While there is no special diet for arthritis, researchers have identified certain foods and supplements that may be helpful. One group of foods that reduce inflammation, called anti-inflammatory foods, has shown promise in some studies. Anti-inflammatory foods contain compounds that help control inflammation in the body, which is a hallmark of RA. These foods comprise what is known as the anti-inflammatory diet, sometimes also referred to as the Mediterranean diet.
Before beginning any new dietary or supplement regimen, it’s important to talk to your doctor.
What’s in the Mediterranean Diet?
Fish oil is an excellent source of omega-3 fatty acids, which the body converts to powerful anti-inflammatory chemicals. Fish oil has been studied extensively in RA and other inflammatory conditions. Studies have shown that fish oil can relieve joint tenderness and morning stiffness, reduce the duration of morning stiffness and reduce disease activity in people with RA. For some people, it has allowed them to lower the amount of conventional medicine they take for their RA. Early studies show that fish oil may have similar effects in people with osteoarthritis.
Some evidence suggests that the positive effects of fish oil supplements are enhanced when fish oil is consumed in combination with olive oil. Since it is difficult to get enough fish oil from food alone, people with RA should consider fish oil capsules with at least 30 percent EPA/DHA.
It’s important to talk to your doctor about the right dosage of fish oil for you if you choose to start taking it. Higher doses of fish oil may interact with certain drugs, including those for high blood pressure.
Foods to Avoid with Arthritis
Some foods have been found to increase inflammation and should be avoided as much as possible if you have arthritis. These include:
While some people believe gluten can worsen RA, there is no evidence to support this. However, those who are sensitive to gluten (found in wheat, barley and rye) should avoid eating it in order to avoid bowel inflammation.
Alcohol and Tobacco – Call it Quits
Cigarette smoking is bad for everyone, but in people with RA it has been shown to increase the severity of the disease. Smoking can also make it harder to manage RA. Studies show that people with RA who smoke are less likely to achieve remission and tend to have a worse prognosis.
Smoking can also increase painful rheumatoid nodules, which form in the joints, and can lead to heart disease, the leading cause of death in people with RA. People with RA are at greater risk for heart disease compared to the general population.
Drink Alcohol in Moderation
Studies are mixed on the effects of alcohol on RA. While alcohol does not contribute to or worsen RA like smoking does, experts say it’s best to have one or two glasses of wine, beer or spirits occasionally, but not more than that. If you are taking non-steroidal anti-inflammatory drugs (NSAIDs) or acetaminophen, alcohol can increase your risk of stomach bleeding and liver problems, respectively. Drinking more than two glasses per day can also increase your risk of certain cancers.
The need for physical therapists and other allied healthcare professionals at skilled nursing facilities is on the rise, driven in part by a growing need for rehabilitative services for the country’s aging population.
Other pressures also are increasing the demand for therapists and therapist assistants at skilled nursing facilities, or SNFs. These include the addition of millions of covered healthcare consumers from the Affordable Care Act or ACA, and regulations pushing reduced readmissions, fewer ER visits and better patient outcomes.
“With increased emphasis on shortened hospital stays, we assist patients in recovering, getting back on their feet and becoming well and strong,” said Keith Collins, Director of Rehab Services for Life Care Centers of America. “This has increased the need for physical therapists in our centers, and we believe that demand is only going to grow in the next several years.” Life Care Centers of America operates 220 skilled nursing facilities in 28 states.
Physical therapist and physical therapist assistant positions are projected to grow at a faster-than-average rate through 2022, according to the U.S. Bureau of Labor Statistics, which reports a 36% projected growth rate over 10 years for physical therapists and a 41% growth rate for physical therapist assistants.
Vital to Healthcare Reform
Physical therapy is vital to enhancing the long-term wellness of patients, which is key to the triple aim of healthcare reform:
As the Baby-Boomer generation continues to age, the need for physical therapists in these skilled nursing facilities is expected to gain momentum. Increased demand can lead to shortages.
“The increase in the aging demographic plays a central role in the increasing demand,” Lyons said. “Baby Boomers are living longer than previous generations, and living longer increases the risk of mobility-related injuries and chronic disease. Those conditions are exactly what therapy can help address.”
Another contributing factor is the growing population of those insured under the ACA. According to the American Physical Therapy Association, while an increase in graduates from physical therapist education could slightly lower projected workforce shortages, the trend of increased healthcare coverage will mean that the demand for therapists and assistants will continue to climb between now and 2022.
Demand Outstrips Supply
In addition, there are a greater variety of employment options for therapists today, which can further exacerbate shortages in particular specialties. Demand for therapists is not only occurring in skilled nursing facilities, but also in other patient care settings. “Therapists have more opportunities to choose among, which will create additional supply constraints in the skilled nursing setting,” Lyons said.
While therapist assistants can relieve some of the shortages, they are also in high demand and Collins said that greater utilization alone of therapist assistants will not solve the supply problem. “Because demand for physical therapists is growing faster than the pipeline of professionals can effectively fill, the demand for certified physical therapists assistants is also increasing,” he said. “However, physical therapist assistants can neither assess nor diagnose patients, but are only certified to assist in executing the rehabilitation plan created by a physical therapist.”
Lyons said the pivotal issue of how to find these in-demand professionals lies in strategic workforce planning and services. “For locating and recruiting the best-qualified professionals for a skilled nursing setting, a Managed Services Provider (MSP) solution is a very good option,” he said. “Generally, the SNF market is made up of larger rehab management companies that either own or manage SNFs across many states and regions. The fragmentation makes them a perfect fit for the MSP model, not only to address supply constraints but to also help them manage risk and efficiency within their organization.”
Balance problems make it hard for people to maintain stable posture and stay upright when standing, walking, and even sitting. Balance problems are more common in older adults and are the most common reason they seek help from a doctor. If balance problems go untreated, they can lead to falls. Physical therapists can help people of all ages improve their balance. They perform balance testing and develop treatment plans that include physical activity to help improve the strength, stability, and movement of people with balance problems.
Physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and prescribed movement. You can contact a physical therapist directly for an evaluation act Zenergy.
What Are Balance Problems?
A balance problem exists when a person has difficulty keeping a stable and upright body position, whether moving or staying still. There are many causes of balance problems, including:
How Does It Feel?
A person with balance problems may experience:
Balance problems can make people fear doing simple daily activities. As a result, they may avoid movements they deem hard or that challenge their muscles. This will cause them to sit too much. This lack of movement leads to weakness that makes balance problems worse. A person who has balance problems also may feel frustration about their condition and become depressed.
How Is It Diagnosed?
If you see a physical therapist first, they will conduct a full evaluation that includes taking your health history. Your physical therapist also will ask you detailed questions about your condition, such as:
People who suffer from lower back pain are encouraged to help with their own recovery by exercising and getting physical therapy, but are seldom given the knowledge and tools needed to accomplish this. This discussion will provide a basic understanding of the causes of lower back pain, and discuss appropriate steps to exercise and rehabilitate a painful back.
Of course, getting better is only the beginning, since further episodes of back pain are quite common as time passes. Whether suffering from the first bout of low back pain or following extensive treatments or even surgery, the best way for patients to avoid or minimize the severity of recurrences is to rehabilitate the back through appropriate back exercises.
Exercise and Causes of Back Pain
There are several structures in the back that can cause and/or contribute to low back pain. These include:
Intervertebral DiscsAlthough the intervertebral disc is a remarkably versatile and strong structure, essentially acting as a shock absorber during everyday activities, sometimes the disc fails when there is a sudden, unexpected force (such as a fall, lifting, or other trauma), or due to ordinary wear and tear over time. And when the disc does get injured it cannot repair itself very well, which is one of the major reasons recurrent back pain is so common.
advertisementMaking matters worse, the pain often interferes with a patient's ability to exercise, which adversely affects disc nutrition. Nutrition for the disc is achieved when physical activities and exercise cause the disc to swell up with water and then squeeze it out - much like a sponge. When pain affects our physical activity, the injured disc is deprived of its nutrition and begins to degenerate.
Activity is also needed to maintain the exchange of fluids in spinal structures and reduce swelling that naturally occurs in the tissues surrounding an injured disc. This swelling can further irritate nerves that are already affected by herniated disc material.
Spinal Muscles, Ligaments, and TendonsThe collective soft tissues around the spine - the muscles, ligaments and tendons - are also very important in maintaining proper spinal balance and strength. With decreased activity, the connective fibers of ligaments and tendons can begin to adhere to each other and lose resilience and may tear when sudden overload occurs. Unlike discs or connective tissue, however, when soft tissues are injured, they can quickly repair themselves.
advertisementSince muscles are in constant communication with the central nervous system, anger or anxiety can tense the muscles and cause muscle spasms. Ongoing tension inhibits normal muscle function and leads to muscle wasting and further stability problems, which in turn can lead to chronic lower back pain.
Spinal NervesWhen nerves are cut, pinched, or otherwise irritated, the muscles that the nerves control cannot work. For example, when a herniated or bulging disc presses on the L4-L5 nerve root, it may inhibit the nerve's ability to make the muscles it controls in the ankle and foot work properly, causing what is known as foot drop - the ability to raise the foot or stand on one's tiptoes.
Acute vs. Chronic Back PainIt is important to note that acute pain is different from chronic pain. We have all experienced acute pain from a sudden soft tissue injury, such as a sprained ankle, or even just a simple paper cut. The pain is immediate, but as the injured part heals the pain goes away.
Unlike acute pain, however, chronic pain does not correlate to an anatomical injury. It comprises a constant low level of stimulation to the nervous system that eventually becomes a pattern. It may even persist as a "neural memory" after the initial source of irritation has resolved. The nervous system adapts to this chronic stimulation by creating an environment in which events that previously caused no pain become a source of pain. Pain may even progress to uninjured areas.
Emotional distress and certain medications can exacerbate this phenomenon. An effective solution is to distract the nervous system by means of active exercise in a controlled, non-destructive manner. Active exercise also helps to create the physiological conditions that allow the injured structures to heal.
The most common cause of knee pain can hit you in your 30s as easily as it can in your 60s and 70s. Orthopaedic surgeon Robert Nickodem Jr., MD says osteoarthritis, or “wear-and-tear arthritis,” is the most common cause of knee pain – and the most common form of arthritis.
Osteoarthritis includes more than 100 different types of arthritis or joint inflammation and rates of it have been steadily rising year after year.
“Osteoarthritis is like a rusty hinge,” says Dr. Nickodem. “The knee still works, but it creaks.”
Fortunately, osteoarthritis is treatable. You may never be completely pain-free, but you can manage the condition and keep your symptoms under control.
To help alleviate the “creaking” and soothe your knee discomfort, Dr. Nickodem recommends:
How can you tell if you have osteoarthritis?
“If you have pain inside your knee, under your kneecap, especially when kneeling, squatting or going up and down steps, it’s usually wear-and-tear arthritis,” says Dr. Nickodem.
Cartilage, the cushioning between bones, deteriorates throughout life. It can erode more quickly in some people due to injury or genetics. As cartilage thins, your bones begin to rub together, causing pain, swelling and stiffness.
Sometimes the level of pain does not always correlate to the severity of the condition.
When to call your doctorIf your pain and swelling are getting worse and you can no longer put weight on your knee, see your doctor. A simple X-ray can show if there is osteoarthritis and, if needed, an MRI scan can check for meniscal tears or loose chips of cartilage.
Arthroscopic surgery can sometimes remove loose cartilage. Partial or total knee replacements are other surgical options, especially for those who can no longer stay as active as they’d like. Sometimes computer assistance is used for some complicated knee replacements.
“Surgery is a last resort, though,” says Dr. Nickodem. “It’s something to consider when nonoperative treatments aren’t helping.”
Women and girls often experience knee problems, especially knee pain and pain around the kneecap.
Anatomically, women may be more susceptible to knee problems than men because the female pelvis is wider than the male pelvis, increasing the angle from the hip to the knee. This is called the “Q angle,” and it can affect the angle between the knee joint and the lower leg. If the “Q angle” is large, there may be increased stress across the kneecap and the knee joint, resulting in knee pain, kneecap tracking and alignment problems.
Women who are bowlegged or knock-kneed often have inner or outer knee pain, pain around the kneecap or cartilage injuries.
Women also tend to have more ligament laxity in their joints than men, which may lead to a higher incidence of injuries like medical collateral ligament (MCL) and anterior cruciate ligament (ACL) strains or tears, especially in female athletes. Hormonal changes through the month can also play a role in the laxity of ligaments.
Other contributing causes of knee pain include:
Stretching with the physical therapist and at home on your own should not be forceful and should not cause pain. If you feel pain, you may be too aggressive with the stretch and need to back off the stretch. A few well-done stretches will give you better therapeutic benefit than many poorly done exercises.
If you have knee pain or pain around the kneecap, you might be a candidate for physical therapy.
Manual physical therapy (PT) refers to a cluster of hands-on therapeutic techniques used by a therapist to treat a wide variety of symptoms and conditions.
This style of treatment, which is often performed alongside other rehab techniques like exercise or pain-relieving modalities, can be helpful in addressing numerous different concerns, including pain, stiffness, or range of motion limitations.
What Makes Manual Therapy “Hands-On”?
Whether it is passively moving your joints, massaging a body region, or stretching a muscle, this type of therapy allows your physical therapist to harness their knowledge of anatomy and pathology while using their own hands to treat your specific condition.
Manual therapy can be utilized for various purposes, including increasing the flexibility of a muscle, relaxing a muscle group, improving the range of motion at a joint, or decreasing your pain.
Oftentimes, this treatment category is particularly valuable during the more acute phases of rehab, when your movement may be more limited in a region and pain levels are traditionally higher.
As symptoms begin to subside and movement improves, manual therapy may still be utilized later on in combination with more active therapy techniques, like strengthening, balance training, or plyometric exercise.
Ultimately, passive hands-on treatments are a beneficial part of your care, but they are seldom performed in isolation without a complementary active component.
Therapeutic TechniquesAs you might expect, manual therapy is considered a “hands-on” treatment because each technique within this category involves the therapist physically touching you.
Among the wide variety of different hands-on techniques included in this rehab category are:
After a thorough evaluation, your physical therapist can provide you with more information about which hands-on techniques may be useful to you.
When to Try Hands-On Physical Therapy
Manual therapy can be a valuable addition to PT for a variety of concerns. For example, following a surgery or procedure, joint mobilizations and passive stretching often play an important role in recovering your range of motion in the affected area.
Certain types of manipulations and mobilizations may also be used following a more acute injury, like a back or neck strain. In addition, soft tissue massage can be beneficial for managing chronic pain complaints and improving participation in the more active components of therapy.
Many different specific diagnoses have been found to benefit from manual physical therapy. For instance, several studies have shown improved pain and function in patients with knee osteoarthritis after being treated with soft tissue massage.
People with shoulder pain also responded favorably to joint mobilizations and manipulations to their mid-back.The same is true for individuals with neck pain whose therapy treatment included mobilizations and manipulations to their upper (cervical) spine.
Finally, passive stretching, massage, and mobilizations can help manage the symptoms associated with plantar fasciitis.
Because of the wide range of conditions that may benefit from hands-on physical therapy, it is important to speak to your physical therapist about your individual symptoms.
Manual Therapy CostsEstimating the cost of manual therapy can be difficult. While most therapists can provide you with an upfront price guide for physical therapy if you pay out of pocket, the large majority of patients elect to use their insurance to cover their therapy costs.
In most cases, manual physical therapy is covered as a part of your insurance’s physical therapy benefits when it is deemed to be skilled and medically necessary by both the therapist and the insurance. That said, under most insurance plans, you are still responsible for any co-pay, co-insurance, or deductible costs that apply.
It is also important to work with your physical therapist to ensure coverage, as some hands-on techniques (like massage) can be coded in several different ways, some of which may be denied by your insurer.
For an accurate estimate of costs, it is a good idea to speak to your insurance carrier before you receive care. They can point you in the direction of a provider whose manual services are in network and can give you a rough idea of what you can expect to pay.
There are no direct substitutes for the skilled manual therapy you receive from a physical therapist. However, in some cases, the cost of physical therapy makes receiving care unattainable, and at-home alternatives must be considered.
Many different devices are available for purchase that attempt to replicate some of the hands-on techniques performed by a therapist. For example, foam rollers can be used to improve flexibility and range of motion in a muscle when combined with stretching exercises.
Other pieces of equipment, like massage guns or massage balls, are also widely available, though their benefits are still being studied. Be sure to speak to your physician before starting to use any at-home device to ensure it is appropriate for your specific situation.
In addition, you may want to speak to your physical therapist about any financial difficulties you are having. Many clinics have self-pay discounts or sliding scales based on your income, which can make receiving physical therapy more affordable.
Manual therapy includes several hands-on treatment techniques used by a physical therapist to treat various conditions. These techniques may be used together or separately, especially in the acute phase of rehabilitation. Later, they may be used in addition to exercises. While all physical therapists are trained in manual therapy, some specialize in it.
A Word From VerywellPhysical therapy is an effective treatment option for a wide range of pain-causing conditions, and manual therapy can play an important role in your rehabilitation. Whether your pain is the result of surgery, an injury, or a chronic condition, it is important to remember that living in pain doesn’t have to be normal.
If you are dealing with a musculoskeletal issue that is impacting your ability to function, be sure to speak to your doctor about whether physical therapy and manual therapy are right for you. Getting connected with a physical therapist who is skilled in hands-on treatments is often the first step on your road to recovery.
Frequently Asked Questions
How does manual therapy differ from physical therapy?
Manual therapy refers to a cluster of hands-on treatments that may be included in a physical therapy session. Depending on your individual condition, passive manual therapy interventions are typically utilized alongside other more active treatments (like exercise) while you are in rehab.
What are the benefits of manual physical therapy?
Manual physical therapy can provide you with several benefits, including pain relief, increased joint mobility, better range of motion, and improved muscular flexibility.
Is manual therapy the same as massage? Soft tissue massage is one of several “hands-on” techniques included in the cluster of manual therapy interventions. Unlike at-home massagers, the manual techniques provided by a physical therapist utilize their specific training in anatomy and pathology to care for your body’s unique needs.
Manual therapy includes several hands-on treatment techniques used by a physical therapist to treat various conditions. These techniques may be used together or separately, especially in the acute phase of rehabilitation. Later, they may be used in addition to exercises. While all physical therapists are trained in manual therapy, The Zenergy Team specializes in it.