What rehabilitative techniques can be used for specific rheumatic diseases?
- • Ankylosing spondylitis: spinal extension and hip and shoulder ROM exercises. Swimming is the best aerobic exercise as it promotes spinal extension and shoulder ROM in a humid setting.
- • Polymyositis/dermatomyositis: daily ROM exercises are important to prevent contractures. Strengthening exercises should be deferred until inflammation is under control, then isometric exercises may be performed at least three times per week. However, patients should avoid overuse weakness by not exercising to the point of muscle fatigue.
- • Steroid-induced myopathy: resistance training, as well as endurance exercise, can attenuate muscle atrophy in steroid-induced myopathy, but not prevent it entirely.
- • Systemic sclerosis: ROM exercises and splinting to decrease contractures. Finger flexion and extension exercises, especially if preceded by paraffin baths, increase joint flexibility, reduce skin stiffness, and improve hand function.
- • Fibromyalgia: generalized aerobic and strengthening exercises. Other techniques that have been shown to have some benefit for pain reduction include acupuncture, cognitive behavioral therapy, hydrotherapy, and mindfulness.
- • Complex regional pain syndrome (CRPS, previously called reflex sympathetic dystrophy): passive and active ROM exercises must be part of any program, with gradual progression to weight bearing of the affected limb. Graded motor imagery and mirror therapy have been employed to treat CRPS. Modalities such as massage, TENS, contrast baths may be helpful for desensitization. Intervention techniques, such as stellate ganglion blocks, lumbar sympathetic blocks, or spinal cord stimulators may be used to facilitate active exercise treatment.
- • Systemic lupus erythematosus: regular aerobic exercise helps to reduce symptoms of fatigue and improves psychological health.
- (O’Dwyer T, Durcan L, Wilson F. Exercise and physical activity in systemic lupus erythematosus: a systematic review with meta-analyses. Semin Arthritis Rheum. 2017;47:204–215.)
- (Millner JR et al. Exercise for ankylosing spondylitis: an evidence-based consensus statement. Semin Arthritis Rheum. 2016;45:411–427.)
- (Alexanderson H, Lundberg IE. Exercise as a therapeutic modality in patients with idiopathic inflammatory myopathies. Current Opin Rheumatol. 2012;24:201–207.)
- (Smart KM, Wand BM, O’Connell NE. Physiotherapy for pain and disability in adults with complex regional pain syndrome (CRPS) types I and II. Cochrane Database Syst Rev. 2016;2:CD010853.)
- (Macfarlane GJ, Kronisch C, Dean LE, et al. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis. 2017;76:318–328.)
- (Maddali-Bongi S, Del Rossa A. Systemic sclerosis: rehabilitation as a tool to cope with disability. Clin Exp Rheumatol. 2016;34:162–169.)
- (LaPier TK. Glucocorticoid-induced muscle atrophy: the role of exercise in treatment and prevention. J Cardiopulm Rehabil. 1997;17:76–84.)