Regular exercise helps keep the joints functioning properly, but it’s important to exercise safely and use correct form. That’s where physical therapy comes in, according to Maura Daly Iversen, doctor of physical therapy, dean of the College of Health Professions at Sacred Heart University in Fairfield, Connecticut. The goal of physical therapy is to reduce pain, restore or improve mobility, make it easier to perform everyday tasks, and prevent disability. A physical therapist may:
Work with you to develop an individualized fitness plan that includes strengthening, stretching, and aerobic exercises.Recommend heat and cold therapies to ease joint pain and stiffness.Show you how to use assistive devices that can help you perform daily tasks.Suggest modifications to help you conserve energy and protect your joints.
Here, Iversen talks about how physical therapy can benefit people with psoriatic arthritis, and what you need to know about finding the right physical therapist for you.
1. When should people with psoriatic arthritis consider physical therapy, and what can they expect?
Joint pain and swelling from psoriatic arthritis usually cause a person to consider a physical therapist. They may also be experiencing severe fatigue because it’s a systemic disease. One of the things we work on is building your aerobic capacity to deal with that fatigue. We would begin with a full body exam, including joint range of motion and strength testing. We check to see if there may be stresses on the joint from movement. That’s an indication that we should be careful if we exercise that joint. We’ll also do a quick aerobic test called a submaximal exercise test, just to see what the patient’s endurance is. If the patient’s having trouble functioning at work, we’ll do an ergonomic evaluation. We can help modify their workspace or even speak to their company to create a better work schedule to accommodate a patient. This could include working from home for part of the time.
3. What are some common obstacles to trying physical therapy, and how can psoriatic arthritis patients overcome them?
The biggest fear patients — and even families of patients — have is that doing more can make them worse. Arthritis is very different from, say, having a stroke. When a person has a stroke, they look to make slow but steady gains in therapy. For people with arthritis, you may look and feel fine one week, and then the next week you don’t. People can’t understand why there is such a fluctuation. That’s a heavy burden that patients with arthritis carry. What I try to do is talk about what the benefits of exercise are. It may seem counterintuitive that exercise is beneficial because we’re stressing the joints a little bit. Exercising within a person’s pain tolerance and building up slowly is the goal. We are going to build your capacity up slowly and see how the body responds. I always tell the patient that they really are the expert on their body. They know what they can and can’t do. If 30 minutes of exercise is too much, we can split it up and do 10 minutes, three times a day. If 30 minutes is the threshold for building aerobic capacity, we can find ways to get that time in without it having to be as painful as it can be.
4. Is physical therapy different for people who are athletic?
Athletes tend to be self-motivated. They’re good at setting goals and achieving them in incremental ways. If they can only do five reps instead of 10, it’s not a big deal. Non-athletes often need external motivation. They tend to benefit from the support of working in a group. They wish they could do more, but they don’t know how to self-motivate. The group setting is very helpful toward making them feel more comfortable. The Arthritis Foundation has some wonderful collaborative programs. I keep a list of what’s available for patients, and I connect them with the types of resources they’re more likely to use.
5. How do you know if you have the right physical therapist?
Exercise is a form of medicine. Just as a rheumatologist will adjust your medication to find out what works best, you need a physical therapist who’ll help you determine things, like whether you’re in a flare and if you need to adjust your exercise. If a patient’s symptoms seem to be related to a flare, I suggest backing off on the exercise a little bit and giving their joints a rest. Some physical therapists may understand exercise but not know the pathologies of the disease. The American College of Rheumatology maintains a database of providers specializing in rheumatoid conditions. Consider somebody who is orthopedic or OCS (orthopedic clinical specialist) certified.
6. Will insurance cover physical therapy for psoriatic arthritis?
Each insurance company has different fee structures and visit allowances. If you are referred by your rheumatologist or primary care specialist, sessions will be covered. Your physical therapist will know what the insurance company allows and can help determine the best way to care for you.
