| Patients with arthritis in our practice are often | | | | of US directly over recently surgically manipulated |
| referred to physical therapists during the course of | | | | nerves such as a recent laminectomy, directly over |
| their management. One question I often hear from | | | | malignant tumors, and over joint replacements and |
| patients when I suggest physical therapy is, "But, | | | | permanent pacemakers. US should also not be used |
| why can't I do exercises at home?" | | | | in areas of thrombophlebitis (blood clots), near the |
| So the big misconception here is that physical | | | | eyes, over the uterus, ovaries, and testicles. US also |
| therapy is just a bunch of glorified exercise | | | | should not be used in areas of acute inflammation, |
| instruction. Nothing could be further from the truth. | | | | over the epiphyseal plates of growing children, and |
| Physical therapy plays an extremely important role in | | | | over breast implants of any type. |
| the management of the patient with arthritis. | | | | Phonophoresis (P) is the use of ultrasound to |
| Before we go into the treatment modalities that | | | | transport therapeutic medications to subcutaneous |
| physical therapists use, let's start with exercises since | | | | tissues. P can be used for inflammatory conditions |
| they are an integral part of treatment. | | | | such as tendonitis, arthritis, and bursitis. The same |
| Exercises consist of stretching, strengthening, and | | | | cautions and contraindications exist as for US. |
| range of motion. In addition, as patients get older | | | | Electrical stimulation (ES) is the process of using |
| they need different types of training such as with | | | | electrical current to deliver a therapeutic effect by |
| balance and gait. Finally, the physical therapist in | | | | generating an action potential in nerve tissue. This |
| conjunction with the occupational therapist may look | | | | action potential leads to two potential results. The |
| into activities of daily living and suggest some | | | | first is a change in sensory input, ie. a reduction in the |
| modifications that may be helpful. | | | | ability to perceive pain. The second is a muscle |
| But where physical therapy plays a major role is in | | | | contraction. Low grade muscle contractions can often |
| using different modalities to relieve pain and speed | | | | relieve the severe muscle spasms that occur in |
| the healing process. | | | | association with arthritis. ES can be used for chronic |
| Diathermy is a treatment method which delivers | | | | pain related to arthritis, bursitis, or tendonitis. It is also |
| deep heat. It is useful for chronic pain conditions such | | | | useful for muscle spasm as well as neuropathic or |
| as deep muscle injury or arthritis. | | | | radicular pain (pain from pinched nerves in the spine). |
| Precautions in regard to skin and subcutaneous tissue | | | | It has the same contraindications as US. |
| depth should be attended to. For example, a person | | | | Low-level laser therapy- also known as cold laser- |
| who is skinny will require much less diathermy than an | | | | acts through the absorption of photon radiation. This |
| obese person. Also patients with damage to sensory | | | | leads to changes in cellular oxidative metabolism. |
| nerves probably should not receive diathermy. | | | | Evidence indicates that levels of inflammatory and |
| Iontophoresis (IP) is a procedure where an electric | | | | pain mediators such as prostaglandin E2 can be |
| current pushes ionically charged chemicals (ie., | | | | reduced with this modality. Cold laser can be used for |
| glucocorticoids or steroids) through the skin to reach | | | | minor musculoskeletal pain, osteoarthritis, chronic neck |
| deeper tissues. IP can be used for calcific tendonitis | | | | and low back conditions, and fibromyalgia. |
| and inflammatory conditions such as arthritis. | | | | It should be used with caution in patients with |
| Contraindications to use of iontophoresis include | | | | malignant tumors or in those being treated with |
| allergy to the chemical being applied, open wounds, or | | | | anticoagulants, corticosteroids, or immunosuppressive |
| neurologic deficits that impair a person's ability to feel. | | | | drugs and should not be used over the thyroid gland |
| Iontophoresis also should not be used near metallic | | | | or over reproductive organs. |
| implants, wires, or staples. | | | | Patients and those providing the cold laser treatment |
| Ultrasound (US) is a type of treatment in which | | | | should use safety goggles to limit eye exposure to |
| high-frequency sound waves are used to "heat up" | | | | laser light. |
| superficial soft tissues and to help with tissue healing. | | | | These are only a very small portion of the many |
| Ultrasound can be used for tendon injuries or for | | | | therapeutic modalities a physical therapist has in their |
| short-term pain relief related to muscle strain or | | | | arsenal. In the care of patients with arthritis, physical |
| spasm. Contraindications of ultrasound include the use | | | | therapists are an indispensable member of the team. |