Rheumatologist Tips for Healthy Joints

When it comes to managing arthritis and taking care of your joints, there’s a big difference between knowing what you should do and figuring out what you realistically can do. In a perfect world, we’d all eat a sugar-free diet of lentils and seaweed and get exactly eight hours of sleep while never stressing about anything. But that’s definitely not the world we live in, especially now when it seems like each day brings a new threat to worry about.

Even the experts themselves struggle sometimes: “I’m afraid I may be a bad example, I’m honestly terrible on my joints,” says Michael Putman, MD, assistant professor of medicine at the Froedtert & the Medical College of Wisconsin and host of the Evidence-Based Rheumatology Podcast. “I try to follow general good advice, like eating a healthy diet and getting lots of good sleep, but I’m always looking for ways to improve.”

To help you (and Dr. Putman!) figure out the most important — and doable — habits for taking care of your joints, we asked rheumatologists and other medical experts to share with us what they personally do from a lifestyle standpoint. (Hint: Nowhere on this list will you find swimming five miles or eating three meals of flaxseed a day.)

Exercise & Physical Activity

I schedule a walk every morning

People with arthritis who exercise regularly have less pain, more energy, improved sleep, and better day-to-day function, says Manisha Mittal, MD, a rheumatologist based in Fresno, California. “I think the best time of the day to exercise is first thing in the morning,” she says. “I like to take a brisk walk to see the sun rising. It has tremendous health benefits, not only for my joint and muscle health, but also my mood.” She adds that she has made her morning walk a non-negotiable part of her daily schedule.

Morning walks may be especially important right now when it may not be safe or comfortable for you to exercise in a gym.

I practice good form walking

Jumping, balancing, walking, and sitting are all essential movements that we do many times a day without thinking about them. However, doing these movements with poor form or posture leads to increased pressure on the joints and more pain and injury over time, says Rosario Barreto, a clinical exercise specialist who works with older adults with arthritis. “Arthritis runs in my family, so I make sure to practice daily techniques to reduce impact on my joints,” she says.

For instance, walking while looking down at your phone or hunching forward in your shoulders puts extra stress on the joints in your neck and upper back, which can lead to increased pain and inflammation over time. However, what’s “proper posture” for you may depend on the nature and severity of your arthritis so if you have questions, a physical or occupational therapist who specializes in arthritis can analyze your movements and give you pointers, she adds.

I do balance training

Cardio and weights get all the fitness love but balance and flexibility training are oft-overlooked aspects of exercise that are so important for joint health, says Jenna L. Thomason, MD, MPH, a rheumatologist at the University of Washington Harborview clinic and a UW instructor of rheumatology. “I like to incorporate different types of exercise, including strength training and aerobic exercise but I also make it a point to work in things that improve balance and flexibility, like barre classes, yoga, Pilates, and movements like single-leg deadlifts,” she says.

I stop if something hurts

Exercise may feel hard or difficult — especially if you’re not used to being physically active or trying a new kind of workout — but if it feels painful in your joints, you need to stop immediately, Dr. Mittal says. “If I start to feel real pain, then I stop whatever activity I am doing and rest,” she says. “The ‘no pain no gain’ philosophy does not work with arthritis and you can cause more damage.” If you’re having a hard time finding a way to move every day without pain, it’s time to talk to your doctor about changing your treatment plan, she adds.

I do hot yoga

The combination of heat and motion can be very soothing to painful, inflamed joints which is why yoga is the go-to exercise for Danielle L. Zelnik, MD, a physical medicine and rehabilitation doctor in Oklahoma City. “I practice combinations and variations of vinyasa yoga and power yoga and it’s been very helpful in dealing with my recurring knee pain and helping to protect my joints,” she says. “Vinyasa or ‘flow’ yoga has been very useful for me in maintaining general joint mobility and flexibility. Power yoga gives me added intensity and muscle strengthening, especially during preparation for snowboarding and skiing season. These sports put a lot of stress on my joints, and the power yoga training provides strengthening and flexibility.”

I have a well-rounded workout routine

The most important thing I do to protect my joints is to keep moving, every day, says Megan Wise, DPT, PT, a licensed physical therapist in New York City, who has osteoarthritis in her hips and neck. “I have a schedule where I do Pilates and dance cardio, and change up my workouts often,” she says. “I’m currently building up a more robust strength routine with weights.”

If you’re new to exercise, you don’t have to go all out — in fact, doing too much can backfire — so start with an activity you enjoy and gradually increase the amount you do, she says.

I take a weekly mobility class

Tight ankles and shoulders have long bothered exercise specialist Barreto so she signed up for a mobility class to improve the range of movement in her joints. “I have always been athletic and over time this has led to muscle imbalances and joint issues,” she says. “It’s really helping to incorporate regular mobility drills into my workouts.”

I swim or bike every day

Developing osteoarthritis meant giving up high-impact exercises he’d previously enjoyed, like running and tennis, says Alejandro Badia, MD, a hand and upper extremity orthopedic surgeon with Badia Hand to Shoulder Center in Florida and author of Healthcare from the Trenches. But he knew it was important to keep moving, both for his joints and his mind. “These days I swim or bike for fitness as they do not exacerbate my arthritis,” he says.

I do targeted weight lifting

“Strengthening the muscles that support my joints may help slow the progression of the arthritis,” Dr. Badia says. Incorporating strength training or weight lifting into your exercise routine can be a great way to improve your arthritis symptoms.

However, be sure to check with your doctor or a physical therapist about the right exercises for you as lifting weights improperly can cause pain and damage. Bodyweight exercises can be a good place to start and as you get stronger you can progress to more complex movements or heavier loads. A physical therapist can design a strength program for your needs and check your form to make sure you are performing each movement safely.

I look for extra opportunities to move

When it comes to movement and exercise, every little bit helps, says Laurie J. Ferguson, PhD, a licensed clinical psychologist who specializes in working with people with chronic illness. “I think of daily movement as ‘oiling my joints’ so I stretch and work movement into my day in as many ways as I can,” she says. Think parking at the back of the parking lot, taking the stairs instead of an elevator, taking a minute to stretch in bed before getting up, or doing a few walking lunges during ad breaks on TV.

I watch out for old injuries

Joint damage can be cumulative so it’s just as vital to avoid exacerbating old injuries as it is to avoid new ones, says Dr. Thomason, the University of Washington rheumatolgist. “For me, this means avoiding side-to-side or twisting movements, and also avoiding running on uneven surfaces, given a history of multiple knee and ankle injuries,” she says. Talk to your doctor or physical therapists about which movements you should avoid to maintain the health and integrity of your joints, she says.

I got a dog

Dogs can be very motivating to get you to take care of your health. “My four-legged ‘child’ ensures that I don’t sit all day,” says Elizabeth Lombardo, PhD, PT, a psychologist and physical therapist. “Taking him out for walks, as well as playing fetch, is a great way to move throughout the day and reduce stress while improving my joint health.”

Diet & Nutrition

I cook with a variety of spices

Turmeric gets a lot of attention but there are many herbs and spices that have anti-inflammatory properties, says rheumatologist Manisha Mittal, MD. “I cook with a lot of spices because they have great benefits for digestion and my joints, and they’re delicious,” she says. You can take them as supplements, such as turmeric capsules, but she recommends learning how to incorporate them into your cooking as well.

I take a daily turmeric supplement

“I use a daily curcumin (turmeric) supplement since its anti-inflammatory effects can help prevent joint discomfort and inflammation,” says Dr. Badia, the orthopedic surgeon. “Sometimes I wonder if it’s really helping but I definitely feel the difference in my joints when I don’t take it.”

I take a daily fish oil supplement

Omega 3 fatty acids — found in fatty fish, certain oils, nuts, and seeds — can help your body fight inflammation, says Amanda A. Kostro Miller, RD, a registered dietitian in Chicago who works with patients with arthritis at Fitter Living. “I take an omega-3 supplement as they have been shown to reduce inflammation in the body and protect joints while reducing pain,” she says.

I have fruit for dessert

Sugar is delicious. It’s also a major source of inflammation. But there is a way to have your cake and eat it too (without causing a flare-up), says Hillary Norton, MD, a rheumatologist in Santa Fe, New Mexico, who has ankylosing spondylitis, a form of inflammatory arthritis. “When I am craving a treat, I will eat fresh fruit or have a piece of dark chocolate for dessert,” she says. Fresh fruit and chocolate aren’t just tasty; they also contain anti-inflammatory compounds.

I eat a good diet, not a perfect one

Eating an anti-inflammatory diet is one of the top recommendations from rheumatologists for helping to manage arthritis but avoiding temptation is tough for us too, Dr. Putman says. What triggers inflammation can be different from person to person but gluten, dairy, sugar, and alcohol are common triggers, he says. If you do fall off your personal healthy-eating wagon, don’t beat yourself up and just decide to make better choices going forward.

I maintain a healthy weight

The more weight you carry, the more pressure on your joints, Dr. Thomason says. “Regarding weight, remember that when we walk or run we are putting multiple times our weight on our weight-bearing joints,” she explains. “Maintaining a healthy weight is one of the best things you can do for your joints.” In addition, being overweight or obese can lead to inflammation and puts you at greater risk for many diseases, including arthritis.

I drink a green smoothie

Fresh vegetables, especially green leafy ones, and nuts are powerful inflammation fighters. Dr. Ferguson says she aims to get at least once serving of each per day. But you don’t have to choke down handfuls of raw spinach or boring, plain almonds. Use this as an opportunity to experiment with green smoothies that incorporate all of these powerful foods in an easy, delicious way. “I love to add ground flaxseed and hempseed to get extra omega-3s,” she says.

Clothing & Shoes

I buy new shoes every three months

Wearing the proper footwear can go a long way with reducing arthritis pain in feet, knees, and hips — but they can only do the job properly for so long before they start to lose vital support, says Dr. Zelnick, the physical medicine and rehabilitation physician. “As a runner, I quickly become aware when my shoes are reaching their mileage limit because my knee and ankle joints start hurting,” she says. “As a result, I do not hesitate to replace them as soon as this occurs. I also try to avoid wearing flat shoes when walking long distances and put insoles in my athletic shoes.”

I keep a sweater and gloves handy

Cold is a big trigger for Dr. Mittal’s joint pain so she takes care to keep warm clothing handy, even in the summer. (Some places have very aggressive air conditioning.) “I avoid cold exposure as much as possible and layer up while outdoors,” she says. This is a particularly helpful tip for people with arthritis in their hands as your extremities can get cold and achy much faster than the rest of your body, she adds. There’s no shame in wearing gloves in the summer.

Injuries and Pain

I use Kinesio tape

Kinesiology (K) tape is a cotton-elastic tape you can use on your skin to provide support to your joints during exercise or daily activities, without restricting your range of motion, says Karena Wu, PT, DPT, a certified physical therapist and owner of ActiveCare Physical Therapy in New York City. “I like to use it because it has many benefits for my joints but also helps the fascia, muscles, ligaments, and tendons around them,” she says. “It’s also safe and easily used with other medical or home treatments.”

I get injuries treated as soon as they happen

“Repetitive trauma to a joint can result in arthritis so I have any joint injuries evaluated as soon as they occur,” says Anca Askanase, MD, rheumatologist and director of rheumatology clinical trials at Columbia University Medical Center in New York City. It makes sense: Ballerinas get ankle arthritis and weightlifters get back arthritis. To prevent cartilage and bone damage, get quick treatment and physical therapy, if necessary, she says.

I use an anti-inflammatory gel

No matter how hard you work to prevent arthritis flare-ups, they will happen sometimes so it’s important to have some treatments on hand. “In a huge win for arthritis patients, diclofenac gel (Voltaren), a topical NSAID, just became available over the counter,” Dr. Thomason says. “It helps reduce joint pain due to arthritis, and I can put it directly on my hand, wrist, elbow, foot, ankle, or knee,” Dr. Lombardo says. “It lets me get on with my day with less pain.”

I use a ‘massage gun’

This device provides sweet relief when her back and hip joints are sore, Barretto says. “Once or twice a week, or whenever I get achy joints, I will spend 20 minutes on the area using a theragun or massage gun,” she says. “I have found that it alleviates the aches and pains in joints quite quickly by loosening up the muscles surrounding the joints.” Massage guns range in price from $50 to $400 but a good one to try is this highly rated Cryotex deep tissue model for $80.

I keep CBD cream handy

Cannabidiol, or CBD, is an extract of the hemp plant that has pain-relief and anti-inflammatory properties. “When I do have pain flare-ups I use a topical CBD cream,” Dr. Badia says. You can smooth it on right on the affected joint.

I get a weekly massage

Massaging tight muscles not only helps you relax but can also loosen up tightness and scar tissue surrounding arthritic joints, Barreto says. “I see a sports massage therapist on a weekly basis; we are currently breaking through scar tissue in my shoulder and ironing out tight muscles in my feet to promote better range of motion,” she says. Even if you can’t afford a weekly massage, even the occasional one can help relieve tension and pain.

I take ibuprofen at the first sign of joint pain

Ibuprofen is a staple in many arthritis patients’ medical cabinets for a reason — it’s affordable, accessible, and effective, Dr. Thomason says. “When I do have joint pain, the first things I do are to take oral NSAIDs, such as ibuprofen or naproxen, and then alternate hot and cold packs,” she says. “Be careful to take NSAIDs with food so they don’t irritate your stomach.”

Mental & Emotional Health

I take a practical approach

It’s important not to let your illness take over every waking thought and to focus on what you can do that is practical and helpful in your life, says psychologist Laurie Ferguson, PhD. “I’m pretty prosaic in my approach. I think about my joints in terms of practical things I can do to turn down inflammation in my body wherever I can,” she says.

I keep a gratitude journal

“I start my day with a gratitude practice, listing things I’m grateful for,” Dr. Lombardo says. People with chronic illnesses like arthritis can fall into a negative mental spiral where they worry about pain, which then triggers more pain. Focusing on what you’re grateful for with your body and your life can help break that vicious cycle, she says. “It also helps decrease stress, which can trigger pain flare-ups,” she says.

I meditate daily

Your state of mind can play a part in your level of pain and how you handle it, Dr. Ferguson says. There can be a lot of “what-if” worries about the future when living with a chronic illness. Taking time each day to meditate is a great way to learn how to calm yourself, stay focused on the present moment, manage anxiety and stay positive. “Meditation is an integral part of my daily routine,” she says.

I limit the news

Watching or reading the news can feel extra important these days but it’s easy to cross the line from “informed” to “anxious wreck” and skyrocketing stress leads to painful inflammation. Limiting news intake is one way Dr. Norton, the Santa Fe rheumatologist, keeps her stress levels down. She adds that while reading is one of her favorite ways to relax, she makes sure to pick something light and fun.

Sleep

I’m in bed by 10 PM, no exceptions

Getting enough rest is crucial to managing arthritis and preventing flareups plus sleep gives your joints time to recover from daily stress. It’s also important for your mental health, Dr. Ferguson says. To do this, she sticks to a consistent sleep schedule.

I wear an eye mask

Just because you’re in bed doesn’t mean you’re getting quality rest so it’s important to do everything you can to improve your sleep hygiene, Dr. Norton says. “I always use an eye mask and make sure to take some time to wind down doing something quiet, prior to going to bed,” she says, adding that she also sticks to a set sleep and wake time.

Not Sure What’s Causing Your Pain?

Check out PainSpot, our pain locator tool. Answer a few simple questions about what hurts and discover possible conditions that could be causing it. Start your PainSpot quiz.

Interview with Alejandro Badia, MD, a hand and upper extremity orthopedic surgeon with Badia Hand to Shoulder Center in Florida

Interview with Amanda A. Kostro Miller, RD, a registered dietitian in Chicago

Interview with Anca Askanase, MD, rheumatologist and director of rheumatology clinical trials at Columbia University Medical Center in New York City

Interview with Danielle L. Zelnik, MD, a physical medicine and rehabilitation doctor in Oklahoma City

Interview with Elizabeth Lombardo, PhD, PT, a psychologist and physical therapist

Interview with Hillary Norton, MD, a rheumatologist in Santa Fe, New Mexico

Interview with  Jenna L. Thomason, MD, MPH, a rheumatologist at the University of Washington Harborview clinic and a UW instructor of rheumatology

Interview with Karena Wu, PT, DPT, a certified physical therapist and owner of ActiveCare Physical Therapy in New York City

Interview with Laurie J. Ferguson, PhD, a licensed clinical psychologist

Interview with Manisha Mittal, MD, a rheumatologist based in Fresno, California

Interview with Megan Wise, DPT, PT, a licensed physical therapist in New York City

Interview with Michael Putman, MD, assistant professor of medicine at the Froedtert & the Medical College of Wisconsin

Interview with Rosario Barreto, a clinical exercise specialist