2. What can a physiotherapist do to help you?
Iverson: A physical therapist can help in several ways. They can help the patient build better aerobic capacity and set up a strength and conditioning program.
If the patient has trouble functioning at work, the physical therapist will perform an ergonomic assessment. A physical therapist can help a patient adjust their workplace or even talk to their company to create a work schedule that best accommodates the patient. This can include working from home part time.
3. What are some common obstacles to trying physical therapy, and how can people with psoriatic arthritis overcome them?
Iverson: The great fear of patients – and even their families – is that doing more can make the condition worse.
Arthritis is very different from, say, having a stroke. When a person has a stroke, they look forward to slow but steady gains in treatment. For people with arthritis, you might look and feel fine one week, and then the next week not. There’s such variability, and that’s a heavy burden that people with arthritis have to bear.
What I’m trying to do is talk about the benefits of exercise. It may seem counterintuitive that exercise is beneficial because we stress the joints a bit. The goal is to exercise within a person’s pain tolerance and to build up slowly. A physical therapist will slowly build your capacity and see how your body responds.
I always tell the patient that they really are the experts on their own body. They know what they can and cannot do. If 30 minutes of exercise is too much, we can split it up and do it for 10 minutes, three times a day. If 30 minutes is the minimum for building aerobic capacity, we can find ways to get that time without it being as painful as it can be.
4. Is physical therapy different for athletic people?
Iverson: Athletes tend to be self-motivated. They are good at setting goals and achieving them in incremental ways. If they can only do 5 repetitions instead of 10, that’s not a big deal. Non-athletes often need external motivation. They tend to benefit from the support of working in a group. They wish they could do more, but they don’t know how to motivate themselves. A group setting is very helpful in making them feel more comfortable.
The Arthritis Foundation has some great collaborative programs. I keep a list of what is available to patients, and I associate them with the types of resources they are most likely to use.
5. How do you know if you have the right physical therapist?
Iverson: Exercise is a form of medicine. Just as a rheumatologist will adjust your medications to see what works best, you need a physical therapist to help you identify things, like if you’re in a flare-up and if you need to modify your exercise. If a patient’s symptoms seem related to a flare, I suggest backing off the exercise a bit and resting their joints.
Some physical therapists may understand exercise but not know psoriatic arthritis specifically. The American College of Rheumatology maintains a database of providers who specialize in rheumatoid conditions. Consider a physical therapist who is certified as an orthopedic clinical specialist (OCS).
6. Does insurance cover physical therapy for psoriatic arthritis?
Iverson: Each insurance company has different fee structures and visitation allowances. If you are referred by a rheumatologist or primary care specialist, sessions should be covered. Your physical therapist should know what the insurance company allows and can help determine the best way to care for you.