[Principles of joint protection in inflammatory joint disease with special reference to biomechanical status]

With respect to rehabilitation in inflammatory joint diseases, the activity of the disease, the influence of the disease on the physical ability and social and psychological situation of the patient should all be taken into consideration and treatment then planned accordingly. In the present article, special attention is paid to the biomechanical situation in the diseased joints of the upper and lower extremities, respectively. In the shoulder and elbow joints, the muscles working with long levers and the loading of joints create large intra-articular forces. In the hands the vulnerable joints are under high intra-articular stress because of loading in all situations in daily life. As the result of synovitis and destruction of cartilage, instability is often present. In the lower extremities, the hips and knees are under great strain when moving, rising from chairs, and walking on stairs. Much can be done to reduce loading on the joints. In the upper extremities splinting and the use of suitable technical aids are essential. In the lower extremities good quadriceps muscles and hip extensor muscles as well as correct loading techniques are essential. Whenever walking aids are used, they should be tried out with attention to grip function and the condition of the shoulder and elbow joints, as well as to the need of unloading the lower extremities. A walking aid should always be checked again later. A daily contracture prophylaxis program should help to prevent deformities. Strength training should be performed with attention to the intra-articular loading and stability of the joints.