Managing Rheumatoid Arthritis With Physiotherapy Massage

Introduction:

Rheumatoid arthritis (RA) is a chronic and severe clinical disorder that shortens life expectancy, causes gradual joint degeneration, and impairs quality of life. Even a small amount of inflammation has the potential to cause lasting impairment. Patients with RA may experience an intermittent or progressive clinical course depending on their symptoms. In the majority of patients, structural damage starts to manifest within the first two years of the clinical course. In order to relieve pain and stop joint deterioration and functional loss, RA therapy must be successful. By enhancing RA management and lowering RA patients' daily living challenges, physical therapy and rehabilitation programs considerably supplement medicinal therapy. The usage of physiotherapy modalities is briefed in the article below, including the use of hydrotherapy, electrical stimulation, cold/heat treatments, massage, education, and patient awareness.

How Is the Patient Assessment Done Before Starting Physiotherapy for RA?

Prior to beginning treatment, a patient's physiotherapy needs are established in accordance with their limitations, disabilities, and handicaps. These elements should be part of a physical assessment:

• Functional evaluation (including transfer status, gait analysis, and daily living activities).
• The whole joint range of motion (ROM).
• Test of muscle strength (manual or via isokinetic apparatus).
• A postural exam and a pulmonary function evaluation.

It should be kept in mind that the findings of these examinations and tests may be impacted by the presence of inflammation, instability, and contractures. Functional assessment can be done using scales such as the

• Arthritis impact measurement scale I and II.
• The health assessment questionnaire.
• The functional independence measure.

What Are the Physiotherapy Modalities for RA Management?

Treatment for RA frequently involves physiotherapy methods. These consist of electrical stimulation, hydrotherapy, and cold or hot treatments. There are very few controlled trials evaluating different physiotherapy and rehabilitation techniques in RA that are carried out with sufficient numbers of cases and use validated objective measures. This is due to the possibility of multiple factors influencing the illness process and the uncertainty surrounding the actual efficacy of the medications under investigation. A variety of physiotherapy tools are frequently utilized in daily practice; frequently, this use is based on individual experiences.

Superficial Heat- Skin and subcutaneous tissues are the primary recipients of the effects of superficial heat. It is especially helpful when the intention is to heat joints with little soft tissue covering, such as those in the hands and feet. Conduction, convection, or conversion are the three methods used to distribute superficial heating agents.

1. Conductive Techniques: Although hot moist packs (hydro collator packs) warm human tissues more quickly than dry heat, there is no known difference in the therapeutic advantages. The distal joints of the upper and lower extremities are warmed using paraffin wax. Another option is to use heating pads. A limb is immersed in hot and cold water in succession during contrast baths in order to trigger reflex hyperemia.

2. Conversion Techniques: Patients who are unable to endure the weight of hot packs typically employ radiant heat, such as infrared radiation. The energy is taken up by the skin and transformed into transient heat.

3. Convective Techniques: These use hot or cold water in hydrotherapy to treat ailments. Hydrotherapy techniques for RA, neurogenic pain, sprains and strains, and moderate peripheral vascular disease include whirlpool baths (partial body immersion), Hubbard tanks (whole-body immersion), and contrast baths. Fluid therapy creates a heated air-fluid mixture that is used in treatment. As a result, fluidization creates a heated mixture of air and fluid. The ability to do range-of-motion workouts and a massaging action have presumed advantages.

Stretching- Resting inflamed joints will prevent symptoms from getting worse. To prevent contracture formation and maintain the existing range of motion needed to carry out the majority of activities of daily living for non-inflamed joints, active or active-assisted stretching of all major joints is necessary. Most people believe that performing range-of-motion exercises once each day can prevent contractures.

Massage Therapy- A massage is a popular form of treatment that can assist in reducing swelling in inflamed joints, increase a patient's sense of connection with other forms of care, and increase flexibility.

Electrical Stimulation- Electrotherapy includes stimulating the muscle or nerve using electrical impulses.

1. Iontophoresis: Iontophoresis is thought to function through the transcutaneous administration of charged drugs (such as lidocaine, corticosteroids, salicylate, and antibiotics). Although its effectiveness has not been established, it is used to deliver medications that must be absorbed locally in order to prevent systemic effects, as well as when oral absorption is unpredictable or inappropriate.

2. Interferential Current (IFC): IFC uses alternating current waveforms at various frequencies to painlessly enter the tissue. Musculoskeletal and neurological problems are among the suggested uses, albeit, like the majority of the other modalities described, literature has not been able to show conclusive advantages over placebo.

3. Nerve Stimulation: Transcutaneous Electrical Nerve Stimulation (TENS) is the main method of delivery for this medication. Its use has apparently proven beneficial in treating illnesses, including RA and OA, among others. Musculoskeletal pain, peripheral nerve damage, peripheral neuropathy, postoperative pain, and complex regional pain syndrome are among the common uses.

Cryotherapy- Several physiologic effects of cold therapy can either improve or decrease natural reactions to some stressors. Reflexive vasoconstriction followed by delayed vasodilation are some of the hemodynamic outcomes. Some studies have demonstrated that neuromuscular effects can alleviate spasticity, including a reduction of nerve conduction velocity and a decrease in the firing of muscle spindles.

1. Cold packs (conduction), ice massages (conduction), and other surface kinds of cryotherapy are among the most common. Cold baths are more painful but are intended for wider areas of immersion (such as the distal leg).

2. Others: To treat spastic areas, the 'spray and stretch' approach uses vaco-coolant sprays like ethyl chloride or flori-methane.

What Precautions Should Be Taken While Managing RA With Physiotherapy?

Some precautions are mandatory while dealing with RA individuals. They are:

• Avoid stretching in cases where the patient is experiencing an exacerbation and the joints are intensely inflamed. Instead, use isometric exercises.

• If the discomfort lasts for two hours after exercising or if there is an increase in joint swelling, change the exercise regimen.

• Exercises that could increase intra-articular pressure in the knee joint, such as stair climbing or weightlifting, should be avoided by patients with active RA in their knees.

• Stretching too much and avoiding ballistic motions will reduce the amount of tension on the tendons.

Conclusion

To lessen the potential long-term disadvantages, rehabilitative therapy for rheumatoid arthritis patients is essential. Rheumatoid arthritis sufferers specifically run the danger of losing flexibility, atrophying muscles, losing muscle strength, and losing cardiovascular endurance. Functional compromise and higher healthcare costs will result from deficits in these areas.