How physiotherapy can ease arthritic pain

Arthritis is very common but is not well understood. Actually, “arthritis” is not a single disease; it is an informal way of referring to joint pain or joint disease. There are more than 100 different types of arthritis and related conditions. People of all ages, sexes and races can and do have arthritis, and though it is most common among women and occurs more frequently as people get older.

Common arthritis joint symptoms include swelling, pain, stiffness and decreased range of motion. Symptoms may come and go. They can be mild, moderate or severe. They may stay about the same for years, but may progress or get worse over time. Severe arthritis can result in chronic pain, inability to do daily activities and make it difficult to walk or climb stairs. Arthritis can cause permanent joint changes. These changes may be visible, such as knobby finger joints, but often the damage can only be seen on X-ray.

Some types of arthritis also affect the heart, eyes, lungs, kidneys and skin as well as the joints.

There are different types of arthritis:

Degenerative Arthritis

Osteoarthritis is the most common type of arthritis. When the cartilage, the slick, cushioning surface on the ends of bones, wears away, bone rubs against bone, causing pain, swelling and stiffness. Over time, joints can lose strength and pain may become chronic. Risk factors include excess weight, family history, age and previous injury (an anterior cruciate ligament, or ACL, tear, for example).

When the joint symptoms of osteoarthritis are mild or moderate, they can be managed by:

• balancing activity with rest
• using hot and cold therapies
• regular physical activity
• maintaining a healthy weight
• strengthening the muscles around the joint for added support
• using assistive devices
• taking over-the-counter (OTC) pain relievers or anti-inflammatory medicines
• avoiding excessive repetitive movements

If joint symptoms are severe, causing limited mobility and affecting quality of life, some of the above management strategies may be helpful, but joint replacement may be necessary.

Osteoarthritis can prevented by staying active, maintaining a healthy weight, and avoiding injury and repetitive movements.

Inflammatory Arthritis

A healthy immune system is protective. It generates internal inflammation to get rid of infection and prevent disease. But the immune system can go awry, mistakenly attacking the joints with uncontrolled inflammation, potentially causing joint erosion and may damage internal organs, eyes and other parts of the body. Rheumatoid arthritis and psoriatic arthritis are examples of inflammatory arthritis. Researchers believe that a combination of genetics and environmental factors can trigger autoimmunity. Smoking is an example of an environmental risk factor that can trigger rheumatoid arthritis in people with certain genes.

With autoimmune and inflammatory types of arthritis, early diagnosis and aggressive treatment is critical. Slowing disease activity can help minimize or even prevent permanent joint damage. Remission is the goal and may be achieved through the use of one or more medications known as disease-modifying antirheumatic drugs (DMARDs). The goal of treatment is to reduce pain, improve function, and prevent further joint damage.

Infectious Arthritis

A bacterium, virus or fungus can enter the joint and trigger inflammation. Examples of organisms that can infect joints are salmonella and shigella (food poisoning or contamination), chlamydia and gonorrhea (sexually transmitted diseases) and hepatitis C (a blood-to-blood infection, often through shared needles or transfusions). In many cases, timely treatment with antibiotics may clear the joint infection, but sometimes the arthritis becomes chronic.

Metabolic Arthritis

Uric acid is formed as the body breaks down purines, a substance found in human cells and in many foods. Some people have high levels of uric acid because they naturally produce more than is needed or the body can’t get rid of the uric acid quickly enough. In some people the uric acid builds up and forms needle-like crystals in the joint, resulting in sudden spikes of extreme joint pain, or a gout attack. Gout can come and go in episodes or, if uric acid levels aren’t reduced, it can become chronic, causing ongoing pain and disability.

Understanding how arthritis affects you

A physiotherapist can help you to understand what happens to your joints and muscles when you have arthritis. Understanding your arthritis will help you to manage its effects.

Managing your pain

Arthritis can cause pain in one particular part of the body or more widespread joint and muscle pain. Medications will help but a physiotherapist can tell you about other methods of pain relief that work alongside your medications. You’ll be able to continue with some of these treatments yourself between appointments:

• Ice packs can be used to soothe hot, swollen joints.
• Heat packs help to relax tense, tired muscles.
• Splinting of swollen or painful joints may be helpful, for example during a flare-up of rheumatoid arthritis. Your physiotherapist or an occupational therapist (OT) may provide temporary splints for you.
• TENS (transcutaneous electrical nerve stimulation) works by blocking pain messages to your brain and altering your perception of pain. A TENS machine is a small electronic device that sends pulses to your nerve endings via pads placed on your skin. This causes a tingling sensation that you may find soothing.

Pace yourself

Overdoing things can increase your pain, but so can not doing enough. Your physiotherapist can advise you on increasing your activity level at a rate you can cope with and on finding the right balance between rest and activity. Planning your activities so that you don’t overdo it will let you to enjoy the things you want to do.

Take regular graded exercise

Graded exercise starts slowly and increases in small steps. This will help you to strengthen your muscles and joints and increase your fitness. Improving your general fitness and stamina will help you to increase your activity level without increasing your pain. Regular exercise will also stimulate production of your body’s own natural pain-relieving hormones (endorphins).

Your physiotherapist may offer other treatments, including the following:

• Massage can help the muscles relax and make joint movement more comfortable.
• Acupuncture can stimulate the brain to produce endorphins. Some physiotherapists are trained to give acupuncture.

Other treatments

• Electrotherapy using techniques such as ultrasound and low-level laser therapy can help to stimulate the healing process and therefore reduce pain.
• Manipulation can help to improve the range of movement in your joint. It’s not appropriate for every patient, but your physiotherapist will be able to advise whether it could be useful to you.

Improving your fitness

Keeping active is very important when you have arthritis. Many people are afraid that exercise will increase their pain or cause further damage to their joints, but your joints are designed to move and the muscles and tissues around them become weaker if they’re not used. This can cause your joint to become unstable and may reduce your mobility and independence. Exercise can increase your general fitness, help you to lose weight or keep to a healthy weight, improve your general mobility and make you feel more self-confident.

The important thing is to find a form of exercise you enjoy so you do it regularly. Think about this and discuss it with your physiotherapist – they can help you plan a programme if you’re new to exercise and advise on any special equipment or training that you’ll need to get started.

It’s important to start gently, pace yourself and gradually increase your activity. You may have a slight increase in pain when you first start, but this should improve as your confidence and strength increase.

Mobilising, stretching and strengthening

Arthritis can cause joint stiffness and muscle weakness, and this can affect your day-to-day activities. Your physiotherapist will assess your muscle strength and the range of movement in your joints, and advise on techniques and exercises so you can keep your joints working as well as possible.