When the arthritis is active, for example rheumatoid arthritis, the doctor may advise admission to hospital, where full assessment and treatment can be done more easy than at home. Bed rest for two weeks or so in hospital or at home is valuable not only for the joints, but also for the body as a whole. Some patients may need rest because of neck or back pain.
As the inflammation in the joints subsides, the patient will gradually be allowed up arid about. In general standing or walking for long should be avoided, particularly if the weight-bearing joints – hips, knees, ankles and feet – are affected. The physiotherapist will be called in to supervise the patient’s rest and exercises.
During the acute stages of arthritis, the physiotherapist will advise on how to maintain correct position of the joints. Special splints may be prescribed for certain joints, such as the wrists, knees and ankles, to protect and prevent them from becoming deformed. Neck collars and back corsets may be looked upon as types of splints. A useful method of straightening out joints already bent is called serial splinting.
Therapists will also supervise suitable exercises. When the joints are painful and swollen, therapists will put them through their full range of movements by moving them with their hands with the patient’s muscles not doing any work. As the arthritis is brought under control with medical treatment, strengthening exercises are used – both isometric (muscle tightening) exercises, in which the joint is not moved, and exercises against weights or other resistance. Mobilization (stretching) exercises are useful, particularly if the joints are stiff, and these may also be done to the spine in selected cases. Traction (pulling of the spine by hand or by a special apparatus) is another treatment for pain in the neck and back.
An important function of the therapist is to relieve pain. This may be done in the form of heat on the painful area; by way of electrical pads, short-wave diathermy, heat lamps; a hot damp cloth, a hot water bottle or simply dipping stiff painful hands in a basin of warm water. The heat itself doesn’t cure anything but may produce sufficient temporary relief of pain to enable the patient to carry out exercises more effectively. Other forms of pain relief used are ice packs and ultrasound. There is little to choose between the different methods, and the type used will depend on what the therapist and patient prefer. Warm baths in a home tub will also help to relax muscles and relieve stiffness.
The main duty of the occupational therapist is to assess what the patient does in normal life and find out how the arthritis has affected personal and household activities. This is usually done in a hospital’s functional assessment unit, though home visits are possible. Accordingly, the therapist will instruct the patient on how best to carry out daily activities,’ such as dressing, bathing and cooking” within the limits imposed by the disability. Various aids and appliances can make life a lot easier.
Occupational therapy has one other function – to retrain certain movements of the arms and legs that have been reduced by arthritis. This takes place in a workshop, where either light or heavy work will be supervised. The advantage of this is that patients are doing things with their minds and bodies, thus making treatment enjoyable. The workshop may even be one way of finding out what jobs the disabled person is fit for, if his or her previous job has become unsuitable.
Whether physiotherapy has been started in hospital or as an out-patient, it is always advisable to continue remedial exercises at home. These should be carried out regularly, twice a day, for five to ten minutes at a time. It should become a habit, like brushing one’s teeth, and will prevent muscles from wasting and joints from stiffening. Over-exercising must be avoided, since this may not, only increase pain, but also damage the joints. Soon the patient will learn how much exercise he or she can tolerate.
Good posture is another thing that the physiotherapist should teach. Patients are tempted to keep painful joints in a bent position, say, by having pillows under the knees. This should never be done since it encourages the joints’ to become stiff in a bad position. Therefore it is worth thinking about posture – standing straight, not with a stoop or hunch, walking with an upright gait, sitting with a straight back and shoulders square on a firm seat; not slouched in an armchair.