May is National Arthritis Month; a time to raise awareness and support for the millions of Americans living with arthritis. Arthritis is a common condition that causes pain, stiffness, and swelling in the joints. According to the CDC, arthritis affects more than 54 million adults in the United States. That makes it one of the leading causes of disability. 

     But there is hope for people with arthritis. Physical therapy is a proven and effective treatment to manage symptoms, improve function, and enhance quality of life. Physical therapists are licensed professionals who evaluate and treat conditions that limit the body's ability to move and perform daily activities. They can also teach you how to prevent or reduce the impact of arthritis on your health and well-being. 

Physical therapy for arthritis can help you: 
• Ease pain. Physical therapists can use things like massage, joint mobilizations, exercise, braces or splints, to relieve pain and inflammation in the affected joints.
• Increase range of motion. Physical therapists can design a personalized exercise program that includes stretching, strengthening, coordination, and balance exercises to improve your flexibility and mobility.
• Improve movement patterns. Physical therapists can teach you proper posture and body mechanics for common activities, such as getting in and out of chairs, climbing stairs, walking, or working. This can help protect your joints to slow down or prevent progression of your symptoms. 
• Enhance your fitness level. Physical therapists can help you create a home workout routine that matches your goals and abilities. They can also show you how to exercise safely and effectively without aggravating your arthritis symptoms.
• Maintain function. Physical therapy can help you maintain or restore your ability to perform everyday tasks like cooking, gardening, shopping, or playing with your grandchildren. 

     Physical therapy treatment for arthritis is based on scientific evidence and tailored to your individual needs. It can also complement other treatments for arthritis, such as medications, bracing, or topical products. Research has shown that physical therapy can be more effective than steroid injections at reducing pain and disability in people with knee osteoarthritis. It can also have positive effects on fatigue, cardio fitness, cognition, and body composition in people with rheumatoid arthritis. 

     If you have arthritis or know someone who does, don't let this month pass by without taking action. Contact your physical therapist for an appointment. You can also visit the websites of the American Physical Therapy Association (APTA) or the Arthritis Foundation to find a physical therapist near you or learn more about physical therapy for arthritis.  Celebrate National Arthritis Month by taking charge of your health and your life with physical therapy!  

References:
(1) How Does Physical Therapy Help Arthritis?. https://www.healthline.com/health/arthritis/doesphysical-therapy-help-arthritis.
(2) Physical Therapy for Arthritis. https://www.arthritis.org/healthwellness/treatment/complementary-therapies/physical-therapies/physical-therapy-for-arthritis.
(3) Ways physical therapy can alleviate arthritis pain. https://www.medicalnewstoday.com/articles/physical-therapy-for-arthritis. 

     If you've been to physical therapy, you likely got a home exercise program. Research says that if you do your home exercise program, you'll have a significantly better chance of meeting your goals and feeling better. Not doing your program increases the risk of recurrent injury or flareups with less positive outcomes long term. Even though they're important, adherence to home exercise programs is terrible. It's estimated that only 40 to 50% of patients do their exercises the way they're supposed to.

What can you do to make sure you do your exercises and get the best outcomes? Here are a few ideas.

Plan ahead
Think about what's going to get in your way your schedule, that you'll forget, or that you don't have the space or equipment that you need. Once you figure out the problems, come up with solutions. Put your exercises in your schedule, talk to your PT about equipment, or adjusting your program to fit the time you have. If you solve problems before they start, they're no longer problems.

Address pain and beliefs
You'll need to work with your PT on these. If your exercises cause pain, you're not going to do them. When your PT prescribes your exercises, try them out. If there's pain, ask your PT about modifications to make them more comfortable. The other thing might need addressed are your beliefs. If you believe that the exercises won't help, or that they're a waste of time, you won't do them. Again, work with your PT to understand why they're prescribing those exercises, and what they're meant to do. Once you know why you're doing those exercises, you're more likely to do them.

Get support
People who have social support are more likely to do their exercises. This is why CrossFit and group exercise classes work. Find a family member or friend to help you stay consistent with your exercises. Your PT can help here too. Have someone ask if you're doing your exercises, and how they're going. This will keep you accountable and more likely to do them. Use Technology If you like technology and gadgets, they can help you be consistent with your exercises. There are plenty of apps that can track your exercise. Seeing that streak of days you've exercised will motivate you not to break it. Smartwatches and activity trackers can fill the same role.

​Doing your home exercise program will help you get the most out of PT. With a little planning and a little help, you can make sure you're one of the 50% of the people who do their home exercises consistently to get the best outcomes.

References:
https://pubmed.ncbi.nlm.nih.gov/32669487/ https://www.physiopedia.com/Adherence_to_Home_Exercise_Programs

     Arthritis is a chronic condition that causes inflammation of the joints. It can cause pain, stiffness, and swelling. The hips, knees, hands, and spine are the most commonly affected joints. Arthritis is not a single disease but an umbrella term that includes a variety of different types. Some of the more common examples are osteoarthritis, rheumatoid arthritis, gout, psoriatic arthritis and ankylosing spondylitis. While physical therapy might not be the first treatment you think of for arthritis, it probably should be.

     A lot of people with arthritis choose to use medication to manage their pain, stop activities that hurt, and wait for things to get bad enough to have a joint replacement. But this isn't a great plan, all medications have side effects, even over the counter ones. Reducing activity leads to muscle atrophy and even stiffer joints. Even though joint replacement surgery usually has good outcomes, it does come with its own set of risks and a painful recovery.

     Physical therapy has been extensively researched as a treatment for arthritis, and demonstrates good outcomes. Physical therapists typically start with exercise as the base for arthritis treatment. Exercise helps to regain lost joint motion, decrease feelings of stiffness, and strengthen muscles surrounding the affected joint. These benefits are all somewhat obvious. What surprises many people is that exercise has been shown to be as effective as medication for pain relief in many types of arthritis, without the side effects.

     Physical therapy has more to offer people with arthritis than just exercise though. Education helps people understand their condition, what to expect, and how to manage it. As experts in human movement, physical therapists are especially good at helping people modify the way they perform certain tasks or activities to reduce strain on joints affected by arthritis. They can also suggest ways to modify the environment at work or home to reduce pain and improve function. They may also suggest things like braces, orthotics, or other devices that can help maintain mobility and reduce pain.

     On top of all of that, PT has been proven to be a cost effective treatment, too. With so many techniques that are proven effective in helping people with arthritis, physical therapy is a recommended first line treatment for many types of arthritis. Now that you have a better understanding of what PT can do, hopefully you'll think of PT first when you think of arthritis too.

References: 1. Research (peer-reviewed) a. PT for juvenile RA - https://pubmed.ncbi.nlm.nih.gov/1946625/ b. PT for hip and knee OA - https://pubmed.ncbi.nlm.nih.gov/33034560/ c. Systematic Review for Juvenile RA - https://pubmed.ncbi.nlm.nih.gov/28729171/  2. Articles and Content a. Effectiveness and Cost-Effectiveness of Physical Therapy for Knee Osteoarthritis-  https://www.rheumatology.org/About-Us/Newsroom/PressReleases/ID/718 b. Can physical therapy reduce arthritis pain? - https://www.medicalnewstoday.com/articles/physical-therapy-for-arthritis 

Many people are focused on fitness so it's worth taking a look at what fitness really means. The dictionary defines fit as "sound physically and mentally, healthy." Using that definition, many "fitness" routines fall short of the goal. If you don't enjoy running and dread every workout, you're probably falling short of the "sound mentally" portion. Exercise should be enjoyable, reduce stress, and leave you feeling better, not worse.

No Pain no Gain?

Exercise should also leave you feeling better physically. If you can run a good time in a 5k, but have aches and pains for days after, you're not "sound physically." If you are increasing your PR in the squat rack, but your joint pain is increasing right along with it, you're not "sound physically" either. Sure, some muscle soreness and fatigue after a hard workout is normal. But if you're having pain that doesn't go away, sore joints, or trouble moving after exercise, you're probably developing movement dysfunction along with your fitness.

Movement Dysfunction

Go back to the dictionary and you'll find that dysfunction is "impaired or abnormal functioning." So movement dysfunction is impaired or abnormal movement. When someone has a movement problem like a sore joint, limited range of motion, or strength loss the brain finds a way to get the body to do what it wants. That usually means moving in a way that is less than optimal. For a while, it works. But eventually it leads to injury. As a concrete example, think of someone who has trouble bending one knee doing squats. When one knee bends further than the other, it will cause one side of the pelvis to drop lower than the other. Now that the pelvis isn't level, the spine bends towards the high side to stay balanced. When that one side of the pelvis drops lower than the other one, it also usually rotates. Now the spine has to bend to the side and twist to keep you upright. This works for a while, but as weight gets added to the squat, and the repetitions add up so does the risk for a back injury.

Preventative Medicine

Pain during workouts, or pain and soreness that don't go away after can be warning signs of a movement dysfunction. If you're experiencing any of these, your physical therapist is a movement expert who can help. We are trained to analyze movement, and figure out the root cause of problems. We can then design a program to treat the cause and correct the abnormal pattern. There is no need to wait until you're injured to see your physical therapist. In fact, it's preferable not to.

Getting minor problems fixed early means fewer visits to the PT, less pain, and not having your workouts put on hold by injury.