What Kinds Of Physical Therapy Work For Arthritis?

Patients with arthritis in our practice are often referred to
physical therapists during the course of their management. One
question I often hear from patients when I suggest physical
therapy is, "But, why can't I do exercises at home?"

So the big misconception here is that physical therapy is just
a bunch of glorified exercise instruction. Nothing could be
further from the truth. Physical therapy plays an extremely
important role in the management of the patient with arthritis.

Before we go into the treatment modalities that physical
therapists use, let's start with exercises since they are an
integral part of treatment.

Exercises consist of stretching, strengthening, and range of
motion. In addition, as patients get older they need different
types of training such as with balance and gait. Finally, the
physical therapist in conjunction with the occupational
therapist may look into activities of daily living and suggest
some modifications that may be helpful.

But where physical therapy plays a major role is in using
different modalities to relieve pain and speed the healing
process.

Diathermy is a treatment method which delivers deep heat. It is
useful for chronic pain conditions such as deep muscle injury or
arthritis.

Precautions in regard to skin and subcutaneous tissue depth
should be attended to. For example, a person who is skinny will
require much less diathermy than an obese person. Also patients
with damage to sensory nerves probably should not receive
diathermy.

Iontophoresis (IP) is a procedure where an electric current
pushes ionically charged chemicals (ie., glucocorticoids or
steroids) through the skin to reach deeper tissues. IP can be
used for calcific tendonitis and inflammatory conditions such as
arthritis. Contraindications to use of iontophoresis include
allergy to the chemical being applied, open wounds, or
neurologic deficits that impair a person's ability to feel.

Iontophoresis also should not be used near metallic implants,
wires, or staples.

Ultrasound (US) is a type of treatment in which high-frequency
sound waves are used to "heat up" superficial soft tissues and
to help with tissue healing. Ultrasound can be used for tendon
injuries or for short-term pain relief related to muscle strain
or spasm. Contraindications of ultrasound include the use of US
directly over recently surgically manipulated nerves such as a
recent laminectomy, directly over malignant tumors, and over
joint replacements and permanent pacemakers. US should also not
be used in areas of thrombophlebitis (blood clots), near the
eyes, over the uterus, ovaries, and testicles. US also should
not be used in areas of acute inflammation, over the epiphyseal
plates of growing children, and over breast implants of any
type.

Phonophoresis (P) is the use of ultrasound to transport
therapeutic medications to subcutaneous tissues. P can be used
for inflammatory conditions such as tendonitis, arthritis, and
bursitis. The same cautions and contraindications exist as for
US.

Electrical stimulation (ES) is the process of using electrical
current to deliver a therapeutic effect by generating an action
potential in nerve tissue. This action potential leads to two
potential results. The first is a change in sensory input, ie. a
reduction in the ability to perceive pain. The second is a
muscle contraction. Low grade muscle contractions can often
relieve the severe muscle spasms that occur in association with
arthritis. ES can be used for chronic pain related to arthritis,
bursitis, or tendonitis. It is also useful for muscle spasm as
well as neuropathic or radicular pain (pain from pinched nerves
in the spine).

It has the same contraindications as US.

Low-level laser therapy- also known as cold laser- acts through
the absorption of photon radiation. This leads to changes in
cellular oxidative metabolism. Evidence indicates that levels of
inflammatory and pain mediators such as prostaglandin E2 can be
reduced with this modality. Cold laser can be used for minor
musculoskeletal pain, osteoarthritis, chronic neck and low back
conditions, and fibromyalgia.

It should be used with caution in patients with malignant
tumors or in those being treated with anticoagulants,
corticosteroids, or immunosuppressive drugs and should not be
used over the thyroid gland or over reproductive organs.

Patients and those providing the cold laser treatment should
use safety goggles to limit eye exposure to laser light.

These are only a very small portion of the many therapeutic
modalities a physical therapist has in their arsenal. In the
care of patients with arthritis, physical therapists are an
indispensable member of the team.

About The Author: Nathan Wei, MD FACP FACR is a rheumatologist
and Director of the Arthritis and Osteoporosis Center of
Maryland. He is a Clinical Assistant Professor of Medicine at
the University of Maryland School of Medicine. For more info:
http://www.arthritis-treatment-and-relief.com/arthritis-treatment.html