Exercise and Rheumatoid Arthritis: Facts & Fallacies

RA

By Erin Buenger, PT, DPT

What is Rheumatoid Arthritis?

Rheumatoid Arthritis (RA) is a chronic, autoimmune disorder in which your body attacks its own soft tissue structures, primarily the synovium or tissue lining of the joints.  About 40% of those affected with RA experience symptoms beyond the joints including skin, eyes, lungs, heart, kidneys, salivary glands, nerve tissue, blood vessels and bone marrow.  This inflammatory condition causes a painful swelling at the affected sites.  Over time, chronic inflammation can cause eventual bone breakdown and visible deformities.

Osteoarthritis (OA), on the other hand, causes a breakdown of cartilage located at the joint interfaces only.  It does not affect the organs of the body directly.

Isn’t it best to stop exercising when in pain?

RA symptoms are highly variable with periods of flare-up and remission.  When it comes to RA, one of the worst things you can do is to become sedentary.  There is a common misconception particularly that during a flare up, cessation of all physical activity is the appropriate prescription.

Exercises for RA should be aimed at decreasing the development of deformities and in hope of preventing joint fusion or joint replacement down the line.  Physical activity must be consistent in order to achieve and maintain gains/adaptations.  Varying the intensity, time, and type of exercise according to symptoms is the key — not discontinuing physical activity for an extended period.  Appropriate exercise levels vary from person to person.  Asking for guidance and listening to your body are important.  If an exercise causes direct pain, it will have to be modified.

You may want to start first with a physical or occupational therapist consultation prior to a more regular exercise routine, particularly if you are sedentary or have been sedentary for a length of time.  He or she can give you modifications for painful activities of daily living, stretches to help keep the joints mobile and start to progress you into regular exercise, as well as offer modalities and manual interventions to help manage the pain.

What are the current recommendations?

According to American College of Sports Medicine, exercise guidelines for RA include:

Regular exercise to improve strength and flexibility.  Strengthening the muscles surrounding the joints can help reduce the disability of RA.  It can additionally help combat fatigue and depression often associated with RA.  Walking, bicycling, swimming are great exercises to start with and easier on your body during a flare period.  Classes to consider include Pilates, yoga, tai chi, and gentle strength training.

Does research support physical activity in RA?

According to Mayo Clinic, those affected by RA are more prone to developing heart disease, diabetes and osteopenia/osteoporosis due to decreased physical activity, as well as some medication side effects.  According to the British Society for Rheumatology, “sedentary behavior may exacerbate already heightened inflammation in RA and hold relevance for disease related outcomes.”

A review article in 2011 of the “Benefits of Exercise in Rheumatoid Arthritis” found that:

Exercise in general seems to improve overall function in RA without any proven detrimental effects to disease activity.  Thus, all RA patients should be encouraged to include some form of aerobic and resistance exercise training as part of their routine care.  More research is still required on the optimal dose and types of exercise, especially when combining types, as well as how best to incorporate exercise into the lives of RA patients across the variable course of the disease. (Fenton, et al.)

Always get the green light from your doctor and keep them apprised of any lifestyle changes or change in symptom status.  Work with you doctor to determine the best plan for managing your RA over time and get back in the driver’s seat to improve your physical activity status!

Feeling like you can’t implement an exercise program safely, have other injury considerations, or just can’t find the motivation to make a change?  Consider a physical therapy evaluation, one of our group fitness classes or one-on-one personal training and/or Pilates at PhysioPartners!

Dr. Erin Buenger is a physical therapist at PhysioPartners.  Visit our website to schedule an appointment with Erin.

 

References:

Benefits of Exercise in Rheumatoid Arthritis – Scientific Figure on ResearchGate. Available from: https://www.researchgate.net/figure/Summary-of-general-exercise-guidelines-for-RA-This-information-is-derived-from-ACSM_tbl1_50395976 [accessed 9 Mar, 2019]

https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/in-depth/rheumatoid-arthritis-exercise/art-20096222?p=1

https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/symptoms-causes/syc-20353648

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3042669/pdf/JAR2011-681640.pdf

https://academic.oup.com/rheumatology/article/57/2/213/3192222.  (Fenton, et. al)

https://www.medicalnewstoday.com/articles/322917.php

Picture reference:  https://www.painfreelivinglife.com/food-exercise/exercise/exercise-and-rheumatoid-arthritis/

 

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What Brings You to Physical Therapy Today?

annual_musculoskeletal_examWhen you kick off a new project at work, chances are you spend a fair amount of time setting and reviewing goals. These goals help you—and those you’ll be working with—create a clear sense of what you’re looking to achieve and begin to map out a plan of attack. Along with specific goals, you also probably find it helpful to set some key milestones to ensure that you stay on task and to prevent your motivation from waning.

These same principles apply when going to physical therapy for an injury. Communicating what you hope to accomplish during your therapy sessions can help your physical therapist to individualize the treatment plan and design an exercise program that aligns with your goals. The idea is to move from “I’m here because my knee hurts” to “I’d like my knee to feel better so I can get back to
doing X, Y and Z.”

Let’s talk about a concrete example to illustrate goal-setting in action: A father of three ruptures his Achilles tendon while playing a game of pickup basketball after work. When he lands in rehab, he explains to his PT that he’s due to walk his oldest daughter down the aisle at her wedding in a few months. This gives the PT a specific goal—and a timeline—to aim for. Of course, not every patient has a goal tied to such a momentous occasion. It can be as simple as carrying your groceries to your car unassisted or lifting your grandchild into a high chair. Either way, it’s important to have goals—and to communicate them clearly to your physical therapist.

Your PT wants you to get better, but every patient is different.  With the right guidance from you, he or she can ensure the program does not unknowingly miss your goals.  Only you know precisely what you want to accomplish by seeing a physical therapist.  If you have a wrist injury and returning to your knitting hobby is important to you, then be specific! Another patient could come in with the same injury, but have completely different goals.

Proper communication ensures success, which also means you should actively participate in your care.  Make communication needs to be a two-way street and speak up at your next session to ensure that your physical therapist knows precisely why you’ve made the appointment, what you hope to accomplish and why it’s
important to you. While this information helps your physical therapist make important decisions about your care, it also helps keep you motivated during therapy.

If you find yourself making an appointment to see a physical therapist for a new injury or a nagging pain, ensure that you prepare in advance. Be prepared to answer this one simple question: What brings you to physical therapy today?

Are You a New Year’s Resolution Newbie, Master or Flunkee?

scrabble resolutions

Photo by Breakingpic on Pexels.com

Turning the page on the new year is a chance to wipe the slate clean—and to be better versions of ourselves. And when it comes to what we want to improve, goals that fall in the health and wellness arena top all other New Year’s resolutions. In fact, three of the top four resolutions in a 2018 YouGov poll were health-related: eat healthier (1), get more exercise (2) and focus on selfcare, e.g., get more sleep (4).

People who choose a goal from the health and wellness category as a New Year’s resolution can be categorized in one of three ways: The resolution newbie, the resolution master or the resolution flunkee.  Let’s see which category you most identify with—and learn how to focus on the right strategy can help you be successful and get healthier in the New Year.

Resolution Newbie: Maybe this is your first time making a commitment to your health and wellness. Good for you! Did a recent health scare or loss of a loved one make you see the light? Or perhaps you want to be more active to enjoy activities with your grandchildren or to carry your own bag on the golf course. Whatever your goals are, taking that first step is a big one, so you will want to be prepared for the challenge. Particularly when exercising for the first time or returning to an active lifestyle after a long hiatus, it’s important to have the proper information and tools to be successful. Tap into the health care resources available to you — clinicians like nutritionists and physical therapists can ensure that your body is prepared to take on new challenges and work with you to a design a program that will help you achieve your goals.

Resolution Master: Perhaps you fall into a different camp — You vowed to get healthy in 2018 and you achieved it! For 2019, your resolution is to continue the work you have already begun. After all, living a healthy lifestyle is a lifelong commitment; it’s not something you do for a while and then revert back to your former habits. As you prepare to embrace the New Year, are there any small tweaks you can make to advance your goals? Maybe you are considering training for and running a half marathon, but don’t know where to begin. A physical therapist evaluation is a great place to start—PTs are trained to assess your movement patterns and identify any limitations or weaknesses. Based on that information, your physical therapist can design a personalized exercise program to help you safely and effectively prepare for the grueling race course.

Resolution Flunkee: Let’s say your plan for 2019 is to get in better shape and improve your overall health (we support you!), but this isn’t your first rodeo. Your 2018 resolution was pretty similar, but it’s one year later, and you’re in the same place you were at the beginning of 2018. Identify what stood in your way—Tim? Affordable options? Access to healthy choices and activities? If any of these barriers sound familiar, then along with your resolution, you need to set an action plan. Without planning ahead, you will find yourself staring down the year 2020 with the same goal in mind. However, don’t focus only on the negative—what went right last year? Maybe you made sleep a priority, which in turn helped you to make better food choices at breakfast but by afternoon, you found yourself choosing to energize with a soda and candy bar when all you probably needed was an apple and a 15-minute walk. Take some time to think about the previous year—good and bad.  Take with you what you need and leave the rest behind.  After all, you can’t plan where you’re going without understanding where you’ve been.

Which is your resolution type?

Some Pay More to Treat Back Pain, but Get Less

grayscale photo of man

Photo by rawpixel.com on Pexels.com

Payless shoe stores recently conducted a very telling social experiment. You may have heard about the shoe chain’s stunt in the news, but to recap, “The Payless Experiment” tricked consumers into buying their typically budget-friendly shoes at sky-high markups. To carry out the clever ruse, the discount retailer invited style influencers to a (fake) launch party for a new high-end label in one of Los Angeles’ glitziest shopping areas. The attendees believed that they were buying fashionable, high-quality footwear and therefore didn’t object to the three-figure price tags.

Aside from being a brilliant marketing ploy for Payless, what lessons does “The Payless
Experiment” have for our current healthcare system, and specifically for patients suffering from low back pain? The experiment is a commentary on perceived vs. real value and how easily people can be swayed into believing that something is as reliable as presented. Think about someone who has had weeks of pain and dysfunction stemming from low back pain: She wants to find a solution that will relieve her symptoms. If a physician presents surgery as the best option—and she’s assured that her pain will go away—then it’s going to sound appealing, right?

Today’s consumer has so many choices when shopping for just about anything from apparel to healthcare. But while it’s customary to shop for the best price for a goose down jacket (without sacrificing quality), shopping around for the best solution (and value) for our ailments is less typical. Due diligence in healthcare may ultimately bring you back to the first proposed solution, but it also may introduce you to solutions that you didn’t know existed.

In the case of low back pain, one such under-heralded solution is physical therapy. Physical therapy, yoga and acupuncture are gaining in popularity as equally (or more) effective and less costly than surgical procedures, injections, MRIs and pain relievers—and for good reason.

Physical therapists are trained to restore and improve patients’ mobility, reduce soft tissue pain, improve function and build muscle strength. They not only develop custom strategies to treat persistent or recurrent low back pain, but educate patients on the prevention of future issues. Some preventive techniques include adopting and following a regular exercise program and learning to lift correctly by keeping the object close to the body.

As you prepared for the holidays, you likely had a long list of gifts to buy. I’m willing to guess that you had a strategy in place for selecting appropriate gifts for each recipient. Just as you matched the right price point, size and color to each person on your list for the holidays, consider approaching your healthcare needs with the same level of scrutiny. After all, finding the right solution at the right price for our health needs contributes to improved long-term outcomes and better piece of mind!

Are Your Arches Falling?

footBy Erin Buenger, DPT

Is there such a thing?  Yes!

“Falling” or “fallen” arches is another term for Adult Acquired Flatfoot Deformity (AAFD).  This three dimensional foot and ankle pathology can affect anyone during the normal aging process and can affect those with pes cavus (a high arched or supinated foot), neutral (normal) arches or those with pes planus (flat feet — yes, they can get flatter!)

Typically, you can see this change around age 30 or older.   Our arches will all flatten or fall a little over time, just as our skin develops wrinkles and becomes less elastic. Variables that may contribute to AAFD or fallen arches include rheumatoid arthritis, neuropathy or decreased sensation, diabetes, weight gain including pregnancy, non-supportive footwear, excess impact activities and injuries to the soft tissues or bones of the foot and/or ankle.

What exactly is a normal arch?  As a quick test, stand up without shoes or socks.  The inside region of the middle part of the foot should not touch the floor; the foot should maintain an arch upwards.  You can also have someone take a picture of your foot in this position from behind and count how many toes you can see in the photo.  With a flat foot, the foot is more likely to be pointed outward with visibility of more than the fourth and fifth toes.

Other issues that can occur with the development of flat foot include bunions, other toe deformities such as hammertoes, heel spurs, plantar fasciitis, posterior tibialis dysfunction and Achilles or calf dysfunction.  Posterior tibialis tendon pathology is a commonly blamed source, estimated to be responsible for approximately 80% of cases of AAFD.  This tendon runs through the arch and is responsible for holding it up (like a sling) when weight-bearing.  Common symptoms include pain on the inside of the ankle and worsening symptoms with increased standing or weight-bearing activities.

Even if you are asymptomatic, addressing this postural issue as soon as possible will benefit you.  During an examination, your doctor or physical therapist will assess your posture, gait pattern, arch structure, strength, flexibility and shoes.  If indicated, your physician will order imaging to rule out other injury or fracture.  More conservative management includes rest, bracing, icing, physical therapy, massage therapy, orthotic prescription, shoe wear modification, anti-inflammatories and potentially weight loss.  A study published in the Journal of Foot and Ankle Surgery in 2011 (Nielsen MD, et al) showed that over a 27 month period, conservative treatment was 87.5% successful for treatment of AAFD.

Surgical options include reconstruction to tighten or lift the flat arch and is classically minimally invasive.  The procedure requires tendon re-routing, ligament repairs, and bone cutting or fusion.  You can expect significant short-term activity restrictions and rehabilitation for a few months post-op.  Your surgeon may also require weight loss prior to surgery.   The prior study by Nielsen MD, et al, found that overall 78.12% of the patients with AAFD were obese.

If you are concerned that your arches are falling, call to schedule a consultation or evaluation with one of our physical therapists.  Your insurance may now allow you to see a physical therapist without a physician’s referral.  Conservative management, including manual interventions, strengthening, shoe wear education and modalities can be very successful in managing flat feet.

Fun fact:  Babies are born without a normal arch structure and it doesn’t progress to full development until around ages 7-10! 

Resources

https://www.health.harvard.edu/a_to_z/fallen-arch-a-to-z

https://www.rushortho.com/body-part/foot-ankle/flat-foot

https://www.ncbi.nlm.nih.gov/pubmed/21458301

Crevoisier X, Assal M, Stanekova K. Hallux valgus, ankle osteoarthrosis and adult acquired flatfoot deformity: a review of three common foot and ankle pathologies and their treatments. EFORT Open Rev 2016;1:58-64. DOI: 10.1302/2058-5241.1.000015.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5367591/

Image:  http://www.healthysteporthotics.co.uk/medical-advice/fallen-arches/fallen-arches-hyper-mobile-flat-feet/

 

 

 

 

 

Get Back in Balance This Holiday Season

cautionBy Katrina Sholeen, PT, DPT

As the first snow of the year has fallen and everyone is gearing up for family gatherings and winter travel, physical health and exercise can easily be shifted to the back burner. However, Chicago’s often unpredictable weather conditions, colder temperatures, snow and ice can pose a risk for falling that you will not want to put a damper on the holiday festivities for you or your loved ones!  Fall-related injuries are particularly common among older adults, and according to the Centers for Disease Control (CDC), one in four older adults will have a fall each year, with one in five of these resulting in a serious injury1.

Not Just an Older Adult Problem

Falls are a leading cause of non-fatal injuries among all age groups, according to CDC statistics. While older adults are more likely to fall at home, younger, more active adults and teens are more likely to fall outdoors2, something to keep in mind when you bundle up for your daily run on a chilly morning or bustle around State Street with an armful of shopping bags. Speaking of shopping, it’s a great time to replace those old, worn out shoes and start your winter workouts on the right foot!

Preventing Falls and Fall-Related Injury

While it’s not possible to prevent every accident or injury, staying fit, flexible and improving your balance can help limit injury risk on those slippery sidewalks this winter. Activities like Tai Chi and yoga are great options for improving your balance, and engaging in any leisure-time physical activity has been shown to reduce falls and fall related injury in middle aged adults3. So whatever activity you enjoy, get your body moving!

Medication management is another important piece of fall prevention, as many older adults have multiple prescriptions, and dizziness, drowsiness or other side effects can increase your risk. With the waning sunlight hours, vitamin D deficiency is another possible culprit for injuries from falls. Talk to your doctor if you have questions about any of your medication side effects or if you are considering taking new supplements.

Other ways to prevent falls include staying on top of your vision screening, reducing clutter and tripping hazards, ensuring your home is well-lit, and installing safety equipment such as handrails or grab bars if you know you have difficulty with your balance. For other ideas, check out this handy brochure from the CDC.

Osteoporosis

Have you had your bone density checked recently? Osteoporosis affects almost 25% of women and 5% of men over the age of 654, increasing susceptibility to fracture with a fall. In January, PhysioPartners will be launching Shatterproof, a program to build your bones, which will incorporate evidence-based exercises for making your muscles and bones stronger and improving balance, reducing your risk for osteoporosis-related fractures.

Preventing falls is not an issue for only the old and infirm. Take a proactive approach to reducing your risk for injury, enjoy the winter wonderland and have your happiest holidays yet!

Resources:

  1. Centers for Disease Prevention and Control. Important Facts About Falls. Accessed Nov 19, 2019. Updated Feb 10, 2017. https://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html
  2. Timsina LR, Willetts JL, Brennan MJ, et al. Circumstances of fall-related injuries by age and gender among community-dwelling adults in the United States. PLoS One. 2017;12(5):e0176561. Published 2017 May 4. doi:10.1371/journal.pone.0176561
  3. Caban-Martinez AJ, Courtney TK, Chang WR, Lombardi DA, Huang YH, Brennan MJ, Perry MJ, Katz JN, Christiani DC, Verma SK. Leisure-time physical activity, falls, and fall injuries in middle-aged adults. Am J Prev Med. 2015;49(6):888–901. doi: 10.1016/j.amepre.2015.05.022.
  4. Centers for Disease Prevention and Control. Osteoporosis. Accessed Nov 19, 2019. Updated Aug 17, 2016. https://www.cdc.gov/nchs/fastats/osteoporosis.htm

 

 

New Parent, New Body

By Jennifer Nelson, PT, DPT, DScPT

Having a child poses a lot of new physical demands on the body. Besides the obvious physical changes on the woman’s body during pregnancy, she and her partner will find that they need to use their body in new ways to care for their new child. Postnatally, the core muscles, including the abdominals and pelvic floor muscles, are especially affected and can make lifting and holding your baby difficult. Below are some common tasks that are often challenging for new parents and some strategies to help support your body.

Lifting

  • The most important thing to remember is to keep the baby close to you. If you are lifting the baby from the changing table or the floor, make sure that you get him or her to you as close as you can to your body before you lift.
  • Plan ahead and make sure the baby/child is directly in front of you and not off to the side so that you can avoid twisting or awkward postures.
  • Position the baby as close as you can to the center of your body.
  • If possible, use your legs to lift rather then your back or arms. Bend your knees and use the leg and gluteal muscles to lift the baby, keeping your arms and back stable while holding the baby close to your body.
  • You can also kneel with one knee on the ground and the other foot in front of you if you are note able to bend your knees down far enough.

Nursing/feeding

  • While looking at your baby while he or she is feeding is completely natural, this forward head posture can lead to problems. Look for a chair with a high back rest so you may relax and lean back into the chair for support. Make sure to use pillows and arm rests to raise the baby up to breast level. If you are bottle feeding, find pillows to support both the arm holding the baby and the bottle. Keep your shoulders and head relaxed and back against the chair to prevent rounding forward. Reclining slightly will make it easier to see your baby without rounding forward, but make sure you do not slouch in the chair.

Transfers

  • New parents often find themselves lying in a bed or on the ground with their little one. When getting out of bed, do not try to sit straight up, especially if you are holding the baby, because it will create a lot of strain on your back and abdominals. Instead, turn to your side, slide your legs off the bed and then use your arms to help you sit upright.
  • When getting out of a chair or moving from sit to stand with your baby, make sure to keep the baby close to your body. Scoot your bottom to the edge of the chair. Lean forward and use your legs to push you upright instead of your back.

Baby Car Seat

  • Baby car seat carriers are heavy and can cause wrist and shoulder problems for many people. They are not meant to be used to carry a baby for long distances. Take the baby in and out of the car seat carrier and instead place him or her in a baby carrier or hold them.  When you do have to carry the carrier, make sure to keep your wrist and elbows neutral. Do not try to lift with your wrists or carry the carrier on your for arm like a bag. Ideally, carry the carrier with both hands in front of you because carrying it at your side leads to increases strain on the shoulder, wrist and low back.  If you must, make sure you are not leaning to either side.
  • When getting the baby in and out of the car, climb into the car by kneeling on the seat and/or floor. Turn your whole body towards the baby and seat instead of twisting and bending forward at the waist and leaning in.

Holding baby

  • Most people want to hold their child in their non-dominate arm to leave their dominate arm free. If the child is old enough, they will rest the baby on the hip. However, this can create a lot of strain on the quadratus lumborum muscle and low back. Instead, use a baby sling or baby carrier, which will give you two free hands, or hold the baby with two arms in front of you. If you need to hold the baby with one arm, make sure you are switching sides often.

Exercises

  • No matter how much you plan and try to use good body mechanics with a child, your body will still be doing new things and you will likely get sore. To help your body prepare and maintain good function try some of these exercises.  Exercises are for educational purposes only – performing them should never be painful and they are not a substitute for medical care or advice:
    • Pectoralis stretch on foam roller or door way (hold 30 seconds x 2)

    • Forearm wrist stretches (hold 30 seconds x 2)

    • Squats (10×2)
      image[7]
    • Standing back extensions (10x)
      image[10]

If you continue to have problems, you should consult with a physical therapist. We wish you success and congratulations on the new addition to your family!