Staying fit and flexible is a good idea for everyone, but is particularly important when you live with rheumatoid arthritis. RA does throw some extra factors into the mix, such as avoiding stress on the joints and dealing with pain. Physical therapy can be a useful tool in developing an exercise program that protects your joints, as well as helping you to manage pain. To find out more about how this kind of therapy can help people who have RA, I interviewed Danielle McCormack, a physical therapist with The Arthritis Society of Canada.
Please tell us a little about what you do.
I am a physical therapist and I have worked for The Arthritis Society for more than 15 years. My role is to provide an assessment and treatment recommendations for people with all types of arthritis. We see people in clinic sites all over Ontario and if need be, in their homes when they are unable to travel to a clinic.
Why is it so important to exercise when you have RA?
When exercise is done properly, it is now known to help reduce overall pain with no negative effect on disease activity. It improves joint nutrition and mobility of the joint, improve muscle strength and joint stability. Exercise also helps fitness level which helps reducing stress and anxiety and improves sleep.
Many people live with RA find it difficult to find the type of exercise that doesn’t make their symptoms flare. How can physiotherapy help with this?
Exercise should not make RA flare. Overuse of actively swollen joints may aggravate your arthritis so it is important to know your joints and adjust your exercise routine accordingly.
- Using ice before exercising may help.
- Not working into pain is very important.
- Not stretching an inflamed joint is also important.
- Hydrotherapy (exercise in warm water) can help with decreasing the load on weight bearing joints.
- Using splints or braces to protect vulnerable joints.
- Pacing is an important strategy.
- What kinds of exercise may be recommended for a person who has RA?
- There are several types of exercise.
- The first type is ROM (range of motion) exercises to help reduce stiffness and pain. They are intended to maintain full movement of the joint by moving the joint through its full available range. They are gentle and are safe to do every day, especially on stiff joints.
- Strengthening exercises help build strong muscles around the joints. They help stabilize the joints when doing activities. It is better to talk to your physiotherapist before using weights and proper positioning.
- Stretching exercises help to increase flexibility or the elasticity of the muscles and tendons, especially after strengthening exercises.
- Aerobic exercise improves the health of heart and lungs. Examples are walking, biking and swimming and can be done in minimum 10 minute bouts up to 120 minutes per week at low to moderate intensity. Allowing a warm up and a cool down period is important and should be enjoyable and painfree.
- 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 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 produces thermal effects in the tissues and may help reduce muscle spasm.
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.
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Lene is the author of the awardwinning blog The Seated View.
Lene Andersen is the Community Leader for HealthCentral’s RA Community. Lene (pronounced Lena) is an award-winning writer, health and disability advocate, and photographer living in Toronto. She’s written several books, including Your Life with Rheumatoid Arthritis: Tools for Managing Treatment, Side Effects and Pain, and 7 Facets: A Meditation on Pain, as well as the award-winning blog, The Seated View. Follow Lene on Twitter @TheSeatedView and on Facebook. Watch her story on HealthCentral.