Stiff joints, inflammation and pain are the most common symptoms of arthritis. Arthritis is the term given to a set of 100 different degenerative and inflammatory diseases which cause hindrance in movement of the major joints in the body.
Various factors like environmental, lifestyle, genetic and age are said to be responsible for the onset of this disease. Patients suffering from arthritis are supposed to take anti-inflammatory and anti-arthritic drugs on a regular basis which leads to numerous side effects.
Thus many patients prefer using natural treatment or other such alternate therapies in addition to regular medications in order to relieve the symptoms of the disease. Physiotherapy is one such option that could be explored by arthritic patients.
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What is Physiotherapy?
Physiotherapy is a type of assistance provided by trained individuals based in individualistic measures like patients’ medical history, joint damage, flare-ups and range-of-movement of affected joints. Regular exercise is very crucial for all the patients with arthritis as it keeps the joints in motion, lubricates the joint tissues, strengthens the muscles and bones and keeps the joints healthy.
However despite so many positives, general exercise may cause more harm to the patients than help. Due to insufficient knowledge, instructions and warnings, general exercise might cause excessive damage to the affected joints and thus aggravate the pain and inflammation.
This is when a physiotherapist comes to the rescue! Physiotherapists are trained to estimate the joint damage of each patients through X-rays and other medical examinations and then advice useful exercises. This way under the guidance of trained professionals one can attain complete range of motion without causing any harm to the joints.
Physiotherapy comprises of numerous modalities like joint mobilisation, electrotherapy, exercise prescription, acupuncture, hydrotherapy, education and support and aids .
How can Physiotherapy help?
The prime objectives of physiotherapy are:
- To assess the disease condition in each patient
- To suggest disease control and monitoring modalities
- To relieve pain and increase functional capacity of affected parts
- To provide patient education.
A physiotherapist first performs a series of clinical tests to assess the physical disability, incapacity and strength in each patient to tailor the treatment accordingly. The physical assessment consists of components like functional assessment including analysis of gait, daily life activities and transfer status; range of motion for all joints; test for muscle strength, posture, and respiratory function for all patients .
After this the treatment modality is decided for each individual. This might include hands-on therapies like massage, passive joint mobilisation and stretching. A physiotherapist might also suggest an exercise program to reduce pain and strengthen joint muscles, a diet plan and various weight reduction methods. Additionally they can suggest other modalities like acupuncture, hydrotherapy or dry needling that might be suited as per the requirements of the patient. In this way physiotherapy can provide assistance to the suffering patients.
Usually people believe that home exercises are equally good as physiotherapy and also cheaper. This might be true to some extent but in the long run, physiotherapy provides added benefits. At first general exercises are the same for all the individuals and are performed without much guidance which might result in unnecessary complications or joint damage among the patients.
Yet again the compliance rate is quite low for these programs over a long period of time. People exercise for some days and feel better and then discontinue. On recurrence of the symptoms they again start their exercise regimen.
These repetitive cycles of exercise and inactivity are extremely harmful for the joints and adversely affect the joint strength and range of movement. Physiotherapy ensures avoiding these irregularities and treats every individual based on their needs and symptoms. A physiotherapist carefully assesses the physical condition of every patient to decide the best treatment regimen for them. Then during each visit within 4-6 weeks, he/she monitors the joint functionality of the patient to tailor the treatment accordingly.
He/she might also advice the patient about the ways to keep a check on their joint movement and might further suggest ways nd motivation to continue regular exercise in order to avail long term benefits. These advantages make physiotherapy a preferred choice among the patients.
Do we have scientific evidence in favour of Physiotherapy?
Natural treatments, though effective, do not become extremely popular owing to lack of scientific evidence. But not physiotherapy! This is a treatment option which is provided by trained individuals and based on the findings of various scientific researches. There are many reports about the effectiveness of various different physiotherapy modalities for the treatment of arthritis. Some of these reports have been listed below.
Early intervention is always favoured for the treatment of arthritis. One study tested the efficacy of early occupational programme for rheumatoid arthritis. This study included 60 patients with early rheumatoid arthritis for a randomised controlled trial. Patients were divided in two groups; one receiving complete information for their occupational therapy with proper guidance for a period of three months, while the other receiving no information and guidance.
On assessing the hand grip strength and health assessment score for all the patients, it was found that the group receiving proper information and guidance during the treatment received a better score. Their grip strength improved and so did their general health condition. This study proved the significance of complete information and guidance to improve the hand function in patients detected with early rheumatoid arthritis .
Physical examination is yet another crucial part of physiotherapy. Proper examination facilitates apt treatment decision for the patients. This fact was proven through a study which was designed to check the specificity, sensitivity and reliability of physical examination for rheumatoid arthritis.
This study included 2 physiotherapy students and 2 trained rheumatologists to examine 25 patients with varying degree of rheumatoid arthritis. A specific examination technique named GALS (gait, arms, legs and spine) examination was employed to diagnose rheumatoid arthritis among the patients.
Considering the rheumatologists’ diagnosis as a standard, the diagnoses done by the students based on GALS examination was tested. It was found that GALS examination was an effective way to screen for arthritis and helped in proper assessment of the patients .
Another famous modality of physiotherapy is Hydrotherapy. It stands for exercises performed in water. It has been considered to be highly effective in treating symptoms of arthritis and arthritic conditions. A study conducted in 2014 tested the effectiveness of aquatic exercises in managing musculoskeletal conditions.
This was a meta-analysis based on random controlled trials performed so far to test the role of aquatic exercises for musculoskeletal conditions from different online resources. It included 26 studies which were reviewed by two reviewers to analyse the outcome data. The results from this analysis proved that aquatic exercises improved the pain, physical function, and quality of life of all the patients included in the review .
Another paper tested the efficacy of hydrotherapy in treatment of fibromyalgia among patients. This review included 10 randomly controlled trials performed in the past years. Review of these studies reported positive effects in symptoms of pain, tender point count and health status of patients with fibromyalgia thus further establishing the significance of hydrotherapy for treating various different arthritic conditions .
In recent times a new and more intensive clinical trial has being designed to support the importance of physiotherapy among patients with arthritis. This study aims at studying the cost effectiveness and overall effectiveness of two physiotherapy strategies through qualitative interviews. This study has recruited 500 adults suffering from knee pain. It aims to monitor the effects of physiotherapy over a period of 10 to 18 months. It is expected that results from this study will prove to be a cornerstone in establishing the significance of physiotherapy as an alternate treatment in combating symptoms of arthritis .
What all these studies imply
Thus all these studies show that physiotherapy could be used as a means to fight against symptoms of arthritis. Early detection and intervention is preferable as it ensures quick diagnoses and treatment of the affected joints. Proper assessment of physical function is mandatory. For this newer and better techniques and parameters could be found and employed in regular practise by a physiotherapist. Again modalities like hydrotherapy, electrical stimulation and the likes have shown promise in the past. With more focussed trials involving larger groups substantial results are expected.
What is included in physiotherapy?
Physiotherapy involves different components and modalities. As stated earlier the first stage before starting any physiotherapy session involves physical assessment of the patient to judge the functional ability of each patient and then decide the most suited modality for them. The most common physiotherapy modalities include cold/hot application, electrical stimulation and hydrotherapy. Each of these have been discussed briefly below;
This is the most common modality for relief from disease symptoms in arthritis. Cold is mostly used for acute stages and hot is preferred for chronic stages of rheumatoid arthritis. Application of heat acts as an analgesic, reducing the pain, relieving muscle spasm and improving muscle elasticity at the site of application.
This could be obtained by external application of hot packs, fluid therapy, paraffin or infrared radiations. It is usually recommended daily once or twice for 10-20 minutes duration.
Cold application on the other hand, is used for active joints where excessive intra-articular heat is not desired. This can be obtained with the help of cold packs, nitrogen spray, ice or cryotherapy.
Electro-stimulation can be used to reduce pain as it acts as an analgesic at the point of stimulation. Usually high frequency wave of 70 Hz is applied at the affected joint. The most common therapy used in this regard is -Transcutaneous electrical wave stimulation (TENS) . Many studies have reported the positive effects of this therapy among patients with arthritis. One such study observed that TENS application resulted in reduction of inflammatory exudates and synovial fluid in the joints thus providing pain relief among the patients .
Hydrotherapy includes taking bath in mineral water and performing exercises in the water itself. It has been used since old times for the treatment of rheumatoid arthritis. It has multiple benefits for treating the disease and relieving its symptoms. The body weight of an individual decreases to a considerable percent in water which helps in performing some of the exercises with ease in water than otherwise.
Further, hydrotherapy leads to relaxation of muscles, ligaments and tendons. It has a sedating effect on the body by increasing the release of acetylcholine in the body. Thus in this way it has been found to be extremely effective for the patients. Better results could be obtained by using warm water during the therapy.
Apart from the common modalities there are various other treatment methods that could be a part of physiotherapy. These include :
- Rehabilitative therapy including patient education, use of assistive devices and performing therapeutic exercises
- Joint protection strategies like rest and splinting, adaptive equipment and assistive devices.
- Acupuncture, etc.
Not much precautions are needed as physiotherapy has no side effects and is always performed under the guidance of the experts. Still one must choose their physiotherapist wisely.
A well trained and experienced physiotherapist is advisable. Again do not shy away from raising questions and sharing your doubts and difficulties with your doctor. This will assist the physiotherapist to assess your symptoms and mental state better thus enabling him/her to choose your treatment effectively. Patients with poor sensations must avoid hot/cold treatment.
Electrical stimulation must be performed only on one or two joints at a time. Applying this therapy at all the affected joints all at once could affect adversely. But most importantly, do listen to the advice of your physiotherapist carefully and follow the suggested treatment regularly. In the long run you will definitely appreciate its benefits.
Physiotherapy could be an effective intervention for patients with arthritis due to reduced risks and side effects. Physiotherapy is performed by trained individuals and involves assessing each individual for their physical condition and then providing treatment accordingly.
It involves mild exercises, and treatment options like massage, spa treatment, hydrotherapy, electrotherapy or thermotherapy. All these have been found to be beneficial for the patients and thus could be an assistive tool in addition to regular medication to relieve the symptoms of arthritis.