Client Health

Arthritic Clients— Handle With Care

Arthritis is the number one disease suffered by women. As a nail technician, you can help clients face it with beauty and serenity by making your salon a comfortable, economically friendly place.

In some ways, Tess Syrjanen is a typical pedicure client. She gets monthly pedicures to keep her feet and toenails in good condition, and the massage, she sheepishly admits, is her favorite part. But unlike for most clients, for her pedicures are a necessity, not a luxury.

Like 40 million other Americans, Syrjanen suffers from arthritis. The joints in her feet and hands get swollen and painful, making it difficult for her to care for her own feet. Women with arthritis are ideal candidates for professional nail care, says Amye Leong, president and founder of Young Et Heart, a support group for young women with arthritis, because it’s hard for them to care for their nails themselves. Says Leong, who herself has had rheumatoid arthritis since she was 18, “Doing your own manicure is very difficult It actually hurts me to file my own nails down. I don’t have the fine finger- pinching strength anymore to use clippers. And I can’t open a bottle of nail polish.”

Syrjanen, who has a form of arthritis called mixed connective tissue disease, describes the same problems in trying to care for her feet. “Some of my toenails have started to deform — they’re growing upward and to the side. My toenails get kind of hard, and because my fingers are so sore, it’s much easier to get them done in the salon every four or five weeks,” she says.

According to a report released in May 1995 by the na­tional Centers for Disease Control (CDC), 23 million women —a startling 22.7% of the female population in the United States — have arthritis. The CDC projects that by the year 2020, arthritis will affect nearly 36 million women. In fact, the CDC’s report labels arthritis as the most common and disabling chronic condition reported by women.

Many women who have arthritis, especially those who have it in their hands and feet like Syrjanen and Leong, find caring for their own nails challenging. Even so, Leong says she prefers to do her nails herself. ‘I don’t like going through all the explanations and I don’t like someone looking so closely at my hands,” she explains. Many women-whose arthritis has wreaked physical changes on their joints feel the same way, adds Leong, who should know. Leong is an arthritis wellness advocate who tours the country speaking at physician conferences and to patient groups. She is also a volunteer with the Arthritis Foundation, a non-profit organization dedicated to finding the causes, preventives, and cures of all forms of arthritis.

Still, most forms of arthritis aren’t disfiguring, and many women with arthritis just might become regular salon clients if it’s not — literally — a pain. Modifying your workstation and your techniques to work on clients with arthritis requires a little effort and an understanding of arthritis and its symptoms.


“Arthritis means ‘inflammation of the joints,’” says Heidi Vandemark, a health educator for the Southern California chapter of The Arthritis Foundation in Los Angeles, Calif. More than 130 muscle and joint diseases fall under this umbrella term. Arthritis is marked by joint deterioration resulting from injury, infection, autoimmune diseases, or even a drug reaction, says Vandemark While the causes, symptoms, prognosis, and treatment for the diseases universally labeled “arthritis” differ, all the diseases have in common pain and stiffness in the joints.

There are two categories of arthritis: inflammatory and non-inflammatory, says Vandemark. Osteoarthritis, the most common form of arthritis, is non-inflammatory. Osteoarthritis is a degeneration of the joints caused by the normal wear and tear of living or by injury. It afflicts six million people, according to the Arthritis Foundation. “This is the type of arthritis the sports guys get,” says Leong. “It breaks down the tissues that allow the joints to move smoothly. It usually affects weight-bearing joints — the hips, knees, and ankles — but it also affects the hands.”

Osteoarthritis is more common in older people, not necessarily because they’re older, says Rodney Bluestone, M.D., a rheumatologist in Beverly Hills, Calif., and the chairman of the Southern California chapter of the Arthritis Foundation. “Osteoarthritis affects predominantly women. There may or may not be inflammation.”

Rheumatoid arthritis, which is what Leong has, is an inflammatory form of arthritis, and the second most common form of arthritis overall — three million women in the United States have it. Inflammatory forms of arthritis are disor­ders of the immune system; in the case of rheumatoid arthritis, the immune system attacks the joints and breaks down the tissues, “Rheumatoid arthritis is much more disabling than osteoarthritis because inflammation makes the joints stiff and immobile,” Dr Bluestone says. Also, the joints often degenerate much faster and to a much greater extent than with osteoarthritis.

Leong and Vandemark both are irked by commercials for pain relievers that say they relieve “the minor aches and pains of arthritis” because the phrase is so misleading. “Arthritis can be a very painful disease,” says Vandemark. “It’s just that often you can’t see the changes or the pain.”

Sometimes arthritis causes visible disfigurement, but most people look normal, says Leong. “The symptoms are not visibly apparent,” she says. “What can be misleading, particularly if you’re young, is that you look so good. People don’t see how bad my ankles are; they don’t notice that I can’t swing my arms when I walk.”

With osteoarthritis and rheumatoid arthritis in particular, any disfigurement will most likely be seen on the hands, says Vandemark. “You’ll see changes in the fingers or in the hand structure. Knobby knuckles are very common, especially with osteoarthritis. With rheumatoid arthritis, the joints lose their strength and the fingers slide to the side,” she says.

Treatment for arthritis varies, depending on the disease and the individuals symptoms. A full treatment program includes pain control methods, therapeutic exercise, resting of the joints and the entire body, medication, and devices and aids to protect the joints.


There’s no medical reason women with arthritis can’t get their nails done, says Dr. Bluestone. While a few forms of arthritis can affect the nails — psoriatic arthritis being one — nail products should cause no greater concern to a woman with arthritis than they do to any other client.

The ergonomics of having the service done, however, is another story. “It’s crucial to consider body positioning, arm positioning, and supports,” says Leong. “Take a look at the chairs, the height of the tables, and the body support in the average salon. The client is leaning forward with no back support, and her hands are reaching across the table with no support for her arms. Even if her elbow is supported, her wrists and fingers need to be supported.

 “Anyone who sits for half an hour at a time with no back support and her elbows extended is not in a good position. Most people won’t say anything because they can do it for the short time they’re in the salon. But anyone with arthritis in the shoulders, elbows, wrists, or fin­gers is going to find sitting like this very uncomfortable,” Leong says.

Explore ways to give all clients — not just ones with arthritis—better body positioning and support during the service. “The tabletop needs to be padded. I need to bend my elbow and lay my forearm flat, which means I have to be close to the table. And I should have back support while I’m doing this so I need a chair that I can scoot up close to the table,” Leong adds.

Clients should be able to scoot the chair up to the edge of the table so they don’t have to lean forward. The chair should also be high enough so that the client doesn’t have to raise her arms up to the tabletop. As for your workstation, it should be high enough for the chair to fit under, but not so high that the client has to raise her arms. The table should also be wide enough for her to fit her legs underneath and for her to lay her forearm flat without hitting you in the stomach.

These are good ergonomic considerations for all clients, not just for those with arthritis. If you’re considering remodeling your salon, keep these issues in mind as you choose new furnishings. If new furnishings aren’t a consideration for now, look around the salon for a place where you can comfortably service your clients with arthritis. For example, if your salon has a skin care area, these clients maybe more comfortable reclining in a facial chair with you sitting at their side.

Regardless of what joints the arthritis is in or where you do the service, encourage these clients to get up and move around every 15- 20 minutes, says Leong; otherwise, the joints may stiffen up and cause even more pain.

 “I don’t want to portray a picture of someone you have to walk around on pins and needles, but you need to communicate and also be aware of her body language,” Leong says.


Clients with arthritis can wear any products on their nails and enjoy almost any service you offer in the salon.

Lianne Koziol, owner of The Little Nail Shoppe of Rehoboth in Rehoboth, Mass., says at least two- thirds of her clients are over 40 and many of them complain of stiff, sore joints in their fingers. And several, she says, have been diagnosed with arthritis. She says her biggest challenge with these clients is to make sure she holds their hands loosely. “You have to make sure you don’t have a death grip on her hand,” Koziol says.

Nancy Burns, owner of Barefoot in the Park in Sacramento, Calif., agrees, adding, “I’m extraordinarily careful on the joints that are uncomfortable.” To make sure she remembers which joints hurt on which clients, Burns keeps notes on her client cards. She also keeps a few neck-roll pillows and pads for arm support for those clients who have arthritis in their shoulders wrists, and elbows.

Burns and Koziol say heat relaxes their clients’ hands, and they recommend using it before or during the service. Burns uses an aromatherapy oil spray that gives the skin a warm sensation, and after every service she wraps her clients hands or feet in warm, dry towels for about five minutes.

Koziol recommends paraffin wax treatments for clients with arthritis. The treatments are so popular with these clients, she says, that many come in between appointments because the warmth eases their pain. Heat is a recognized pain-control method for arthritis, says Dr. Blue-stone, and if paraffin treatments offer relief to the client, he wholeheartedly recommends them. Remember, though, that different clients get relief from different methods, so some of your clients may not enjoy paraffin treatments.

More controversial is the hand and arm massage, so popular with salon clients. Gentle, circular massage and pressure shouldn’t cause any problems, says Dr. Bluestone, if you take care not to pull on any joints forcefully. “If somebody has a joint disease and you forcibly move that joint through a range of motions the person couldn’t do on her own, you could damage the joint,” says Dr. Bluestone.

As for the service itself, Koziol says it’s no different, unless the client has a form of arthritis such as rheumatoid arthritis that can deform the hands. “Sometimes arthritis turns the knuckles so that the nails appear crooked. I had a client who moved to North Carolina but came back to me every six months for years to get a new set of nails because I could make her nails appear straight,” she says. “If their fingers move to the side, the nail plate will appear crooked. The trick is to line up the forms or tips with the part of the finger that isn’t crooked.

“I line up the form with the lower part of the finger, from the hand to the first knuckle. I look at the hand from the client’s perspective, positioning the form so that it lines up with the straight part. The lines can be way off from the fingernail bed—that’s OK. It’s best to look at it from the back, because that’s where the client is looking from,” Koziol recommends.

Many women with arthritis—like Syrjanen, a specialty under-writer for an insurance company, and Leong—are active, professional women. They want to appear well-groomed, but not at the price of pain. They’ll judge not only the final product, but the gentleness of your technique, your ability to read their body language and the comfort of your salon. You’ll know their verdict when they book another service—or not.


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