Occupational and Physical Therapy for Arthritis

How is arthritis treated?

"Arthriti" means inflammation of the joints, and it might cause pain, swelling, and limited motion of one or many joints in the body. More than 100 different illnesses can cause arthritis.

Treatment begins after diagnosis by a doctor, who might prescribe medicine to reduce inflammation, pain, swelling, and loss of motion. As part of a comprehensive plan for arthritis treatment, your doctor might also prescribe occupational and physical therapy, which can provide additional help in your recovery.

How can occupational therapists help?

Occupational therapists can teach you how to reduce strain on your joints during daily activities. They can show you how to modify your home and workplace environments to reduce motions that might aggravate arthritis. Occupational therapists might also provide splints for your hands or wrists, and might recommend assistive devices to aid in driving, bathing, dressing, housekeeping, and other tasks.

How can physical therapists help?

Physical therapists can teach you exercises designed to preserve the strength and use of your joints. They can show you the best way to move from one position to another. They can also teach you how to use walking aids such as crutches, a walker, or a cane when needed.

What are the goals of treatment?

The therapists on your health care team will work closely with your doctor to tailor a program to your specific needs, whether your arthritic problems are widespread or confined to one joint or body area.

The goals of treatment are to:

• Prevent loss of use of the joints
• Restore abilities that may have been lost
• Help you adapt to new activity levels
• Maintain your fitness
• Maintain your ability to take part in the activities you choose with minimal help from others

Therapy should be started early in order to reduce painful symptoms of inflammation, prevent deformity and permanent joint stiffness, and maintain strength in the surrounding muscles. When pain and swelling are better controlled, treatment plans may include exercises to increase range of motion, and to improve muscle strength and endurance.

What are some benefits of occupational and physical therapy programs?

Physical therapy programs may provide:

• Education about your kind of arthritis, so that you can be a well-informed member of your health care team
• Foot care advice, including information on how to choose well-fitting shoes with shock-absorbing outer soles, and sculptured (orthotic) insoles molded exactly to the contour of each foot
• Therapeutic methods, including physical techniques and activity modifications, to relieve discomfort and improve performance

What are some therapeutic methods?

Rest

Bed rest helps during flare ups to reduce both joint inflammation and pain, and is especially useful when multiple joints are affected and fatigue is a major problem. Individual joint rest is most helpful when arthritis involves one or only a few joints. Custom splints can be made to rest and support inflamed joints, and a soft collar can support the neck while you are sitting or standing.

Thermal modalities

Applying ice packs or heating pads, as well as deep heat provided by ultrasound and hot packs, helps relieve pain locally. Heat also relaxes muscle spasms around inflamed joints. Heating joints and muscles with a warm bath or shower before exercising might help you exercise more easily.

Exercise

This is an important part of arthritis treatment that is most effective when done properly every day. Your doctor and therapist will prescribe a program for you that may vary as your needs change.

• Range of motion exercise. Gentle movement of each joint through its normal range of motion will help relieve stiffness, improve and maintain joint movement, and increase flexibility.
• Strengthening exercise. Strengthening exercise helps preserve or increase muscle strength. Isometric exercises tighten and strengthen the muscle without moving the joint and are most useful when joints are painful. Isotonic exercises strengthen the muscle by using it to move a weight.
• Water exercise. Warm water helps relieve pain and relax muscles. Swimming is not necessary, as water exercises may be done while sitting in a shallow pool or standing in shoulder-high water. Support by the water decreases body weight applied to the joints of the spine, legs, and feet. Water support of the arms and legs also helps you move your joints through range of motion exercises more easily.
• Recreational exercise. Recreational exercise does not replace your therapeutic exercise program, but might enhance it with a variety of enjoyable activities. Some examples are games, sports, exercise classes, and swimming, all of which can benefit muscle strength and joint range of motion. Swimming are excellent aerobic activities and will help improve your endurance and lessen fatigue. Any exercise needs to be tailored to the patient's disease and limitations.

Therapy for joint surgery patients

Preoperative programs of education and exercise, started before surgery in the outpatient therapy department, are continued at home. They might be changed in the hospital after surgery to fit new needs in the rehabilitation period. These exercises might be added to your usual exercise regimen, and you might find your ability to exercise has improved after surgery.

Joint protection techniques

There are ways to reduce the stress on joints affected by arthritis while participating in daily activities. Some of these ways include:

• Control your weight to avoid putting extra stress on weight-bearing joints such as your back, hips, knees, and feet.
• Be aware of body position, using good posture to protect your back and the joints of your legs and feet. Sit down to do a job when you can instead of standing. Change positions often, since staying in one position for a long time tends to increase stiffness and pain.
• Conserve energy by allowing for rest periods, both during the day and during an activity.
• Respect pain. It is a body signal that is telling you something is wrong. Don't try an activity that puts strain on joints that are already painful or stiff.

A therapist can show you ways to do everyday tasks without worsening pain or producing joint damage. Some joint protection techniques include:

• Use proper body mechanics to get in and out of a car, chair or tub, as well as for lifting objects.
• Use your strongest joints and muscles to reduce the stress on smaller joints. For example, carry a purse or briefcase with a shoulder strap rather than in your hand.
• Distribute pressure to minimize stress on any one joint. Lift dishes with both palms rather than with your fingers, and carry heavy loads in your arms instead of with your hands.
• If your hands are affected by arthritis, avoid tight gripping, pinching, squeezing, and twisting. Ways to accomplish the same tasks with alternate methods or tools can usually be found.

Assistive devices

Many assistive devices have been developed to make activities easier and less stressful for the joints and muscles. Your therapist will suggest devices that will be helpful for tasks you might have found difficult at home or work.

A few examples of helpful devices include a bath stool in the shower or tub; grab bars around the toilet or tub; and long-handled shoehorns and sock grippers. Your therapist can show you catalogs that have a wide variety of assistive devices you may order.

Summary

As the central member of your treatment team, you are the person responsible for following through with your therapy program. This includes taking medicines as prescribed, and continuing daily exercises and other suggestions made by your therapist. You should discuss questions and problems with your doctor and your therapist as they come up so that the program can be adjusted to best meet your needs.

A positive attitude, patience, and persistence will help you to get the greatest benefit from your occupational and physical therapy activities, which are so important in meeting the challenges of arthritis.