Arthritis Flashcards
(16 cards)
Common location for OA
Hip, knee, DIP, CMC, lower cervical and mid to low lumbar
Prioritize Rx in early OA vs late OA
Early OA means pain is present only during activity not at rest hence, balance activity with rest.
Late OA means pain is present all the time and hence, activity modification plus assistive devices would take focus.
- Pain Mx via TENS and heat
- Bracing and biomechanical corrections
- Balance and proprioception
- Promote as much independence as possible until the disease gets worse (ADL wise) (balancing activity with rest)
- Strengthening via multi angle isometrics and stretching to prevent deformities
- Prescribe gait aid
- Activity modification
- Weight loss
Most common location for RA
Small joints of wrist and hand,
PIP>MCP > wrist
Best Rx in flared up RA
Possible Rx in flared up RA include:
1. Preventing deformities before they occur hence, protective bracing and adaptive ADL tools. (If you can’t avoid the activity modify the activity)
2. Gentle active pain free ROM.
3. Avoid stretching
4. Avoid lifting or strengthening
5. Energy conservation
6. 8 to 10 hours of sleep at night and 1 hour of nap during the daytime to reduce the effect of systemic fatigue.
7. Do not contribute immobility and a lot of REST !!!!!!
8. Respect patient’s pain and fatigue
Red flag in RA
Hypermobility
Transverse ligament instability
Rx Priority in Ankylosing Spondylitis
Breathing exs would take the forefront for people with AS even if it is mild because we want to strengthen diaphragm as much as we can and even if the patient has dypnea.
second would be the posture- ROM and postural strengthening would be the primary way to strenghtening this population
Pain mx in ankylosing spondylitis
Through movement and posture correction is the main goal.
Look at the specifics provided in vignette.
SI joint pain MX in AS? Bracing or something else?
The best Rx for SI joint pain is Bracing and TA strengthening if it is due to hypermobility like in pregnancy.
In AS, pain is due to inflammation and most likely the stiffening of the spine, hence, no bracing here but ROM always.
Any C/I or precautions when working with AS population?
NO high impact cardio or strengthening exercise as they do not have shock absorption.
Avoid running and recommend aquatics or walking with a walking pole( increase rotation of the trunk) and recumbent leg press.
AS- Flexion based or extension based exercise?
Extension based
Prioritize activity in case of JIA acutely flared up state
Activity modification, ice, gentle AROM, protective bracing.
Modifying or avoiding activity that will be detrimental like soccer for time being. (J. TACH)
Keep it moving- Frequently change positions even in flared up stage to prevent contractures.
Focus on pacing and planning- best option? Liase with parents and the school.
Strength- Resisted isometrics is an option during flared up state.
In case of some athlete prefer doing low impact cardio like biking and swimming to maintain the training effects while in the active state of the disease.
Main focus- Play based activities to ensure compliance in kids + Bippsychosocial approach
Prioritize Rx JIA chronic stage
Get the child in for strengthening and flexibility.
Increase strength around the joint using light to moderate resistance exercises
o Promote functional bodyweight movements (e.g., sit to stand, stairs) during
non-active disease states
C/I or precautions when working with JIA
NO passive ROM or stretching during flare up
(heavy lifting and loading should always be avoided in this population)
List Rx in priority in acute GOUT followed by chronic gout
- Pain mx and reduction of inflammation
- Joint protection- education on injury prevention
- Rest
Chronic-
Add strengthening and functional exercise
When starting strength training in patients what’s the type of exercise that you should use first?
Resisted isometrics
Concentric
Eccentric
Resisted isometrics always !!!
