Rheumatoid Arthritis Massage

rheumatoid arthritisRheumatoid 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