Rheumatoid arthritis, or RA, is a chronic inflammatory disease that affects approximately 1 percent of the population. The cause of RA is unknown, though most evidence points to an autoimmune process in which your own immune system attacks and progressively destroys joint cartilage throughout the body. This leads to joint pain and loss of function, which can significantly affect quality of life, especially if this process occurs in your hands. While multiple medications are available to treat this condition, in some cases surgery is necessary to relieve pain and repair joint deformities. However, it is crucial to consult with a rheumatologist and physical therapist before and after surgery, as exercise rehabilitation will significantly improve outcomes.
Goals of Surgery
The overall goals of therapy for RA include pain relief, reduction of inflammation and maintenance of joint function. Surgery is typically used for pain relief and restoration of joint deformities. This is not a cure, however. Other treatments, such as exercise following surgery, are necessary for preserving joint function and curbing inflammation.
Goals of Exercise
According to the book "CURRENT Medical Diagnosis and Treatment," the goal of exercise rehabilitation is to increase hand muscle strength and improve joint range of motion. To guide your exercise routine, the authors suggest eliminating exercises that cause joint pain for over one hour. As your exercise tolerance increases and muscle continues to gain strength, introducing progressively higher resistance exercises will improve the outcome of rehabilitation.
Types of Exercise
According to an article by G. Mark published in the German journal "Therapeutische Umschau" in 1989, there are three phases of healing, each of which requires a different approach to care. The first involves promoting optimal wound healing, and the second involves increasing mobilization of joints as pain and swelling subside. The final phase is the actual rehabilitation, which is involves increasing strength in the hands by working against gradually higher resistances, as well as building up fine sensory and motor function in the fingers.
Surgery does not cure the disease; it is mainly useful in relieving symptoms. It is therefore crucial to continue with exercise therapy to prevent progression of the disease after surgery. According to the Arthritis Foundation, patients will benefit most from regular exercise routines, often demonstrating reduced joint pain and stiffness, as well as increasing joint mobility and muscle strength. You should consult with your doctor or physical therapist regarding exactly what exercises, and at what intensity, you would most benefit from.
Expert Insight
According to Dr. David Hellmann in a 2010 article in "CURRENT Medical Diagnosis and Treatment," the application of heat or cold can be helpful in controlling the inflammatory processes occurring in arthritic joints. Given that rheumatoid arthritis is a disease of excess inflammation leading to joint degeneration, applying heat prior to exercise will stimulate blood flow and promote healing. However, following exercise, when the joint is painful and inflamed, treatment with cold packs will prevent excess inflammation and further degeneration.
Implementation
It is essential to continue contact with your physician following surgery so your progress may be monitored and any necessary adjustments in therapy can be made. Physical therapists are excellent resources for information on how to properly exercise your hands to promote optimal healing post surgery, as well as preventing further arthritis progression. In general, the earlier you can address rheumatoid arthritis the better, as the effects are cumulative and joints may become nonfunctional over time.
References
- "CURRENT Medical Diagnosis and Treatment"; Chapter 20: Musculoskeletal and Immunologic Disorders; David Hellmann; 2010
- "Harrison's Internal Medicine"; Rheumatoid Arthritis; Peter Lipsky; 2010
- PubMed.gov: After-care Following Hand Surgery
- Arthritis.org: Introduction to Exercise; 2010
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