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Q & A

• I have arthritis. What can you do for my arthritis pain?

There are many things that can be done to decrease the pain that is caused by arthritis. Physiotherapy directed treatment has a large part to play in the overall management of arthritis. The physiotherapist, as well as other members of your pain management team, are trained to understand and treat the physical aspects of the human body.

Physiotherapy directed treatment for people with arthritis is aimed at:

  • reducing pain
  • improving movement
  • strengthening muscle power
  • assisting a person to be independent and functioning as well as is possible.

The range of therapies which may be used include pain relief methods and treatments to relieve pain and stiffness. Physiotherapy directed treatment will not cure arthritis as it is not curable.

Pain relief methods

  • Thermal (heat treatments) These treatments produce heat within your body tissues. The application can be directed towards superficial or deeper parts of the body. The most common types of treatment used are infra-red radiation (heat lamps), wax baths and hot packs for superficial treatments, and microwave diathermy and shortwave diathermy for deep heating treatment.
  • Electrical treatments (electrotherapy) These treatments produce electrical stimulation of your body tissues. They may be extremely useful in the treatment of both acute and chronic arthritis, where pain, swelling and muscle spasms are present.
  • Physical treatments These treatments include the use of, ice therapy and traction.

Treatments to relieve pain and stiffness

Exercise
A balanced programme of rest and exercise, and careful attention to joint posture is an important part of pain management, joint protection and maintenance of your joint function.

Controlled exercise helps lessen pain and stiffness and improves the strength of muscles and ligaments, so helping to stabilise joints. This is essential in all aspects of self care and particularly important before and after joint surgery.

Manual therapy
Mobilisation and manipulation techniques are passive movements applied to a joint or soft tissue by the therapist in a specific manner to help restore full movement to a joint that is painful and restricted.

With increased understanding of the structure and movement of the spine and peripheral joints, the usefulness of manipulation in the treatment of arthritis has become much clearer. Manual therapy is often useful in the chronic forms of arthritis and is often successful when other methods such as heat and exercises have given little or no relief.

Hydrotherapy
Hydrotherapy or pool therapy is a very useful means of exercising arthritic joints using the buoyancy of water to assist or resist movement. The warmth of the water increases the circulation and helps reduce muscle spasms, producing more effective movement. Joint mobility, muscle strength and general fitness can be improved with hydrotherapy.

• My 84 year old mother was living at home when she fell and fractured her pelvis. Now she is in long-term care. What can your team do for my mother? Is there any chance that she may be able to move back home if her recovery goes well?

Treatment plan

A fractured pelvis will take a lengthy amount of time to recover. It may be painful to mobilize the affected joint and to receive treatments for a few months but it must be done if she wants to recover. Physical therapy is a great idea and it has numerous benefits for pelvic fractures. If there was no Hardware (screws, plates and nails) she will have to keep most weight off the fractured side for the time being until some strength and stability have been attained from exercises and as she can tolerate. If she did receive hardware during the surgery there is then less restrictions on weight bearing activities, and weight can be put on the affected leg on an as tolerated basis.

The treatment that would be included would be sessions from us 2-3 times per week for the duration of 30 minutes. Our sessions will be exercises that need to be done with a therapist to assist and give direction, such as walking. We will also give your mother exercises that can be done once every day on an as tolerated basis.

Some of the exercises that we would perform would be:

1. The first few weeks would be feather weight bearing activities on the pelvis including strengthening the muscles of the lower extremities.

  • Straight Leg raises while lying down
  • Quad Contractions lying down
  • Knee bends (heel to bum) exercises lying down
  • Leg abduction/Adduction, lying down
  • Bum/glute squeezes lying down
  • Ankle pumps sitting or lying down

Do these exercises 2-3 x 10 reps with rehabilitation therapist or on your own. Do for each leg.

Time frame for these exercises may vary due to age, motivation and general health of your mother. This could take between 4-8 weeks.

2. Once pain subsides and the lower extremity muscles become stronger, transfers and sitting to standing exercises and practice will take place. Teaching your mother how to properly get in and out of bed/toilet/car etc. Some of these exercises may be started on an as tolerated basis within the first 4-8 weeks as well.

After standing and transfers are proficient then a walking program will commence. Start small and build up the amount of distance done week to week. Start with walker, until enough strength and stamina has been gained then canes can be used only if strength and stability is there.

3. As strength and stability gradually improve over the next 8-12 weeks from doing these exercises, sit to stands and walking. Then the addition of weights and bands can be implemented as well. Also the addition of walking up and down stairs and commence with caution.

Your mother can get better with physical therapy but it will be a lengthy process and it will take lots of time. The amount of time will depend on the severity of the fracture, motivation of your mother, as well as the general health of your mother. However the goals she has for being able to move back home and live an independent life are attainable and will take lots of hard work. Her pelvis may not be the same and her gait and strength may not recover fully but being able to walk with an assistive device such as a walker or cane can be done and possibly eventually without an assistive device. The main goal is to improve her independence and quality of life. Physical therapy can help attain that.