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Article #125: What Kinds Of Physical And Occupational Therapy Will Help My Rheumatoid Arthritis?

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Rheumatoid arthritis (RA) is a chronic, prevent joint stress, support joints, and
progressive disease which may lead to decrease joint stiffness.
considerable disability. While there are Wrist splints and ring splints are useful
no cures for RA, recent developments in for reducing inflammation and preventing
biologic therapy make it possible to deformity in the hands.
place many patients into remission. Joint stress in the feet can be reduced
In addition to medications though, it is by using a supporting pad at the sole of
important to add adjunctive treatments the foot and by using metatarsal pads.
such as physical therapy and Visco-elastic soles may help reduce shock
rehabilitation which help to increase loading occurring in the legs with
functional capacity, provide pain relief, walking.
and also provide patient education. For RA patients with serious neck
Before starting therapy, physical involvement, particularly with the first
assessments should include: functional and second vertebrae, a Philadelphia
assessments (what the patient is capable collar may be needed. The Philadelphia
of at the present time), range of motion, device provides excellent immobilization
muscle strength, posture, and level of and may be used in the presence of neck
fitness. instability.
Cold and hot modalities are the most Patients using compression gloves have
commonly used physical treatments in reported reduced joint swelling and pain
arthritis therapy. Cold application is but there is no hard evidence that they
mostly used in acute stages whereas hot improve grip strength or hand function.
is used in chronic stages of RA. Improvement may be provided by using
Heat works because it induces analgesia, compression gloves both during the day as
relieves muscle spasm, and improves well as at night in patients with
flexibility. Heat can be used before inflammation in their hands or fingers.
exercise to help loosen muscles and Occupational therapy interventions such
joints. Heat treatment may be applied as as assistive devices and adaptive
a hot-pack, infrared radiation, equipments have beneficial effects on
diathermy, paraffin, or hydrotherapy. joint protection and energy conservation
Applications are recommended for 10-20 in arthritic patients. Assistive devices
minutes once or twice a day. Caution are used in order to improve functioning,
should be exercised in patients with reduce pain, and keep patients self
nerve damage, impaired circulation, or sufficient.
diabetes, since there is a risk of Loading over the hip joint may be reduced
thermal injury. by about 50% by using a cane. Elevated
Cold therapy is preferred in active toilet seats, widened gripping handles,
joints where inflammation is bathroom adjustments all help improve
uncontrolled. Cold packs, ice, nitrogen activities of daily living.
spray, and cryotherapy are different ways Massage is used to improve general well
of applying cold-therapy. being and help diminish swelling of
Cartilage-destroying enzymes such as inflamed joints. Massage can help with
collagenase, elastase, hyaluronidase, and depression, anxiety, mood, and pain.
protease are produced in the inflamed Muscle weakness in patients with RA
joints of patients with RA. Levels of occurs as a result of immobilization or
these enzymes are affected by the reduction in activities of daily living.
temperature within joints. Increasing Maintenance of normal muscle strength is
temperature inside the joint leads to an important not only for physical function
increase in collagenase activity and but also for stabilization of the joints
cartilage damage. and prophylaxis of traumatic injuries.
Electrostimulation is used in patients Exercise therapy has beneficial effects
with RA to relieve pain. Transcutaneous on RA by improving endurance and
electrical nerve stimulation (TENS) enhancing fitness.
therapy is the most commonly used method. Things to consider before launching an
TENS is a short-acting therapy and it exercise program include: whether the
also has a high placebo effect. involvement of the joints is local or
Water therapy, also known as hydrotherapy systemic, disease stage, patient age, and
or "balneotherapy" has been used for patient compliance.
arthritis since ancient times. Range of motion exercises, stretching,
Objectives of hydrotherapy are to strengthening, aerobic conditioning
increase range of motion, strengthen exercises, and routine daily activities
muscles, relieve painful muscle spasms, all should be included in a comprehensive
and improve a patient's well-being. exercise program.
There have been studies showing Every joint should be moved in full range
beneficial effects of hydrotherapy with of motion at least once per day in order
pain reduction and improvement in grip to prevent contracture. In the case of
strength. Because of buoyancy, water acutely inflamed joints, isometric
therapy allows patients to perform exercises provide muscle tone without
exercise without undue joint stress. Some worsening disease activity.
studies have shown that hydrotherapy If the disease activity is minor, then
leads to muscle, tendon, and ligament isotonic exercises should be performed by
relaxation and a feeling of well-being. using very low weights. If pain persists
Endorphin release may also contribute to more than 2 hours or too much fatigue,
improved pain control. loss of strength, or increase in joint
Some have suggested that water therapy swelling occurs after an exercise
may have beneficial immune system program, then the program should be made
benefits with reduction in less intense. Walking can aggravate knee
pro-inflammatory cytokines. pain in patients with active
Physical and occupational therapists inflammation. Therefore, patients with
educate patients in joint protection active RA should avoid activities such as
strategies, use of assistive devices, and climbing stairs or weight lifting.
performance of therapeutic exercises. Producing excessive stress over the
Joints should be put at rest during the tendons during the stretching exercises
acute phase of the disease. Bed rest should be avoided.
relieves the pain in cases of extensive When arthritis is controlled medically,
joint involvement. It is critical, at conditioning exercises such as swimming,
this stage, to put the joints into rest walking, using an elliptical trainer, and
at a functional position. Fortunately, cycling with adequate resting periods are
bed rest is not needed as much as it once recommended. They increase muscle
was. Splints are used to keep involved endurance and aerobic capacity and
joints in a functional position. Splints improve function of the patient, and they
help to mitigate pain and inflammation, also make the patient feel better.
prevent development of deformities,






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