Rheumatoid Arthritis

Physiotherapy & hydrotherapy for rheumatoid arthritis

Physiotherapists can help people maintain movement and function of joints and muscles with exercises, hydrotherapy (exercise in warm water), relaxation techniques, acupuncture (see 'Complementary and alternative therapies') and various other treatments. Many people receive physiotherapy after joint operations to help them recover strength and movement. Some are given splints (see 'Occupational therapy'). Physiotherapy is usually provided to inpatients, outpatients and sometimes in the community.

One woman benefited from both physiotherapy and hydrotherapy and most people said that being referred to see a physiotherapist was good and treatment helped their joints 'loosen up'. However a few had not been helped much.

People described exercises for specific joints and being given exercise leaflets to take home. Many exercises stretch and strengthen muscles supporting joints, to maintain or increase movement. People did the exercises over a long period, or for a short time or did not feel well enough for any. One woman advocated exercising even when joints felt stiff and painful, as this was the only way to maintain movement. Two people had not persevered with the exercises and then realised they had lost some mobility. In one young woman this affected her shoulders, in another her neck. In contrast, a woman who continued neck exercises had regained movement and decreased the stiffness.

People learnt exercises from their physiotherapists and incorporated specific or general exercise into their daily routine e.g. walking and swimming (see 'Exercise'). One man found that continuing to play the organ kept his fingers moving.

Physiotherapists provided heat or ice packs for inflamed and painful joints. Several people described hot wax (or hot mud) treatment on their joints, most commonly on their hands. The hands are dipped in warm melted wax, left to cool for while, before peeling it off. The retained warmth eases pain and many people found this relaxing and helpful. One individual had bought a wax bath to use at home.

One woman was advised to put her hands in iced water before exercising her fingers but found this unbearable so stopped but continued the stretching exercises. Successful treatment for a woman's hands involved electrical pulses and ultrasound therapy, which increases blood flow through the joints. She had 18 months private physiotherapy on her hands that was time consuming and interrupted her work. A retired physiotherapist had intensive hand therapy after surgery.

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Physiotherapy often followed joint surgery but one woman, despite asking, did not get any and thought that was why her elbow replacement had not worked well (see 'Surgery - Upper limb and neck'). One woman who had had numerous joint replacements had had some physiotherapy but the main advice was to use the joints as much as she could. A young woman followed a home exercise routine after two hip and two knee replacements. A community physiotherapist checked her progress.

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People were motivated by one to one sessions with a physiotherapist. They valued having someone taking an ongoing interest in their well being. For this reason a few people chose to pay for physiotherapy treatment so they could get to know one person who would know their individual joint problems.

Physiotherapy services in the NHS were often restrictive, allowing only a maximum number of sessions; waiting lists meant treatment was not received when it was most needed and people saw several different physiotherapists. This situation was particularly acute for a young woman who needs ongoing physiotherapy but the local hospital has told her that they cannot provide it. She hasn't had physiotherapy for the past three years and described herself has being 'stiff and stuck'. However, two people described a much better self-referral system; one woman benefited from specialist rheumatology physiotherapists. Physiotherapy referrals were commonly for one joint. One woman noted that a joint could hurt because of associated problems with other joints and felt that being referred for one particular joint limited the service. Most physiotherapists would carry out their own initial assessment of the problem and treat as required.

People in pain could find physiotherapists' enthusiasm for exercise difficult, though recognising it was for their own benefit.

Other treatments talked about included' manipulation under anaesthetic which they found very painful; massage; relaxation and pine needle baths.

Most people offered hydrotherapy enjoyed it and found it relaxing, helped relieve pain, increased mobility, prevented joint damage and was both physically and psychologically beneficial. Two women said they were tired immediately after the exercise but felt the overall benefits the next day. Two women who did not like water did not enjoy hydrotherapy.

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The physio/hydrotherapist teaches exercises in the water which may use resistance in the form of different sized buoyancy aids. People found that because exercises in water are non-weight bearing, movements are freer and easier than in air. Many people used such hydrotherapy exercises at local swimming pools, health clubs with jacuzzis and at swimming sessions for those with disabilities. The water temperature was important' many found local swimming pools too cold to stand and do exercises, although swimming alone could be beneficial.

Hydrotherapy, like physiotherapy, is often limited in the NHS, e.g. 6 weeks per year, so some people paid for sessions. One woman established sessions at a local rehabilitation centre for groups of people with different illnesses. This also acted as a support group and gave access to regular advice from a physiotherapist. One hospital allowed patients to ring up and book a 3 week hydrotherapy course when they felt they needed it. One man had installed a jacuzzi in his home that he used regularly; it helped especially with early morning stiffness.

Last reviewed August 2016.

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