Living with psoriatic arthritis can mean chronic joint pain and swelling, constant fatigue, and a limited range of motion that makes daily activities a challenge. But working with a physical therapist can help alleviate some of these symptoms.
Regular exercise helps keep joints functioning properly, but it’s important to exercise safely and use correct form. That’s where physical therapy (PT) comes in, according to Maura Iversen, DPT, dean of the college of health and wellness at Johnson & Wales University in Providence, Rhode Island.
- Develop an individualized fitness plan that includes strengthening, stretching, and aerobic exercises, and show you how to execute them properly.
- Demonstrate proper posture and body mechanics for day-to-day activities to help relieve pain and improve function.
- Recommend options such as braces or splints, shoe inserts, and heat or cold therapy to support joints and ease pain and stiffness.
- Teach you how to use assistive devices that can improve your mobility and help you perform daily tasks.
- Suggest modifications to your physical environment (ergonomic recommendations) and lifestyle to help you conserve energy and improve function while protecting your joints.
In this Q&A, Iversen talks about how physical therapy can benefit people with psoriatic arthritis and what you need to know about finding the right physical therapist for you.
1. When Should Someone With Psoriatic Arthritis Consider PT, and What Can They Expect?
Iversen: Joint pain and swelling from psoriatic arthritis, coupled with tendon inflammation (enthesitis), are usually what lead people and their physicians to consider physical therapy as a treatment option. You may also be experiencing severe fatigue due to the systemic inflammatory nature of the disease. Whether you have active or stable disease, a referral to a physical therapist can help you understand how exercise and lifestyle changes can help you manage. If your doctor has not yet suggested PT, consider asking for a referral at your next visit.
A physical therapist would begin the initial clinic session with:
- Your complete health history, including sleep habits, hygiene, and more
- A discussion about your physical environment at home and work
- A vital sign assessment, including blood pressure and heart rate at rest and with exercise
- A full-body exam, including joint range of motion
- A joint alignment exam to determine if malalignment is placing stress on the joint during movement (if so, it indicates a need to practice caution when exercising that joint)
- Strength testing
- Aerobic performance test to assess endurance
A physical therapist may also ask about your goals for treatment and function, discuss potential barriers, and talk about how to implement a comprehensive PT program.
2. What Can a Physical Therapist Do to Help You?
Iversen: A physical therapist can help you manage psoriatic arthritis symptoms in a variety of ways. The PT program can enhance endurance through regular aerobic exercise, such as bicycling, speed walking, and swimming. Low-impact exercises, such as tai chi and yoga, are recommended during flares. High-impact exercise can be implemented when the disease is stable, when there is no joint malalignment, and based on your preferences. Strength and joint motion can be improved with a tailored strengthening program and stretching regimen. Losing weight through lifestyle changes and exercise can also be effective in reducing psoriatic arthritis symptoms. Additionally, passive treatments, such as massage or TENS (transcutaneous electrical nerve stimulation), can be used in conjunction with exercise to help you manage symptoms.
If you’re having trouble functioning at work, a physical therapist can conduct an ergonomic evaluation. They can help you modify your workspace or even speak to your company to create a better work schedule to accommodate you. This could include part-time or fully remote work.
3. What Are Some Common Obstacles to Trying PT, and How Can People With Psoriatic Arthritis Overcome Them?
Iversen: Fear of movement and of engaging in exercise is a common concern for people with psoriatic arthritis. You may worry that movement may cause more joint destruction.
Chronic, inflammatory diseases such as psoriatic arthritis have symptoms that come and go. With psoriatic arthritis, one week you may look and feel fine, and then the next week your symptoms may flare. This fluctuation in symptoms makes it difficult to understand whether the pain you’re experiencing is typical discomfort from exercising after a period of inactivity or from an increase in disease activity.
The benefits of exercise may seem counterproductive, because you’re stressing the joints during exercise. But the goal is to exercise within your pain tolerance and slowly build up strength, endurance, and range of motion. A gradual increase in intensity and frequency of exercise allows you and your physical therapist to determine how your body responds to exercise.
Remember: You are the expert on your body. You know what you can and can’t do. You need to pay attention to your body’s reaction to exercise. If 30 minutes of exercise is too much, you can split the routine into smaller intervals — for example, 10 minutes of exercise, three times a day. If 30 minutes is the threshold for building aerobic capacity, you and your therapist can find ways to complete 30 minutes of exercise while reducing joint pain and stiffness.
4. Is PT Different for People Who Are Athletic?
Iversen: Athletes tend to be self-motivated and good at goal setting and achieving goals. They often are very aware of their body’s capabilities and listen to their body’s response when exercising. If an athlete can only do five reps instead of 10, it’s not a big deal to them.
Nonathletes often need external motivation and tend to benefit from the support of exercising in a group or with a physical therapist or fitness instructor. Someone who is not athletic may wish they could do more but might be unclear on how to self-motivate. The group setting is very helpful for nonathletes to feel more comfortable with exercise.
The Arthritis Foundation has some wonderful collaborative programs. I keep a list of what’s available for people, and I connect them with the types of resources they’re more likely to use.
5. How Do You Know if You Have the Right Physical Therapist?
Iversen: Exercise is a form of medicine. Just as a rheumatologist will adjust your medication to identify which drug works best, you need a physical therapist who will help you determine the best exercise regimen, use of assistive devices, and adjunct therapy (such as massage) for the different phases of disease activity and based on your current physical condition. When you’re in a flare, the regimen needs to be adjusted according to the active symptoms. When the flare subsides, a greater emphasis on higher intensity, frequency, and duration of exercise can be used.
Physical therapists can specialize in various practice areas, such as geriatrics or pediatrics. Identifying a physical therapist who specializes in rheumatic diseases is important. The American College of Rheumatology maintains a database of providers specializing in rheumatic conditions. You can also search for a physical therapist who specializes in orthopedics through the American Physical Therapy Association.
6. Will Insurance Cover PT for Psoriatic Arthritis?
Iversen: Each insurance company has different fee structures and visit allowances. If you are referred by your rheumatologist or primary care specialist, sessions should be covered. Your therapist’s office should know what the insurance company allows. This can help the physical therapist determine the best way to care for you.
The Takeaway
- Engaging in physical therapy for psoriatic arthritis can greatly improve joint mobility, strength, and daily functioning while helping you stay active safely.
- A physical therapist can also help you overcome barriers such as fatigue or fear of worsening symptoms, guide you through an individualized exercise plan, and help you modify your exercise program as needed during a flare.
- Seeking out a physical therapist with expertise in rheumatic diseases, such as psoriatic arthritis, can help you get specialized care.
