World Arthritis Day 2021: Physiotherapy Plays Important Part In Arthritis Management

If managed holistically with clinical treatment and physiotherapy, patients with arthritis can continue to maintain a good quality life. On World Arthritis Day, a physiotherapist explains the role of physiotherapy in the management of arthritis.

The term 'arthritis' is a disease that includes a range of symptoms, all involving pain and inflammation in the joints. Joints are the regions where the different bones of the body meet and create movement. Arthritis usually involves degeneration of the joints. This degeneration causes pain, stiffness, swelling and reduced movement. Arthritis most commonly affects the feet, hands, hips, knees, and lower back.

Every year, World Arthritis Day is observed across the world on October 12 to raise awareness of the existence and impact of rheumatic and musculoskeletal diseases. The theme of this year's World Arthritis Day is "Don't delay, connect today: time2work".

Causes of arthritis

The joints of the body are cushioned by soft, connective tissue called cartilage, which prevents the bones from rubbing against each other. Cartilage assists in the lubrication of the joints. Besides cartilage, some joints are also supported by tissues called tendons that connect the bones to muscles; and ligaments that connect bones to other bones.

There are two types of arthritis: osteoarthritis (OA) and rheumatoid arthritis (RA).

Osteoarthritis arises because of wear and tear of the cartilage that is between the bones. This causes the bones to rub against each other during movement, leading to friction, damage, and inflammation. Rheumatoid arthritis is an autoimmune disease that can attack the tissues of the joints, even healthy tissue.

Treatment of arthritis

The treatment of arthritis will depend on the type of arthritis, and the severity of the pain. There are five basic treatment protocols for the management of arthritis.

Lifestyle change: The first and most basic step in managing arthritis involves a lifestyle change, and that is to keep our body weight under control. This will reduce the stress on the joints. It is very important in the case of weight-bearing joints like the feet, hips, and knees. Weight control involves eating healthy foods, undertaking appropriate physical activity, reducing physical, mental, and emotional stress, and ensuring proper sleep.

Exercise: The following forms of exercise are useful in managing arthritis:

1. Low Intensity exercise: This includes walking at a slow normal pace, swimming, and water aerobics. Other examples are cycling, outdoor games and mountain climbing. Exercise increases the strength and flexibility of the joint tissue, decreases pain, and reduces fatigue. While arthritis increases immobility, exercise counteracts that immobility.
2. Stretching of the tightened structures: Stretching helps in lubricating the joints through tissue movement. It serves to maintain movement that is tending to get reduced due to the arthritis. Stretching warms up the muscles and tendons, making them more flexible and less prone to injury. Stretching should be done slowly and gently; the initial pain soon gives way to a feeling of well-being.
3. Strengthening of the weak muscles: Strengthening exercises includes half squat, hamstring curls, calf raises, straight leg raise, side leg raise, dynamic quadriceps exercises, and prone hip extension. Strength training can reduce the pain and stiffness caused by arthritis. These are physical exercises that improve strength and endurance. They tone up the muscles, maintain bone strength, and help in an improved lifestyle by facilitating good sleep and regulating body weight.
4. Balance and proprioception training: Proprioception is the ability to sense your environment and move your body and limbs. It is also known as kinesthesia and is important for daily living. It involves the ability to sense physically the change in the environment and react accordingly, such as when the slope of the ground on which you are walking changes. Proprioception training increases spatial awareness and balance. Proprioceptors are sensory cells on the nerve endings in the muscles, tendons, joints, skin and ears. They respond to changes in the environment by sending a signal to the brain. The brain then instructs the affected organ to respond accordingly. Since arthritis impairs proprioception, such training can reduce the symptoms of arthritis.

(iii) Pain relief therapy: Along with exercise, there are pain-relieving treatments that can be given to ease the pain. They involve specialized treatments and include interferential therapy (IFT), transcutaneous electrical nerve stimulation (TENS) and ultrasound (US) therapy. Your physiotherapist will decide on the mode of pain-relieving therapy to be given, depending on your clinical symptoms and medical evaluation.

(iv) Cold and hot packs: These can be given either individually, or in combination. Once again, your physiotherapist will be the best judge about how to go about this form of treatment.

(v) Supportive devices: Devices such as braces and shoe inserts provide support to the inflamed joints and reduce the pressure on these areas. They can be ordered based on the advice of your physiotherapist.

As we have seen, besides clinical treatment, physiotherapy plays an important part in the management of arthritis. If managed holistically, patients with arthritis can work around their ailment and continue to maintain a good quality life.

The article has been contributed by Dr Anjali Venu, Senior Physiotherapist, Bhatia Hospital.