Rheumatoid arthritis ( RA ) is an inflammatory, systemic, chronic, autoimmune disease of multiple joints and connective tissue throughout the body.
RA is medically diagnosed by the presence of the following:
- Morning stiffness for at least 1 hour
- Involvement of at least 3 joints for 6 weeks
- Symmetrical joint swelling
- Rheumatoid nodules
Rheumatoid Arthritis Massage Therapy Treatment Goals:
- relaxation
- decrease: pain, edema, spasm
- maintain joint mobility
- prevent joint contracture
Rheumatoid Arthritis Massage Therapy Treatment:
During RA Flare Up:
- Treat only unaffected areas of body
- Cold hydro to affected joint
- Treatment to head and neck, proximal to affected joint
- GENTLE Active Free and Active Assisted ROM to affected joint
- NO distal treatment
Between RA Flare Ups:
- Pain free rhythmic techniques – rocking and shaking to affected joint
- May use contrast or hot/warm hydro if there is no inflammation
- treat compensating muscles
- Muscle Stripping, Ischemic Compressions, Cross Fiber Frictions in the Muscles crossing affected joints
- Work proximal to distal, always draining
- Gentle Passive ROM of joint throughout the treatment
Joints involved in RA ( Rheumatoid Arthritis ):
- Wrists and the index and middle metacarpophalangeal joints
- Proximal interphalangeal joints
- Metatarsophalangeal joints
- Shoulders, Elbows, Hips, Knees, Ankles
Considerations and Contraindications for Rheumatoid Arthritis Massage:
- when inflamed: no hot hydro and No Testing except Active ROM
- treatment with any fever is contraindicated
- local or distal massage on acutely inflamed joints is contraindicated
- aggressive joint play is contraindicated
- avoid giving active or passive ROM of the joint as homecare if joint acutely inflamed
- between flare ups, deep vigorous techniques may provoke inflammation
- no stretching if joint is hypermobile
- do not fatigue muscle with strengthening
- in severe cases, C1 and C2 may become unstable. In this case, NO tractioning and Passive ROM of the cervical spine
Signs and Symptoms of Rheumatoid Arthritis:
- often starts in the hands
- symmetrical
- generalized fatigue, aching, stiffness, weight loss
- affected joints hot, puffy, swollen, skin shiny and tight
- joint stiffness overtime
- spasm in the muscles crossing the affected joint/s
- subluxations may occur in the joint
- swan neck deformities: extension of proximal interphalanges, flexion of distal interphalanges
- boutenniere deformities: flexion of proximal interphalanges, extension of distal interphalanges
- ulnar drift of fingers
- knee valgus
- baker’s cyst (enlargement of post knee bursa)
- neck pain
- during flare ups; pain, fatigue, low grade fever, weight loss, anemia, rheumatoid nodules
- sjorgran’s syndrome: dry eyes and mouth
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Self care for Rheumatoid Arthritis:
- between flare ups, gentle stretching of muscles crossing the affected joints
- sub maximal isometric exercise to maintain strength of the muscles crossing joint
- cool hydro during flare up, warm hydro between flare ups
