Role of Physiotherapy in Arthritis

ARTHRITIS CARE : PHYSIOTHERAPY TREATMENT

World Arthritis Day was established in 1996 by Arthritis and Rheumatism International (ARI) and is celebrated every year on 12 October. World Arthritis Day is an ideal focus for organizations to raise awareness of issues affecting people with rheumatic and musculoskeletal diseases (RMDs) and for individuals to support campaigns. World Arthritis Day is a global effort to increase awareness of the many forms of arthritis and to call on individuals and policymakers to take action to reduce the burden of arthritis around the world.

Physical activity is good for our body and boosting our mood which is why the theme of 2011 has been set as" MOVE TO IMPROVE".This movement specialist is none other than "PHYSIOTHERAPIST". That is why the role of physiotherapist is significant in conservative management of Arthritis. In general, studies have shown that physical exercise of the affected joint can have noticeable improvement in terms of long-term pain relief. Furthermore, exercise of the arthritic joint is encouraged to maintain the health of the particular joint and the overall body of the person.

In arthritis the joints become stiff and the range of movement can be limited. Physical therapy has been shown to significantly improve function, decrease pain, and delay need for surgical intervention in advanced cases. Exercise prescribed by a physio therapist has been shown to be more effective than medications in treating osteoarthritis of the knee. Exercise often focuses on improving muscle strength, endurance and flexibility. In some cases, exercises may be designed to train balance. Being Physically active is especially important for people with rheumatic and musculoskeletal diseases. Even doing a small amount of mobility activity around the home also can help people suffering with arthritis.

WHAT IS ARTHRITIS?

Arthritis (from Greek arthro-, joint , itis- inflammation) is a form of joint disorder that involves inflammation of one or more joints. There are over 100 different forms of arthritis. The most common form, osteoarthritis (degenerative joint disease) is a result of trauma to the joint, infection of the joint, or age. Other arthritis forms are rheumatoid arthritis, psoriatic arthritis, and related autoimmune diseases. Septic arthritis is caused by joint infection.

The major complaint by individuals who have arthritis is joint pain. Pain is often a constant and may be localized to the joint affected. The pain from arthritis occurs due to inflammation that occurs around the joint, damage to the joint from disease, daily wear and tear of joint, muscle strains caused by forceful movements against stiff, painful joints and fatigue.

SIGNS AND SYMPTOMS:

The common symptoms for all arthritis disorders include varied levels of pain, swelling, joint stiffness and sometimes a constant ache around the joint(s). Arthritic disorders like lupus and rheumatoid can also affect other organs in the body with a variety of symptoms.

It is common in advanced arthritis for significant secondary changes to occur. For example, in someone who has limited their physical activity:

ROLE OF PHYSIOTHERAPY:

The main aim of physiotherapist in Arthritis patient is treatment of Pain. Secondary to pain management, reducing joint stiffness by improving range of motion,improving the circulation around the painful joints,improving the strength of the muscles passing across the effected joints and one joint above and below, enhancing the proprioception around the effected joints, proper gait training,sitting and standing balance, maintaining Postural alignment remains the mainstay of Physiotherapy treatment. To reduce pain, physical therapy modalities like Interferential therapy(IFT), Ultrasound, TENS, LASER, Cryotherapy, Hot packs are commonly used. Therapeutic Exercise techniques such as MAITLANDS graded oscillation Techniques (Grade 1 and 2 for pain relief,Grade 3 and 4 for improving joint range of motion), KALTENBORN'S SUSTAINED Joint play Techniques (grade 1 and 2 to reduce pain,grade 3 to improve joint. ROM) are used. These above modalities along with exercises reduce pain, improving joint range, improve the blood circulation around the effected joints.

In addition to these blood circulation can also be improved by therapeutic soft tissue mobilization such as kneading ,effleurge, stroking, wringing, hacking etc. Also joint strengthening can be achieved by initially advising the patient isometric exercises to the effected joints and the near by unaffected joints. Isometric quadriceps, hamstrings, abductors, hip extensors, ankle dorsiflexos, plantarflexors, subtalar joint invertors, evertors will help in improving strength and postural biomechanical alignment and stability in early stage of osteoarthritis at the effected joints. Patello-femoral joint glides help to reduce pain and improve range of motion between patella and femoral surface that significantly contributes to increased ROM IN THE TIBIO FEMORAL JOINT.

The isometric exercises are gradually progressed to multiple angle isometrics and followed by Progressive resisted exercises such as sitting on the chair and extending the knee and maintain the position for 5 to 10 counts according to the patients tolerance, and later tying sand bags of certain low weight and repeating the same above exercise to improve the strength of the muscles passing around the joint. These strengthened muscles take up some of the loads that are directly passing through the bones. That is how strengthening muscles reduces pain, improves mobility and range of motion thus contributing to joint health. Proprioception is trained by asking the patient to consciously bear equal weight on the effected joints even during walking or standing. Taping techniques also help to improve proprioception. Another cause of Osteoarthritis of knee joint is obesity. Due to obesity, the effected joints can no longer carry excess weight. So the tibia and the fibula starts bowing . This obesity causes excess stress on the knee joint and abnormal biomechanical forces shifting the line of gravity anteriorly causing deformities in the knee joint such as genuvaram (bow legs) because of which many patients walk with altered gait(waddling gait) This gait can be corrected by first reducing pain,postural biofeedback gait training in parallel bars and proper support to the joints by orthotics and braces such as knee caps, knee immolizers etc..To reduce obesity, Physiotherapists Emphasize on sub maximal endurance exercises (aerobic) such as brisk walking, jogging, running (not for people above 35 yrs), swimming, cycling,water walking only after pain relief. Hydrotherapy, that is treatment in water by application of principles of Archemedis and Byouancy play an important role in reducing pain and improving strength. All effected joints can be exercised in water Isotonically.

A STUDY funded by World Arthritis Foundation proved that an exercise program that includes walking, strength training, stretching improved physical function and reduced Arthritic symptoms. Further, foot problems and hip problems can also cause Arthritis pain in knee joints. Hence advice on use of proper foot wear and strengthening exercises to the Intrinsic foot muscles along with faradic foot bath therapy is very beneficial to the patient with foot problems. In case of supinated and pronated foot medial, lateral wedges in shoes and MCR chappals are adviced. Moving is the best medicine to fight against arthritis pain. According to JOHN H . KLIPPIL, MD (PRESIDENT AND CEO) World Arthritis Foundation, Physiotherapy is the best conservative mode of treatment of Arthritis in early stages. The commonest Arthritis effecting the majority of Indian population (around 10 million people) is Osteo arthritis that effects the knee, hip, joints of the hands and foot and that of spine most commonly affecting the knee joint.

According to WORLD HEALTH ORGANISATION, Osteoarthritis, characterized by focal areas of loss of articular cartilage with in sinovial joints, which are associated with hypertrophy of bone (ostophytes and sub chondral bone sclerosis) and thickening of the capsule. In addition to this precautions should be taken to reduce the stress on the joints. They are:

Hello Arthritis ,

You may cause pain in the joints, muscles and bones

You may not allow the patient to walk,

You may not allow the patient to sit and stand

You may make the patient feel depressed.

Your pain may be relieved temporarily by medicines and injections

But

Only as long as the physiotherapists does not intervene.

But once the patient approaches physiotherapist that day will mark the end of your presence.