Physical Therapy Must Be Discussed by Arthritis Patients and Doctors

Maintaining Physical Function Is as Important as Pain Relief

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I have a long history with arthritis, specifically, rheumatoid arthritis. Yet, I have relatively limited experience with physical therapy. As I look back over the years, since I was diagnosed in 1974, physical therapy was never encouraged by my doctors, nor its importance emphasized.

I was sent to physical therapy after joint replacement surgeries for about 6-8 weeks each time, but essentially, the purpose was post-op rehabilitation.

It was never recommended to me as part of routine arthritis care to maintain or improve range of motion, to maintain or improve physical function, or to maintain or build muscle strength.

As a matter of fact, when I had my first hip surgery in 1980, a surgeon affiliated with one of the most highly respected medical institutions in the world told me that I didn't need to have physical therapy because I was young (24 at the time) and would bounce back. More recently, in 2013, when I had a herniated disc, I was told by two doctors that physical therapy wouldn't help until the pain was managed. My primary doctor, however, did refer me for physical therapy in 2013, but the physical therapy clinic I went to seemed lost regarding what to do with me -- a patient who had a long history with rheumatoid arthritis and more recent experience with back problems. 

Now for the good news. While there seemingly are many doctors who don't recognize the benefits of physical therapy as part of routine arthritis care and while there are physical therapy clinics that may be less than optimal, you shouldn't give up.

You must advocate for yourself. That's what I did in August 2014. I felt that, after a few rough years, my pain was finally well-controlled. I felt that it was the right time to pursue physical therapy or orthopedic rehabilitation (call it what you will) to re-gain some movement and strength which I had lost.

I didn't get much support for the idea when I called to request a referral and spoke with my orthopedic doctor's assistant. But, I persisted and got the referral I needed. I found an impressive place after doing an online search for physical therapy facilities in my area. I found S.P.O.R.T.S. (Scott Pensivy Orthopedic Rehabilitation Therapy Services) in Las Vegas, Nevada. According to their website, they offered exactly what I needed. But, I had to talk to them and determine if they felt that what they offered could be helpful to me.

At S.P.O.R.T.S., I was evaluated and interviewed. I was actually listened to and heard. The physical therapy team understood that, although I had a long and somewhat complicated history with arthritis, I could benefit from therapy/orthopedic rehabilitation. My therapist put together a workout routine that includes Pilates, stretching and strengthening exercises, the semi-recumbent elliptical, and the HyperVibe (using a modified stance). After just two weeks, I felt stronger.

A month in, stronger yet. And, it has been such a good experience that I don't feel like I want to stop.

Was It Just Me Not Being Referred for Physical Therapy?

Which brings to mind this question: Am I the only person with arthritis who was steered nowhere near physical therapy as they consulted doctors and tried to manage the disease over many years? I asked a group of friends with arthritis whom I have known for years, as well as another group of users of this website. The consensus was that they were not advised to consider physical therapy as part of their arthritis treatment regimen either. I could count on one hand those who were advised to have a physical therapy consultation. As I dug deeper, regarding why physical therapy isn't on the radar of many patients or doctors, I noticed that the same issues seemed to surface.

  • Insurance provides limited coverage for physical therapy. (e.g., Medicare allows $1,920 in 2014 per calendar year). Some people were completely unaware of what their insurance coverage would be for physical therapy, if it was covered at all, or if their out-of-pocket costs were reasonable and manageable. 
  • There is a strong misconception and negative perception that people with arthritis can't do enough to matter. Yes, some people with arthritis think that about themselves.
  • Some arthritis patients didn't know they could request a referral.
  • Some people have been told or they believe that physical therapy would worsen their condition.

Many Who Could Benefit From Physical Therapy Are Missing Out

Clearly, physical therapy is not for everyone, but just as clearly, it seems many who could benefit are missing the boat. This is a discussion that should take place between every arthritis patient and their doctor.

Just this month (September 2014), the American Physical Therapy Association released Choose Wisely - Five Things Physical Therapists and Patients Should Question.  Number two of 5 offers this advice to therapists, "Don’t prescribe under-dosed strength training programs for older adults. Instead, match the frequency, intensity and duration of exercise to the individual’s abilities and goals. Improved strength in older adults is associated with improved health, quality of life and functional capacity, and with a reduced risk of falls. Older adults are often prescribed low dose exercise and physical activity that are physiologically inadequate to increase gains in muscle strength. Failure to establish accurate baseline levels of strength limits the adequacy of the strength training dosage and progression, and thus limits the benefits of the training. A carefully developed and individualized strength training program may have significant health benefits for older adults."

The Cleveland Clinic states, "Physical therapists can provide you exercises designed to preserve the mobility, strength, and use of your joints. Your physical therapist will tailor a program to your specific needs, whether your arthritic problems are widespread or confined to one joint or body area." The Cleveland Clinic also emphasized, "Therapy should be started early in order to reduce painful symptoms of inflammation, prevent deformity and permanent joint stiffness, and maintain strength in the surrounding muscles. When pain and swelling are better controlled, treatment plans may include exercises to increase range of motion, and to improve muscle strength and endurance."

Bottom line: Talk to your doctor. It's never too late to increase movement, activity and exercise at a level that is appropriate for you. The most important takeaway from this article is this advice: "Match the frequency, intensity and duration of exercise to the individual’s abilities and goals."

Sources:

American Physical Therapy Association. Five Things Physical Therapists and Patients Should Question. Released September 15, 2014.
http://www.choosingwisely.org/doctor-patient-lists/american-physical-therapy-association/

Cleveland Clinic: Diseases and Conditions. Occupational & Physical Therapy for Arthritis. September 17, 2012.
http://my.clevelandclinic.org/health/diseases_conditions/hic_Arthritis/hic_Occupational_and_Physical_Therapy_for_Arthritis

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