Patient should stop before excessive fatigue sets in. Gradually with the exercise of the joints, mobility will increases. A patient must exercise on his own and can do a few exercises assisted by his therapist. The patient can sit in a chair and do exercise, he can stand and do exercises. He can walk with the help of a walker or assisted by somebody. He can walk with crutches. Use elbow crutches rather than axillary crutches to avoid crutch palsy. After crutches the patient can walk with the help of a cane. Gradually the patient starts building up his muscle control. All this will depend upon age, the patientís endeavour and how determined he is to quickly come out of it.
Exercises are important at the chronic stage, otherwise deformity is certain. If the joints are not exercised properly, they become fixed in flexed position, muscles become thin and wasted and inflammatory products get deposited around the joints. This is common in Ankylosing spondylitis.
Many other deformities occur in rheumatoid arthritis. If the patient has been sleeping on a soft bed, the cervical spine flexes till the chin reaches near the chest. The dorsal and lumbar spine gets flexed. The hip and knee get flexed and the ankle joint is extended. The patient looks as if curled up in a ball. The bones become osteoporotic and more often get fractured by little training.
These patients need a well planned and supervised exercise therapy. Attention must be given to the joints. Gradually their movement and muscle power will increase. Some heat therapy to the joints before exercise may be given. This helps to relax the muscles and increases the blood supply and so the exercise become more effective.
The joint stiffness and contraction improves slowly and needs a lot of patience and perseverance on the part of both the physician and the patient. The first exercises for the affected joint should be taught by the therapist in a long session. The patient would do them 2-3 times a day. Exercise should be supervised atleast twice a week by the therapist and the improvement noted. Exercise pools are of great help, where the patient can move his joints freely in all directions.
General exercise should also be given along with specific joint exercises. Resistance exercises should be had to increase the power of muscles which support the body in movement and during work. Exercises should be correlated with other form of treatment.
Exercises in Swimming Pool
A swimming pool used to be a luxury, but not any more. Pools are coming up in bigger towns. Buoyancy makes you lighter so many exercises in pool are not possible outside. Water gives you upthurst, your weight reduces to 9/10. If your weight is 70kgms, in water your legs has to support only 7 kgs. Due to weak legs as in paraplesia or due to painful knees as in arthritis you cannot stand, probably you will able to balance, water will help you to do so. Water relaxes spastic muscles so you can do exercises in water more easily. Water relieves tension and is of great help for tense patients. If pool water is at 37 degrees centigrade it will relax you better and relieve aches and pains. Weightlessness promotes relaxation.
- Tone Up Arms And Shoulders
Stand in water at shoulder level, extend arm on each side, make vigorous circles, 10 forward and ten backwards or more.
- Strengthen Hip And Leg Muscles
Stand in shoulder deep water, back facing side of the pool. Hold on to with both hands, float both legs out in front of you. Move legs alternatively keeping the knee straight. Kick on for one minute. Keep same complete sequence while on your front. Do it 2 minutes and go up to 4 minutes or more.
- Improve Breathing
Stand in chest deep water, take a deep breath in, submerge, squat and exhale slowly at bottom. Straighten and regain standing position. Start again. Do it 5 time and go up to 15 or more.
Many more exercises can be devised. You can do exercises like knee raising, lateral bending etc. Donít forget swimming is the best. Breast strokes are most effective.
Peripheral Vascular Disease
The patient after walking for a few minutes gets acute pain in the calf muscles and is relieved by rest for a few minutes. This is due to the narrowing of blood vessels. The blood supply has to increase during walking. Blood demand increases when the patient walks and if due to narrowing of the blood vessels the supply of blood does not increase an ischaemic condition is reached. The patient get acute pain.
These patients should stop smoking, as cigarette smoking is known to have detrimental effect in such patients. They are instructed to take a brisk walk of one hour every day. They are allowed to rest for a few minutes when the pain recurs and then resume brisk walk again. In a study it was found that the walking ability gradually increased on an average three times, whereas a patient treated by drugs, and no exercises, does not show any improvement. Patients with arterio sclerotic obliterance symptoms who are confined to bed or chair must exercise through progressive restrictive movements performed with the help of a therapist or a member of the family. Age is no bar for doing exercise. A 67 year old man with intermittent claudicating could walk only 5 blocks. Through walking exercise he was cured at the ripe age of 71.