Nicole Jack

Nicole Jack, OTR/L, CHT on Easing Pain and Limitations of Arthritis

Originally posted on

May is National Arthritis Awareness Month. According to the Centers for Disease Control and Prevention, 58.5 million people suffer from arthritis, which is almost a quarter of the United States population. What many do not realize is that it is not a disease limited to the elderly. More than half of those suffering from arthritis are less than 64 years of age which is the leading cause of work disability. The most common form of arthritis is osteoarthritis. Other forms include gout, rheumatoid arthritis, and lupus. Symptoms of arthritis are pain, aching, stiffness, and swelling in or around the joints.

Nicole Jack, OTR/L, CHT, works with arthritis patients at Bone and Joint Institute Rehabilitation Services. She is a registered and licensed occupational therapist and Certified Hand Therapist. Arthritis often affects the hands and upper extremities, which she specializes in treating. Jack received her Bachelor of Science degree from the University of Wisconsin, and her Master of Occupational Therapy degree from Tennessee State University in 2014.

Williamson Source: You are an occupational therapist; can you explain how that is different from a physical therapist?

Nicole Jack: They are similar; however, we work primarily with the shoulder, hand and upper extremities to help people relearn or adjust how they do everyday activities to help them heal from disease or injury. At Bone and Joint Institute, I am part of an upper extremity surgery team working closely with our board-certified physicians to treat patients with a holistic approach. Shots, medication, or surgery are not always the only option. At times, increasing education regarding their condition or rehabilitation is an option for patients.

WS: How do you work with patients who have arthritis?

Jack: First and foremost, we respect it. It causes inflammation, swelling of joints, redness and degeneration.

We start by seeing how much the patient can do, how far they can move afflicted joints, how strong they are, and their endurance level. Essentially, we measure their independence.

Next, we look at how they live their lives and do their jobs. We want to allow our patients to remain as independent as possible while still remaining safe.

Before a shot or surgery, we look at ways to change the way our patients do things so they can avoid actions that make the burning and aching worse. There may also be adaptive equipment available to help them perform their duties.

WS: What adaptive equipment is available? How can it help?

Jack: It all depends on where they need help. Arthritis is most prevalent in the hands, and it affects the pinching and grabbing motions, so we look at what adaptive and ergonomic equipment is available.

There are many adaptive tools for the kitchen and garden, as well as for those who play golf and tennis. Tight gripping or pinching can enhance pain levels, so we find widened grips and better shapes that require less pressure when holding.

There are kitchen tools with wider handles and gripping surfaces, thumb and wrist braces, and all kinds of other items that make living with arthritis easier. The goal is to keep patients from doing things that aggravate inflamed joints.

WS: What are joint protection principles? How do they help a patient with arthritis?

Jack: Joint protection principles begin with respect for the pain. While pain must be respected, inactivity can make joints stiff. So, the second concept is to find a balance between activity and rest. A patient should only work up to a point of pain or exhaustion and not push beyond. Next, wear a brace or custom splint to support effort, try to reduce activities that cause flare-ups, and do not stay in one position for too long.

Going back to adaptive equipment, if there are activities that cannot be reduced, find other ways to do them or equipment that can ease the burden on affected joints.

There are also ways to adapt the environment to allow for less movement that causes pain. Only use lower cabinets so shoulders do not have to be raised, or find ways to make smaller activities easier, such as using a grabber to reach items on higher shelves.

When there is pain, alternating between heat and cold can reduce pain and bring down swelling.

WS: Are there other options?

Jack: There are injections and medication that can be given for arthritis. An injection may work right away but can wear off over time.

If there is great pain and it is affecting a patient’s quality of life, surgery can be an option to consider. Almost all the joints in the hand, including finger joints, can now be replaced with really good outcomes. The most common is thumb joint replacement, also known as arthroplasty. Surgeons can also do surgery to heal arthritic wrists. It is not a joint replacement, per se, but a different procedure to reduce joints rubbing or grinding.

WS: What happens after these surgeries?

Jack: People tell us right away that they don’t have arthritic pain anymore, but they will do rehabilitation right after surgery. They will have about eight weeks of limited use of their hand.

Occupational therapy is located at our Bone and Joint Institute location in Franklin so we can work collaboratively with doctors. Pre- and post-surgery, we regularly measure a patient’s functional skills and then report treatment success. We have a team approach and communicate daily with our Physicians and Advanced Practice Providers on the progress of individual treatments.

If you are suffering from arthritic pain and seek occupational therapy to cope, contact Bone and Joint Institute Rehabilitation Services.

To learn more about dealing with arthritis pain in the hands and upper extremities, contact Bone and Joint Institute Rehabilitation Services at 615-791-2640.