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Information for Patients

Sports-Medicine Kalyan-Dombivali
Exercise In Arthritis.
Should People With Arthritis Exercise?
How Does Exercise Go With Other Treatment Modalities:
What Are Different Types of Exercise?
Types of Active Muscle Exercise:
Which Exercise Are More Suitable In Arthritis?
How Does A person With Arthritis Start Doing Exercise? Whom To Approach?
What Is The Role of Occupational Therapists?
What Is The Role of Physiotherapists?
What Are Different Pain Relief Methods Before Exercise?
What Are Different Exercises Recommended For Different Forms of Arthritis?  
How Often Should Exercise Be Done?
When To Stop Doing Exercise? What Are The Danger Signs?
Should Someone With Rheumatoid Arthritis Continue To Exercise During A General Flare? How About A Local Joint Flare?

Should People With Arthritis Exercise?

Physical therapy forms an integral part of any rehabilitation program for arthritis patient. Any treatment for arthritis is incomplete if this aspect is ignored or underestimated. The exercise therapy can help to:

  1. Reduces Pain
  2. Strengthens bones & prevents osteoporosis
  3. Improves joint heart & lung fitness
  4. Improves posture
  5. Controls weight & helps in reducing fat
  6. Decreases stress
  7. Improves sleep patterns
  8. Creates a feeling of well being

How Does Exercise Go With Other Treatment Modalities:

In fact exercise is one of the most important part of any comprehensive arthritis treatment plan. The treatment plan not only comprises of medication but also rest, relaxation, proper diet, exercise, instruction about proper use of joints & ways to conserve energy.

What Are Different Types of Exercise? 

There include range of motion exercise & active muscle exercise

Types of ROM exercise:

Passive ROM: The motion is performed by mechanical device or some other person without help of the patient

Active ROM: Performed by patient himself

Active Assisted ROM: Here the motion is performed by patient with the assistance of the therapist.

Active-Resisted ROM: Here active motion is performed by patient against resistance by mechanical device or therapist

Types of Active Muscle Exercise:

  1. Isometric Training: It is a method of static muscle contraction, useful in the presence of active joint inflammation. In this method there is no movements across the joint as muscle length remain static. It helps in maintaining muscle strength.
  2. Isotonic Training: Here the active joint motion is done against a fixed resistance. It is to be done when inflammation has subsided .
  3. Isokinetic Training: With the rate of movements maintained constant, the force produced by the individual vary through the area of motion.
  4. Aerobic & Aquatic Exercise Programs

Which Exercise Are More Suitable In Arthritis?

These include:

  1. Active range of motion exercises (e.g. dance) help maintain joint movements, relieve stiffness. This type of exercise helps maintain or increase flexibility.
  2. Strengthening Exercises (e.g. weight training) help keep or increase muscle strength, strong muscles help support & protect joints affected by arthritis.
  3. Aerobic Or Endurance Exercise (e.g. bicycle riding improve cardiovascular fitness, help control weight, and improve overall  function, weight reduction reduces overall load on many joints. There are some studies suggesting that aerobic exercise can reduce inflammation in some joints.

How Does A person With Arthritis Start Doing Exercise? Whom To Approach?

The patient should discuss his exercise option with his medical team. In the beginning usually easy, range of motion exercise & low impact aerobics are started. The doctor will suggest if any sports are off-limit but mostly patients can participate in a variety of but not all sports & exercise programs.

What Is The Role of Occupational Therapists?

They can help if you have difficulty with every day tasks like washing, dressings, cooking & cleaning. They are expert on equipment in arthritis, how to use it, where they are available. They can see you in hospital or at your residence. They can also help you in getting expensive instruments or equipment on temporary loan.

What Is The Role of Physiotherapists?

Physical therapists may help by designing an appropriate home exercise program & teach about pain relief methods, proper body mechanics (placement of the body for a given task, such as lifting a heavy box), joint protection and conserving energy. Physiotherapist can also offer hydrotherapy session (exercise in water) to reduce inflammation & to reduce loading off joints. He can provide manipulation therapy, acupuncture. He may also provide electrotherapy to reduce inflammation of joints & injured tendons or muscles.

What Are Different Pain Relief Methods Before Exercise?

Mobilisation Therapies: These methods reduce pain & increase joint motion & muscle & tendon flexibility. These include traction (gentle steady pulling, massage, and manipulation).

Diagram 14.1:Traction used in neck pain (Intermittent Cervical Traction): Click here to see diagram

Usually kept 30 seconds on & 30 seconds off

Started from 10 to 15 lbs & then increased if required in tractions applied in sitting position.

Duration of treatment is 10 to 30 minutes Depending upon patient condition for both static traction & intermittent traction.

TENS (Transcutaneous Electrical Nerve Stimulation) & Biofeedback: These are pain relieving methods. In TENS, an electrical shock is transmitted through electrode placed on skin's surface.
Relaxation Therapy: patient is taught how to release the tension in their muscles to relieve pain. Health spas & vacation resorts sometimes have special relaxation course.
Acupuncture is a traditional Chinese method of pain relief, whereby needles are placed in certain sites. It is believed that the needles stimulate deep sensory nerves that tell the brain to release natural painkillers (endorphins). Acupressure is similar to acupuncture, but pressure is applied to the acupuncture sites instead of using needles.
Heat & Cold Therapies: Heat therapy increases blood flow, tolerance for pain & flexibility. It involves treatment with paraffin wax, microwaves, ultrasound, or moist heat. Physical therapists are needed for some of these therapies, such as microwave or ultrasound therapy, but patients can apply moist heat themselves. Some ways to apply moist heat include placing warm towels or hot packs on the inflamed joint or taking a warm bath or shower.

Cold therapy numbs the nerves around the joint & may relieve inflammation & muscles spasms. The common methods are:

· Ice Massage

· Cold packs

· Over the counter sprays

· Soaking in cold water

· Refillable bladders

· Ointment that cool the skin & joints capsaicin cream is also useful in reducing pain only when one or two joints are involved. This preparation is put on the skin.

 

What Are Different Exercises Recommended For Different Forms of Arthritis?

Ankle exercises
Back pain exercises
Neck pain exercises
Knee exercises
Hand and wrist exercises

How Often Should Exercise Be Done?

  • Range of motion exercise can be done daily & should be done at least every other day.
  • Strengthening exercise should be done every other day unless you have severe pain or swelling in your joints
  • Endurance exercise should be done for 20 to 30 minutes three times a week unless you have sever pain or swelling in your joints. According to American College Of Rheumatology, 20 to 30 minute exercise routines can be performed in increments of 10 minutes over the course of a day

When To Stop Doing Exercise? What Are The Danger Signs?

  • Increases joint pain or swelling following exercise program
  • Excessive pain during exercise program
  • Post exercise fatigue lasting for more than on hour
  • Post exercise soreness lasting for more than two hours

Should Someone With Rheumatoid Arthritis Continue To Exercise During A General Flare? How About A Local Joint Flare?

It is appropriate to put joints gently through their full range of motion once a day, with periods of rest, during acute systemic flares or local joint flares, patient can talk to their doctor about how much rest is best during general or joint flares.