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Physical therapy (PT) can help people with rheumatoid arthritis (RA) by providing a personalized exercise program and simple movements to help them better manage the condition. For people with RA, exercise can reduce pain, improve muscle function, and delay the onset of disability.
For people living with the pain and tenderness of RA, even simple movements and mild exercise can be particularly hard. While PT can be difficult at times, many myRAteam members are pleased with their experiences and recommend that others stick with it: “Do the physical therapy,” one member encouraged another. “I really think you will be pleased.”
Rheumatoid arthritis is an inflammatory autoimmune disease that affects the joints. RA happens when the immune system mistakes the tissue of the joints for a pathogen (like a virus or bacteria). The immune system makes antibodies that attack and damage the joints, leading to joint pain and inflammation of the affected joints.
| You should know: exercise and physical therapy for RA in the knee |
Over time, this disease can affect joint function and make daily activities more difficult. While there is no cure for RA, there are several treatment options and strategies for managing RA. Physical therapy can be an important tool, alongside disease-modifying antirheumatic drugs (DMARDs) like Janus kinase (JAK) inhibitors.
Physical therapy focuses on moving your body in ways that can improve strength and reduce pain. According to the American Physical Therapy Association, physical therapists and physical therapy assistants are licensed health care professionals and movement experts. They help people manage pain, reduce the symptoms of an injury or disease, and improve movement and function.
Physical therapists create a personalized program and teach specific exercises to help people improve their ability to move. These therapists will teach you exercises you can perform at home between sessions or after you complete physical therapy. The goals of physical therapy in people with RA are to prevent disability, relieve pain, and to improve mobility and function.
Occupational therapy can also help manage RA. While a physical therapist focuses on movement and exercise, occupational therapists help people modify their habits and environments to be as independent as possible. For example, an occupational therapist might help a person use adaptive equipment or modifications to make cooking or dressing less painful. People with RA can benefit from both occupational and physical therapy.
Several physical therapy approaches can be used to help people with RA reduce pain, increase range of motion, gain strength, and improve overall well-being.
Heat and cold applications, like heating pads or ice packs, can be used to relieve pain. Applying heat can reduce muscle spasms, and is sometimes recommended before exercising. Members of myRAteam frequently turn to heating pads or cold packs to manage discomfort: “Had a really bad day yesterday. Everything was hurting, I just laid around wrapped in a blanket with my heating pad,” one member wrote.
The most commonly used method for electrical stimulation is transcutaneous electrical nerve stimulation (TENS) therapy. Use of electrical stimulation has been shown to help reduce joint pain and increase the range of motion in people after knee surgery. Some myRAteam members love TENS therapy. One member wrote, “I just used mine on my shoulder yesterday morning for an hour, and it knocked the pain away for most of the day. I have had mine for almost five years and love it!”
Hydrotherapy, also called aquatic therapy, involves performing exercises in a heated pool. Hydrotherapy is led by a physical therapist — as opposed to water aerobics, which may be led by an aerobics instructor or other fitness professional.
Being in water lowers the amount of weight on a person’s joints, which can be helpful for people with sore or swollen joints. A systematic review found that hydrotherapy can reduce pain and joint tenderness and improve grip strength and overall mood.
Hydrotherapy is very popular with myRAteam members. “Pool therapy is wonderful!” one member posted. “The water temp is warmer than a regular pool, which feels amazing. You also feel more buoyant than a regular pool. It’s so soothing and relaxing on your joints.”
Another member commented, “Aquatic physical therapy helped tremendously. There were exercises I could do in the water that I couldn’t do on dry land. Therefore, I was able to strengthen muscles that I couldn’t before.”
Support is particularly important during flare-ups, when joints are especially achy and stiff. Physical therapists can provide an orthotic or splint specifically to provide support and relieve pain in the joints. A small study of 38 people with RA in the foot found that foot braces helped improve pain and physical functioning. A 2019 systematic review found that foot orthotics made of soft materials provided more pressure relief than rigid materials. There is also evidence that wrist splints can help control pain and inflammation and prevent deformities.
Members of myRAteam commonly use splints. One member wrote, “I am now using a splint on each wrist. They seem to help when lifting things by preventing twisting of the wrist by sudden motion.”
Splints are commonly available at pharmacies and online. However, consulting with a physical therapist can help you find the best option for your needs. “New splints arrive today for my knuckle and I can't wait!” a member posted. “So tired of the bulky splint.”
Gloves to help people with RA can provide heat, support, or both. Gloves that provide support or compress the hands are called therapy gloves, arthritis gloves, or compression gloves. A review of studies on people with RA found that using therapy gloves helped reduce pain, stiffness, and swelling in the hand. However, researchers note that it is difficult to tell exactly how the gloves help because there are many types of gloves with different materials and levels of pressure.
A physical or occupational therapist can recommend compression gloves that may help with RA pain and swelling. Several members of myRAteam use compression gloves: “I've just received new compression gloves. I have to say they are wonderful. My hands have been stiff and painful for days. When I put these gloves on, there was instant relief.” Read more about myRAteam members’ experience with compression gloves.
There are many popular devices that can make it easier for people with RA to perform tasks involved in daily living, like standing up, fastening jewelry, and removing socks. Ergonomic tools are also available that can make working at a computer or participating in hobbies more comfortable.
An occupational therapist can recommend assistive devices and ergonomic tools to make daily activities easier while maintaining your independence. Finding the right tools can make painful activities enjoyable again. One myRAteam member posted a photo of an ergonomic crochet hook and wrote, “I was able to start crocheting again. Makes a huge difference.”
Massage therapy involves the manipulation of soft tissues (muscle, connective tissue, tendons, ligaments, and skin) by a trained professional. A 2013 study found that people with RA receiving massage therapy once a week for four weeks had less pain, greater grip strength, and greater range of motion in their wrists, elbows, and shoulders. In that study, moderate pressure was more effective than light pressure in managing RA symptoms.
Talk to your doctor or a physical therapist before trying massage therapy. They can help you understand what to look for and what information to share with a massage therapist before a session.
Physical activity can be difficult for people with RA because of pain and stiffness. However, exercise can be particularly beneficial for people with chronic pain. A systematic review of exercise interventions in people with chronic pain found that exercise can improve physical function, pain severity, and quality of life. Another systematic review showed exercise therapy improved aerobic capacity and muscle strength in people with RA, without increasing disease activity or pain. Therapeutic exercise can include range-of-motion exercises, stretching, strengthening, and aerobic exercise.
A physical therapist can teach you exercises to help strengthen your muscles and better support your joints. One myRAteam member described her first PT visit: “I had my first therapy session this morning. Mostly they measured my range of motion. She gave me some putty to use to exercise my fingers, and instructions for writing and other exercises.”
Since physical therapy is personalized, there are not many high-quality controlled studies on how physical therapy impacts RA. One randomized controlled trial of 127 people with RA found that six weeks of physical therapy — with physical therapists who received rheumatology training — improved morning stiffness and self-efficacy (the ability to execute tasks like walking a short distance, cutting food, or turning on a faucet). A follow-up study of the same people found that these improvements continued a year later. A systematic review of studies found that occupational therapy improved functional ability for people with RA.
If you think physical therapy can help manage your RA, talk with your rheumatologist for recommendations or a referral. Some physical or occupational therapists may have more experience with RA than others do. You can find tips on choosing a physical therapist from the American Physical Therapy Association.
On myRAteam, the social network for people with rheumatoid arthritis and their loved ones, more than 145,000 members come together to ask questions, give advice, and share their stories with others who understand life with RA.
Have you used physical therapy to manage your RA? Share your experience in the comments below, or share your story on your myRAteam Activities page.
References
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Ariel D. Teitel, M.D., M.B.A.
is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network.
Learn more about him here.
Ashley Knox
is a doctoral candidate at the University of Colorado, where she studies the noncoding RNAs involved in gammaherpesvirus pathogenesis.
Learn more about her here.
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