Rheumatoid arthritis (RA) is an autoimmune disease that primarily affects the joints of the body. The immune system, which is responsible for attacking foreign substances such as bacteria and viruses, mistakenly attacks the joints of the body. (April Chang-Miller, 2014). The inability of the body to recognize its own healthy tissue will cause severe inflammation around the joints that eventually deteriorates surrounding cartilage and thickens the synovial fluid. This may lead to swelling, redness, decreased range of motion, loss of function, and in severe cases, deformity (Eric Ruderman, 2013).
Like many other autoimmune diseases, researches are not exactly sure what causes RA. What is known is that RA usually affects joints in symmetry. For example, both of the wrists, hands, knees and/or ankles are typically affected. The symmetry is what sets this type of arthritis apart from all the others (Foundation, A. n.d.). Additionally, RA is a debilitating, lifelong disease that must be managed to maintain and improve quality of life.
An estimated 1.5 million people have RA, and women are 3 times more likely than men to develop (Vandever, 2014). When hearing the word “arthritis” we often associate this with the elder population. However, RA can be diagnosed in young adults as well as children, such as my sister, Allison. At the age of 6, she was diagnosed with Juvenile Rheumatoid Arthritis (JRA). Luckily for her and millions of others, aquatic therapy remains one of the best treatments for all forms of arthritis, including RA.
What makes the aquatic environment different from any other form of therapy?
- Buoyancy: Buoyancy reduces weight bearing stress to the joints is reduced and allows performance of exercises that may not be possible on land due to gravity.
- Warm Water: The warm water helps to reduce pain and stiffness associated with rheumatoid arthritis. (Ed Zimney, MD, 2013)
- Resistance: The resistance of the water will help to increase strength without putting stress on the joints.
- Hydrostatic Pressure: Hydrostatic pressure, or the pressure applied to immersed body, can reduce swelling associated with arthritis.
- Endorphins: Aquatic therapy can release endorphins in the body, which act as natural pain killers, reacting similarly to over the counter medications.
- Fall Prevention: Aquatic therapy can significantly reduces the risk of falls due to the support of the water. Comfort and confidence of movement may also be increased.
- Flexibility: The warm water can increase joint flexibility, which continues to last after the therapy session is over.
- Vasodilation: The water creates a vasodilation effect that helps to reduce blood pressure, increases peripheral circulation, and decrease peripheral edema (swelling).
- Balance: The water helps to increase balance and coordination through increased awareness by activating more response receptors.
- Psychological Effects: Being in the water can boost confidence, mood and creates an enjoyable environment for movement.
Below are a few examples of exercises that can be performed to improve the symptoms of RA.
- Walking – forward, backward, side steps, knees high, heels high
- Step Up – performed on submerged box or pool step
- Squat – balance assisted by holding pool wall or bar/rail as needed
- Suspended Exercises – bicycles, flutter kicks, scissor kicks
- Arm Circle – circumduction of shoulder in small, medium and large range of motion
- Arm Swings – hip flexion, extension, normal range hyperextension with good alignment
- Side Arm Lift – shoulder abduction and adduction in frontal plane
- Pronation & Supination – as if turning a doorknob in both directions
- Hand Gripping Exercises – using a sponge or small rubber ball
- Leg Swing – hip flexion, extension, normal range hyperextension with good alignment
- Side Leg Lift – hip abduction and adduction in frontal plane
- Hip Rotation – internal and external rotation
- Plantar Flexion & Dorsi Flexion – point toes and pull toes back towards the shins
- Pool Jets – allows for a relaxing massage at the end of an exercise session
Without a doubt, aquatic therapy and water exercise can assist individuals with RA to enjoy healthier, happier and more actives lives. Make a difference in your community!
April Chang-Miller, M. (2014, October 29). Retrieved from Mayo Clinic : http://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/basics/definition/con-20014868
Ed Zimney, MD. (2013, March 08). Everyday Health . Retrieved from http://www.everydayhealth.com/rheumatoid-arthritis/hot-and-cold-therapy.aspx
Eric Ruderman, M. a. (2013, August ). Retrieved from American College of Rheumatology: http://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Rheumatoid-Arthritis
Foundation, A. (n.d.). www.arthritis.org. Retrieved from http://www.arthritis.org/about-arthritis/types/rheumatoid-arthritis/what-is-rheumatoid-arthritis.php
Vandever, L. (2014, June 10). Retrieved from Healthline : http://www.healthline.com/health/rheumatoid-arthritis/facts-statistics-infographic
Matthew Hersh is a senior in the Exercise Physiology program at West Virginia University who is also an AEA Certified Aquatic Fitness Professional. He plans to continue his education at Palmer College of Chiropractic, located in Davenport Iowa.