Role of Physiotherapy in Arthritis

The word ‘Arthritis’ literally means joint inflammation. The warning signs of arthritis are pain, swelling, joint stiffness, difficulty in moving one or more joints. Arthritis can be a life changing event which can affect your personal, social and work life unless it is well understood and treated in time.

There are 127 different kind of arthritis. The most common types are Osteoarthritis and Rheumatoid arthritis. Osteoarthritis is degenerative joint disease. It may be due to chronic wear and tear or due to injury.

Rheumatoid arthritis is an autoimmune disease in which ones own immune system attacks cells in the joint capsule and associated chronic inflammation destroys cartilage, bone and ligaments, leading to deformity and disability. Physiotherapy plays a major role in treating both Osteo & Rheumatoid arthritis along with medicine or by itself.
Even though many other factors contribute the development of Osteo arthritis, the root cause may be deviation of normal body mechanics. By correcting the body mechanics the percentage of wear and tear can considerably reduced. Obesity, muscle wasting, poor muscle strength, prolonged standing and internal derangement of knee like ligament injury can also contribute to Osteo arthritis. Physiotherapist can assess these basic causes and helps to correct the pre disposing factors. If it is found and corrected early, Osteo arthritis can be controlled to a great extend. Some patients may need medicine along with Physiotherapy.

Major symptoms seen with Osteo arthritis are pain, restricted range of motion, swelling etc. Pain and swelling can be relieved with the use of hot packs or cold packs, Ultrasound therapy, laser therapy, use of TENS or interferential therapy, taping techniques etc. Range of motion and strengthening exercises can be given to achieve maximum functional independence at home and at work place.

Type of Exercise useful for Arthritic patients

1. Range of motion exercises: It helps to maintain normal joint movements and relieve stiffness. These are gentle stretching exercises which move each joint as far as possible in all directions. Normal daily house work or office work may not help to improve joint range of motion and are not a substitute for ROM exercise.

2. Strengthening Exercises: It helps to keep or increase the muscle strength, provide stability, support and protection to the joint, helps the joint to move more easily with less pain and helps to prevent deformity. Isometric, isotonic or isokinetic exercises can be used according to the condition of the patient. Isometric exercises involves tightening of muscle without joint movement which maintains muscle tone, prevents muscle wasting when joint range is impaired.

3. Endurance exercises: This helps to maintain cardiac fitness, ROM, to increase physical strength, to control body weight and to improve arthritic symptoms. Aerobic exercises like graded walking, use of bicycle or treadmill initially with the supervision of the physiotherapist may help to prevent complication.

How often people with arthritis should do Exercises?

ROM exercises can be done daily many times and should be done at least every other day. Strengthening exercises should be done every day unless you have severe pain or swelling in your joint and repeated daily.

Endurance exercises should be done 20 to 30 minutes at least 3 times a week unless you have severe pain or swelling in your joint. Before starting endurance exercises it is better to have a medical consultation to assess your medical fitness.

In case of rheumatoid arthritis prolonged medical treatment is required. Here Physiotherapy helps to maintain ROM, muscle strength and to prevent joint deformity. Once joint deformity is established the patient may develop severe ambulation problem. This can be prevented with medication and timely physiotherapy.


There have been no studies comparing outcomes from home exercise programs versus physical therapy directed interventions in a clinic setting until recently.

In a randomized controlled study of 134 patients with OA of the knees, a clinic treatment group (n=66) underwent supervised exercises, manual therapy & home exercises for 4 weeks, and a home exercise group (n=68) underwent home exercises only (instructions & a follow up examination were provided for the same exercises as the clinic groups).

Outcomes that were measured consisted of the distance walked in 6 minutes and the Western Ontario & McMaster Universities Osteoarthritis index (WOMAC).

Both groups in the outcome measures at 4 weeks; the clinic treatment group improved 52% on the WOMAC, whereas the home exercise group improved only 26%. Both groups improved 10% on the 6 minute walk distance.

After 1 year there was no difference between the groups , and both groups demonstrated improvement over base line measurements, although it was noted that the clinic treatment group was less likely to be taking medication for the arthritis and were more satisfied with the outcome of the their rehabilitation References :

Deyle, GD, Alison, SC, Matekel, RL, et al: Physical therapy treatment effectiveness for osteoarthritis of the knee: a randomized comparison of supervised clinical exercise and manual therapy procedures versus a home exercise program. Phys Ther 85:1301-1317, 2005.

‘Think positive about arthritis, Physiotherapist can guide you to lead a pain-free independent life’.