Physiotherapy for Arthritis

We are all familiar with the word ‘arthritis’ but, probably, very few of us realize that there are approximately 150 different forms of arthritis. The two best known forms are OSTEO-ARTHRITIS and RHEUMATOID ARTHRITIS.

Osteo-Arthritis (OA)

Osteo-Arthritis commonly occurs as part of the ageing process whereby the joint cartilage lining is worn down in much the same as our car tyres do as mileage increases. This wear and tear process can be accelerated by:

• injury to joints
• overuse of the joints, as occurs in some occupations eg. knees in bricklayers
• excess weight or abnormal forces which increase the load through a joint and can increase painful symptoms.

OSTEO-ARTHRITIS can occur in any joint but most commonly affects spinal joints, hips and knees, as these are the major load-bearing joints of the body. The joint cartilage changes of osteo-arthritis are permanent, but the pain and associated loss of function can be modified with physiotherapy treatment.

Symptoms of osteo-arthritis may vary. Minor osteo-arthritic changes may cause mild pain only when the joint is subjected to trauma or when the activity level is increased. More marked degenerative changes can cause significant pain and limitation of function. Severe osteo-arthritis may require surgery, such as a total hip or knee replacement.

Rheumatoid Arthritis

RHEUMATOID ARTHRITIS is an active inflammatory disease which attacks and erodes joint structures, often causing joint deformities, most commonly in the hands, feet and knees. Rheumatoid arthritis tends to follow a pattern of flare-ups when the disease is actively progressing, and remissions when only residual symptoms are present. During flare-ups activity level may need to be limited. During remissions patients will benefit from an exercise programme designed to increase function and reduce pain.
SIGNS AND SYMPTOMS of both osteo and rheumatoid arthritis include:

• pain or swelling in a joint;
• redness or heat in a joint;
• stiffness or difficulty in moving a joint, particularly first thing in the morning
• joint deformity.

TREATMENT of both osteo and rheumatoid arthritis usually involves physiotherapy management and may also include the use of anti-inflammatory medication.

Physiotherapy treatment aims to:

• Reduce pain and swelling through the use of electrotherapy and either ice or heat;
• Increase joint range with gentle passive movements;
• Use muscle stretches and strengthening exercises to restore the correct muscle balance around the damaged joint. Increasing muscle strength can often provide enough support to the joint to greatly reduce pain and increase function;
• Splints may be used to protect joints from further damage occurring.

In cases of marked osteo-arthritis an operation such as a total hip or knee replacement may be required. Physiotherapists are involved in preparing the patient prior to surgery and in restoring maximum function post-operatively.

Physiotherapy treatment will usually involve a home exercise program which may include hydrotherapy (exercise in water), cycling or walking. The program is individually designed to best suit the patient’s particular problems. Exercises promote improved posture and circulation as well as helping to lubricate the joints. Muscle strength and endurance are improved, thereby increasing the ability to perform activities of daily living.

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