1.Joint activity training
(1) Shoulder and elbow movement: Hands together, swing up and down along the midline, place the hand on the pillow and neck, then move to the back, relax the shoulder, swing the hand back and forth or make circular movements.
Wrist movement: Cross your palms and fingers together for a back and forth movement.
Note: Only slightly cross your hands and gently squeeze your fingers, place your wrists flat on the table or in warm water.
Finger exercises: one hand helps the other hand to flex the distal phalanges first, then the proximal phalanges and metacarpophalangeal joints.
Hip and knee exercises: bend the knee, heel as close to the hip as possible, stay for 1min, then straighten and alternate between the legs.
Foot-distance calf joint movement: standing position, hands on the table, tiptoeing in a circle movement.
(2) Bipedal exercise: the patient stands with his back against the wall, with his feet separated by the same width as his shoulders, squats slowly until the knees are flexed 45°-60°, then rises again, once a day, squats repeatedly about 10 times. Supine position, feet do “pedal bicycle” exercise, once a day, repeatedly pedal about 10 times.
2.Muscle strengthening training
Supine position, straight leg raise, knee extension, bilateral knee flexion 90°, ankle dorsiflexion, then lower limbs consciously force to the knee, while straight leg raise to the level of the opposite knee, hold in the air for 5 seconds, relax after falling; can easily complete the straight leg raise when the ankle hanging sandbags (0.5kg) exercises, gradually increase the weight, the maximum to 4.0kg, once a day, 15 times for a 15 sessions per day.
Isometric contraction of quadriceps: supine knee extension, consciously pull the patella proximally with quadriceps while pressing the N fossa downward on the bed, slowly contract at the beginning, contract completely with all your strength, hold for 5 seconds, then relax.
Supine straight leg raise exercise: supine knee extension position, contralateral knee flexion 90 °, first ankle dorsiflexion, then the entire lower limb consciously to the knee force, while straight leg raise to the level of the contralateral knee, hold in the air for 5 s, fall down and relax, to be able to easily complete straight leg raise when the ankle hanging weights exercise (home training can be made of rice or sand 0.5kg bags several) Later, from 0.5kg, gradually increase the straight leg raise to half the height of the opposite knee when hanging weights. The maximum weight is increased to 4.0kg.
Lateral lying hip abduction exercise: lying on the side, knee extension position, do hip abduction exercise, keep parallel to the body in the air for 5 seconds, then put down, repeat several times.
Supine knee abduction exercise: supine knee extension position, put a ball between the two thighs, hold the ball with force for 5 seconds, then relax, repeat several times.
Lower limb elevation exercise in prone position: prone, knee extension position, hip posterior extension, hold in the air for 5 seconds, then lower.
Stretching exercises for the posterior thigh muscles: sit on the bed with straight legs and slightly abducted hips, stretch the back muscles and touch one side with both hands, or press the chest to the thighs.
Double bridge exercise: supine position, feet on the bed, with the back and feet support, try to lift the waist and hips. This action can enhance the muscle strength of the posterior thigh muscle group and the lumbar muscle group.
3.Exercise therapy
Passive exercise is used in combination with active exercise. Passive exercise: The patient fixes the affected limb on the CPM machine for passive flexion and extension exercise. During bed rest, the knee joint is extended and flexed 0-120°, the patella joint 0-90°, and the ankle joint plantarflexion range 0-?40°, 4-6h/d, completed in 2-4 times.
Exercise therapy: knee inflammation is obvious, pain is severe, supine position to do lower limb isometric contraction exercises, for 10 seconds, while the lower limbs alternate, straight leg elevation, repeat 20 times, 1-2 times / day; to joint stiffness or dysfunction, do lower limb isometric contraction exercises, prone position, both lower limbs alternate.
Alternatively, the therapist can hold the patient’s ankle to help the knee flex, and kneel in a seated position with the weight down to help the knee flex and continue for 1 minute, both repeated 20 times.
Aerobic training significantly improved the quality of life of patients with rheumatoid arthritis by participating in 30 minutes of active resistance training per person per session, 4 times per week for 12 weeks. The use of a treadmill for aerobic exercise is conducive to mobilizing patients’ sense of participation, enhancing their mobility and balance, etc.
Other proposed exercise methods are.
(1) supine position, straight knee (if not straight, a soft object under the knee), foot dorsiflexion, internal rotation, straight leg elevation, maintain this position for a certain period of time, gradually lengthened with the increase in endurance.
(2) Make the patient sit, legs relaxed, knees straight, only lift the empty leg at the beginning, and later add 1-2kg weights at the ankle as the muscle strength increases, 2 movements, 2 times a day, 10 minutes each time. Exercise therapy should adhere to the principle of gradual progression and avoid strenuous joint and muscle activities. It is best to develop a one-on-one training program under the supervision of a rehabilitation specialist.
4. Rehabilitation Gymnastics
Joint gymnastics training.
(1) Finger joints: alternate between fist clenching and flat finger extension. To increase the range of motion of the joints, the patient can place both hands on a flat surface (such as the bedside table) and try to keep both hands close to the flat surface when releasing the fists.
(2) Wrist joint: both hands together, repeatedly alternating force to one side flexion and extension; one hand wrist for rotational movements.
(3) Elbow joint: palms up, both arms forward and flat. Quickly make a fist and bend the elbow, try to make the fist reach the shoulder, then quickly extend the elbow, then both arms are raised to the sides, make a fist and bend the elbow movement as before.
(4) Shoulder joint: one arm from the front from the side of the neck to the back, fingers touching the back, while the other arm from the side (armpit) to the back, fingers touching the back, try to make the fingers of both hands touch in the back.
(5) Distance calf (ankle) joints: sitting position, distance calf joints for flexion, extension and rotation on both sides respectively.
(6) Knee and hip joints: squatting exercises and forward lifting exercises. 2 times a day, once in the morning and once in the evening, 10-15 minutes each time.
In addition, someone introduced a wrist joint exercise, a total of 3 steps.
(1) Massage the diseased hand joints and surrounding tissues, moving each joint for 2-3 minutes.
(2) Finger joint exercises: flexion exercises.
(1) The order is distal interphalangeal joint → proximal interphalangeal joint → metacarpophalangeal joint, flexing as much as possible.
(2) finger extension exercise: the order is metacarpophalangeal joint → proximal interphalangeal joint → distal interphalangeal joint, try to straighten the joint.
③ finger movement: thumb tips of both hands opposite each other, then try to straighten the five fingers and spread out in a fan shape, according to the index finger, middle finger, ring finger, little finger order to do finger tip to finger movement.
(3) Wrist joint movement training.
① Slowly rotate the wrist joint clockwise and counterclockwise for 5 turns, 10-15 minutes each time, twice a day.
(2) hands palms together, fingers naturally crossed, one hand gently press the other hand to dorsiflexion, alternating left and right, 10 minutes each time, 2 times a day, knee exercises in 2 steps.
① lying down, do knee active and passive flexion training, 5-10 minutes each time, 2 times a day.
②Sit on the edge of the bed, legs down, feet hanging over the bed, like a “pendulum” swinging the knee joint back and forth, 10-15 minutes each time, 2 times a day.
5.Activity of daily living training
Focus on training for activities of daily living limitations, so that patients can live and work independently without relying on others, whether at home or in society. Generally speaking, patients with rheumatoid arthritis tend to be inactive and lack confidence in life. Training patients to maintain the movements necessary for daily living and to live independently can help build their confidence to live independently and make treatment more successful.
We focus on training rheumatoid arthritis patients with restricted items twice a day for 60 minutes to enable them to achieve self-care. For example, the 10 items of daily living ability scale training: combing hair, washing; dressing and undressing, unbuttoning clothes, putting on and taking off shoes and socks; eating with chopsticks; writing; personal hygiene (bathing, toileting); winding and unlocking a watch; drinking with a spoon; opening and closing a drawer; taking a thermos and pouring water; opening and closing a faucet. The training of the upper limbs is mainly to increase the range of motion of joints and muscle strength, and to complete the self-care of daily life, such as dressing, eating, washing, cooking, etc. Lower limb training is mainly for daily life movements such as standing, walking and squatting, and then walking up and down steps in a walker. Standing training restores muscle strength and endurance, and walking with manual assistance. In order to reduce the weight of the joints, crutches are used to assist walking.
6.Physical factor treatment
Various physical therapy, such as heat therapy, wax therapy, infrared ray, warm water bath, etc., can reduce swelling and analgesia, accelerate blood circulation, promote the absorption of inflammation, reduce adhesions, protect joint function and prevent joint deformation.
7.Traditional fitness program
By controlling posture and training flexibility, joint symptoms can be slowed down and function optimized. It has been confirmed that tai chi is a weight-bearing exercise with the potential advantages of stimulating bone growth and enhancing connective tissue strength, helping to increase elbow joint counterforce and flexor muscle strength, and helping to prevent and control elbow stiffness and upper limb muscle atrophy, especially biceps and brachialis atrophy and osteoporosis. Taijiquan focuses on the characteristics of coordinated, even and balanced movements. Improving the strength of the ligaments and muscles around the ankle, especially the calf triceps, helps maintain the stability of the ankle structure.