What is Rheumatology Physiotherapy?
Rheumatological or 'inflammatory' conditions are autoimmune conditions affecting the joints. Normally the body creates inflammation after an injury, which helps things to heal. But with Rheumatology conditions, the immune system gets confused and targets the body's own healthy tissues. This occurs through inflammation, which often causes joint stiffness and pain.
Symptoms go beyond joint pain and it's common to experience low mood, fatigue, tendon issues, reduced muscle mass and higher risk of other conditions such as cardiac problems. Rheumatologists are doctors who are experts at diagnosing these different disorders and targeting them with medication.
It's difficult to work out exactly how many people have inflammatory disorders. Often studies that try to find out combine other conditions such as osteoarthritis (this does involve inflammation but isn't autoimmune in nature). However, we know that the numbers in general are rising.
People are tending to live longer so the average age of people is increasing overall meaning we are likely to see these numbers continue to rise. There is also evidence that shows higher prevalence of autoimmune rheumatic disease in First Nations populations. As this is something we're likely to see a lot more of, it's important to know how best to manage these conditions.
Below we discuss some of the most common Rheumatology conditions and will look at how Physiotherapy fits in with a holistic management plan. Finally, we’ll look at how Embody Movement can help you live well with an inflammatory disease.
Embody Movement Senior Physiotherapist Rory McIntyre who offers Rheumatology specialised Physiotherapy for people with inflammatory autoimmune conditions.
What are some examples of inflammatory conditions?
The most common inflammatory conditions are Rheumatoid Arthritis, which mainly affects the joint lining, and Spondyloarthritis, an umbrella term for several types of arthritis that affect both joints and the entheses (the bit where tendons and ligaments attach to bone). There are many other conditions seen in Rheumatology, such as Lupus (SLE), Juvenile Idiopathic Arthritis and Gout – but for now this blog will focus on some of the most common conditions.
Rheumatoid Arthritis
Rheumatoid Arthritis (RA) commonly causes pain and swelling around the wrists, hands and feet. However, it can also affect larger joints like the elbows, hips and knees, as well as some of the organs.
In RA, the immune system targets the lining of the joints with inflammation. RA is typically diagnosed between the ages of 40-60, and is about 2-3 times more common in females than males. Usually your Rheumatologist will do some blood tests and sometimes get some scans to help with diagnosis.
We know a variety of genetic and environmental factors play a part, but we still don't understand all of these yet. Having a relative with RA makes you more likely to get it, while smoking and being overweight are the main lifestyle factors.
In the past, medical options were limited, which meant many patients were left with debilitating joint damage. Thankfully these days there are much more effective options, with most patients able to enjoy a full and active life.
Spondyloarthritis
This term refers to a range of conditions which cause inflammation in the joints but also the 'entheses', which is the place where the tendons and ligaments attach to bone. Some examples of Spondyloarthritis conditions are Ankylosing Spondylitis (AS), non-radiographic Axial Spondyloarthritis (nr-Ax SpA), Psoriatic Arthritis (PsA), Enteropathic Arthritis and Undifferentiated Spondyloarthritis.
People with Spondyloarthritis can have a wide variety of symptoms in and around the joints and extra-articular features (outside of the joints) often occur. These include inflammation of the eyes (uveitis), tendon issues, skin inflammation (Psoriasis), inflammation of the digestive system (Ulcerative Collitis or Crohn's), dactylitis (a 'sausage-like' swelling in your fingers / toes) and changes to the appearance of nails on the fingers or toes. Usually with Spondyloarthritis, people feel better with movement and worse with rest.
Symptoms usually start earlier in life than with RA but are often missed as they can present similarly to other conditions. However, similarly to RA, with early diagnosis and treatment, most patients can still enjoy full lives.
The role of Physiotherapy in supporting patients with Rheumatology conditions
Physiotherapy is a vital part of a management plan for Rheumatology conditions, with guidelines recommending seeing one with experience and knowledge of your specific condition. In the past, patients were recommended to get complete bedrest during flare ups – but we have long since left that behind. We now know that exercise is safe and effective.
Although modern drugs can effectively suppress the inflammation, this doesn't help with the reduced muscle mass. Strength (resistance) training is important to improve muscle mass and reduces the risk of general aches and pains. Another key benefit of exercise is the cardiovascular effects. Unfortunately inflammatory conditions increase the risk of heart conditions, so exercise that brings your heart rate up / increases your breathing is the best type to help.
Finally, range of movement can be limited by joint stiffness or damage over time. Therefore, a Physiotherapist can help you find stretches specific to each body area to maintain as much function as possible. Physiotherapists are ideally placed to help manage these issues with in-depth knowledge of the body. Seeing a Physiotherapist alongside your Rheumatology team can make a huge difference.
Exercise prescription isn't the only thing that your Physiotherapist can provide, with pain management a key part of treatment. This looks different for everyone and your Physiotherapist can help you to form your own strategy including massage, mobilisations, heat, hydrotherapy, pacing strategies and advice on splints or small aids that may make life more manageable.
What you can expect at Embody Movement
Our approach
At Embody Movement, we appreciate the complex nature of these conditions and offer extended appointment slots to allow more time. We take a full history including asking about general health and any other medical conditions you may have and asking about medications you are taking. We also value looking at the whole person and not just symptoms, so we will ask a bit about you – your hobbies, whether you’re working and what your social support system is like. This is so that we fully understand the impact of your condition, as we know that people with inflammatory conditions are more likely to leave work due to their symptoms.
Expertise
As a Senior Physiotherapist with a special interest in Rheumatology I have a wealth of experience in inflammatory disease management, having spent over four years in the UK public healthcare system working alongside Rheumatologists and Specialist Nurses to help patients with inflammatory diseases. I was also the lead Physiotherapist with a patient charity group (National Axial Spondyloarthritis Society) in Glasgow, where I worked with patients building supported self-management programs and running group exercise classes.
Although Physiotherapy is strongly recommended for Rheumatology patients, unfortunately physiotherapists receive very little specific training around inflammatory conditions as part of their degree programs. A recent article also highlighted that the public sector in Australia doesn't have enough specialists in this area, meaning it is difficult to find someone who really understands your condition and has experience treating it. Embody Movement is one of the few practices to offer this specialist service and we’re here to provide the care you need.
Book with Rory today
If you or someone you know is living with a Rheumatology condition, why not book today with Rory for an assessment and treatment specific to your condition? Or give our friendly reception team a call on 07 5337 9853.
Keep an eye out for future blogs, where Rory will be answering some frequently asked questions about living with inflammatory diseases.