Physiotherapy & Magnet therapy
Body-based and manipulative therapies including magnet therapy and physiotherapy (application of heat and cold, hydrotherapy, and electrical nerve stimulation) have potential therapeutic benefits in RA.
Magnet therapy has been used as a medical treatment for thousands of years in several different cultures, with traditions of use dating back to ancient Egypt and 4th century Greece. Magnets are available in a variety of types and sizes (including electromagnets) and a range of methodologies are used, from self-application and magnetic implants, to treatments administered by a trained professional. There is a small body of evidence supporting the effectiveness of magnet therapy in neuropathy. However, there is limited evidence showing the effectiveness of magnet therapy in managing pain associated with arthritis (rheumatoid, general, and osteoarthritis).1
Physiotherapy approaches, including the application of heat and cold, hydrotherapy, and electrical nerve stimulation, are commonly used as part of the management of RA to improve symptoms and increase and maintain joint function. These interventions are typically used in the setting of physical or rehabilitative therapy.
Heat and cold. Application of heat and cold is perhaps the most common form of physiotherapy used in RA. Application of cold is most often used for acute relief of symptoms (particularly pain) during flares or periods of disease activity. Additionally, it is used for symptom relief in actively inflammed joints where heat is not desired. Techniques for application of cold include cold pack, ice, nitrogen spray, and cryotherapy. The local temperature of joints has been shown to affect the activity of enzymes responsible for cartilage destruction in RA (collagenase, elastase, hyaluronidase, and protease). The normal temperature within joints is about 33º Celsius, or 91.4º Fahrenheit. However, with RA-associated inflammation, the temperature may rise as high as 36º Celsius (96.8º Fahrenheit), resulting in increased enzyme activity and cartilage destruction. Application of cold can lower temperatures within the joint to 30º Celsius (86º Fahrenheit) or lower, at which temperature the activity of enzymes is much decreased and cartilage damage decreased.2
Application of heat (thermotherapy) is more often used for pain relief, relief of muscle spasm, and to improve range of motion and elasticity of muscles and other structures around joints on an ongoing, chronic basis (not at the time of disease flare). Consistent with the idea that lowering the temperature within inflamed joints inhibits cartilage destruction, increasing the temperature within joints provides no benefits in terms of the progression of joint destruction and is best used during periods when inflammation is controlled. There are several techniques available for application of heat, including superficial hot-pack, infrared radiation, paraffin dips, and fluid therapy, with applications typically made for 10 to 20 minutes, once or twice per day. Thermotherapy should be used with caution in patients with decreased circulation or deficits in nerve sensation due to the risk of burn from prolonged exposure to excessive heat.2
Electrical stimulation. Electrical stimulation of tissue in and around the joints is used in RA for relief of joint pain and is most commonly achieved using a technique called transcutaneous electrical nerve stimulation (TENS). TENS therapy is generally short-acting, with effects persisting from 6 to 24 hours. The most beneficial frequency has been shown to be in the range of 70 Hertz (Hz) (Hz is the measure of the number of cycles per second). Studies have shown that TENS therapy administered at higher frequencies is most effective in providing pain relief, resulting in analgesic effects lasting up to 18 hours. In addition to pain relief, studies have shown that TENS also may provide other benefits including increased grip strength (with daily application of TENS for 15 minutes) and decreased synovial fluid volume. TENS has also been shown to be effective in pain relief following surgical procedures including knee joint arthroplasty, with a decrease in the need for pain medication and decreased length of hospital stay.2
Hydrotherapy. Hydrotherapy (also called balneotherapy: balneum is the Latin word for bath) has been used for centuries to relieve symptoms of rheumatic diseases, including RA. Hydrotherapy can involve either thermal and/or mineral water bathing. It has several goals, including improvement of range of motion, increased or maintained muscular strength, relief of muscle pain and/or spasm, and improvement of general health and well-being.2
Use of hydrotherapy in RA has been evaluated in several studies, which have attributed symptom improvements (decreased joint pain, improved physical functioning) to factors including reductions in rheumatoid factor (RF) levels, decreased joint loading, increased relaxation, and improved general physical conditioning.2
The positive effects of hydrotherapy have been attributed to several factors, including the mineral content of waters, the mechanical effect of decreased weight due to buoyancy, and thermal and physical effects. Body weight can be decreased by as much as 90%, depending on the type of hydrotherapy, which can provide relief from the effects of joint inflammation and allow the patient to engage in physical exercise. Studies have demonstrated that hydrotherapy provides significant relaxation to muscles, tendons, and ligaments, and increased sense of well-being. Other mechanisms that provide therapeutic benefits include increased pain thresholds at nerve endings (decreasing the perception of pain), action on gamma muscle fibers to relieve muscle spasm, vasodilation and increased blood flow to limbs, and increased release of endorphins (neurotransmitters responsible for making us feel relaxed and comfortable).2