With rheumatoid arthritis it is important to balance exercise and resting your joints. The most appropriate health professional to advise on exercise is a physiotherapist.
The balance also depends on how active your disease is. During a disease ‘flare-up’ exercise may aggravate the condition. However, during remission, a simple exercise plan can improve muscle strength, preserve joint function, reduce pain, improve sleep patterns and help maintain a healthy weight.
A physiotherapist may be involved in care throughout treatment, but the extent and nature of their involvement may vary.
In the early stages, when a person has just been diagnosed with rheumatoid arthritis and the symptoms are not severe, a physiotherapist will provide helpful advice on how to manage their symptoms. They may give guidance on joint protection, and on how to manage ‘flare-ups’. They may also give direction on how to pace activities as well as providing advice on coping with fatigue and obtaining effective pain relief. For some patients, this will be the extent of their contact with a physiotherapist, whereas others may need ongoing help and physical therapy.
In most cases, it is a GP or rheumatologist who will refer an individual with rheumatoid arthritis to a physiotherapist. You can however, visit a physiotherapist privately without being referred by your doctor.
What happens at your first physiotherapy visit?
Physiotherapists are often based in hospital departments, but some work in health centres. A thorough assessment is the first step in treatment, and a physiotherapist will usually conduct both a physical examination of your joints and muscles as well asking about your symptoms and daily activities.
Your physiotherapist may test you to see how easily you can carry out certain daily activities (called a functional assessment). For example they may ask you to open a can with a manual can opener.
Physiotherapists may also look at the range of motion you have in your joints. Often a person with rheumatoid arthritis will have lost the full range of movement in their limbs. As part of their routine examination, physiotherapists may perform a muscle strength test.
This assessment helps the physiotherapist determine the most appropriate course of action. A physiotherapist will offer advice and design a simple treatment programme. This may include stretching exercises to increase the range of movement (ie. the normal range of movement for a joint) and strengthening exercises to improve muscle strength.
In addition to exercises, the treatment plan may also include other treatment options:
Posture
The physiotherapist will analyse a person’s gait (walking) patterns, and suggest simple ways of improving poor gait such as insoles and walking aids. When necessary they will refer to other health professionals such as podiatrists (a foot specialist).
Hydrotherapy
Individuals with rheumatoid arthritis often benefit from hydrotherapy. This may include using hot tubs in conjunction with massage or water exercises
Cold/hot applications
This is an important self-care technique in which your physiotherapist can advise you.
Massage
Massage is a commonly used treatment tool by a physiotherapist that improves flexibility and general well-being, and can help to diminish swelling of inflamed joints.
TENS
Transcutaneous electrical nerve stimulation (TENS) therapy is a commonly used electrostimulation method for relieving pain in rheumatoid arthritis. A psychotherapist may administer TENS as part of their therapy.
Rest/splinting
A physiotherapist will give advice on how to balance rest with simple exercises. It is important to rest joints in a functional position and splints can be used to provide extra support. To fit a splint, a physiotherapist may refer the patient to an orthotist. An orthotist is an expert in the design and development of the devices that provide both support and/or correct musculoskeletal abnormalities.
Finding a physiotherapist
More information on how to seek physiotherapy services can be obtained by visiting the Citizens Information website, www.citizensinformation.ie. This website provides information on physiotherapy services available. A limited community service is usually provided by the HSE. The website also has information on tax relief on costs associated with physiotherapy services.
For more information on physiotherapists, contact the Irish Society of Chartered Physiotherapists at www.iscp.ie or email info@iscp.ie