Rheumatoid Arthritis And Physical Therapy

“Physical therapists, also known as physiotherapists, comprehensively assess RA patients in an ongoing manner. The evaluation of each patient includes an examination of affected joint flexibility, bony alignment/joint deformity, muscle strength, endurance, mobility, ambulatory status, and the ability to perform activities of daily living. It can be a delicate balance to enhance mobility and strength without fatiguing the patient or creating an acute arthritis flare-up. Physical therapists are able to progressively tailor treatment plans to the individual by incorporating periods of activity and rest. Exercises that gently improve flexibility, strength, and endurance help to improve the patient’s mood, outlook, mobility, and the ability to participate in important life events.” From ‘Pathway to Independence: Physical Therapy for Patients With Rheumatoid Arthritis’ by Anne Ahlman, MPT.

Over the past couple of years, I’ve attended approximately 350 hours of physical therapy.

Yes, you read that right: for the past two years, I’ve averaged about half an hour of physical therapy per day. Of course I don’t go each and every day, but usually go two or three times a week…and while most patient appointments last 60 minutes, having practically attained Frequent Flyer (Lifetime Gold!) status at my clinic, I’m usually given an extra 30 minutes during each visit. My longest session to date: 2-1/2 hours!

I’ve had some people tell me that by not taking medicines, that I’m not ‘treating’ my rheumatoid arthritis. (Most readers probably know by now that I’ve been off all meds since earlier this year.) Judgement issues aside, such a statement couldn’t be further from the truth. Am I worried about the possibility of continued joint damage that *might* be caused by not taking any NSAIDs, DMARDs, or Biologics? Quite frankly, no. While I have previously included many of these pharmacologicals into my treatment plan, at the moment I am choosing treatment options that are less taxing on my body, my stomach, and my liver. (Oh, and on my pocketbook!)

At the moment, I am choosing physical therapy to be the cornerstone of my overall treatment plan. And the best part is, it’s working!

I don’t think I’ve underlined enough the importance that physical therapy plays in my treatment plan; and to be quite honest I don’t think I’ve even recognized–until recently–the role that PT has played in my current improved state of health. For the first time ever, we’ve moved away from continually being in crisis mode, and are currently cruising in maintenance mode. It’s a wonderful feeling.

And it should go without saying that my physical therapist, who is a few years younger than me, has become of my most trusted health professionals, one of my best friends, and at times even acts as a stand-in emergency therapist when I’m going through a particularly rough flare. (I don’t think anyone, other than my partner, has seen me shed more tears.)

So what exactly do we do during all of these sessions, that have helped me so much? First of all, let me say that many times the relief that is provided is not immediately obvious; in fact there are certain treatments that actually make me feel a little worse before I feel a little better (in particular, when we have to stretch certain muscles that have tightened too much.) There are periods, however, when the benefits are quickly visible…and while these periods are often temporary in and of themselves, being able to experience a string of breaks from my highest levels of pain–over an extended period–goes a long way in improving my overall well-being, both physically and mentally.

The therapies that we use most often during my physical sessions are:

  • electrotherapy: basically, the use of electrical energy as medical treatment. There are many different electrical currents that can be used, ranging front analgesic currents to anti-inflammatory currents to many others that I myself cannot explain. (Of course, my 10-year old nephew was visiting years back when I started PT, and overheard me speaking about electrodes being applied to me and having the current slowly turned up. He insisted on attending my next appointment, and ultimately did…but was quite disappointed when he never saw me thrashing around on the table, as some big Frankenstein-like switch was flipped!)
  • ultrasound therapy: after the application of gel, a small handheld device is slowly rubbed around the joints that are being treated. Not only does it reduce pain, but it’s also supposed to promote tissue healing. Unlike the electrotherapy mentioned above, ultrasound therapy cases no physical sensation other than the shock of having cold gel applied to your skin.
  • heat therapy and massage: self-explanatory, but must be done with care (especially the massage part) because too aggressive a treatment can actually make things worse…and be careful with the heat part. Once, I actually received some pretty bad burns on my wrists. (Usually I can determine if it’s too hot, but on that particular day my wrists were so numb from the pain and inflammation that I my skin was burning–literally–and I couln’t feel a thing!)

Having done so many hours of physical therapy, I’ve been able to get to know my body better. During a recent visit, my physical therapist commented on how I’m now able to recognize certain problems and complications much earlier than usual, before they reach a critical state. To some this may sound simple, but when the incessant buzzing of chronic pain masks so much of what is actually going on in my body, this is not always an easy thing to do. In addition, I’ve also learned that this is about so much more than ‘just’ my joints. Quite often, the most serious issues, and some of the worst pains, are related to the surrounding muscles and tendons.

It’s also been a great resource when I’ve had complications beyond the ‘traditional’ symptoms of rheumatoid arthritis. For example, every few months I have severe muscles problems along the entire length of my back; this is usually caused by inflammation in my shoulders, which sets off a domino-like chain reaction in my back muscles, all the way down to the lumbar region. Once I reach a certain point, this becomes its own medical situation that requires a lot of time and energy to resolve. I also seem to get a bout of sciatica around once a year, which–when combined with my rheumatoid arthritis–quickly becomes a difficult catch-22 to correct. Yeah, let’s take a condition where it hurts to move (rheumatoid arthritis), and combine it with a condition where it hurts to stay still (sciatica.) I think we have ourselves a winner!

Have you used physical therapy as part of your treatment plan? If so, has it helped?

Stay tuned…for the next adventure of Rheumatoid Arthritis Guy!

7 Comments
7 comments
  1. Kristen Thiessen says:

    Thanks for sharing, RA guy!! My sweet (and sexy) hubby is a physiotherapist here in (friggin` cold) Winnipeg. He`s so good at what he does and I feel truly blessed to have such support right in my home! PT is an invaluable part of my health, and although I take ridiculous amounts of meds (which I am aware are killing my liver and tummy….stupid ulcers…), I still find it important to continue having my hubby work with me. I`m so pleased that it is helping you!!!

  2. Deb aka abcsofra says:

    P/T is a wonderful resource but dependent on one’s insurance limits. All too often insurance companies limit the number of visits a person can undergo within a year. I so agree with you that it will help for most. Great post with all the different tools they have in the p/t kit :-)

  3. Miss_RA says:

    nice to hear it helps! But when it comes to money, one bottle of 100pcs of methotrexate pills costs me 3€ (the rest is paid by insurance) and one hour at private physioterapist costs 15€, 1/2hour of massage costs 9€. That´s a bit difference. But still, I try to get massage at least once a week and do exercises at home as much as possible :)

  4. Lisa H says:

    Oh how I would love to be able to do even half that much PT. My insurance requires me to spend $350 (US) out of pocket before they’ll start to cover PT, and even then it’s partially covered. It only takes 10 sessions to get there, but since I’m unemployed (by RA & by choice) we don’t ever have enough to cover it. My therapist last time was very sweet and made me a big packet of exercises that can be done at home or at my local gym, so I’ve been doing that. I’m so glad you are able to get so much time in with a therapist! :)

  5. Wayney says:

    I credit my work with a PT for me being able to walk. From Dec. 2008 until March 2011, I couldn’t stand on my own let alone walk. I started working w/my PT at the nursing home Jan 5th, 2011. By March 29th, he had me standing. On April 18th, I took my first steps. My PT wasn’t sadistically hard on me like some PTs can be (I had one in the past that insisted on working with me even though I was unable to go 10 min w/o throwing up). In fact, he was a great judge at when to push and when to cut me some slack. When I was ready to leave the nursing home, he said if I couldn’t get PT where I planned on it, to let him know and we’d figure something out. He is an awesome man. The residents at the nursing home who worked with him ALL praised his way of working with them, how much he helped them and how wonderful he is. He truly cared.

    And being in a nursing home at the age of 34 made me wonder if the PT would be appropriate for me and not more geared toward the normal age and limits of nursing home residents. But, he has worked with all ages in the past, so he was able to prepare me for the things I needed to be able to do when I left the nursing home.

    He is one of the people I miss quite a bit. I saw him daily and worked with him 4 days a week. My son is a little older than his so we had similar kid stories. I don’t think of him as just my PT but a friend as well. And for someone that used to call PTs “patient torturers” that’s a big thing. My childhood PT experiences taught me a lot but many were also horribly painful.

  6. Steve Lyon says:

    Just started pysical therapy this week. Have been heated, electrocuted, ultrasound waved and massaged all with excellent results. Going in, I was extremely apprehensive about it. If you are an RA patient, you are naturally very timorous of doing anything that might aggravate your joints and tissues that are already tender. I have found the therapists to be very understanding and willing to listen. My problem has been major shoulder, arm and back pain due to inflammation around the cervical spine and even migrating down to the lumbar. PT has been what I would call a major breakthrough in my overall condition. Thanks RA Guy!

  7. pierette logan says:

    I am so glad that I stumbled onto this website! As a PT veteran I cannot say enough about how much PT has helped me deal with my illness/symptoms. I am presently in my second round this year, this time for frozen shoulder elbow damage that has led to some ulnar nerve involvement. It’s always something!

    I too am off medication after 5 years of steroids! If I didn’t have the stretching/workout regiem that I have learned over the years from a combination of PT/trainers/doctors/massage therapists I don’t know where I would be but it’s all good at this point today!!!

    Thanks for reminding me that depression and blame can and is a big part of daily life with RA and that since it is so often a “silent disease” that since we are so involved on a daily basis in self care and management of our symptoms that it is easy to forget and to be reminded that we are not alone is a really blessing! Thank you for this website!!!

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