The Benefits of RA Physical Therapy for Joint Health

There are several effective treatment options, including physical therapy (PT), that can help manage rheumatoid arthritis (RA) symptoms. This article will discuss the effects of RA, the benefits of physical therapy, types of physical therapy, and several exercises that may be appropriate.

Where Does RA Happen?

Rheumatoid arthritis is the most common form of autoimmune arthritis. This disease occurs because of a faulty immune response that causes the body to attack its own tissue. Specifically, RA attacks the lining, or synovium, of a joint, leading to swelling and eventually erosion in the joint itself over time.

While the causes of RA are unknown, there is strong evidence of a genetic predisposition to this disease.

Early on, rheumatoid arthritis typically affects smaller joints. In particular, the hand, wrist, and toe joints are commonly impacted. However, as the disease develops, larger joints (including the knees, hips, and shoulders) and organs like the eyes, lungs, and heart can also be impacted.

Stages of Rheumatoid Arthritis

The progression of RA is typically categorized by four unique stages:

• Early-stage RA: This occurs when swelling and inflammation initially develop in the lining of your joints. This stage is categorized by soreness, stiffness, and swelling in the affected areas.
• Moderate-stage RA: This phase occurs when the joint inflammation and swelling become advanced enough that cartilage damage is present in the joint. This erosion typically results in range-of-motion limitations and reduced mobility in the area.
• Severe-stage RA: During this stage, the inflammation and swelling become so advanced that it causes the bones in a joint to erode. The affected areas may start to look deformed, and the range of motion is typically severely limited. Reduced strength may also appear in the area as the bone becomes more damaged.
• End-stage RA: In this final phase, the inflammation in an area resolves and the joint stops working or functioning. Severe mobility problems, pain, and swelling are typically seen during end-stage RA.

Benefits of RA Physical Therapy

While rheumatoid arthritis can have a traumatic effect on the joints and organs of the body, physical therapy can provide several meaningful benefits. These include:

Pain Control

Strengthening the muscles that surround and stabilize RA-affected joints can support the damaged areas and reduce your symptoms. In addition, your physical therapist can provide pain-reducing strategies for mobility and energy conservation during a flare-up.

Temporary pain-reducing modalities like ice, heat, or electrical stimulation may be beneficial in the short term.

Improved Function

PT can help improve your overall function in these ways:

• A therapist-developed aerobic exercise regimen can help stave off RA-associated fatigue and improve your sleep quality.
• Stretching exercises and splinting can also preserve and improve the mobility in affected joints, making it less difficult to move around.
• Strengthening exercises can make daily tasks less painful to perform, resulting in a better overall quality of life.

Decreased Inflammation

Your physical therapist can provide guidance on how to safely and comfortably incorporate cardio exercise (like walking, biking, or swimming) into your daily routine. This type of activity can help reduce any excess weight you are carrying and, in turn, decrease the overall amount of inflammation in the body.

Lowering systemic inflammation levels may help reduce the rate at which your rheumatoid arthritis advances.

Reduced Cardiovascular Risk

Exercising consistently is important to reduce several harmful risk factors, including insulin resistance, high cholesterol levels, and hypertension (high blood pressure). Lowering these levels can reduce your risk of developing cardiovascular disease (which people with RA are already more prone to).

Types of Physical Therapy

Once you decide to seek a therapist for your rheumatoid arthritis, it can be confusing to make sense of your treatment options. Both physical therapy and occupational therapy (OT) can provide valuable benefits to people with this condition.  

• Physical therapy typically addresses mobility problems during tasks like walking, transferring between positions (such as from sitting to standing), or climbing stairs.
• Occupational therapy tends to focus more on maximizing your independence by making activities of daily living (ADLs) like dressing, cooking, and bathing easier to accomplish.

Admittedly, there can be a lot of crossover in the treatment components between these two disciplines.

In addition, several different types of treatments may be performed during a PT or OT session. These interventions can generally be grouped into two categories—active and passive:

• Active treatments require the patient to take a hands-on role. Examples of this include balance drills, strengthening exercises, and transfer or ADL practice.
• Passive treatments involve the therapist administering the intervention without an active patient component. Treatments in this category include massage, stretching, splint fabrication, and modalities like electrical stimulation.

9 Exercises to Try

While many unique exercises can be used to manage RA, here are several commonly seen examples that are taught in physical therapy. Two to three sets of eight to 12 repetitions of each technique can be completed two to three times per week.

Be sure to avoid exercising an area during a flare-up and stop any movement that causes increased pain.

Heel Slides

To perform this exercise:

1. Lie on your back with a towel under your heel.
2. Slowly slide your heel back toward your buttocks and allow your knee to bend.
3. Stop when you feel a pull, but avoid forcing into pain. Hold this position for a second or two before straightening the leg again.

Straight Leg Raise

To perform this exercise:

1. Lie on your back and tighten the thigh muscle on one of your legs.
2. Slowly lift the leg 12 to 16 inches off the ground without allowing your knee to bend.
3. Hold your leg at the top of the motion for a second before lowering it back down to the ground.

Heel Raises

To perform this exercise:

1. Stand with your feet shoulder-width apart and your fingers resting on a countertop.
2. Slowly raise your heels off the ground as you roll upward through your toes.
3. Once you reach the top of the movement, slowly lower your heels back down again. Be sure not to move your body forward toward the counter as you go up in the air.

Bridge

To perform the bridge exercise:

1. Lie on your back with both knees bent and your feet on the ground.
2. Squeeze your stomach muscles as you lift your buttocks in the air as high as you can without pain.
3. Hold this pose for 5 seconds before returning to the starting position.

Rows

To perform this exercise:

1. Stand facing a door with a resistance band secured in it.
2. Hold both ends of the band and pull backward toward your body as you squeeze your shoulder blades together. Be sure to keep from shrugging your shoulders as you do this.
3. Relax the hold and return your arms to the starting point.

Toe Crunches

To perform this exercise:

1. Sit in a chair with your bare feet resting on the floor and a hand towel under them.
2. Without moving your heels, squeeze your toes as you attempt to scrunch the towel under your feet.
3. Continue the squeezes until the end of the towel is near your toes, then repeat the exercise.

Hand Squeezes

To perform this exercise:

1. Sit in a chair with your arms resting on the armrests and your wrists dangling off the edge.
2. Squeeze your hands into fists as hard as you can without causing pain. Hold this position for 5 seconds and then relax.
3. Continue to alternate between the squeezed and relaxed position. To make this more challenging, try squeezing a relaxation ball or a piece of putty.

Biceps Curls

To perform this exercise:

1. Holding light dumbbells in your hands, stand with your arms at your side and your palms facing upward.
2. Bend your elbows and bring the weights up toward your shoulders through your full range of motion (keeping it pain-free).
3. Once you reach the top of the movement, slowly lower the weights back down to your side.

Walking Program

To enjoy a walking program:

• Begin walking on a treadmill or a relatively flat outdoor course.
• Select a pace that makes your heart rate increase, causes you to feel flushed, but allows you to have a conversation.
• Walk for as long as you can comfortably go, and try to increase the time or distance each week. Set a goal of 30 to 60 minutes of walking each day.

Summary

Physical therapy has several benefits for people with rheumatoid arthritis. It can help reduce pain and inflammation, maintain function, and help keep them active for better heart health. There are both passive and active treatments and exercises that may be used in physical therapy.

A Word From Verywell

Physical therapy can play a key role in helping people with rheumatoid arthritis maintain their independence while reducing the pain the condition causes. While therapy can be expensive, it can also help manage the symptoms of this challenging disease. If your budget allows, be sure to speak to your physician about a referral to physical therapy.

You can also investigate the many online resources for patients with RA, including the Arthritis Foundation’s website, which provide free information that is evidence-based.

Frequently Asked Questions

What physical therapy exercises help with RA pain management?

Physical therapy can help you cope with the symptoms of rheumatoid arthritis with exercises focusing on building strength, increasing flexibility, and improving your aerobic capacity. Techniques that decrease the amount of energy you expend during daily tasks can also be beneficial in reducing your pain.

What movements make RA worse?

Rheumatoid arthritis impacts the lining of the body’s joints. Moving an affected area, especially forcing a joint beyond the available range of motion, can worsen RA symptoms. In addition, if the joints in your legs or feet are impacted, standing, walking, and climbing stairs can be particularly irritating.

How much does RA physical therapy cost?

Estimating the cost of RA physical therapy can be a challenging task. While most therapy clinics can provide a cost estimate for their services, the out-of-pocket payment will vary greatly depending on your insurance.

It is worth noting that many clinics offer a sliding-scale or budget program based on your income, which can make care more affordable in some cases. For a better understanding of how much PT will cost, be sure to speak to your insurance provider and your therapist.