Massage, Exercise, Heat Pads, and Electrical Stimulation – Just Another Day at the Physical Therapist

In the recent RA in America poll reported on this website, 41% of respondents indicated that they had partaken in physical therapy and 11% in occupational therapy as part of their treatment. Personally, countless hours have been spent in my local physical therapy facility due to the impact of rheumatoid arthritis. These experiences began as the consequence of ankle problems that ended up resulting in three surgeries over a three-year period. Physical therapy was prescribed after each surgery and it helped in the recovery process. The therapy usually lasted a few months until I was able to continue the strategies learned at home on my own.

My experience with physical therapy for RA

I’m currently seeing a certified hand therapist (CHT) two days a week for a torn tendon in my elbow. I was referred to the therapist by an orthopedic surgeon who specializes in the hand and arm. The therapist was initially trained as an Occupational Therapist (OT) and received additional training in hand therapy. I noticed that many of the patients seeing the OT/CHT have rheumatoid arthritis or are recovering from a recent hand surgery.

Physical and occupational therapy are grounded on evidence-based practices that come from years of research about how various strategies impact patients.¹ The focus on research has also impacted the educational preparation of PTs and OTs. Preparation programs used to be part of bachelors degrees but moved to masters and now doctoral degrees. Half of the PTs in my particular facility, mostly the newly minted PTs, have a Doctorate of Physical Therapy (DPT). These are intense 3-4 year programs beyond a bachelors degree that include coursework and internships.²

Therapy strategies for RA treatment

There are many therapy strategies that can be employed to help RA patients to increase functional and occupational abilities.³ These as designed to be used alongside drug treatments that reduce disease activity. Exercises may include stretching, strengthening, and aerobic conditioning. In my experience, such exercises usually occur in this order as you slowly build up strength.  Physical strategies, or modalities, used by PTs and OTs are designed to “relieve pain, improve circulation, decrease swelling, reduce muscle spasm, and deliver medication in conjunction with other procedures.”⁴Moist heat pads, paraffin wax baths, or ultrasound can be used to deliver heat to painful joints. Electrical stimulation can be delivered via transcutaneous electrical nerve stimulation (TENS) and is based on the gate theory of pain where non-painful stimulation is used to distract the nervous system.⁵ For my current therapy, moist heat pads are combined with TENS for the first part of the session. Massage therapy provides manipulation of soft tissue to reduce pain and impact muscles.⁶  Occupational therapists may use orthotics and teach patients to use adaptive equipment for better life functioning.

Physical and occupational therapy should be part of a well-rounded plan for helping RA patients achieve better functioning and life skills.