Physical therapy offers relief for arthritis sufferers

By KIM MULFORD

Al Schell/Courier-Post

Courier-Post Staff

By the time Nancy Smith of Cherry Hill started going to physical therapy three times a week, her arthritis was keeping her from ballroom dancing. The pain in her lower back, hips and legs made walking difficult, rendering the tango a no go for Smith. "I was in pretty bad shape," said Smith, 65. "I had to stop everything."

She had back surgery five years ago, and used anti-inflammatory medication and a device to zap herself with mild jolts of electricity to mask the pain, but it wasn't enough. A family friend suggested she try physical therapy, so she asked her doctor for a prescription and went to see John Marmarou at Total Rehab & Fitness in Cherry Hill.

At first, Smith said, "I was scared for him even to touch me. I was so tender."

But she was willing to give it a shot.

Arthritis covers more than 100 different conditions affecting the joints and other parts of the body. It's one of the most common causes of chronic health problems and disability in the United States, according to the Arthritis Foundation.

Osteoarthritis, the most common form, causes the joint's cartilage to break down, forcing bones to rub against each other. Symptoms include stiffness, pain and loss of movement in the joint.

Depending on the form of arthritis, treatment can include a combination of drugs, rest, physical activity, heat or cold to reduce pain, and physical or occupational therapy. Surgery may be needed for advanced cases.

For Smith, adding physical therapy to her treatment mix was the right move. She returned to ballroom dancing several months ago, reduced her medication use and stopped using the electrical device.

Marmarou, her physical therapist, calls his center a "medical gym."

"We're really using exercise as medicine," said Marmarou.

Physical therapy is an effective pain reliever for some types of arthritis, including osteoarthritis, said Dr. Elliot Rosenstein, a rheumatologist who serves on the board of directors of the Arthritis Foundation's New Jersey chapter. It also improves joint mobility and may delay the need for orthopedic surgery.

"It's very helpful for stretching and strengthening the muscle that supports the joint," said Rosenstein. "We know that physical stress is often an aggravator of joint pain. If the muscles can be reconditioned, the amount of pain a person experiences can be minimized."

Nearly all arthritis patients are given exercises to do at home, Rosenstein said. If they can't do those exercises, patients can try physical therapy three times a week for four weeks. At that point, a doctor may decide they can continue doing the exercises at home. If improvement is slow, the doctor may prescribe additional therapy for a longer period.

For some people with advanced cases, however, therapy is not effective, he said.

Ten months after she first started physical therapy, Smith still goes in to see Marmarou three times a week. After her insurance stopped covering the sessions, she signed up for his maintenance program for a monthly fee. Without that additional encouragement and oversight, she said, "I'd just fizzle out."

Marmarou uses a combination of exercises, heat or cold therapy and stretching to help his patients move properly. He works to build up the supporting muscles to reduce impact on the joint.

"I'm like a new person," said Smith. "The consistency of going there and (Marmarou) building up my body has made it a lot better."

Another patient at the center, Shelli Goldstein of Cherry Hill, started physical therapy for her knee. Arthritis was causing her bones to rub together, making it feel "like a toothache in my knee."

A yoga student and teacher, she took 12 weeks of physical therapy and now continues the exercises at home. Now, she can do the full-lotus posture.

"It never occurred to me he could rehab my knee to the point that I'm not thinking about it every time I take a step," said Goldstein, 69.

Proper exercise and weight control is a good idea for most arthritis patients. Cartilage has no blood supply, Rosenstein said, so in order for the joints to receive nourishment (from something called synovial fluid), they must move. Without movement, the cartilage breaks down faster.

Non-impact exercises, like biking and swimming, are recommended. Before starting an exercise program, arthritis patients should consult their rheumatologist, orthopedist or physiatrist, Rosenstein said.

"There's always this tendency not to use the painful joint," said Rosenstein. "You need to use it, but you have to be careful how you use it."

Reach Kim Mulford at (856) 486-2448 or kmulford@courierpostonline.com.

Additional Facts
ARTHRITIS AND EXERCISE

• Exercise helps reduce pain and fatigue, increases range of movement, and helps arthritis patients feel better overall. A doctor, physical therapist or other specially trained health professional can show you exercises that can benefit a patient with arthritis.
• Walking is the ideal exercise for most people with arthritis. It strengthens muscles and builds denser bones without impacting fragile joints.
• Stretching keeps joints and muscles flexible.
• Exercising in water reduces the impact on joints, while building strength and increasing a person's range of motion.
• Use ice packs to reduce pain and swelling on hot, achy joints.

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