Physical therapy is a non-surgical treatment for rheumatoid arthritis that can effectively relieve your inflammation and joint pain. These techniques will also help restore muscle, range of motion, and flexibility—equipping you with the necessary strength to combat future rheumatoid arthritis pain.

There are a variety of physical therapy techniques that may ease your rheumatoid arthritis symptoms. Passive treatments relax your body and include massage, heat and cold therapy, hydrotherapy, TENS (transcutaneous electrical nerve stimulation), and ultrasound.

Your physical therapy program will usually begin with passive treatments. When you feel ready, you will start ctive treatments that strengthen your body and prevent further RA pain. Exercise is a vital part of your treatment, and your physical therapist will work with you to develop a plan catered just for you.

Passive Treatments

• Cold Therapy: Cold therapy (also called cryotherapy) eases painful RA flare-ups. Cold therapy slows circulation, which reduces swelling. Your physical therapist may place a cold compress on the target area, give you an ice massage, or even use a spray known as fluoromethane to cool enflamed tissues.
• Heat Therapy: Heat triggers the body's natural healing process by relaxing your tired joints and muscles and speeding up blood flow to the painful area. Extra blood delivers extra oxygen and nutrients.
  
  Heat may not completely eliminate the source of your RA pain, but it can effectively reduce your chronic pain. This therapy is used in a couple of ways—through dry heat (a heating pad or a dry, hot towel) or moist heat (steam heat or a moist, warm cloth).
  
  When using heat therapy on your own after physical therapy ends, never overheat painful areas. If you're using a heating pad, set it to low or medium. When using a hot towel, touch it first to make sure it's not too hot.
  
  Both heat and cold therapies offer their own set of benefits, and your physical therapist may alternate between them to get the best results.

• Hydrotherapy: As the name suggests, hydrotherapy involves water—and it's an ideal rheumatoid arthritis treatment. As a passive treatment, hydrotherapy may simply involve sitting in a whirlpool bath to relieve pain, relax muscles, and condition your body without adding unnecessary stress on tired joints.

• Massage: Be it deep tissue or therapeutic, massage may help relax your joints and muscles so you'll be able to use them more effectively. Your physical therapist may use heat and cold therapies with your massage to boost the benefits. An important note: you should not be massaged at or near the arthritic area—it will likely cause pain. But massage can relax the muscles and tissues that impact your tired joints, even if they aren't located directly near them.

• TENS (transcutaneous electrical nerve stimulation): TENS therapy sounds intense, but it really isn't painful. Electrodes taped to your skin send a tiny electrical current to key points on the nerve pathway. TENS is generally believed to trigger the release of endorphins, which are your body's natural pain killers.

• Ultrasound: This therapy uses sound waves to create a gentle heat that increases blood circulation to your deep tissues. Ultrasound helps reduce inflammation, stiffness, and pain. This passive therapy also improves your range of motion, which will likely be limited due to your rheumatoid arthritis pain.

Active Treatments
Exercise is the cornerstone of any rheumatoid arthritis physical therapy program. Once you complete your course of passive treatments, your physical therapist will develop an active program specifically for you.Active treatments, which include regular exercise, help address flexibility, strength, and joint movement. This will not only curb recurrent pain but will also improve your overall health and help you lose weight, if necessary. Your physical therapist will work with you to develop a program based on your specific symptoms and health history.

Watch a slideshow of rheumatologist-approved exercises for rheumatoid arthritis.

Active treatments include:

• Muscle flexibility and strengthening: Your range of motion will likely be restricted if you have rheumatoid arthritis. Using customized stretching and strengthening exercises, your physical therapist will help you lengthen and strengthen your muscles, and improve joint movement. Strong, lean muscles better handle pain.
• Aerobic exercise: Aerobic exercises, such as walking and biking, are ideal for RA sufferers because they strengthen your spine without putting unnecessary stress on your joints. Aerobic exercises will also help you lose weight, and a few less pounds will take pressure off your tired joints.
• Hydrotherapy: Water-based exercises may be recommended to provide gentle aerobic conditioning.

Your physical therapist will teach you "self-care" principles so you understand how to best treat your rheumatoid arthritis pain. The ultimate goal is for you to develop the knowledge to help control your symptoms yourself, without the direct supervision of a physical therapist. It's essential that you learn the exercises and continue them after the formal therapy ends. If you keep with a fitness program, you have a much better chance of enjoying the long-term benefits of your physical therapy.