Physiotherapy in Rheumatoid Physiotherapy in Rheumatoid ArthritisArthritis

Information for patients Information for patients Gina Wall Gina Wall

Senior PhysiotherapistSenior Physiotherapist

What do Physiotherapists do?What do Physiotherapists do?

We conduct assessments by asking detailed We conduct assessments by asking detailed questions about your symptoms, medical questions about your symptoms, medical

history and daily life. history and daily life.

Using specific tests we can then measure Using specific tests we can then measure joint movements, muscle strength, muscle joint movements, muscle strength, muscle length and functional abilities, in order to length and functional abilities, in order to provide you with appropriate treatments provide you with appropriate treatments

and advice. and advice.

What are the aims of Physiotherapy in What are the aims of Physiotherapy in Rheumatoid Arthritis?Rheumatoid Arthritis?

Prevent disabilityPrevent disabilityIncrease functional capacityIncrease functional capacityImprove general fitnessImprove general fitnessProvide pain relief and educationProvide pain relief and educationImprove flexibility and strengthImprove flexibility and strengthEncourage regular exerciseEncourage regular exercise

Physical AssessmentPhysical Assessment

Gait AnalysisGait AnalysisAssessment of postureAssessment of postureTesting muscle length & strengthTesting muscle length & strengthMeasuring joint movementMeasuring joint movementFunctional tests (balance, stairs etc)Functional tests (balance, stairs etc)

Physiotherapy Treatments for Physiotherapy Treatments for Rheumatoid ArthritisRheumatoid Arthritis

Cold Therapy: E.g. Ice packs Cold Therapy: E.g. Ice packs

Provides pain relief Provides pain relief Causes constriction of the blood vessels around Causes constriction of the blood vessels around the treated areathe treated areaNormal temperature inside the bodyNormal temperature inside the body’’s joints is s joints is 3333°°, but in rheumatoid arthritis this can rise to , but in rheumatoid arthritis this can rise to 3636°°. Ice helps limit the activity of enzymes that . Ice helps limit the activity of enzymes that can damage cartilagecan damage cartilageUseful in the acute phase or active period of Useful in the acute phase or active period of inflammation, but can also give day to day pain inflammation, but can also give day to day pain reliefrelief1010--20 20 minsmins 11--2 times a day 2 times a day

Treatments ContTreatments Cont’’ddHeat Therapy: Hot water bottle/wheat packHeat Therapy: Hot water bottle/wheat pack

Provides pain relief by reducing muscle spasmProvides pain relief by reducing muscle spasmImproves the elasticity of soft tissues Improves the elasticity of soft tissues -- can be can be used before exerciseused before exerciseEncourages blood vessels in the surface of Encourages blood vessels in the surface of tissues around the joint to dilate, drawing tissues around the joint to dilate, drawing circulation away from the painful jointcirculation away from the painful jointUseful for chronic phases, or day to dayUseful for chronic phases, or day to day2020--30 30 minsmins 11--2 times day2 times day

Treatments ContTreatments Cont’’ddTENS TENS ““ TranscutaneousTranscutaneous Electrical StimulationElectrical Stimulation””

Small current passed across the skin by Small current passed across the skin by electrodeselectrodesProvides shortProvides short--term pain relief (6term pain relief (6--18 hours)18 hours)Can be used several times a dayCan be used several times a day-- time usage time usage with times of the day when you find your pain is with times of the day when you find your pain is worseworseNeed to have regular breaks from using TENS Need to have regular breaks from using TENS as your nerves can become acclimatised to it as your nerves can become acclimatised to it which reduces its effectswhich reduces its effects

Exercise For Rheumatoid ArthritisExercise For Rheumatoid ArthritisMaintaining muscle strength is important Maintaining muscle strength is important for joint stability & preventing injuryfor joint stability & preventing injuryMuscles can become weak following Muscles can become weak following reduced activityreduced activityPain signals from your nerves and swelling Pain signals from your nerves and swelling can both inhibit muscles can both inhibit muscles Muscle length can be affected by Muscle length can be affected by prolonged positions & immobilization and prolonged positions & immobilization and tightness can limit daily activities tightness can limit daily activities

Considerations for ExerciseConsiderations for Exercise

The number of joints affectedThe number of joints affectedStage of conditionStage of conditionPatientPatient’’s age / other medical conditionss age / other medical conditionsPatientPatient’’s goals s goals

Exercises for the Acute PhaseExercises for the Acute Phase

Performed at least once a day Performed at least once a day Gentle assisted movement through the Gentle assisted movement through the jointjoint’’s normal range, to prevent s normal range, to prevent contracturecontractureIsometric Isometric ““static muscle contractionstatic muscle contraction”” exercises to maintain muscle tone without exercises to maintain muscle tone without increasing inflammationincreasing inflammation

Acute Phase ContAcute Phase Cont’’ddThese exercises should not be pushed into pain These exercises should not be pushed into pain & any discomfort felt after exercising should & any discomfort felt after exercising should settle within one hoursettle within one hourBuild up new exercises gradually so that you can Build up new exercises gradually so that you can differentiate between the differentiate between the ‘‘normalnormal’’ amount of amount of pain you get and pain from overusing a jointpain you get and pain from overusing a jointThe acute phase is when joints are most The acute phase is when joints are most vulnerable to damage, so adjust the number of vulnerable to damage, so adjust the number of exercises or how far you move each joint for exercises or how far you move each joint for how you feel that day how you feel that day

Exercises for the Chronic Phase Exercises for the Chronic Phase

Can progress the above exercises to Can progress the above exercises to include use of light resistance include use of light resistance Postural / core stability exercises Postural / core stability exercises Swimming / walking / cycling to maintain Swimming / walking / cycling to maintain cardiovascular fitness cardiovascular fitness Gentle stretches for areas that con Gentle stretches for areas that con become tight, such as knees & calves become tight, such as knees & calves

Joint ProtectionJoint ProtectionTry to avoid prolonged positionsTry to avoid prolonged positionsBalance activity with rest periodsBalance activity with rest periods-- rest rest should come before you get fatigued or should come before you get fatigued or sore sore Look at your work or home desk setLook at your work or home desk set--upupDuring the acute phase activities such as During the acute phase activities such as stair climbing can put stress through your stair climbing can put stress through your knees ankles & hipsknees ankles & hips--try to keep the try to keep the number of trips up & down to a minimum number of trips up & down to a minimum

Any Questions? Any Questions?