Arthritis: Rehabilitation Tips and Exercises

What is arthritis?

Arthritis describes a set of conditions associated with inflammation of the joints and associated muscles.  Arthritis is mainly characterized by swelling and pain in the affected joints. Individuals who suffer from arthritis commonly complain from joint pain, stiffness (particularly in the mornings), limited mobility and swelling. It is a long term condition and lasts for a lifetime and gradually worsens the movements of the affected joints. Degeneration of joints occurs with aging and many individuals aged above 50 typically have arthritic signs.

Joints are normally protected by a covering called cartilage which on repeated use gets damaged or degenerated. A specialized fluid known as synovial fluid is present between the joints which help in lubricating the joints thus preventing the wear and tear. In people with arthritis, this fluid might be present in inadequate amounts.

This can cause damage to the cartilage covering the bones. The degeneration of the cartilage can affect the fluidity of movements in the joints. Identifying the cause for arthritis is very difficult as multiple factors are implicated like bad genes, age, overweight, previous injuries and stress.

Types of arthritis and treatment

A total of 100 or more arthritic conditions are present and each differs in their clinical presentation, number of joints affected and underlying disease conditions. Some of the major ones include:

• Rheumatoid arthritis (affects the joints all over the body)
• Juvenile arthritis (affecting children)
• Osteoarthritis (particularly affects extremities such as hands or legs)
• Gout (accumulation of crystals in joints)
• Reactive (infectious) arthritis
• Ankylosing spondylitis (affects spine)
• Lupus (associated with a condition called systemic lupus erythematosus)
• Psoriatic arthritis (associated with a skin disorder known as psoriasis)

These types differ in their features, clinical symptoms and complications but their similitude is the fact that all types mainly affect joints, ligaments, cartilages, etc. Arthritis can be a reason for limiting an individual’s activities but fortunately it can be managed through proper treatment, rehabilitation exercises and balanced diet.

How is arthritis treated?

Treatment modalities for arthritis are very complicated because of the varied types of arthritis seen. The treatment options are selected based on the severity of the arthritic disease process and the type of arthritis. Common strategies for managing arthritis include medications, physiotherapy, and surgery. Other options include use of splints, application of cold packs, paraffin wax dips etc.

The drugs belonging to the group of analgesics, anti inflammatory, immune modifying agents and surgical procedures such as joint replacement are commonly advised in the treatment of arthritis. Steroids, disease modifying agents, immunosuppressants and monoclonal antibodies are certain specialized drugs that are used in severe cases of arthritis. Numerous other modalities of treatments have been used in the treatment of arthritis.

Rehabilitation for arthritis

The rehabilitation therapy for individuals suffering from arthritis involves a variety of interventions apart from the medications and other treatment modalities that are being followed. The goals of the rehabilitation process are:

• Minimize pain and control joint swelling
• Increase physical fitness in affected individuals
• Bring down stress
• Improve emotional stability

Exercises for rehabilitation

Rehabilitation exercises are mainly aimed at strengthening the affected joints and improving their function. Further, improving the flexibility of other joints and prevention of spread of the symptoms associated with arthritis are also considered as the goals of rehabilitation exercises. These exercises also help in the improvement of the mobility of the affected individuals. 

Rehabilitation exercises are also necessary in individuals who have undergone joint replacement surgeries. The rehabilitation surgeries help such individuals to adjust to the joint replacement and improve the range of motion of such joints.

Stretching/Range-of-motion exercises

Individuals suffering from arthritis often suffer from restriction of the joint movements which prevents them from performing day to day activities.

The stretching exercises help in normalizing movement of each joint through their normal maximum range of motion. Routinely performing this stretching exercise can minimize morning stiffness and deformities. Doing these daily can actually make joints more fluidic and mobile. These kinds of exercises are very important for those who do not use their joints to their full range or those who have chronic pain.   These exercises are not alternatives to daily activities. They have to be done in addition to performing daily chores.

The stretching exercises include a wide variety of exercises including:

• Hip and knee warm up stretches
• Knee stretches and wraps
• Lower back stretches

Strengthening exercises

These types of exercises are usually done to restore muscle strength. Joints are supported by muscles and appropriate strength in the muscles helps in stabilizing the joints.

Two kinds of strengthening exercises are usually advised: isotonic (involves movement of joints) and isometric (doesn’t involve joint movements). By practicing these exercises on a regular basis the mobility of the affected joints improve and pain also tends to subside gradually.

Some of the common strengthening exercises include:

• Hip and knee strengthening exercises
• Hip joint strengthening exercises
• Knee joint strengthening exercises

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Endurance/ cardio exercises

Endurance or cardio exercises are mainly aimed to improve the functioning of the heart by gradually increasing the intensity of the exercises to a certain limit. Regular exercise improves the heart rate and increases the amount blood being pumped to all parts of the body. These exercises are also beneficial in other conditions such as arthritis wherein it improves the mobility of the joints. 

In arthritic individuals these exercises are advised to cause an increase in physical strength, relieve symptoms like pain and immobility and also for improving mental status of the afflicted persons. These kinds of exercises are limited to those who can endure the strenuous activity associated with it. Those who are having functional impairment as a result of long term arthritis will find it unable to perform endurance exercises. Adequate precautions are necessary before attempting to perform these exercises and a doctor’s or a physiotherapists consultation is necessary before practicing endurance exercises. 

Regular performance of the endurance/cardio exercises have been associated with various benefits such as improvement in the work capacity, lesser absenteeism from work and improved quality of daily activities.

Daily activity living (DAL)

Aerobic conditioning exercises can also be initiated to maximize oxygen utilization and decrease exertion. Other exercise choices that can also be beneficial in individuals suffering from arthritis include cycling, walking, yoga, and running.

Rehabilitation tips

Rehabilitation programs are generally individualized based on the severity of arthritis. You may need to meet your physiotherapist to identify which of these exercise suit your age, body condition and severity of arthritis. Once identified, perform these rehabilitation exercises on a regular basis. Rehabilitation can help in bringing back normal functioning of the joints and can bring about a dramatic improvement in quality of life.

• Consistent exercise regimen

Adequate exercise can help the affected individuals to feel emotionally, physically and psychologically better. Consistent exercising regime should be followed everyday and gradually the level of exercise should be increased.

• Do not over exert

Affected individuals should not over stress themselves as it can lead to worsening of symptoms. Affected individuals can start the exercise when their pain and discomfort is at a minimum.

• Importance of resting

Rest adequately between exercises to help the joints to relax. Prolonged rest will stiffen the joints affecting the joint mobility and must hence be avoided.

• Joint protection

Adequate amount of care should be taken to avoid injuries to the affected joints. Use of straps, braces or other protective devices is advised for protection of the affected joints. Strenuous exercise and overuse of the joints must be avoided.

• Nutrition: A diet rich in vitamins and minerals, omega 3 fatty acids and other essential nutrients can be helpful in faster recovery.