Importance of Exercise in Rheumatic diseases

Rheumatic diseases affect either the joints or muscles or skin or a combination of more than one or all of the above mentioned organs. The inflammation in the joints or the muscles leads to stiffness in the joints and weakening of the muscles. Muscles are extremely important in moving the joints and supporting the bones.

To illustrate a few examples:-

In Osteoarthritis the knees suffer from wear and tear of the cartilage and subsequent grating and friction between the bones which causes pain while walking, climbing stairs or getting up from sitting position. It is extremely important to off load the knees by strengthening the thigh and the buttock muscles so as to prevent further wear and tear of the knees.
In Ankylosing Spondylitis (A kind of arthritis affecting the spine, dealt with in a separate article), the inflammation results in fusion of the vertebrae and the entire spine becomes stiff over time. Here exercises are exceedingly important to keep the vertebrae mobile and prevent them from fusing with each other. Mechanical back pain due to degenerative disease of the vertebrae such as “slipped disc” etc would benefit greatly from exercise. In fact in such patient exercise is the main treatment and not medication.
Hence exercises are extremely important in all patients suffering from rheumatic diseases.

Which exercises do you need to do?

What we mean by exercises are systematic exercises as taught by a physiotherapist under the guidance of a rheumatologist: These exercises are taught after examining the affected joints so as to improve the range of movement of the joints and toning the muscles in the affected area without straining the joints.

The following do not construe exercise:

Household work: A lot of women feel that because they do all their household work they are set and no further exercise in needed. Household work is tiring. Exercise is refreshing and rejuvenating so how can they be the same. During our routine lives we do a lot of work which strains the joints. Exercise is meant to reverse that so it is not the same.
“Pranayam”: Pranayam is very good for improving our breathing pattern and calming the mind. But it does not contribute to our muscle strength or improve joint mobility.
Walking: Walking is a good exercise for the legs. It promotes blood circulation in the lower limbs mainly the calf muscles and hence is a useful for patients with Diabetes mellitus and heart disease. Walking does not help the thigh muscles hence it will not help people with Osteoarthritis. Moreover walking is of no help for the shoulders, arms, hands, neck , back etc unless you do “Shirsasan” (Head stand) and also walk on your hands.

What about Yoga?

Well Yoga is nearly as good but the problem with Yoga is that some yoga postures are not appropriate for patients with certain rheumatic diseases and this prescription varies from patient to patient depending on their rheumatic disease. Since Yoga teachers are not medical professionals, they cannot decide which exercises are recommended or inappropriate for a particular patient. Many patients resorting to yoga have landed up suffering an injury or worsening in their joint condition.

“But exercise makes me feel worse!”

It is only natural to feel pain when you have hardly ever done any exercise before. Your joints are weak and stiff. Your muscles are weak. Initially, exercises are bound to feel like the most difficult task in the world, but as you persist things get better and better. Soon, you will reach a stage where you feel like normal human being again, and doing day to day activities become easier.

“But Doctor I just don’t have any time!”

“My family duties take up all my time. My children … school … cooking … tiffin … homework… in-laws … blah blah blah!”
Narendra Modi exercises every single day. He is a busy man, you’d have to agree. Manmohan Singh exercised every single day he was a PM and still does, by the looks of it. If the Prime Minister of India can exercise everyday, then why can’t you? Do you have to worry about 1.3 billion Indians?

Exercise does need to be done at a specific time. Who said you have to do it only in the morning? Do it in the afternoon when you children are in school, just before you have your lunch. Or do it in the early evening before you start cooking dinner. Any time is a good time to exercise.

Please remember, medicines will only control the inflammation in the joints and relieve you of pain. Only exercise can help reduce the joint stiffness, improve mobility and regain strength. There is absolutely no way to avoid exercise. you may even start enjoying it!