Editor’s Note: This story is Part 1 of a 2-part series on supplementary treatments for arthritis. Part 2 covers massage for arthritis.
When dealing with the stiff, painful joints that come with arthritis, you might hesitate to try exercises such as Pilates. But incorporating these exercises into a physical therapy routine can be helpful.
“Pilates-based rehabilitation emphasizes controlled movement, postural alignment, core strength, flexibility and body awareness,” said Carolyn Dieter, a physical therapist at UCHealth SportsMed Clinic in Oak Creek. “This approach allows people to improve stability and movement patterns in a low-impact way that is gentle on the joints.”
Pilates is a set of exercises that was developed by Joseph Pilates to improve alignment and core control. By incorporating Pilates into physical therapy, and also maintaining focus on joint flexibility and mobility, Dieter has found that patients can use their muscles in a way that’s more supportive to their joints.
“With arthritis, muscles often begin guarding against pain, which can limit mobility and increase compression on the joints. Over time, that can lead to compensation patterns and additional issues,” Dieter said. “Pilates helps retrain the body to move more efficiently by improving movement patterns and helping the right muscles activate at the right time.”
When working with patients, Dieter often begins with gentle exercises in which the patient is lying down.
“Supine exercises support the trunk and make it easier to find and maintain a neutral spine while learning spinal stabilization and core control,” Dieter said. “Then you can progress to more challenging exercises.”
It can take some focus and thought to perform Pilates exercises correctly, but maintaining good form is of top importance. Which means it’s important not to force the exercises.
“When we talk about core control, sometimes people picture really aggressive core exercises. That’s a misconception,” Dieter said. “While Pilates exercises can be challenging, it’s really about alignment and efficacy, so it’s challenging in a different way.”
Using equipment created specifically for Pilates can also be beneficial. For instance, with the Pilates Chair, patients can do functional exercises with less stress on joints.
“If you’re going down stairs, the muscles are working in a specific way, and the joint angle can create increased stress and pain,” Dieter said. “The Pilates Chair allows you to train those same muscles and movement patterns with less force through the joint. It’s often a more comfortable and effective way to build strength, so patients can perform stairs and other daily activities with less pain.”
The Pilates Chair can also help address hip disassociation, in which the pelvis moves more than it should. By improving alignment and muscle activation, patients can reduce extra motion in the lumbar spine and pelvis, helping to reduce aggravation of arthritic joints.
When incorporating Pilates into a physical therapy regimen, Dieter likes to start by seeing patients twice a week, then spreading out visits as patients progress and become more independent.
While it can take six to eight weeks to gain strength, patients often notice changes in body awareness and posture, along with the ability to move more efficiently, within the first few weeks.
Another physical therapy modality that can be helpful in arthritis is dry needling, in which a small needle is temporarily inserted in trigger points to help stimulate tissue remodeling and help reduce inflammation.
“Arthritis often leads to muscle tension, guarding, and compensatory movement patterns that contribute to pain and stiffness,” Dieter said. “Dry needling can help reduce muscular tightness, improve mobility and decrease pain, allowing patients to move more comfortably and participate more fully in exercise and daily activities.”
While people may sometimes worry that dry needling will be painful, Dieter said that most patients just feel the twitch response of the muscle releasing, which can cause a brief but deep aching sensation.
“A large majority of my patients find it beneficial,” Dieter said.
While the degenerative changes that arthritis brings aren’t reversible, finding ways to reduce pain and improve movement can help people stay active.
“A comprehensive treatment approach that combines manual therapy, strengthening, mobility work and pain management strategies – including Pilates and dry needling – can help individuals with arthritis maintain function, reduce pain and improve quality of life,” Dieter said.
Susan Cunningham writes for UCHealth Yampa Valley Medical Center. She can be reached at cunninghamsbc@gmail.com.