Physical and Complementary Therapies

Content provided by the Faculty of the Harvard Medical School
Excerpted from a Harvard Special Health Report

Despite the variety of medications available for arthritis, physical therapy remains a cornerstone of traditional treatment. In addition, many people with arthritis try various complementary therapies to alleviate pain and other symptoms. Options abound in both these areas and, when carefully chosen, such therapies can help you maintain and improve joint function.

Physical and occupational therapists focus on restoring or maintaining physical function by designing an individualized treatment program for you. First they thoroughly evaluate your pain, functional ability, strength, and endurance levels. They may offer suggestions about how to optimize your capacity to manage everyday tasks at home and at work. They will also provide advice about ways to ease pressure on your joints while building muscles to support them. Physical therapy can take place at a hospital or outpatient clinic, in the therapist's office, or in your home. Some activities can be done alone; others require the therapist's assistance.

These therapists can also provide you with special assistive devices to help conserve your energy and protect your joints. For example, during times when your joints are particularly tender, you can use a splint, brace, sling, elastic bandage, or cane to reduce the pressure on your joints and protect them from further injury. A podiatrist may provide shoe inserts (orthotics), recommend special shoes, or suggest other treatments to reduce pain in your feet and improve your ability to function.

Assistive devices

To date, very few studies have been published on using splints or braces for any of the joints in osteoarthritis, but the research that has been done suggests these devices may relieve some symptoms. In two separate studies, people with rheumatoid arthritis reported that assistive devices made it easier for them to perform daily activities. And a 2006 study in the American Journal of Physical Medicine and Rehabilitation linked the use of assistive devices to psychological well-being in people with rheumatic disease. Because it is important to get the right brace or splint and the correct fit, be sure to consult a doctor or physical therapist before buying any kind of assistive device.

Knees

If you have knee arthritis, braces and shoe inserts may reduce pain and help you to function by reducing the amount of stress walking puts on your knee. If you have early, mild arthritis with sudden flare-ups, a simple neoprene or elastic sleeve (see photo) may help to relieve pain and provide support. Because the sleeve itself doesn't provide much support, these effects are thought to be due to improvements in the knee's movement and position. However, your physical therapist may prescribe a variation of this type of brace that incorporates pulsed electrical stimulation, which has proven especially effective in treating knee osteoarthritis.

Assistive Devices for the knee: Knee wrap

Thermoskin arthritic knee wrap

If you have knee osteoarthritis affecting only one part of the joint, a different type of brace known as an unloader brace may help by taking some of the pressure off that part of the knee and redistributing the weight (or load) to other parts (see photo). These braces change the angle of the knee joint using special hinges to reduce force on the joint. However, many people find these types of braces cumbersome or uncomfortable.

Assistive devices for the knee: Knee brace

Photos courtesy of Patterson Medical/Sammons Preston.

Another kind of brace is used in people with arthritis affecting the joint beneath the undersurface of the kneecap. Consisting of a sleeve with a cutout at the kneecap and pads below and to the outside, this brace is designed to reduce compression of the kneecap, improve its alignment, and prevent side-to-side shifting.

Foot orthotics, or specialized shoe inserts (which can be custom-made), may also prove helpful for people with arthritis, because flat feet or other foot problems play a role in the alignment of the ankle and knee, which can put additional stress on the joints. Shock-absorbing insoles made of a gel-like material may also help reduce the symptoms of knee osteoarthritis. One study showed that these shoe inserts reduced the force of each step by 42% and improved symptoms in 78% of the people who used them.


Ankles

If you have ankle osteoarthritis, you may change the way you walk to compensate for pain and limited movement, which can put stress on your other joints. Ankle supports are designed to improve balance and normalize your walking patterns. Devices range from a lace-up ankle brace, to a semirigid foot orthotic, to shoe modifications (such as a lateral wedge insert or rocker sole and cushioned heel), to custom-made, molded-plastic orthotics for people with more severe disease. Ask your doctor or therapist which is right for you. If your arthritis is severe, he or she may order one of various forms of immobilization boots, which can be effective when used for walking and standing.

Assistive devices: Ankle brace

Thermoskin ankle brace


Hips

Except in rare situations, using a brace to support the hip doesn't seem to be helpful. A straight cane, on the other hand, can help quite a bit. When you stand without leaning on a cane, the pressure on the hip increases as much as four times. If you have pain in both hips, you should use the cane on the side opposite to the hip that is the most troublesome, and alternate sides as needed (see "Easing the strain with a cane").

Easing the strain with a cane

For something so low-tech and simple in design, a cane performs complex functions. You hold the cane in the hand opposite the side that needs support, about four inches to the side of your stronger leg. This redistributes weight to improve stability, helps reduce demand on muscles that may be weak, and takes the load off weight-bearing structures such as the hip, knee, and spine.

A cane can help you maintain mobility and ward off further disability if you have arthritis of the knee or hip, as well as assist in recovery after surgery. So don't let self-consciousness stop you from using a cane if your doctor recommends you try one.

A physical therapist or other clinician can help you select a cane, make sure it's the proper length, and show you how to use it. He or she may also suggest certain muscle-strengthening exercises before you start walking with your cane.

Assistive devices: Canes

Canes are available at medical supply stores and pharmacies, through specialty catalogs, and on the Internet. They generally come in standard, offset, and multiple-legged versions. Government or private insurance usually covers the cost of a basic cane if you have a written prescription from your doctor.

Standard canes. These are low-tech, lightweight, and generally inexpensive. They usually come with a curved or T-shaped handle and a rubber-capped tip at the bottom. Many people find that a T-shaped handle is more comfortable than a curved one. A standard model is good for people who need help with balance but don't need the cane to bear a lot of weight.

Offset canes. The upper shaft of an offset cane bends outward, and the handle grip is usually flat — often a good choice for people whose hands are weak or who need a cane that bears more weight than the standard type.

Multiple-legged canes. Multiple legs offer considerable support and allow the cane to stand on its own when not in use. One drawback to using such a cane is that for maximum support, you must plant all the legs solidly on the ground. Doing so takes time and can slow the pace of walking.


Hands

Hand splints can provide pain relief, improve function, or realign the joints of the hand to a more anatomically correct position. They come in a wide range of materials and forms. A prefabricated splint from the drugstore or medical supply store works well for certain hand problems, provided it is chosen and adjusted correctly. Other conditions require specially fabricated splints, which are usually made of thermoplastic materials and molded to fit around the contours of the hand. Static splints hold the joint in one position, while dynamic splints allow movement. Some are designed to help lengthen tightened joint capsules, muscles, and tendons. Others, which feature elastic or spring-loaded parts, make up for missing motion in the hands and wrists caused by muscle weakness or nerve damage.

Several types of splints are designed to address problems with the finger joints. These include a figure-eight splint and a prefabricated "oval-eight" splint, which allow you to fully bend the finger joint closest to the hand but protects the joint from hyperextension. In addition, custom-made splints prevent the joint from bending backward and from moving sideways. Last, a "gutter" splint may be fabricated to immobilize only the joints that are painful or swollen. Various custom-made splints can also be made to help with problems at the base of the thumb. Your doctor or therapist will help you determine which one is most appropriate. Even if you use a splint or brace, it is important to take steps to protect your joints (see "Joint protection strategies"). Adaptive aids may also be useful (see "Helpful gadgets").


Wrists

There are several options for wrist splinting, depending on your needs. For people with early disease, simple off-the-shelf elastic or neoprene splints may be enough to reduce pain and improve function. If your arthritis is more severe, custom-molded splints may be a better option because they provide more joint control. The type of splint and materials used in its fabrication will depend on the demands of the wrist. For example, a laborer will need sturdier material than someone who works at a desk.


Elbows

Elbow braces are designed to maintain range of motion and relieve pain. This is especially important during flare-ups. During the early stages of the disease, it may be helpful to rest the elbow with a soft or rigid support, depending on whether it needs to be held in place. People who plan to wear the splint during periods of activity should use one that supports the back of the elbow and add a wrist brace during acute flares. At night, a splint that supports the front of the elbow may be more comfortable.

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Treatments for any type of arthritis are largely the same.