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ARTHRITIS

Arthritis can be quite debilitating. Its disease course is typically chronic, having episodes of both flare-ups as well as remittance. Arthritis often interferes with function establishing the groundwork and often creating disability. Hence, a rehabilitation team of specialists are often useful in preserving, restoring and preventing the patient’s decline. These specialists most often include physiatrists, physical and occupational therapists, social workers, vocational counselors, speech pathologists, and recreational therapists. As is the case with most teams, a team leader is needed to help orchestrate the goal effectively. The team leader in this case is the physiatrist. Patients with decline in function, difficulty in performing usual activities of daily living, weakness, pain, and fatigue, are those that are most likely to benefit from rehabilitative services.

Treatments of people with arthritis must be tailored to each individual. Often we use various modalities to assist us in our management. Some of these modalities include the use of heat, which can be provided by various mechanisms, including hot packs, infrared hydrotherapy, ultrasound, and microwave. Heat is useful for stretching, sedation, and anesthesia by raising the pain threshold. Cold can be used also to raise the pain threshold producing analgesia, decreasing spasticity, decreasing muscle spasm, as well as diminishing the metabolic rate. Cold can be delivered in many ways, ice being the most traditional. Some evidence also suggested that the use of cold as a modality may also be useful for increasing the patient’s range of motion for soft tissue problems as well as degenerative joint disease.

Transcutaneous electrical nerve stimulation (TENS) is another useful technique for pain management. It functions by delivering a low voltage pulsed form of a neuromuscular stimulator to mask the pain fibers irritated by the inflammatory process of the arthritis.

Rest is also extremely beneficial in most arthritic conditions. This may be provided by simply asking the patient to rest the involved joint or to become more aggressive and provide cast or splints to ensure immobilization. This can be extremely effective, however, one must take caution to ensure that the joint immobilization has not been prolonged to the extent of limiting the range of motion. Therefore rest therapies being either focal or diffuse, should be carefully monitored to minimize the risk and provide the maximal benefit.

Exercise is also of utmost importance, as most arthritides not only cause a decline in function, but also cause fatigue and decreased endurance. It is important to realize that a muscle can lose approximately 30% of its bulk in one week. This loss of bulk is obviously reflected in the patient’s weakness and inability to perform usual activities.

These exercises must not be partaken upon haphazardly and must be guided by a musculoskeletal expert, such as a physiatrist. Generally with acute inflammation, physiatrists like to use isometric exercises. Isometric exercises involve contraction of a muscle with no movement of the joint, therefore providing the adequate rest as needed. As the inflammation subsides, isotonic exercises with low weight resistance may be initiated. Isotonic exercises involve the shortening of a muscle belly in a concentric fashion. As physiatrists are concerned with function, we are also asked to provide information in regards to the suitable recreational activities. Low impact aerobic activities are often recommenced, as they provide the patient with enjoyment as well as beneficial aspects of maintaining and preserving function.

Manipulation, massage, and traction are also very useful in managing arthritis. These must be used with extreme caution, as certain arthritides can create unstable support mechanisms of the body; for example, rheumatoid arthritis frequently can cause laxity and disruption of the ligaments of the spine, which support our head. Manipulation and traction done to the cervical spine, can prove to be a devastating disruption in a Rheumatoid patient. Therefore, supervision by a musculoskeletal expert is needed in prescribing, as well as managing such forms of treatment.

Rehabilitation focuses on adaptive aids, which may assist the patient’s function beyond their own capacity. Such adaptive aids not only maximize function, relieve pain and conserve energy, but, as previously stated, can substitute for absent or deficient function. The adaptive aids, which can be provided, are almost limitless pending the innovation and creativity of the physiatrist and therapist involved in the patient’s care.

People with rheumatoid arthritis, as well as degenerative osteoarthritis have the highest disability rates. Rehabilitative treatments can optimize the patient’s functional level. Rehabilitative services can improve one’s functional abilities and, in doing so, tailor to the patient’s personal goals and can optimize both his personal life as well as working situation.

Rehabilitation of a patient with arthritis, as with most other diseases, demands comprehensive care. This is best accomplished with a well-organized rehabilitative team, a team of therapists, nurses, case workers, vocational counselors, and speech therapists headed by a physiatrist. The patient is also an integral part of the team, for they must be motivated and goal directed. The team’s responsibility is to provide the function according to the patient’s goals. As with most things, the finished product is highly dependent on the raw materials that entered into it. Northeastern Rehabilitation Associates provides comprehensive care to the arthritic patient. It is headed by several musculoskeletal experts highly trained to improve people’s functions, maximizing their potential and accomplishing the goals the patient has.

Some situations which do arise from arthritis can be irreversible; however, it is extremely rare that we can provide no benefit whatsoever. If you suffer from an arthritic problem which impedes upon your functional capabilities, as well as personal satisfaction and are motivated for self-improvement, we urge you to seek a musculoskeletal expert for an evaluation and probably improvement. Physiatrists are the musculoskeletal experts.

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