the following two major components [1,2]:

Individualized assessment of a patient’s activities to ascertain the potential to contribute to worsening pain, inflammation, instability, and/or deformity of an already abnormal joint

Creation of a program to increase a patient’s functional ability that includes altered work methods, behavioral modifications, and good body mechanics and that is supplemented, if necessary, with splints, braces, or adaptive equipment designed to minimize further joint damage


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Literature review current through: Sep 2016. | This topic last updated: Jun 2, 2015.
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  1. Cordery J, Rocchi M. Joint protection and fatigue management. In: Rheumatologic Rehabilitation, Melvin J, Jensen G (Eds), American Occupational Therapy Association, Bethesda 1998. Vol 1, p.279.
  2. Hammond A. Rehabilitation in musculoskeletal diseases. Best Pract Res Clin Rheumatol 2008; 22:435.
  3. Christie A, Jamtvedt G, Dahm KT, et al. Effectiveness of nonpharmacological and nonsurgical interventions for patients with rheumatoid arthritis: an overview of systematic reviews. Phys Ther 2007; 87:1697.
  4. Hammond A, Young A, Kidao R. A randomised controlled trial of occupational therapy for people with early rheumatoid arthritis. Ann Rheum Dis 2004; 63:23.
  5. Scholten C, Brodowicz T, Graninger W, et al. Persistent functional and social benefit 5 years after a multidisciplinary arthritis training program. Arch Phys Med Rehabil 1999; 80:1282.
  6. Hammond A, Freeman K. The long-term outcomes from a randomized controlled trial of an educational-behavioural joint protection programme for people with rheumatoid arthritis. Clin Rehabil 2004; 18:520.
  7. Hammond A, Freeman K. One-year outcomes of a randomized controlled trial of an educational-behavioural joint protection programme for people with rheumatoid arthritis. Rheumatology (Oxford) 2001; 40:1044.
  8. Nordenskiöld U. Daily activities in women with rheumatoid arthritis. Aspects of patient education, assistive devices and methods for disability and impairment assessment. Scand J Rehabil Med Suppl 1997; 37:1.
  9. Stamm TA, Machold KP, Smolen JS, et al. Joint protection and home hand exercises improve hand function in patients with hand osteoarthritis: a randomized controlled trial. Arthritis Rheum 2002; 47:44.
  10. Liemohn W. Exercise and arthritis. Exercise and the back. Rheum Dis Clin North Am 1990; 16:945.
  11. Hasegawa M, Chin T, Oki S, et al. Effects of methods of descending stairs forwards versus backwards on knee joint force in patients with osteoarthritis of the knee: a clinical controlled study. Sports Med Arthrosc Rehabil Ther Technol 2010; 2:14.
  12. Nordenskiöld U. Evaluation of assistive devices after a course in joint protection. Int J Technol Assess Health Care 1994; 10:293.
  13. Silva AC, Jones A, Silva PG, Natour J. Effectiveness of a night-time hand positioning splint in rheumatoid arthritis: a randomized controlled trial. J Rehabil Med 2008; 40:749.
  14. The Arthritis Helpbook, 6th, Lorig K, Fries J (Eds), Perseus Books, 2006.
  15. Furst GP, Gerber LH, Smith CC, et al. A program for improving energy conservation behaviors in adults with rheumatoid arthritis. Am J Occup Ther 1987; 41:102.
  16. www.osha.gov/SLTC/etools/computerworkstations/ (Accessed on September 08, 2005).
  17. Kettunen JA, Kujala UM. Exercise therapy for people with rheumatoid arthritis and osteoarthritis. Scand J Med Sci Sports 2004; 14:138.
  18. Semanik P, Wilbur J, Sinacore J, Chang RW. Physical activity behavior in older women with rheumatoid arthritis. Arthritis Rheum 2004; 51:246.
  19. Hammond A. Joint protection behavior in patients with rheumatoid arthritis following an education program: a pilot study. Arthritis Care Res 1994; 7:5.
  20. Hammond A, Bryan J, Hardy A. Effects of a modular behavioural arthritis education programme: a pragmatic parallel-group randomized controlled trial. Rheumatology (Oxford) 2008; 47:1712.
  21. Hochberg MC, Altman RD, April KT, et al. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken) 2012; 64:465.
  22. Mathieux R, Marotte H, Battistini L, et al. Early occupational therapy programme increases hand grip strength at 3 months: results from a randomised, blind, controlled study in early rheumatoid arthritis. Ann Rheum Dis 2009; 68:400.
  23. Masiero S, Boniolo A, Wassermann L, et al. Effects of an educational-behavioral joint protection program on people with moderate to severe rheumatoid arthritis: a randomized controlled trial. Clin Rheumatol 2007; 26:2043.
  24. Ekelman BA, Hooker L, Davis A, et al. Occupational therapy interventions for adults with rheumatoid arthritis: an appraisal of the evidence. Occup Ther Health Care 2014; 28:347.
  25. Macedo AM, Oakley SP, Panayi GS, Kirkham BW. Functional and work outcomes improve in patients with rheumatoid arthritis who receive targeted, comprehensive occupational therapy. Arthritis Rheum 2009; 61:1522.
  26. Feinglass J, Song J, Semanik P, et al. Association of functional status with changes in physical activity: insights from a behavioral intervention for participants with arthritis. Arch Phys Med Rehabil 2012; 93:172.
  27. Haskett S, Backman C, Porter B, et al. A crossover trial of custom-made and commercially available wrist splints in adults with inflammatory arthritis. Arthritis Rheum 2004; 51:792.
  28. Adams J, Burridge J, Mullee M, et al. The clinical effectiveness of static resting splints in early rheumatoid arthritis: a randomized controlled trial. Rheumatology (Oxford) 2008; 47:1548.
  29. Weiss S, LaStayo P, Mills A, Bramlet D. Prospective analysis of splinting the first carpometacarpal joint: an objective, subjective, and radiographic assessment. J Hand Ther 2000; 13:218.
  30. Egan MY, Brousseau L. Splinting for osteoarthritis of the carpometacarpal joint: a review of the evidence. Am J Occup Ther 2007; 61:70.
  31. Falconer J. Hand splinting in rheumatoid arthritis. A perspective on current knowledge and directions for research. Arthritis Care Res 1991; 4:81.
  32. Zijlstra TR, Heijnsdijk-Rouwenhorst L, Rasker JJ. Silver ring splints improve dexterity in patients with rheumatoid arthritis. Arthritis Rheum 2004; 51:947.
  33. Egan M, Brosseau L, Farmer M, et al. Splints/orthoses in the treatment of rheumatoid arthritis. Cochrane Database Syst Rev 2003; :CD004018.
  34. Page MJ, Massy-Westropp N, O'Connor D, Pitt V. Splinting for carpal tunnel syndrome. Cochrane Database Syst Rev 2012; :CD010003.
  35. Brouwer RW, Jakma TS, Verhagen AP, et al. Braces and orthoses for treating osteoarthritis of the knee. Cochrane Database Syst Rev 2005; :CD004020.
  36. Stern EB, Callinan N, Hank M, et al. Neoprene splinting: dermatological issues. Am J Occup Ther 1998; 52:573.
  37. Sakata S, Cahill J, Nixon R. Allergic contact dermatitis to thiourea in a neoprene knee brace. Australas J Dermatol 2006; 47:67.