# Hydrotherapy in relation to Rheumatoid Arthritis
## Background

Rheumatoid arthritis (RA) Is a condition of the body where sufferers experience excessive joint pain and stiffness. Commonly occurring during the mornings, RA leaves people with restricted movement and swollen joints. Prolonged endurance of RA can leave patients having stretched ligaments and tendons. Rheumatoid arthritis is commonly due to specific gene types, in conjunction with environmental factors, but has yet to be defined to a specific cause. Including the pain and suffering experienced, RA is linked to other complications including anemia, osteoporosis, muscle weakness and cardiovascular problems and most often affects the hands, knees and feet of both sides of the body. It is unknown as to how RA is triggered, although various bacteria have been thought to attack similar microorganisms, leaving the development of arthritis as a result. Rheumatoid arthritis has an effect on more than 1% of our overall population and predominantly occurs in people aged 35 to 65. RA is an issue that could affect anyone in their middle life. With limited treatment and relatively unknown diagnosis, management of pain and swelling is vital for sufferers.

## Exploration Of Issue

Rheumatoid arthritis occurs in a joint where two bones meet. Often the aggressive bacteria will attack the synovium, forcing white blood cells to rush in, leaving the joint un lubricated and supported from cartilage and synovial membrane. This weakens the muscles, inflames the synovial membrane, causes bone erosion and considerable pain and tenderness. This process can be examined with the picture assistance to the right of page.
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### Hydrotherapy and the Benefits

Exercise is a very important part of our daily lives. Although sometimes the pain can be overwhelming, for rheumatoid arthritis sufferers it's a crucial element for management and recovery. With full weight bearing exercises and potential jarring movements, this is often hard and unwelcoming for sufferers. Hydrotherapy has proven to be an effective method for rehabilitation and management of many illnesses and conditions. Rheumatoid arthritis is no exception. With many sufferers having stability issues, lack of muscle strength, inflammation of joints and severe pain, management and treatment is limited. Hydrotherapy poses a way of exercising while avoiding the unwanted pain and risk of further injury. Hydrotherapy allows free movement, while maintaining strength, range of motion and endurance all before full weight bearing exercise is allowed.
During a hydrotherapy session, the patient will run through set exercises or simply be allowed to soak. Through slight movements, natural water stimulation and water temperatures they will experience ease through movements and enhanced flexibility. Modern hydrotherapy rehabilitation centres have complete control over the environment. Water temperature is one and is a vital with RA treatment. For therapeutic recovery, 34.4 degree waters are ideal. Warmer waters will increase pain threshold and decrease stiffness allowing more ease of movement.

###### Types of Hydrotherapy Exercises

* Mobility - Mobility is aimed at increasing the range of movement in joints. Often this isn't accomplished through daily tasks or light exercise. Hydrotherapy increases temperatures and takes gravity away to allow ease and stress free movement.
* Strength - This is targeted at increasing the power output of muscles. Isometric exercises including stretching are commonly associated with strength rehabilitation as tightening muscles without movement is possible.
* Fitness/Aerobic - Commonly more advance than mobility and strength, fitness exercises involve more full body movements. Only recommended after progressive improvement in all rehabilitation areas. These activities include, under water running, swimming and general movement.

### Supported Studies

* Study supporting effective relief of RA
In 2007 one hundred and fifteen suffers of RA take place in a randomised study. Patients either took part in one 30 minute hydrotherapy session a week or equivalent land exercise. The researchers documented a report of impression of change on a scale of one to seven. The results were strongly showing improvements in comfort, physical function and quality of life. 87% of people doing the weekly hydrotherapy session responded with a six to seven on the scale. With 47% completing the land exercise saying they also felt improvements, the effects of hydrotherapy prove to be greater than weight bearing exercise. Yet both land and hydrotherapy being more effective than no exercise at all.
* Systematic review
In 2013 a review of numerous studies concluded that hydrotherapy was most favourable in management and intervention RA. In comparison to light exercise, walking and weight bearing activities, the greatest positive effect was seen through hydrotherapy sessions. It was clearly noted that the major areas of improvement included reducing pain, lowering joint tenderness, mood and tension reducing, and increasing common grip strength. Hydrotherapy has proven to be an effective method for sufferers of RA. There is currently little known about how effective the long term treatment of hydrotherapy is.

## Recommendations

</gallery> If signs of rheumatoid arthritis are present that sufferers must first see a doctor.Once after diagnosis, hydrotherapists can than be referred to in conjunction with other specific treatments.
Other forms of treatment or assistance methods in treating rheumatoid arthritis include:
* Prescribed medications from Doctor.
* light exercise to increase movement and muscle strength.
* Support and aids. I.e. walking frames, specific cooking utensils.
* Nutritional monitoring, for inflammation treatment.
* Relaxation techniques for pain and emotional induced stress.
* Group activities to share stories and experiences.

## Further reading

* The Arthritis Foundation for further arthritis Information - http://www.arthritis.org/
* Life Care Australia: Hydrotherapy Information - http://www.lifecare.com.au/physiotherapy-hydrotherapy.html
* Further Hydrotherapy information - http://www.sportandspinalphysio.com.au/our-services/hydrotherapy/

## References

* ↑ Mikuls, Ted R. Cannella, Amy. Moore, Gerald. O'Dell, James R. Erickson, Alan, R. Thiele, Geoffrey, M. (2013). Osteoarthritis and Inflammatory Arthritis. Rheumatology (pp. 42). London: Manson Publishing.
* 1 2 3 Elaine N. Marieb & Katja Hoehn (2013). Human Anatomy & Physiology (9thth ed.). USA: Pearson.
* 1 2 Department Of Health and Ageing. (2009). A picture of rheumatoid arthritis in Australia. Australian Institute of Health and Welfare, 4. Retrieved from http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442459857
* ↑ Foundation, A. (2014). Rheumatoid Arthritis. Retrieved September 28, 2014, from http://www.arthritis.org/arthritis-facts/disease-center/rheumatoid-arthritis.php.
* 1 2 Channel, B. H. (Oct 2013). Symptoms of rheumatoid arthritis. Retrieved September 28, 2014, from http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Rheumatoid_arthritis
* ↑ Nedim, D. M. (2011). Hydrotherapy & Aquatherapy. Sports Injuries (pp. 1132). Turkey: Springer.
* 1 2 Australia, A. (2013). Hydrotherapy. Retrieved September 28, 2014, from http://www.arthritisaustralia.com.au/images/stories/documents/info_sheets/english/colour/Hydrotherapy.pdf
* ↑ Barbara, B. (2014). Physical Agents: Theory and Practice (3rd ed.). Philadelphia: F. A. Davis Company.
* ↑ Lis, Eversden., & Paresh, Jobanputra. (2007). A pragmatic randomised controlled trial of hydrotherapy and land exercises on overall well being and quality of life in rheumatoid arthritis. Retrieved September 29, 2014, from http://www.biomedcentral.com/1471-2474/8/23/
* ↑ Department of Health Professions (2013). The effectiveness of hydrotherapy in the management of rheumatoid arthritis: a systematic review.. Retrieved September 29, 2014, from http://www.ncbi.nlm.nih.gov/pubmed/22806987
* ↑ Kennedy, K. (n.d.). Nutrition Guidelines for People With Rheumatoid Arthritis. Retrieved September 28, 2014, from http://www.arthritistoday.org/about-arthritis/types-of-arthritis/rheumatoid-arthritis/daily-life/nutrition/rheumatoid-arthritis-diet.php