PHYSICAL THERAPY AND THE ARTHRITIS SUFFERER

After orthopedic surgery for his osteoarthritis, Len Mednick saw a physical therapist, who taught him exercises to loosen his shoulder and restore range of motion in his neck. "Soon, I was less at risk biking and driving -- I could look both ways. Eventually, I could even lift my kayak onto the car top, again," recalls the avid outdoorsman.

Susan Mineo, diagnosed with juvenile rheumatoid arthritis in 1972, declares, "Surgery's worked for me, but physical therapy is what keeps me on my feet: it gives me strength, independence and self-confidence."

For anyone with arthritis, physical therapy can be a great help, because it treats three major types of problems:

* pain
* decreased function in everyday activities
* joint deformities

A physical therapist assesses a new patient's weak areas and custom-designs an individual treatment plan. For example, if you have restricted motion in your hip, physical therapy could increase it, which would ease walking, bending, and an array of other activities. Short-term physical therapy helps people recuperating from surgery or recent hospitalization.

Joseph DuPont, a physical therapist since 1978, treats older, homebound arthritis patients in 30-minute sessions. Asking about pain or specific problems, he evaluates their range of motion, muscle strength in limbs and trunk, walk, condition of joints, and the way they perform basic tasks-- from getting out of bed to getting around the house.

"I check on how they were functioning in the community before the current problem occurred or worsened, and try to restore them as much as possible to their previous level," he explains. Besides treatment, he may recommend an assistive device, like a cane or walker.

"Arthritis pain can make people less active. It's a vicious cycle: inactivity leads to weakness and affects the cardiovascular system. A muscle can even atrophy from disuse," DuPont observes. Over time, strengthening a muscle and increasing joint support will often lessen pain, ease walking, and build endurance.

DuPont cautions, "Exercise is for long-term improvement --it won't relieve pain right away, and takes a number of sessions. The patient really has to incorporate a routine to see improvement. I ask them to do some exercise every day."

For 12 weeks, Mednick's therapist, at a local hospital's outpatient clinic, assigned neck or shoulder exercises using a large green stretch band. "At home, I did them every day. After my sessions ended, I kept up those exercises for months--until the band broke," he admits.

Mineo walks and uses a treadmill and stationary bicycle, daily. "My physical therapist has taught me so many different ways of bending, reaching and even showering -- not the norm, but at least I can do them independently," she says.

At treatment centers, physical therapists have more equipment than those seeing homebound patients. Modalities to relieve pain and reduce joint swelling can include hot or cold treatments and ultrasound, and exercise gear such as treadmills, hand weights or stationery bicycles. You won't be trying the most aggressive exercises if you have any significant degree of arthritis, DuPont notes.

It's important to decrease impact-loading on your joints when you exercise. You may want to shift from jogging to walking, or using a Nordictrak, which strengthens without wear and tear, says DuPont. Consider an aquatic program -- water resistance strengthens muscles as you swim or exercise. Some hospitals have therapeutic pools, as do YM/YWCAs and other local facilities, in conjunction with the Arthritis Foundation. (For an Aquatic Program near you, check www.arthritis.org).

"If you don't have severe arthritis, get an evaluation and some tips from a physical therapist. Then formulate your own exercise program within those guidelines--perhaps at a health club, if you can get someone to help you," suggests DuPont.

Physical therapy can bring less pain, more strength, easier walking, greater endurance, and fuller functioning -- but "It's not easy! You have to build a relationship and work with that person. A positive attitude and emotional state are key to maintaining good health with arthritis. My physical therapist helps me maintain my optimism and gives me ways to stay physical," Mineo notes gratefully.

FINDING A PHYSICAL THERAPIST Physical therapists are licensed health care professionals who complete at least a 4-year degree and pass a state- administered national exam. (After 2002, a Master's degree will be required.) In the USA, 90,000 physical therapists treat nearly 1 million people a day, in hospital programs, rehab centers or private practice. Health insurance plans often cover their services. Patients are usually referred by internists, general practitioners, rheumatologists or orthopedists. To try physical therapy, start with a good evaluation and referral from your doctor. To choose a therapist, "Check on their reputation. Make sure the office is well-equipped and pleasant," Dupont advises. Your physician may recommend a particular program, or see the Certified Specialist directory on the American Physical Therapy Association web site, which provides ample information about the profession (www.apta.org)

Many of these articles appear on the publication's website, which are often password-protected or members-only. For your convenience, I've gathered them on my own website.