Arthritis Flashcards
goals of exercise intervention
slow or reverse body’s response to joint pathology by increasing strength, flexibility, endurance and by decreasing pain
improve impairments, functional limitations, and disabilities resulting from arthritis
lead to overall improved health status as an effect of cardiovascular, strengthening, ROM and stretching exercises
ligs, muscles, tendons, capsule, cartilage, bone
stabilize
absorb
transmit forces
OA
nonsystemic
mostly noninflammatory
localized pathology
RA
systemic
inflammatory disease
usually involves multiple joints
often affects organ systems
articular cartilage function
shock absorption
joint congruence
effects of OA on articular cartilage
thickening to softening
thinning to loss
effects of RA on articular cartilage
erosion
synovium function
secretes synovial fluid for nutrition of cartilage, lubrication and stability
effects of OA on synovium
abnormal joint alignment stresses
effects of RA on synovium
microvascular lining cells activated by inflammatory process pannus formation (granulation tissue)
ligament function
stability
reinforce capsule
limit movement
guide movement
effects of OA on ligaments
abnormal joint alignment stresses
effects of RA on ligaments
erosion
weakens
muscle function
reinforce joint capsule
reflex joint protection
move joints
effects of OA on muscle
immobility shortens pain, causes guarding and reflex inhibition leading to weakness
effects of RA on muscle
joint deformity interferes w/ peak torque immobility shortens myositis weakens pain & effusion cause guarding reflex inhibition leads to weakness
bone function
structural support
effects of OA on bone
subchondral bone remodeling changes shock absorption properties
joint margin spurring leads to bony blockage and pain
effects of RA on bone
erosion leads to joint deformity
bony blockage
pain
OA effects on extra-articular system function
increased energy expenditure from abnormal movement patterns
RA effects on extra-articular system function
myositis anemia sleep disruption fatigue increased energy expenditure from abnormal movement patterns
RA Class I
EARLY
completely able to perform usual ADLs
no destructive changes on roentgenographic exam
roentgenologic evidence of osteoporosis may be present
RA Class II
MODERATE
able to perform usual self-care and vocational activities, but limited in avocational activities
roentgenologic evidence of osteoporosis, with or without slight subchondral bone destruction; slight cartilage destruction may be present
no joint deformities, although limitation of joint mobility may be present
adjacent muscle atrophy
extra articular soft tissue lesions, such as nodules and tenosynovitis
RA Class III
SEVERE
able to perform usual self care activities, but limited in vocational and avocational activities
roentgenologic evidence of cartilage and bone destruction in addition to osteoporosis
joint deformity, such as sublux, ulnar deviation, or hyperextension, w/out fibrosis or bony ankylosis
extensive muscle atrophy
extra-articular soft tissue lesions, such as nodules and tenosynovitis, may be present
RA Class IV
TERMINAL
limited in ability to perform usual self-care, vocational and avocational activities
fibrous or bony ankylosis
criteria of stage III
exercise recommendations and wellness
appropriate exercise regiment should emphasize:
- maintaining appropriate BW
- sustaining good postural alignment
- developing good muscular strength and length
- correct movements during functional activities
therapeutic exercises for OA
- decrease pain and inflammation
- re-establish muscle length and strength around the joint
- address adaptive changes in proximal and distal joints
- performance of basic functional tasks
therapeutic exercises for RA
*considerations are similar to OA
PLUS
-pts must be taught how to recognize symptoms, to modify activity according to symptoms development and stage of illness
results of pain
pain, swelling and splinting disuse atrophy reduce protective reflexes further cartilage breakdown disruption of soft tissue balance inefficient movement/muscle patterns decrease in cardiovascular activity activity reduced further
pain
exercise is used to restore muscle balance, joint ROM, CV conditioning
thermal modalities and estim for management
impaired mobility and ROM can be diminished by:
- stiffening and shortening of muscles or tendons from spasm, guarding, or habitual postures
- capsular stiffness or contracture
- loss of joint congruity because of bony deformity
RA prescription
1-2 daily application of PROM (large joints) and AROM (small joints)
single submax isometric contractions (2/3 of MVC) 6 sec work/20 sec rest (acute and subacute phases)
caution should be used during MVC efforts
reps at various angles
OA prescription
isometric contractions in acute phase
as pain and swelling decreases, graduating into a routine containing dynamic contractions
impaired aerobic capacity
CV training should be a major part of therapy programs with OA or class I and II of RA
*aquatic therapy
aquatic benefits
allos performance of movement patterns that may not be possible on land bc of balance or strength deficits
provides ms relaxation
modifying pain perception through sensory stimulation
special considerations
protect joints during strengthening when lig or capsular laxity exists
restore muscle balance when splinting, postural habit, pain inhibition has weakened muscle groups around 1 or more joints
normalize specific joint movement patterns
restore functional activities
treat pain during and after exercise
