Arthritis

Arthritis | Its Treatment and Management by Physiotherapy

Are you suffering from Arthritis and are taking painkillers to suppress the pain caused by this condition? Then you should immediately take proper treatment before this condition progresses to a level where it might restrict the movement of the affected joints. Exercising every day and consulting a well-trained physiotherapist is one such step that can be beneficial. Arthritis targets the skin and multiple joints of the body affecting day to day life of an individual. This blog is written to give you a better understanding of arthritis, its types, and its physiotherapy management.

 

Types of Arthritis

Arthritis is the inflammation of the joints, it affects one or multiple joints. The symptoms of this condition may develop over time and are not constant. Arthritis is broadly classified into three categories:

1: Osteoarthritis:

This type of arthritis occurs due to an injury or aging.

2: Rheumatoid arthritis:

Rheumatoid arthritis happens due to the immune system attacking (by accident) the functional cells of the body.

3: Infectious arthritis:

Infectious arthritis spreads to the joint from a different body part.

4: Juvenile arthritis

Juvenile arthritis takes place in children.

5: Psoriatic arthritis

Psoriatic arthritis occurs in people with psoriasis, it affects their skin and joints.

 

Physiotherapy management

Physiotherapy for arthritis is an effective and safe way to help:

• Decrease pain
• Reduce discomfort
• Strengthen the joints and muscles
• Improve mobility
• Helps in increasing the range of flexibility and motion.
• Restore the use of affected joints
• Prevent further damage to the joints
• Prevent progression of arthritis
• Maintain fitness
• Improve functionality.

 

Physiotherapy intervention

According to the patient's needs, the physiotherapist would tailor the exercises. The physiotherapy treatment program for arthritis includes:

1: Rest and Splinting:

Rest or splinting is recommended if required during the acute stage of the disease. Bed rest relieves extensive joint pain and puts the joints into rest at a functional position. Rest and splinting, diminishes pain and inflammation, to prevent stress, stiffness, and deformities.

 

2: Ultrasound Therapy:

Ultrasound therapy creates warmth and gentle heat that increases blood circulation in deeper tissues thus decreases pain and increases range of motion.

 

3: Transcutaneous electrical stimulations (TENS):

Transcutaneous electrical stimulations are found to be significantly effective in increasing strength. This helps to prevent the progression of the condition that limits movement and functionality in daily life.

 

4: Low-level Laser Therapy (LLLT):

Low-level Laser Therapy is a non-invasive treatment that reduces pain, inflammation and also increases mobility.

 

5: Paraffin Therapy:

Paraffin therapy is extremely beneficial for arthritis. It has a very high capacity for absorbing heat, which helps to improve the patient's performance while exercising.

 

6: Ice therapy:

Use of ice pack or cloth soaked in cold water can be applied to the affected area or by submerging the part in ice-cold water.  Ice packs can be used to reduce pain, swelling, and inflammation. 

 

7: Heat therapy:

Similarly, heat packs can also help decrease stiffness and improves blood circulation.  A heating pad, warm shower, hot water bottle on the affected area can be used. Heat packs can also help decrease stiffness and improves blood circulation.

 

8: Massages:

Moderate pressure massage is given by a trained physiotherapist. Massage therapy is proved to be helpful and soothing for many arthritis sufferers. Regular massages can relieve pain by lowering the production of cortisol (stress hormone) in the human body.

 

9: Acupuncture:

Acupuncture is another treatment that can be used as an intervention by the physiotherapist to stimulate the brain to release endorphins.

 

10: Exercise:

Graded exercises help reduce arthritis pain. These exercises are started slowly and then gently increased when progressed further.  These exercises strengthen the muscles and joints and increase overall fitness. Strengthening, endurance, stretching & stability exercises are a part of the exercise program. The therapist also advises holding correct body posture while carrying out daily activities to relieve pain and prevent further damage.

 

11: Hydrotherapy:

Physiotherapy for arthritis is not limited to simple exercises or the use of modalities only, but also extends to other exercises such as swimming which is a great form of exercise without putting pressure on the joints. Water-based exercises can relieve pressure on the joints, reduce body fat, and improve mood, coordination, and range of motion.

 

12: Assistive devices:

The physiotherapy also recommends assistive devices like wearing braces or walking with a cane.

 

13: Posture correction

Arthritis can also be caused due to bad body posture while sitting and working. Simple exercises at home or at the workplace can help in preventing arthritis. Some simple stretches include neck rotations, head tilts, leg raises, hamstring stretches, finger and thumb bends and wrist rotation to ease the tension in the joints while working on the desk.

 

Physiotherapy has beneficial effects on increasing physical capacity and reduces the activity of the disease. The physiotherapist provides patient education about their condition and makes them aware of the various physiotherapy options that are available to improve the quality of life.

 

Pathology of Osteoarthritis

How Osteoarthritis affects the body? Pathophysiology of Osteoarthritis

Do you suffer from swollen, painful, and restricted joint movements? Are you diagnosed with Osteoarthritis? If yes, then you should start taking treatment and should also self-educate yourself regarding this condition. After reading this blog you will be certainly able to answer the queries that you might have in your mind regarding osteoarthritis.

What is osteoarthritis?

Osteoarthritis is a chronic progressive degenerative condition of the joints, meaning that the condition will deteriorate over time as it is a continuous process. Osteoarthritis affects mainly the articular cartilage of the big weight-bearing joints of the body mainly in aged individuals. It can be broadly classified into two types.

• Primary Osteoarthritis
• Secondary Osteoarthritis

Primary osteoarthritis is due to the wear and tear changes occurring in old age in which weight-bearing joints like the hips and knees are more commonly affected. It is uncommon in non-weight-bearing joints like the shoulder and the elbow.

Secondary osteoarthritis is due to abnormal wear and tear in a joint, caused by mechanical incongruity (lack of symmetry) of the articular surfaces. This incongruity may be the result of a preceding fracture involving the articular surface or partial destruction or deformity due to a previous disease. It can arise as a consequence of other conditions such as hyperthyroidism, dislocation, hemophilia, infection (tracking into a joint from an open wound) or tuberculosis of a joint, etc.

An osteoarthritic joint might be

• Painful
• Swollen
• Stiff
• Tender on restricted movements
• Crackling or grating sound
• Bowlegs deformity (in later cases)

What changes take place in our joints due to osteoarthritis?

• Articular cartilage of the surface

The place, where 2 bones meet, is normally covered with a rubbery material called cartilage. This material allows the bones to slide over each other without causing pain. When osteoarthritis sets in, the cartilage begins to break down and undergoes degeneration. As it is cyclically loaded during movements of joints, it undergoes fatigue failure leading to the fragmentation of the surface and fibrillation (cracks and fissures). In the later stages, the cartilage gets completely eroded, exposing the sclerosed or eburnated (hard and thick) bone and the subchondral cyst is also formed (Subchondral is the layer of bone just below the cartilage in a joint, chondral refers to cartilage. Subchondral bone is a shock absorber in weight-bearing joints. It has many blood vessels supplying it with nutrients and oxygen and taking away wastes).

• Bone

The bone surfaces become hard and polished as they lose protection from the cartilage. Subchondral cysts and cavities are formed as the eburnated bones are brittle. Blood flow may be reduced by venous occlusion (blockage of a blood vessel) and the development of microemboli (small particle often a blood clot) in the subchondral vessels occurs.

And microfractures occur allowing the passage of synovial fluid into the bone tissue. There can be venous congestion (when arterial inflow is greater than venous outflow) also. The bone undergoes hypertrophy (increase in no and size) forming peripheral osteophytes (bony projections)

• Synovial membrane

The synovial membrane undergoes hyperemia (excess blood in the vessels) dry and reactive inflammatory thickening. Reduction of synovial fluid secretion results in loss of nutrition and lubrication of the articular cartilage.

• Capsule

There is degeneration of the capsule along with chronic inflammation.

• Ligaments

Ligaments become contracted or elongated.

• Muscles

Muscles undergo atrophy meaning muscle wasting due to loss of movement and function, as a result of pain

• Joint space

Joint spaces become narrow and joints become stiff. The stiffness is maximum at the end of a long rest period and loosens for few minutes during activity.

There is no permanent cure for osteoarthritis but with a good diet and exercise, you can stop the condition from progressing further. The management involves the role of Doctors, Dieticians, Pharmacists, Occupational therapists, and Physiotherapists.