rheumatological physiotherapy

Rheumatological physiotherapy is a specific form of physiotherapy aimed at treating a variety of rheumatological conditions. Rheumatological conditions are autoimmune diseases which cause inflammation to joints, muscles, tendons or ligaments. The causes of these conditions are often unknown although hereditary factors can be common.

rheumatological conditions

ANKYLOSING SPONDYLITIS

Introduction
Ankylosing spondylitis is an inflammatory condition that can cause some of the bones in the vertebrae to fuse. This fusing makes the spine less flexible which results in a hunched posture. If ribs are affected, there will be breathing difficulty.

Symptoms
Lowe back and hip stiffness may be the first signs and symptoms of ankylosing spondylitis, especially in the morning and after periods of inactivity. Fatigue and neck pain are also frequent. At sporadic periods over time, symptoms may get better, get worse, or stop completely.
The regions most affected are:- the connection between the pelvis and the base of the spine, ,the lower backs vertebrae, primarily in the spine, but occasionally also down the back of the heel, the joint between the ribs and the breastbone, the hip, and shoulder joints.

Causes
Although there is no etiology for ankylosing spondylitis, genetic factors play a role. The chance of developing ankylosing spondylitis is in those who carry the HLA-B27 gene. Only some carriers of the gene may experience the illness.

Physiotherapy management
Physiotherapy is a crucial component of treatment. Its objectives include pain relief, improvement of the patient’s psychological status, reduction of morning stiffness, correction of postural abnormalities, increased mobility, and increased spinal mobility and functional capacity. A monitored or private home exercise program is preferable. The three primary components of rehabilitation are education, a plan of individualized exercises, and a schedule of physical activities that can be done at home or in a group setting.

EHLERS-DANLOS SYNDROME

Ehlers-Danlos syndrome is a group of inherited disorders that affect connective tissues, skin, joints and blood vessel walls.
Highly flexible joints and stretchy, fragile skin.

SYMPTOMS
 Stretchy skin
 Fragile skin.
 Hypermobile joints
 Unstable joints
 Soft skin than normal
 Excessive bruising

CAUSES
Faulty gene that leads to weak collagen

PHYSIOTHERAPY MANAGEMENT
 Aerobic exercise program
 Strengthening exercise
 Assistive devices
 Bracing
 Pain relieving modalities
 Myofascial release techniques

GOUT

INTRODUCTION
Gout is a type of provocative joint pain that regularly appears as eruptions that most recent up to 14 days
prior to disappearing. Flares of gout much of the time start in the enormous toe or a lower appendage.
High serum urate levels cause gout, which can bring about thin molded precious stones shaping in and
around joints.

SYMPTOMS
• Abrupt and extreme torment, generally around midnight or early morning
• Delicacy; the joint can likewise be warm to the touch and look red or purple
• Solidness
• Expanding

CAUSES
• Heftiness, hypertension or potentially diabetes
• Having a direct relation with gout
• Kidney issues
• Gobbling food varieties that cause a development of uric corrosive, like red meat, offal and
fish
• Drinking a lot of brew or spirits

PHYSIOTHERAPY MANAGEMENT
• Pain control
• Electrotherapy
• Strengthening and range of movement exercises
• Cardiovascular activity
• Hydrotherapy
• Wax therapy
• Cryotherapy (cold therapy)
• Mobilisation techniques
• Home exercise programme

HYPER MOBILITY SYNDROME

Introduction

The circumstance of musculoskeletal symptoms in hypermobile healthy persons.
Generalized common hypermobility with or without disturbance/ subluxation. The joints of
the body may suffer larger range of movement than normal.

Symptoms
o Primary symptom is inordinate laxity of multiple joints.
o Acute or Traumatic sprain like intermittent ankle sprains.
o Meniscus gashes.
o Joint insecurity – Acute or intermittent disruptions or subluxations of the shoulder, patella.
o Joint pain( traumatic arthritis)
o Bruising
o Fractures
o spine curve
o Muscle pain
o Fatigue for long duration.
o whim-whams contraction diseases.
o Joint swelling
o Clumsiness.
o Failures in tendon, ligament, bone, skin and cartilage.

Causes
o Peak at 15 years of age in girls.
o Hormonal changes that happen in puberty especially in girls.
o further common in children than grown-ups and girls than boys.

Physiotherapy Treatment
o Education of Hypermobility Syndrome.
o exertion revision.
o Strengthening exercise.
o Strengthening exercise for affected joint.
o Osteopathic manipulative treatment.
o Active rallying exercise.
o Proprioception common position sense exercises – collaboration and balance exercises.
o Control neutral common position – Postural muscle training.
o Retrain dynamic control – muscle training.
o Movement control – muscle training.

OSTEOARTHRITIS

INTRODUCTION
Knee osteoarthritis (OA), commonly known as degenerative joint disease, is frequently brought on by wear-and-tear and articular cartilage loss that occurs over time. It comes up most often in elderly people and comes in two varieties: primary and secondary.
Osteoarthritis is a debilitating, long-term joint condition that typically impacts the knees, hands, hips, and spine. Each person's symptom intensity varies, and they typically worsen gradually.

CAUSES
-Obesity
-Injury or surgery to the joint
-unusual joints from birth
-Your hobby and work
-Gouts
-Diabetes
-Body mechanics

SYMPTOMS
-Ache gradually getting worse
-swelling or sensitivity
-Buckling and locking
-Cracking or popping sounds
-Poor range of motion
-Loss of joint space
-Deformities of the knee

PHYSIOTHERAPY MANAGEMENT
-Education
-Exercise
-Hydrotherapy
-Taping
-Massage
-Electrotherapy modalities such as IFT and TENS.

POLYCHONDRITIS

Introduction
Relapsing polychondritis, commonly known as polychondritis with polyarthritis, is an uncommon condition that causes inflammation of cartilage throughout the body. The condition typically affects the lungs, airways, ears, and nose.

Causes
The majority of cases affect persons in their 50s or 60s, and the reason is unknown. One popular explanation holds that polychondritis is an autoimmune disorder, in which the body is attacked by the immune system rather than external intruders like viruses. It's likely that a trigger for polychondritis, such as an infection, causes the immune system to react and launch an attack on the cartilage of the body.
It's possible that some people are genetically predisposed to this. It does not appear that the disease runs in families. Vasculitis, systemic lupus erythematosus, and rheumatoid arthritis are a few conditions that it can occasionally manifest in persons who already have (SLE or lupus).

Signs and Symptoms
Early signs of polychondritis relapsing include abrupt cartilage pain, ear swelling, joint inflammation, and eye issues. Although there is presently no cure for polychondritis, therapy can help with symptoms.

Physiotherapy management:
Pain controlling modalities
Cryotherapy
Electrotherapy including ultra sound and mega pulse
Strengthening exercises
Range of motion exercises
Balance retraining
Hydrotherapy
Cardiovascular activities

POLYMYALGIA RHEUMATICA

Introduction
Polymyalgia rheumatic is an inflammatory condition that causes muscle pain and stiffness, especially in the shoulders and hips. Symptoms will begin quickly and are worse in the morning. Most people develop older than 65. It rarely affects people under 50. This is also related to another inflammatory condition called giant cell arteritis. Giant cell arteritis can cause headaches, vision difficulties, jaw pain, and scalp tenderness. It's possible to have both conditions together.

Symptoms
This occurs on both sides of the body and includes:-
 Aches or pain in shoulders, necks, upper arms, hips, or thighs
 Pain and stiffness in wrists, elbows, or knees particularly in the morning
 Limited range of motion
 Generally, signs include; Mild fever, fatigue, loss of appetite, weight loss, and depression

Physiotherapy Treatment
 Include a range of movement exercises, which can help to reduce pain and maintain mobility.
 Weight-bearing exercise for maintaining bone strength.
 Walking is usually the most suitable weight-bearing exercise.
 Sitting for a long time may cause stiffness, activities such as driving more difficult. Simple measures such as a hot bath or shower can
help to ease pain and stiffness.

PSORIATIC ARTHRITIS

INTRODUCTION
In psoriatic patients, their bones may undergo changes in degenerative pattern followed by pain and bulging in the same area.

CAUSES
 Psoriasis
 Family history
 Age (30-55 yrs)
 Environmental (Injury /Infection.)

SYMPTOMS
 Joint pain
 Jointstiffness (morning stiffness )
 Swelling

PHYSIOTHERAPY MANAGEMENT
 ROM exercises
 Strengthening exercises
 Cardiovascular conditioning
 Stretching (for relaxation )
 Aquatic therapy
 Walking
 Patient education.

REACTIVE ARTHRITIS

Introduction
Inflammation of joints which manifests after several days to weeks following a bowel or
genito-urinary infection. More than one joint may be affected in reactive arthritis.

Symptoms
o Intermittent or non-noticeable urethritis discharge.
o Pink eye.
o Joint inflammation – usually asymmetrical and many joints may be infected together
– especially large joints including knees, ankles etc.
o (The above mentioned 3 symptoms may occur together)
o Dry skin patches
o Weakness, generalized tiredness, fever and weight loss.

Causes
o Typically caused from sexually transmitted infections and bowel infections such as
food poisoning

Physiotherapy Treatment
o After symptoms subside, Physiotherapy treatment is important
o Patient education.
o Exercise regimen
 Regular aerobic activity.
 Range of motion exercise.
 Strengthening of muscles around the affected joints.
 Teach patients to avoid over use of inflammated joints.
o Pain relieving electrical modalities.
o Electrical modalities to reduce joint inflammation.
o Daily living activities training.

SEPTIC ARTHRITIS

INTRODUCTION
Septic arthritis is a painful infection in a joint that can come from germs that travel through your bloodstream from another part of your body. Septic arthritis can also occur when a penetrating injury, such as an animal bite or trauma, delivers germs directly into the joint.

CAUSES
-The condition is most caused by bacteria such as Streptococcus, Staphylococcus, and Neisseria gonorrhoeae. The bacteria enter the joint:
Through the bloodstream from an infection elsewhere in the body such as the skin, or urinary tract (common)
Directly Through a wound, surgical incision, or drug injection (less common) Rarely, septic arthritis might be caused by viruses or fungi.
The risk factors include:
History of joint surgery
Joint problems such as arthritis, gout, or lupus
Having open wounds
Smoking
Diabetes
Weakened immune system.

SYMPTOMS
Severe pain in the affected joint
Inability to move the joint.
Swelling, warmth and joint redness
High-grade fever
Chills

PHYSIOTHERAPY MANAGEMENT
Once the patient receives a round of antibiotic treatment in combination with either joint aspiration, debridement, or arthroscopy, the patient may then be referred back to physical therapy including:
-Educate on how to properly protect the affected joint.
-Gentle mobilization of the infected joint
-Once the infection is well-managed, current evidence states the patient will usually respond best to aggressive physical therapy to allow
maximum post-infection functioning.
-Physical therapy needs to consist of allowing the joint to be in its functional position and positioning the joint to allow passive range of
motion activities.

TENOSYNOVITIS

Introduction
Tenosynovitis is the condition due to inflammation or infections of tendons of muscle which connects muscle to bone. It can be seen in any tendon in our body surrounded by synovial sheath. most commonly affects Hands, Wrists, Feet, knee...

Symptoms
 Pain
 Swelling
 Tenderness
 Discoloration of skin
 Redness

Causes
 Normally seen in middle ages
 Repeated motions(overuse)
 Compression over tendon
 Injury
 Diseases

Physiotherapy Treatment.
 Rest
 NSAID’s
 Cryotherapy
 Strengthening exercises
 Splint or removable brace.

HOW DOES CARDIOVASCULAR REHABILITATION HELP IN RECOVERY?

Heart and circulation issues are referred to as cardiovascular issues. One important system that is essential to your survival is your cardiovascular system. This is why, if there is a problem, it is crucial to receive efficient treatment. Cardiovascular issues can be quite crippling, and physiotherapy is essential to recovery. The goal of physical therapy is to gradually get the patient back to their previous level of activity.

A skilled physical therapist will evaluate your cardiovascular health, pain thresholds, and muscle strength. Either at home or at one of our clinic locations, assessments can be given. You will have the chance to review the assessment's results and set specific goals with your therapist. A short-term objective would be to walk 10 metres with a stick in two weeks. To swim three laps of the pool in five minutes might be a more long-term objective. Goals vary from person to person and are based on your present level of fitness, your interests, and your aspirations. To assist you in achieving these goals within the allotted time span, your physiotherapist will collaborate closely with you.

You will be given an exercise regimen to follow outside of therapy sessions by your physiotherapist. These workouts will help you achieve your goals and be interesting, difficult, and exciting. You must learn how to warm up before exercise and cool down afterward if you want to securely control your heart rate. Your physiotherapist will assist you in learning how to keep an eye on your angina symptoms to lower the likelihood of developing future cardiac issues.

WHAT ARE THE BENEFITS OF CARDIOVASCULAR REHABILITATION ?

The wide variety of benefits include:
Increased cardiovascular fitness
Increased flexibility and range of movement
Exercise in confidence with the supervision of a specialist physiotherapist
Decrease your risk factors for further cardiovascular problems
Learn the best exercises for you to do in the gym or at home
Learn how to integrate fitness and exercise into your daily routine
Maintain your motivation to keep your risk factors under control
Access to a gym or hydrotherapy pool

Bethany Navajeevan Physiotherapy Clinic
& Rehabilitation Centre

'Learn to Heal' with Care & Compassion