Rheumatoid arthritis (RA) is an autoimmune disease that causes inflammation and swelling in the joints. Although medications may be necessary to help slow the progression of the disease, self-management strategies such as physical therapy can help alleviate the symptoms and improve quality of life.
RA is a chronic condition for which there is no cure. The symptoms can vary among individuals, but RA most commonly affects the joints in the feet, ankles, knees, hands, wrists, elbows, and shoulders.
In this article, we describe what physical therapy is and how it can help people with RA. We also outline the potential benefits and risks of physical therapy for RA and provide some additional tips on how to manage the disease.
What is physical therapy, and how can it help with RA?
According to the American Physical Therapy Association (APTA), physical therapy is a combination of prescribed exercise, hands-on care, and patient education. It aims to help people by:
- improving movement
- restoring function
- preventing disability
- reducing or managing pain
- improving quality of life
Physical activity is an important part of RA management. The American College of Rheumatology states that people with arthritis who exercise regularly tend to experience the following health benefits:
- increased energy levels
- reduced pain levels
- improved sleep
- improved daily function
Some people may wish to work with a physical therapist to develop a tailored treatment plan. Others may prefer to try a variety of low impact exercises to see what works best for them.
Examples of physical therapy exercises and tactics for RA
Various physical therapy exercises may help relieve the symptoms of RA. Some examples include:
Stretches
People with RA may feel discouraged from exercising due to joint pain and fatigue. Stretching is a good way to loosen stiff joints without exacerbating pain.
People should gently warm up for 3–5 minutes before stretching. They should then hold each stretch for 30–60 secondsTrusted Source before releasing it.
Balancing
Most people with RA develop the disease between the ages of 40 and 60 years. Older adults who develop RA may be more susceptible to injury from falls. Balancing exercises can help prevent such injuries.
Walking
Walking is a gentle form of exercise that a person can do almost anywhere. People can start off slowly and increase the pace, distance, and elevation over time to suit their individual capabilities.
The Centers for Disease Control and Prevention (CDC) recommend that people do a minimum of 150 minutes of moderate intensity activity per week. The organization states that brisk walking counts toward this goal.
Yoga and tai chi
Both yoga and tai chi incorporate a variety of different postures, flowing movements, and breathing exercises that may help Trusted Source with the following:
- balance
- flexibility
- range of motion
- stress reduction
According to a 2019 review, tai chi may provide the following health benefits for people who are older:
- decreased stress levels
- increased muscle strength in the lower body
- improved balance
- improved posture
- improved mobility
The same review states that it is unclear whether tai chi improves pain, function, or disease activity in people with RA. Nonetheless, the researchers note that there is likely to be a low incidence of adverse effects.
Many online videos are available to help guide beginners in yoga or tai chi. There may also be local classes that people can attend in person. It is advisable to talk with a doctor before beginning a new exercise program.
Swimming and water aerobics
According to the CDC, swimming is the fourth most popular sports activity in the United States. It may be a particularly beneficial form of exercise for people with RA, as the buoyancy of the water helps alleviate strain on the joints. Due to this, people with RA can often exercise for longer in the water than on land.
People with RA may also wish to consider trying other aquatic activities, such as water aerobics.
Gardening
Light gardening is another form of gentle exercise that may benefit people with RA. it may also be beneficial for mental health.
To avoid aggravating the joints, people with RA can try the following while gardening:
- working slowly and taking regular breaks
- using lightweight, ergonomic gardening tools
- wearing gardening gloves to improve grip and reduce strain on the fingers
- avoiding lifting heavy objects
- building elevated flower beds to avoid bending, stooping, and kneeling
- sitting on a stool to avoid kneeling
- using a gardening pad when kneeling is necessary
- trying container growing, which reduces the need to dig into the soil
- creating a low maintenance garden that is manageable during an RA flare
Benefits and outcomes
According to the Arthritis Foundation, physical therapy for RA aims to help by:
- maintaining fitness
- increasing strength to support the joints
- improving range of motion in the joints
- maintaining the ability to carry out day-to-day tasks
A 2020 study found that a structured exercise program also provided the following benefits for people living with RA:
- reduced fatigue
- improved cardiovascular fitness
- improved cognitive function
Risks and cautions
Physical therapy can help a person manage their RA symptoms. However, it is always best to speak with a doctor before embarking on a new exercise regimen to ensure that the exercises are appropriate.
People can do almost any form of exercise they choose, as long as it is low impact. Such exercises place minimal pressure and stress on the weight-bearing joints, such as the hips, knees, and ankles. Examples of low impact exercises include:
- walking
- swimming
- water aerobics
People should avoid high impact exercises that put pressure or stress on the weight-bearing joints. Examples of high impact exercises to avoid include:
- running
- soccer
- basketball
- tennis
Sometimes, people may notice that they experience pain, stiffness, and swelling after beginning a new exercise routine.
According to the CDC, it can take 6–8 weeks for the joints and muscles to adjust to a new regimen. During this time, people should modify their activity to ensure that they can continue safely without too much pain. Although some muscle soreness is expected, anyone who experiences significant joint pain should lower the intensity of their exercise program until their symptoms return to their usual level.
Movement can provide pain relief, but it is important to “listen” to the body. The goal is to stay as active as possible without worsening RA symptoms.
It is also important to wear comfortable and appropriate footwear and clothing while exercising to minimize the risk of discomfort and injury.
Other tips for managing RA symptoms
Some additional tips for managing RA symptoms include:
- taking RA medications as a doctor or pharmacist advises
- applying heat or cold to the affected joints before and after physical therapy to alleviate pain and inflammation
- losing excess body weight to reduce pressure and stress on the weight-bearing joints
- quitting smoking, if applicable, as smoking can exacerbate RA and make it more difficult to carry out physical activity
Summary
Rheumatoid arthritis is an autoimmune disease that causes pain, swelling, and inflammation in the joints. Treatments and therapies are available to help manage the disease, alleviate symptoms, and improve quality of life. One self-management technique that people may find beneficial is physical therapy.
Physical therapy combines prescribed exercises, hands-on care, and patient education to help alleviate pain, improve movement and function, and prevent disability for those with RA. Some low impact exercises that a physical therapist may recommend include walking, swimming, and gardening.
People should talk with a doctor or physical therapist before trying a new exercise regimen to ensure that it is appropriate for them. When starting a new regimen, RA symptoms may initially worsen as the body adjusts. If this occurs, and joint inflammation and pain are persistent, it is important to reduce the intensity of the activity.
It is also important to take any prescribed medications because these help minimize symptoms. An individual should work with a doctor or physical therapies to find the best exercise program for their body.