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In RA, the synovium, the tissue that lines the joint, mistakenly becomes a target for the immune system. The immune system cells release inflammation-causing chemicals which cause inflammation in the synovium. The synovium creates a fluid called synovial fluid, which lubricates the joint allowing for smooth movement. When the synovium becomes inflamed and damaged, it fails to produce this lubricant and the joint does not move as freely. If the inflammation of the synovium continues over time, the cartilage and eventually the bone become damaged. The joints can then become deformed and misshapen, and movement becomes limited.

RA affects more than just the hands and other smaller joints; it can affect the entire body making it a systemic condition.

Symptoms

  • pain in multiple small joints for six weeks or longer,
  • morning joint stiffness lasting longer than 30 minutes,
  • bilateral pain,
  • loss of energy and appetite,
  • low grade fever,
  • dry eyes and mouth (Siogren’s syndrome),
  • and rheumatoid nodules, or lumps, which can grow beneath the skin.

Trouble breathing, anemia and inflammation of the blood vessels can also be symptoms of RA.

Joints affected by RA may be tender, warm and swollen, typically in a symmetrical pattern – meaning if one side is affected the other side usually is affected as well. RA shows up in the smaller joints first, so wrist and finger joints are affected most often, but other joints such as the neck, shoulders, elbows, hips, knees and ankles along with the feet can be affected. While there is a great deal of variation in symptoms, once someone shows signs of RA, those symptoms usually last for years.

Drug treatment for RA involves drugs called disease modifying antirheumatic drugs (DMARDs) that relieve symptoms and slow the progression of the disease. Analgesics like non-steroid anti-inflammatory drugs and NSAIDs may also be used to reduce swelling, pain and fever.

Massage and Rheumatoid Arthritis

While massage can aid in increasing mobility and alleviating muscle tightness resulting from chronic pain, it cannot do much to alleviate pain from deformed or degenerating joints. Moderate pressure Swedish massage and myofascial release are the two types of massage that research has proven offer benefits for those with RA, but there may be other techniques that reduce pain and increase mobility as well.

Massage therapy has been shown to reduce pain and increase joint mobility as well as decrease depression and anxiety in clients with RA. In one study, those with RA who received moderate pressure massages enjoyed less pain and greater mobility and grip strength than those who received lighter pressure massage therapy (Field, et.al., 2013). Another study showed that the stress hormone cortisol decreased immediately when RA patients received massage therapy (Field, et.al., 1997).

A 2011 study showed that myofascial massage, applied three times per week for two weeks, provided significant pain relief from RA symptoms. Myofascial release works through the application of sustained moderate to deep pressure, which allows the muscle to lengthen, reducing strain on the joints from muscle tension (Cubick, et.al., 2011).

Deep tissue massage techniques or trigger point therapy on clients with RA, should be limited, as these techniques might trigger a flare up of inflammation, especially near joints affected by the disease. When employing these techniques, it is important to work slowly, giving the client time to react, and to not overdo it. Let the client “live with” the work after a short, limited amount of deep work to see how their body reacts. If they are okay and do not have an increase in inflammation in RA-affected joints after the session, you can do a little more deep work at the next appointment. If they have a flare up of symptoms, avoid deep tissue techniques. Communication from the client is key. Massage should never be more painful than a good workout. Discomfort is one thing, but especially when dealing with RA, pain is not optimal.

Contraindications

Basic contraindications for massage therapy apply to those clients with RA as well; avoid massage when there are open wounds, fever, skin rashes or irritation, or deep vein thrombosis. Clients with any significant health concerns should be cleared by their physician before getting massage therapy.

When working on clients with RA, joints that are in an acute stage of inflammation and are warm, red, or extremely painful should be avoided. The therapist should check in with the client regularly to ensure that the pressure is not too deep, as it is important to ensure the massage does not trigger muscle contraction and cause more tension and pain. If a client is having a significant flare up of symptoms, massage should not be performed until symptoms calm down. Joint mobilization and stretching should be performed with care, as joints may be damaged or compromised.

Massage therapy has been shown to significantly reduce pain, increase mobility and reduce stress and anxiety for clients with Rheumatoid Arthritis. Massage therapy should be light to moderate, and care should be taken with inflamed and potentially damaged joints. Clients with RA live with pain as a constant companion and truly appreciate any intervention which offers relief from that pain.

Communication with the therapist as to medications taken is important. Depending on the medication considerations will be made pertaining to how the medications affect the body including pain relief, muscle relaxation, nerve reaction, dehydration, time of last dose etc.

 Adapted from an article Written By Leslie DeMatteo, LMT, MS  December 7th, 2016

 

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agingEverybody talks about active aging, but not everybody knows what it’s supposed to look like. Working to stay happy and healthy as we get older shouldn’t be a drag, something done to slow an inevitable decline into decrepitude. Some things get better and better with age! While the grocery store magazine rack offers all kinds of tips for getting a bikini bod or looking 20 forever, there’s not much actual health advice anyone ought to be taking. So here are five tips for keeping active with each amazing birthday.

1. Keep moving, in whatever ways work for you. Don’t limit yourself.

However you choose to stay active, make sure it’s something you enjoy. Being miserable while you move is not a great way to stay motivated! If being happy in motion means finding a salsa dance partner who can keep up with you all night long, don’t worry about the fact that the rest of your friends are more into yoga or golf. Don’t let assumptions about your age keep you away from the judo dojo, skating rink, or climbing wall.

The other part of “what works for you” is feasibility. Walking is something you can do right on your own street, or even at the local Home Depot if there’s three feet of snow on the ground. No fancy equipment or gym membership necessary! If you’re really into dance but your joints don’t appreciate the intensity, think about water aerobics or even a synchronized swimming group. If an activity truly doesn’t fit into your schedule or lifestyle very often, there’s no reason you can’t try it out. But for the other 364 days of the year, do something that makes sense for you.

2. Not every health and wellness issue is about “just getting older.” Ask questions and get honest answers.

Sometimes, people like to wave away problems as a normal part of getting older. But just because people say it doesn’t necessarily make it the truth! For years people have passed around myths like the idea that sarcopenia (age-related muscle loss) is an inevitable part of getting older. But recent studies people of all ages can maintain, even build strength and muscle. Flexibility and cardiovascular fitness don’t have to fall by the wayside either!

Of course, it’s no secret that our bodies do change over time. This is where the asking questions part comes in. So ask your doctor, a personal trainer, a massage therapist, or whatever experts you have at hand, and get the answers you need. Will swimming make the arthritis in my shoulder worse? How does this medicine affect my heart rate? Is it normal to feel this sore two days after lifting weights? Is this bruising just old skin?

3. Don’t just ignore it.

You know what the “it” is for you. Those headaches that seem to be getting worse, the stress, the way you feel out of breath carrying groceries up the stairs. If you see a physician about it, you might find that it’s actually something quite fixable. Maybe all you need is a change of medication, better posture when lifting, or a massage. Maybe it’s something a bit more involved, like a change in your activity level or cutting back on smoking. But knowledge is power, and ignoring the issue just guarantees you don’t have the power to make those choices for yourself.

4. Health doesn’t just mean physical health, and “active” doesn’t just mean physically active.

So often we think about health and wellness as an issue of the body, and forget about the importance of mental health as well. According to the National Alliance on Mental Illness, depression affects 6.5 million Americans over the age of 65. This often goes undiagnosed for the same reason physical illnesses do: people assume that these feelings are a normal part of aging, and so they don’t seek help.

Being active in a variety of ways also helps fend off depression and anxiety. Strong friendships, regular touch, physical activity (yeah, that again), and working towards goals are all important for maintaining mental health. Be an active community member by volunteering, voting, and working to keep your neighborhood welcoming, safe, and clean. Keep your mind active by taking a class or learning a new skill. If you find yourself suffering from depression or other form of mental illness, take an active role in getting the right treatment; therapy or medication can be a huge help when it feels like nothing will.

5. Being active and independent doesn’t mean never asking for assistance.

Everybody needs help. Kids need help. Parents need help. Athletes and firefighters and librarians and piano teachers all need help. Sometimes it’s easy to feel like if you ask for help, everything you’ve built for yourself (and by yourself!) will crumble, leaving you at the mercy of those who would take on responsibility for your life. But worst-case scenarios are rarely useful in planning for the real world.

What kind of help would be useful in staying active and healthy? A walking buddy? A lift to the gym? An encouraging phone call once a week? Maybe a professional could help. A personal trainer, counselor, or coach might be just what you need. Sometimes help comes in the form of a holiday gift, an evening of conversation over a tasty meal, or a great book on indefinite loan. The greatest thing about accepting help is that it shows you how you can turn right around and help someone else most effectively.