For treatment of arthritis, rest and exercises play a great role if given discriminately. Rest when the condition is acute and there is a lot of pain. Exercise when the condition is chronic and the pain has minimised. We will deal here with three types of arthritis.
3. Infective arthritis
Rheumatoid arthritis can be acute sub acute or in chronic stage. Exercises can safely be started in chronic rheumatoid arthritis, osteoarthritis and when supuration has stopped in the infective arthritis. An acute stage is reached when the pain is acute the joint is inflamed. Rest is important.
Such patients need a lot of reassurance. This should be given generously. These patients should be treated with confidence, the message will reach automatically to the patient and he will know that he is in the right hands. The acuteness will pass off to chronic stage in 3-4 weeks. These patients should be handled carefully to prevent deformities. These arise due to bad posture in the acute stage.
They should be provided with a firm bed. On a wooden bench a thin cotton mattress should be good enough. It should not be sagging in the middle. The foot can be placed against a padded board to prevent foot drop. A pillow under the knees should be avoided. Only one thin pillow should be given in the night. The arm should be held close to the body and with the elbow flexed. The position of the arm should be changed frquently. The inflamed and acute joint can be supported in a splint. The swelling reduces much after and the patient gets relief in pain much faster. The splint should be removed 2-3 times a day for exercises.
The deformity in ankylosing spondylitis generally occurs due to bad posture during sitting and lying down. It often happens when a person sleeps with high pillows in the bed and is propped up with pillows in the back. Gradually the curvature and the restriction of movements of these patients goes on increasing. They should try to sleep on a hard bed with a thin pillow. They should try to sleep on the back and in front without any support for a few minutes. They should always sit on a straight back chair and should keep on exercising even with some bearable pain. This way they can stop or slow down the oncoming deformity, can have more movement and pain will be much less.
These joints can quickly get stiffened and lose mobility if not cared properly. Even from the onset of the disease when the pain is acute, a gentle local joint movement should be started for a short period once or twice a day. The patient should be encouraged to do exercises himself, or with joints supported by the therapist. The movements should be done gently and not be forced. An increase of pain after exercises indicates an excessive amount of motion. In the next session it should be reduced.
The muscles around the affected joint should be voluntarily contracted and relaxed by the patient by moving the joint called static exercise, done 2-3 minutes every hour. This will prevent wasting, otherwise the splinted joint starts wasting quickly and the rehabilitation and recovery take longer. As the patients condition improves, exercises must increases but not too rapidly otherwise a relapse may occur.
Sub Acute Stage
When swelling and pain have subsided and active measures will not cause a relapse the patient will be sub-acute stage. Now gradually exercises should be increased but overindulgence may cause a relapse. The patient can reduce his period of rest. The splint can be removed for longer periods or kept during the night only. If the patient improves, swelling subsides, body temperature becomes normal. Erythrocyte sedimentation rate (ESR) comes down and anaemia improves.
Patient should stop before excessive fatigue sets in. Gradually with the exercise of the joints, mobility will increases. A patient must exercise on his own and can do a few exercises assisted by his therapist. The patient can sit in a chair and do exercise, he can stand and do exePatient should stop before excessive fatigue sets in. Gradually with the exercise of the joints, mobility will increases. A patient must exercise on his own and can do a few exercises assisted by his therapist. The patient can sit in a chair and do exercise, he can stand and do exercises. He can walk with the help of a walker or assisted by somebody. He can walk with crutches. Use elbow crutches rather than axillary crutches to avoid crutch palsy. After crutches the patient can walk with the help of a cane. Gradually the patient starts building up his muscle control. All this will depend upon age, the patient’s endeavour and how determined he is to quickly come out of it.
Exercises are important at the chronic stage, otherwise deformity is certain. If the joints are not exercised properly, they become fixed in flexed position, muscles become thin and wasted and inflammatory products get deposited around the joints. This is common in Ankylosing spondylitis.
Many other deformities occur in rheumatoid arthritis. If the patient has been sleeping on a soft bed, the cervical spine flexes till the chin reaches near the chest. The dorsal and lumbar spine gets flexed. The hip and knee get flexed and the ankle joint is extended. The patient looks as if curled up in a ball. The bones become osteoporotic and more often get fractured by little training.
These patients need a well planned and supervised exercise therapy. Attention must be given to the joints. Gradually their movement and muscle power will increase. Some heat therapy to the joints before exercise may be given. This helps to relax the muscles and increases the blood supply and so the exercise become more effective.
The joint stiffness and contraction improves slowly and needs a lot of patience and perseverance on the part of both the physician and the patient. The first exercises for the affected joint should be taught by the therapist in a long session. The patient would do them 2-3 times a day. Exercise should be supervised atleast twice a week by the therapist and the improvement noted. Exercise pools are of great help, where the patient can move his joints freely in all directions.
General exercise should also be given along with specific joint exercises. Resistance exercises should be had to increase the power of muscles which support the body in movement and during work. Exercises should be correlated with other form of treatment.