Importance Of Exercises In Management Of Arthritis: Protocols & Techniques

INTRODUCTION:

Arthritis is probably the common disorder afflicting modern man & is one of the leading causes of disability mainly in the elderly. Its rising incidence can be attributed to changing lifestyle as well as ever-increasing life expectancy. More than 50% of people aged above 60 years suffer from this problem.

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. In simple word, Arthritis is an inflammation of the joints. It can affect one joint or multiple joints. It can be described as wearing a way of joints with use. It essentially leads to an erosion of this cartilage and underlying bone. In Reality, the condition is a degeneration of the joints where the reparative processes cannot keep pace with the daily wear and tear of the joints. This capacity of joints to repair itself reduces as age advances.

The role of aging, physical stress and consequent inflammation in the genesis of the disease is still confusing. The role of heredity and environmental factors need further clarification. Excessive body weight by itself is not entirely responsible for disease but definitely contributes to rapid progression of joint degeneration.

Common arthritis joint symptoms include:

Swelling, Joint 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 Difficulty in walking or climbing stairs. Arthritis can cause permanent joint changes.

Different Common Arthritis:

Degenerative Arthritis
Osteoarthritis (OA) is the most common type. 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.
Inflammatory Arthritis
Rheumatoid arthritis and psoriatic arthritis are examples of 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.
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 gonorrhoea (sexually transmitted diseases) and hepatitis C (a blood-to-blood infection, often through shared needles or transfusions).
Metabolic Arthritis
Uric acid is formed as the body breaks down a substance found in human cells and in many foods Called Purines. 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. This 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.

Physical Therapy Management of Arthritis:

Physical activity plays a vital role in the management of arthritis & is essential for optimizing both physical and mental health.

Regular physical activity can keep the muscles around affected joints strong, decrease bone loss and may help to control joint swelling and pain. A regular activity increases lubrication to the cartilage of the joints & reduces stiffness and pain.

A physiotherapist has a major role against the inactivity epidemic as educators & motivators. We as a physiotherapist must continue to stress the importance of physical activity to each and every patient and help to motivate them to choose the way to good health & long life.

Following are the Approaches for exercise in arthritis:

Exercise adaptations for people with arthritis:

Slow start and progress gradually
A safe exercise program is gradual progression in exercise intensity, complexity of movements and duration. Most of the arthritis patients have lower level of fitness due to pain, stiffness or biomechanical abnormalities. Excessive exercise may results in increased pain, inflammation & Joint damage. So the initial goals should be a few minutes of activity and alternating activity with rest.
Avoids rapid movements of affected joints
Joint protection strategies and avoidance of activities that required rapid repetitions of a movement should be taken care. As per example faster walking speed increases stress on the joints, so walking speed should be matched to biomechanical status of individual. The unstable & misaligned Joints should be given special attention. Footwear selection or use of orthotic to control pronation & shock absorption may be indicated.
Physical activity adaptation
Adapt physical activity according to the needs of the individuals. Joints with arthritis may be restricted in movements and unstable because of pain, stiffness, swelling, bone changes or fibrosis. These joints are in high risk of Injury. Proper care must be taken to ensure that appropriate joint protection measures should be in place.

American Council on Exercise Suggest the Following reasons to start an exercise program for arthritis. These are:

Flexibility Training to improve ROM & Reduces stiffness, mainly the early morning stiffness often associated with arthritis.
Low impact Aerobic exercises like walking not only improves overall fitness but also helps in reducing the psychological and emotional pain.
Strength training exercise helps in building muscle strength, increases joint stability and improves mobility making it easier to perform ADL.
Weight bearing or weight loading activity (walking /strength training) affects bone mass, which helps in reducing the risk of developing Osteoporosis. Osteoporosis is a degenerative bone disease often associated with arthritis, due to decreased physical activity and age.
Regular Exercise can improve the posture, balance and coordination of body, which is mostly affected by arthritis.
Maintaining a healthy body weight is very important in arthritis. Overweight puts additional strain on the joints. Exercise along with proper diet plays a key role in maintaining body weight.
Arthritis mostly affects people’s normal life style and also develops depression and stress pattern. Exercise helps to manage stress, reduces depression and tends to promote more positive mental outlooks.
Painful joints reduces sleep and increase irritability. Regular exercise improves overall sleep pattern and may help reducing this problem
Staying active & exercising regularly is an effective means of controlling the affects of arthritis but also of reducing or eliminating the risk of developing a variety of other life style related diseases (Heart disease, diabetes etc.)

DR. KUMAR BRAHMESH (PT)
SPECTRUM PHYSIO
SBSH BRANCH