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Physical Therapy in Rheumatoid Arthritis

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Physical Therapy in Rheumatoid Arthritis

5 min read


Rheumatoid arthritis is a systemic autoimmune disease. This article explains various physical therapies to manage and treat the condition.

Medically reviewed by

Dr. Rajesh Gayakwad

Published At July 19, 2022
Reviewed AtNovember 9, 2022

What Is Rheumatoid Arthritis?

Rheumatoid arthritis is an autoimmune disease. Our body tissue is destroyed by our own immune system in this condition. It causes harm to the soft tissues that surround joints. Inflammation, discomfort, and stiffness are symptoms of fluid accumulation in the affected joints. The cause for this is unknown. It could be caused by a mix of heredity, environment, and hormonal factors. Women are three times more likely than men to get the condition and be diagnosed with it.

What Are the Symptoms of Rheumatoid Arthritis?

Symptoms include:

  • Joint stiffness that worsens in the morning.

  • Joints which are present on both sides of the body will be painful and swollen.

  • Experiencing bouts of exhaustion and general pain.

  • Fever of low intensity.

  • Joint function or range of motion is lost.

  • In the joint areas, there is redness, warmth, and discomfort.

How Is Rheumatoid Arthritis Diagnosed?

Factors that help the rheumatologist determine a diagnosis of rheumatoid arthritis include:

  • Inflammation around the joints.

  • The number of joints involved.

  • Blood test.

How Can a Physical Therapist Help With Rheumatoid Arthritis?

Physical therapists are crucial in helping patients with the illness in regaining and maintaining function. Your physical therapist will discuss with you to create a treatment plan that will meet your individual requirements and goals while also keeping you mobile. Physical therapists are experts in the interaction of bones, joints, and muscles. They can assist you in regaining control of your body.

Because the indications and symptoms of illness can vary, so can the treatment you receive. It is possible that what works for you would not work for others.

The physical therapist will customize a treatment plan according to your specific needs, which may include the following:

  • Give you tips and encouragement on how to improve your overall fitness by exercising regularly. Education is essential for achieving and maintaining good health, as it is for many other conditions.

  • Create a personalized workout routine to enhance your joint flexibility and muscular strength.

  • Assist you in developing energy-saving strategies to improve your day-to-day activities at home and work.

Individuals with rheumatoid arthritis must have their rehabilitation managed carefully in order to avoid long-term impairments. Rheumatoid arthritis patients, in particular, are at risk for diminished flexibility, muscular atrophy, muscle strength, and cardiovascular endurance. Deficits in these areas will result in functional compromise and higher healthcare costs. As a result, a multifaceted strategy involving drugs and rehabilitative treatments is required. Fortunately, individuals with rheumatoid arthritis can exercise safely with correct guidance, enhancing overall physical fitness, ease in daily activities, and a better sense of well-being. Appropriate intervals of rest and activity modification, therapy modalities such as heat, cold or electrical stimulation, bracing, and adaptive equipment are rehabilitative techniques that are used.

The therapy goals include:

  • Improvement in disease management knowledge.

  • Improvement in activities of daily living.

  • Improvement in joint stiffness.

  • Prevent or control joint damage.

  • Improve strength.

  • Improve fatigue levels.

  • Improve the quality of life.

  • Pain control.

  • Improve aerobic condition.

  • Improve stability and coordination.

How to Manage Rheumatoid Arthritis With Physical Therapy?

1. Relative Rest

Rest and energy conservation can assist with locally inflamed joints, but they should be avoided in the long run as it has the risk of negative side effects. Acutely, resting the affected joints can help with pain management and reduce inflammation in the joint. Reduced range of motion, loss of strength, altered joint-loading response, and diminished aerobic capacity are possible adverse consequences of inactivity.

2. Exercise

Individuals with rheumatoid arthritis might benefit substantially from a planned fitness regimen that improves their general well-being and function. Stretching, strengthening, and aerobic conditioning should be encouraged while conserving energy in such a program.

3. Stretching

Acutely inflamed joints should be rested to avoid worsening symptoms. Active or active-assisted stretching of the major joints is required for non-inflamed joints to prevent contracture formation and preserve the existing range of motion needed to conduct most daily tasks. Contractures are usually assumed to be prevented by once-daily range-of-motion exercises. Most notably, appropriate posture is required for bedridden patients to avoid joint contracture. Contracture treatment must be done safely so that overly severe stretching does not occur. Furthermore, the presence of a bony block as a causative component in the restriction of full joint motion must be ruled out.

4. Strengthening

In non-inflamed joints, strengthening exercises should be used, while isometric exercises can help maintain strength and prevent injury or weariness. Exercise regimens should be gradually increased while patients are monitored for signs of inflammation.

5. Aerobic Conditioning

A variety of studies have demonstrated the advantages of aerobic conditioning or aquatic training regimen. In-water exercise would reduce the stresses acting on joints, and the warmth would aid in the reduction of joint discomfort and muscle spasms. Strength and endurance improve as a result of the water workout regimen. Aquatic treatment should be good for people who have trouble bearing weight or keeping their balance. High-intensity exercise improves functional ability, cardiovascular fitness, and muscle strength while preventing rheumatoid arthritis from worsening in terms of radiographic progression.

6. Superficial Heat

The skin and subcutaneous tissues are most affected by surface heat. It is especially effective when you need to heat joints covered by a thin layer of soft tissue, like those in the hands and feet. Conduction, convection, and conversion are the three ways by which surface heating agents are provided.

7. Deep Heat

Deep heating raises the temperature of the tissue at a deeper level without overheating the skin or subcutaneous fat. Ultrasound and diathermy, where high-frequency electromagnetic currents are used to induce heating of biologic tissues, as well as shortwave and microwave, are examples of deep heating.

8. Cryotherapy

Cold therapy has a number of physiological effects that either enhance or decrease typical stress responses. Slowing nerve conduction velocity and decreasing muscle spindle firing are two neuromuscular actions found to improve spasticity. It is assumed that it works in inflammatory arthropathies by lowering synovial collagenase activity, which is why it is effective. Relief of muscle spasms, reduction of stiffness, and management of inflammation in the acute inflammatory stage are common uses of cold.

9. Electrical Stimulation

The use of electrical impulses to stimulate a muscle or nerve is known as electrotherapy.

  • Electrical Nerve Stimulation (TENS): The most common delivery method is through transcutaneous electrical nerve stimulation (TENS). Its use has been reported to be beneficial in the treatment of rheumatoid arthritis. Musculoskeletal pain, peripheral nerve damage, peripheral neuropathy, post-surgical pain, and complex regional pain syndrome are common indications.

  • Iontophoresis: Iontophoresis is believed to act by delivering charged drugs through the skin.

  • IFC (Interferential Current): Interferential current penetrates tissue without causing discomfort by using alternating current impulses of different frequencies.

What Are the Precautions of Physical Therapy in Rheumatoid Arthritis?

They include:

  • Isometric exercises should be performed when the patient's condition worsens and the joints become irritated.

  • Stretching should be avoided in acute situations.

  • Revise the workout schedule if the pain remains two hours after the activity or joint edema increases.

  • Climbing stairs or lifting weights should be avoided by patients with active rheumatoid arthritis in their knees because it might cause intra-articular pressure in the joint.

  • Stretches should not put too much stress on the tendons, and ballistic motions should be avoided.


Physical therapy is a non-surgical rheumatoid arthritis treatment that can significantly reduce inflammation and joint pain. It will also help you regain muscle mass, range of motion, and flexibility, giving you the strength you need to fight rheumatoid arthritis symptoms in the future. Although physical therapy can assist with chronic pain, joint inflammation, and other rheumatoid arthritis symptoms, you should consult your doctor to see if physical therapy is an appropriate treatment option for you.

Frequently Asked Questions


What Positive Effects Might Physical Therapy Have On Rheumatoid Arthritis?

Mild to moderate rheumatoid arthritis can benefit from physical exercise. It can help in building strength, increase flexibility, and improve aerobics. Cases of severe arthritis would require low-impact physical therapy.


How Is Physical Therapy Used to Treat Arthritis?

Passive physical therapy helps in relaxation. They can include massage, joint mobilization, and electrotherapy. Low-impact exercises like an elliptical machine or swimming that are gentle on the joints are recommended for such people, as they are less likely to cause further damage while helping to improve mobility.


What Kind of Strength Training Is Most Effective for Rheumatoid Arthritis?

Strength exercises can help challenge the muscles and protect the joints from injuries. Using resistance bands is a piece of good equipment to exercise at home. Best strength training exercises for rheumatoid arthritis can include;
- Squats.
- Push-ups against a wall.
- Lunges.
- Exercises that use the body weight.


Which Yoga Poses Are Beneficial for Rheumatoid Arthritis?

Studies have shown that yoga can help to alleviate and improve the condition of rheumatoid arthritis. Vinyasa yoga and Ashtanga yoga are the best yogas for rheumatoid arthritis patients. They are useful in strengthening and building muscles and supporting the joints with arthritis.


What Physical Activities Prevent Arthritis?

Low-impact exercises, which do not exert pressure on the joints, are advised. They include brisk walking, cycling, swimming, water aerobics, gardening, and dancing. Generally, exercising for about ten minutes at a time or as per ease of the patient is advised.


Which Kind of Massage Is Most Beneficial for Rheumatoid Arthritis?

Any type of body massage with moderate pressure can help to improve circulation, ease tension, and relieve pain in arthritis. Massaging can also help to reduce swelling and improve the quality of life. Consulting a doctor before the massage can help to clear any doubts and get the right advice on the right type of massage required.


Is Rheumatoid Arthritis Improved by Sitting?

Joint stiffness can be worse after a long period of sitting idle or inactivity. Hence, sitting for a long period can deteriorate arthritis. They can cause swelling and increase joint problems.


What Is the Most Effective Cure for Rheumatoid Arthritis?

The first medicine given for rheumatoid arthritis is usually Methotrexate. The golden standard treatment for rheumatoid arthritis includes a combination of monoclonal antibodies and tumor necrosis inhibitor adalimumab with a folic acid antagonist called Methotrexate. It works better even for patients who do not respond to Methotrexate alone.


Is Massage With Coconut Oil Beneficial for Arthritis?

Coconut oil is considered to have anti-inflammatory properties and analgesic properties. This can help to reduce the pain and swelling associated with arthritis. It also lubricates the joints and reduces muscle stiffness.


How Can Someone With Rheumatoid Arthritis Relax?

Slow, gentle exercises can help to strengthen the joints and muscles. A balance between exercising and rest is required. Sufficient sleep must be provided to help the muscles relax and repair. 


Is Vitamin B12 Beneficial for Rheumatoid Arthritis?

The exact relationship between vitamin B12 and rheumatoid arthritis is not yet fully known. Studies show that vitamins B3, B9, and B12 might benefit in treating arthritis, especially in improving joint mobility and hand grip.


Does Ayurvedic Medicine Treat Rheumatoid Arthritis?

Rheumatoid arthritis cannot be cured completely. Ayurveda focuses on diet, exercise, and lifestyle modification. It helps to relieve inflammation and pain in arthritis. 
Dr. Rajesh Gayakwad
Dr. Rajesh Gayakwad

Orthopedician and Traumatology


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