Role Of Exercises In Rheumatoid Arthritis
The more you keep the joints in motion, greater the circulation of synovial fluid thereby washing out of the cytokines and lesser the joint damage.
The right exercises for rheumatoid arthritis help mobilise the joints
Rheumatoid Arthritis is a chronic, inflammatory, autoimmune disease characterised by pain, swelling, stiffness and progressive destruction of small joints of hands and feet. It can be managed with drugs which are called conventional synthetic Disease Modifying Anti Rheumatoid Drugs (csDMARD). RA is a chronic deforming disease of the small joints of hands and feet which if untreated can result into disabling pain and poor quality of life. RA is characterised by pain and stiffness of multiple small joints of hands and feet. Untreated it can result into deformities and disabilities. Treatment is done by a Rheumatologist with low dose short term steroids, some disease Modifying Anti Rheumatoid Drugs (csDMARD) and Biologics.
Exercise and RA
Exercises are designed with one simple principle- the more you keep the affected joints in motion, lesser are the chance of destruction. All these joints have a liquid or gel at the site of articulation. This gel is known as Synovial fluid. The destruction of the joint structures is caused by accumulation of pro-inflammatory chemicals (also known as Cytokines) such as TNF alpha, IL-6 inside the synovial fluid. These chemicals tend to accumulate when the joint is not in use. As the joint comes in motion, the synovial fluid undergoes a slow recirculation by getting absorbed into the blood and fresh synovial fluid accumulates from ultrafiltration from the blood. The freshly formed synovial fluid practically has very less quantity of those chemicals (cytokines). Thus the logic is, the more you keep the joints in motion, greater the circulation of synovial fluid thereby washing out of the cytokines and lesser the joint damage.
Although a joint is made up of two bones and their covering cartilage, but the functioning and integrity of the joint is mostly controlled by adjoining muscles. Hence, the health of the muscles is of prime importance. Isometric exercises (exercises where the length of the muscle remains unchanged e.g compressing a hard ball in a fist) helps build the bulk of the muscle and thereby putting less work load on the joints. Whereas Isotonic exercises (exercises where the tone of the muscles remains unchanged e.g. squeezing a sponge ball) helps maintain the health of the muscle and increase range of motion around the joint, thus mobilising the synovial fluid and prevent damage.
I am sharing some of the best exercises for a patient with rheumatoid arthritis:
1. Make a Fist
Hand and finger exercises can help strengthen your hands and fingers, increase your range of motion, and give you pain relief. Stretch only until you feel tightness. You shouldn't feel pain. Start with this simple stretch: Make a gentle fist, wrapping your thumb across your fingers. Hold for 30 to 60 seconds. Release and spread your fingers wide. Repeat with both hands at least four times.
2. Finger Stretch
Try this stretch to help with pain relief and to improve the range of motion in your hands: Place your hand palm-down on a table or other flat surface. Gently straighten your fingers as flat as you can against the surface without forcing your joints. Hold for 30 to 60 seconds and then release. Repeat at least four times with each hand.
Isometric exercises (exercises where the length of the muscle remains unchanged e.g compressing a hard ball in a fist) helps build the bulk of the muscle and thereby putting less work load on the joints. Whereas Isotonic exercises (exercises where the tone of the muscles remains unchanged e.g. squeezing a sponge ball) helps maintain the health of the muscle and increase range of motion around the joint, thus mobilising the synovial fluid and prevent damage."
Dr. Tanoy BoseSenior Consultant in Internal Medicine, Arthritis, Rheumatology & Interventional Muscoskeletal Ultrasonography, Kolkata
3. Claw Stretch
This stretch helps improve the range of motion in your fingers. Hold your hand out in front of you, palm facing you. Bend your fingertips down to touch the base of each finger joint. Your hand should look a little like a claw. Hold for 30 to 60 seconds and release. Repeat at least four times on each hand.
4. Grip Strengthener
This exercise can make it easier to open door knobs and hold things without dropping them. Hold a soft ball in your palm and squeeze it as hard as you can. Hold for a few seconds and release. Repeat 10 to 15 times on each hand. Do this exercise two to three times a week, but rest your hands for 48 hours in between sessions. Don't do this exercise if your thumb joint is damaged.
5. Pinch Strengthener
This exercise helps strengthen the muscles of your fingers and thumb. It can help you turn keys, open food packages, and use the gas pump more easily. Pinch a soft foam ball or some putty between the tips of your fingers and your thumb. Hold for 30 to 60 seconds. Repeat 10 to 15 times on both hands. Do this exercise two to three times a week, but rest your hands for 48 hours in between sessions. Don't do this exercise if your thumb joint is damaged.
6. Finger Lift
Use this exercise to help increase the range of motion and flexibility in your fingers. Place your hand flat, palm down, on a table or other surface. Gently lift one finger at a time off of the table and then lower it. You can also lift all your fingers and thumb at once, and then lower. Repeat eight to 12 times on each hand.
7. Thumb Touch
This exercise helps increase the range of motion in your thumbs, which helps with activities like picking up your toothbrush, fork and spoon, and pens when you write. Hold your hand out in front of you, with your wrist straight. Gently touch your thumb to each of your four fingertips, one at a time, making the shape of an "O." Hold each stretch for 30 to 60 seconds. Repeat at least four times on each hand.
Exercise has to be done under a professional guidance and it has to be a graded one. That implies that they should start with milder and easier ones and then strength building has to be addressed. The more the joints in motion, lesser are the chances of damage.
Peoples suffering from severe osteoporosis (which is common in Rheumatoid Patients) should inform the instructor about the issue. Overzealous exercises can cause fracture of small bones.
(Dr Tanoy Bose is a leading practitioner of Internal Medciine, Arthritis & Rheumatology and Interventional Musculoskelatal Ultrasonography, Kolkata. He holds a MD. EULAR certificate in Rheumatology)
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