At Total Physiotherapy we will complete a detailed assessment to determine the nature and stage of arthritis, including onwards referral where necessary. Our aim is to improve your symptoms and functional ability. Arthritic conditions can be extremely debilitating with intense pain affecting the particular joints function and possibly affecting the individual’s mobility. Arthritis will be diagnosed through blood tests (Rheumatoid Arthritis, Gout), X-Rays (Osteoarthritis) and a physical examination. It is important for a patient who is suffering from arthritis to see the correct health professional to help treat their condition, with physiotherapists being a key part of this process.
For more information see: https://www.versusarthritis.org/about-arthritis/conditions/gout/
Osteoarthritis is a degenerative condition that affects your joints with the surfaces of your joints breaking down and becoming damaged, affecting their function. Where bones meet to form joints, the bone is covered in a smooth layer of cartilage. This cartilage allows the joint to move freely in a pain free manner. However in osteoarthritis this cartilage begins to break down and become thin, revealing the bone underneath (subchondral bone). Within this bone there are a large number of pain receptors, which when stimulated cause a deep pain to the area (arthritic pain). As a consequence the bone begins to grow outwards, forming bony spurs called osteophytes. The inner layer of the joint capsule (synovium) which produces synovial fluid may thicken and produce extra fluid causing the joint to swell. The ligaments around the joint will also stiffen to provide extra stability, however this will only inhibit the joints movement.
Rheumatoid arthritis is an autoimmune disease that causes inflammation in your joints, affecting the joints function. The main symptoms of rheumatoid arthritis are pain and swelling to the joint. Rheumatoid arthritis causes inflammation in the synovium (inner layer of the joint capsule) and as a result, the joint becomes red, hot and it will swell dramatically. As the joint swells and the synovium is irritated, the joints stability is compromised and the capsule is stretched. As the inflammation within the joint reduces, so will the swelling. However the joint capsule stays stretched and cannot hold the joint in its proper position, affecting its integrity and stability. This is why people who suffer with rheumatoid arthritis may experience joint deformity. Further information can be found on the Arthritis UK webpage
Gout is a form of arthritis that is caused by a build-up of crystals in your joints, leading to extremely painful inflammation. Gout is a form of arthritis that is caused by a build up of crystals in your joints, leading to extremely painful inflammation. The pain or attacks can come on suddenly which are described to be extremely painful and most commonly come on at night time. Symptoms of gout include intense pain at the joints with redness, heat and swelling. The skin over the affected joint may become thin and shiny, sometimes peeling away. The condition most commonly affects the big toe, however it can also affect the joints within the mid foot, ankles, knees, elbows, wrists and fingers. It is also common for the urate crystals to collect outside the joint and occasionally under the skin. Here they may form little lumps called tophi which can break down to form a discharge containing white gritty material, the urate crystals themselves. For more information please see the Versus Arthritis webpage by clicking here.
How can Physiotherapy help with Arthritis?
Research has shown that physiotherapy can help people manage arthritis and reduce their symptoms. The National Institute for Health and Care Excellence (NICE) recommends specialist physiotherapy for Arthritic conditions in order to treat the symptoms and manage the condition. The NICE guidelines for each form of Arthritis can be found below:
At Total Physiotherapy we will complete a through assessment to determine the intensity of the arthritis and how we can help to improve the symptoms and the patient’s functional ability.
Physiotherapy for Osteoarthritis:
It may be that as a consequence of osteoarthritis at the lumbar spine (also known as Spondylosis), the spine has become very stiff and the patient has developed low back pain. As a result of the joint stiffness the muscles and fascia around this area will have stiffened and restrict movement (bending forwards and side to side.) With deep tissue massage and joint mobilisations, the joints and soft tissue will become more mobile, improving the spines mobility and reducing pain. It is also important to complete specific exercises that the physiotherapist may have issued to improve the stability and mobility at the lumbar spine. The physiotherapist will also encourage general mobility to prevent the risk of losing range of movement in the joint. When treating arthritic conditions it is important for the patient to control their pain, this may be through pain relief prescribed by a pharmacist or doctor, or through electrotherapy in the form of a TENS machine. The NICE guidelines recommend the above treatments to be used in conjunction with one another, especially alongside an exercise routine designed to provide local joint strengthening and general aerobic fitness. At Total Physiotherapy we can also provide the patient with specific walking aids to help maintain mobility, as well as advice with specific aids in the home environment to help sustain independence with everyday tasks. If the osteoarthritis is too painful and the patient is struggling with exercise and mobility, it may be appropriate for the physiotherapist to refer the patient to an Orthopaedic doctor to consider intra-articular corticosteroid injections or surgery in the form of a joint replacement.
Physiotherapy for Rheumatoid Arthritis (RA):
Due to the nature of RA it is extremely important for the individual to maintain their function and find ways to manage their condition. At Total Physiotherapy we will complete a thorough assessment to determine where they may be struggling and aim to use manual treatment techniques, alongside exercise prescription and advice/education to improve the patients function. With inflammation at the joint capsule, the joints stability is compromised. It is therefore important to maintain muscle strength and stability at the affected joints to reduce the risk of further irritation and loss of function. Through simple exercises that the individual can complete at home, alongside further treatment options that may have been implemented by the Rheumatology medical team, the patient will be able to manage their condition and maintain their functional ability. It may be appropriate to provide the patient with specialist splints to support particular joints (wrists, knees, ankles, elbows) to help provide extra stability if the condition progresses. As mentioned above we can also provide the patient with specific walking aids to help maintain mobility, as well as advising with specific aids in the home environment to help maintain independence with specific everyday tasks.
Physiotherapy for Gout:
At Total Physiotherapy we treat a number of patients who suffer with gout, aiming to improve their mobility and reduce the irritation to the specific joint. As mentioned before, gout can be extremely painful. As a consequence the joint affected will lose its function which will impact on the patient’s ability to complete certain tasks. However, if the patient is advised with preventative measures and ways of managing the condition when it is in its acute form the pain can be reduced and physical ability maintained. Gentle exercises can be given to the patient to help maintain the joints mobility, as well as advising with ice as a treatment modality.
At Total Physiotherapy we have good links with the local GP’s and can therefore communicate with the patient’s doctor with regards to the most appropriate treatment methods and recommend referrals to any other health professionals if required.
If you would like to discuss your problem before booking an appointment please give our physiotherapy team a call, we will do our best to help.