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Physical Therapy in

Spondyloarthritis

Angelo Papachristos BSc, BScPT ,CAFCI, MBA

Advanced Practice PhysiotherapistSt. Michael’s HospitalToronto, Canada

Boston, May 3, 2018

PT Management: What the Rheumatology Trainee Needs to

Know

Disclosures

• Nothing to disclose related to topic and discussion material

Objectives

• To better appreciate the common rehabilitation therapies and treatment modalities utilized in the treatment of spondyloarthritis in ambulatory care practice

• To appreciate the current rehabilitation landscape when referring clients for therapy

• Have basic understanding of treatment protocols and care plans implemented by PT

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• Strong recommendation:

– Physical therapy over no physical therapy

– Supervised exercise over passive interventions (massage, ultrasound, heat)

– Land based over aquatic therapy

“What does a rheum trainee

need to know”…about PT and SpAmanagement

1. Provide Education

2. Stretch/Strengthen/Postural

3. Cardiovascular conditioning programs

4. Mobilize / Manipulation

5. prescribe assistive devices / bracing / splinting / orthotics

6. Use of Therapeutic Modalities [electrotherapy and non-electrotherapeutics]

7. Ergonomic and functional abilities evaluation

Common Modalities

• TENS –Transcutaneous Electrical Nerve Stimulation

Interferential Current (IFC)

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Therapeutic Ultrasound Therapeutic Ultrasound

• Actually NOT a form of sound or electrical energy…..

• Mechanical Energy

• Piezoelectric crystal vibration at high frequency producing sound energy

• Typically humans hearing 16 Hz-20000Hz

• Ultrasound typically 1-3 Million cycles per second

• It is Pro-inflammatory

1 MHz vs. 3MHz

Half Value Depths

Blood Fat Nerve Muscle Skin Tendon Cartilage, Bone

Increased Protein content RESULTS in Increasing absorption

• To some degree operator dependent [settings, dose, duration, proper application]

• Reflection of almost all US at metal/air interface (>99.99%)

• Refraction if beam does not strike surface at 90°. ie the path of beam will be angled. If treatment head is at angle >15° beam will just travel via the dermal tissue /parallel to skin surface.

Pulsed vs. Thermal

• Thermal – essentially continuous wave,generates deep heating in tissue. Can raiseinternal temp to 40-45° and cause tissuehyperemia. Possible use in chronicinflammatory state

• Pulsed (Athermal): interrupted pulse,combination of cavitation and acousticstreaming. Most effective in proliferativestage, early remodeling stage

Low Level Laser Therapy [LLLT]

Superficial application of laser at wavelengths of 632-904 nm

The penetration of both He-Ne and infra-red lasers was observed for only a few millimeters.

The most important absorption was observed at the depth level of 0.4 and 0.5 mm.

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Acupuncture /Dry needling

12 Standard Meridians, 8 extraordinary channels 400 standard acupuncture body points

Graston Technique• “Changing the way soft tissue injuries are treated. Graston Technique® is

an evidence-based form of instrument-assisted soft tissue mobilizationthat enables clinicians to effectively address scar tissue and fascialrestrictions through comprehensive training, resulting in improved patientoutcomes”

Knee acupuncture /electroacupuncture

Yes…TAPE…because we can….

Shoulder Impingement /RC Cupping

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Acupuncture/ Moxa

Exercise Benefits

• Increased cardiovascular endurance• Reduced blood pressure and stress• Increased good cholesterol (HDL) • Maintains muscle mass• Maintaining bone density• Maintain or reduction in weight• Psychological –improves well being,

depression• Improves fatigue• Pain reduction / pain modification

ACSM RECOMMENDATIONS

Exercise Benefits –

Recommendations - Guidelines

• Osteoporosis Guidelines

▫ Exercise (30 min 5X /week , stretch 2X/ week), quit smoking, ↓ ETOH, ↓ Caffeine, ↑Vit. D.

• Diabetes Guidelines

• Osteoarthritis Guidelines

• Cardiac Guidelines

• Chronic Fatigue, Depression, Fibromyalgia

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% grade 9-12 students watching >3 hours TV /school night

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Get Started –Home Exercise

www.wegotyourbacktwh.ca

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iPhone App

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Neck Retraction

1 2

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12

3

140°

1.5-2 feet

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Supine to Sit -Bed Rise from Chair

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Lumbosacral Rotation

Core –rotation with weighted ballSummary

• 150 minutes per week of physical activity is magic number!

• Passive modalities not indicated in SpA –exception rather than rule

• Link with physiotherapist /facility in community

that has interest in SpA

• Physiotherapy intervention for most part is to develop, monitor and alter physical fitness and wellness program for SpA over time.

• Program must be patient specific /setting specific

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Questions?

Core with weighted ball - BOSU

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