• Hydrotherapy can be used for support, assistance and resistance. It is easier for weight bearing joints such as hips and knees.

It is important to speak to your physical therapist or doctor before you start an exercise program as it needs to be tailored to the individual.

Are there any particular types of exercise you would not recommend for someone who has RA?
It is important to avoid pain when exercising. ROM can be done daily, even in a flare, but not into pain. Strengthening exercises with weights should be painfree. High impact exercises should be avoided if hips, knees or ankles are involved.

Physiotherapy for RA can include different types of treatments. Please tell us how the following may be helpful:
TENS
TENS can be used for symptomatic pain relief. It is important to be careful not to mask the pain from a flared joint and continue to exercise joint protection principles until the disease activity subsides.

Ultrasound
Ultrasound produces thermal effects in the tissues and may help reduce muscle spasm.

Massage
Massage may help with relaxation of tight musculature. Caution needs to be exercised around the cervical spine (neck) as it can be affected by RA.

Are there other ways in which a physical therapist can help someone who has RA?
As RA is a chronic disease, education is a very important part of learning to live with RA. Education includes information on the disease, medications, pain and stress management, energy conservation and joint protection principles.

Therapeutic interventions include recommendations on exercise, thermal modalities, splints, footwear and the use of assistive devices.

Heat can help to decrease pain, relieve muscle spasm and improve circulation. It helps by increasing the circulation. Hot water bottles, hot packs, paraffin wax baths or electric pads are different ways to apply heat to a joint. Heat should be comfortably warm and should be discussed with your physical therapist or doctor before using it.

Cold can help to decrease pain and swelling and help reduce muscle spasm. It helps by blocking the release of histamine which decreases the feeling of pain. Cold packs, ice massage, cold bath and contrast baths. Cold should be discussed with your physical therapist before using it.

Many assistive devices can help people with RA. The use of splints helps protect vulnerable joints. The use of walking aids helps support a painful or active joint of the lower extremity. The use of devices in the kitchen like angled knives, electric can or jar openers helps protecting the small joints of the hand. The use of orthotics helps protecting joints by restoring alignment in the lower extremities and providing cushioning for vulnerable joints of the feet.

Danielle McCormack has been a physical therapist with The Arthritis Society since 1994. Since 1999, she has been involved in teaching the rheumatology module for physical therapy students at the University of Toronto. Danielle received the 2010 Recognition Award for outstanding performance as a lecturer and facilitator.