Ask the Expert: How Does Physical Therapy Work for PsA?

The main goal of physical therapy (PT) is to improve your quality of life — everything from sleeping to performing everyday tasks to work activities.

Psoriatic arthritis (PsA) is a chronic inflammatory joint disease. Although there’s currently no cure, many people with PsA manage their condition through a combination of medication and other treatments, like massage and PT.

There isn’t a lot of dedicated research on PT for PsA, but many people find it to be an effective supplemental treatment for their symptoms.

I sat down with Greg Minnis, PT, DPT, to hear all about physical therapy for PsA: what the benefits are, how it works, and when to start treatment.

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What are the overall benefits of physical therapy for PsA?

Physical therapy may help people with PsA improve their joint mobility and strength and reduce pain.

People with PsA often have difficulty moving. A PT’s main goal is to try to improve their patient’s joint mobility, which can also affect their balance, day-to-day activities, and how they walk. We look at each patient, see what they need to work on, and develop a treatment plan specifically for them.

When should someone start seeing a physical therapist?

You can start seeing a PT at any time. If you’re having trouble performing daily activities, PTs can help modify your daily activities or teach you ways to perform them with less pain.

If you’re in a lot of pain, physical therapists use modalities like heat, ice, electric stimulation, ultrasound, and low light laser, all things to try to reduce pain with hands-on treatment. If you’re in a bad flare-up, it will be a more mellow physical therapy approach, but you can still see your PT.

Is there ever a time when a patient wouldn’t be a good candidate for physical therapy?

Typically, PT can be a good option for everybody, but if someone’s having so much pain that it’s difficult to get out of the house or move much, then it could be counterproductive.

However, working with a PT on gentle movements even when you’re in a lot of pain can often help your joints and improve your mobility.

If someone is seeing a PT for the first time, what can they expect from their first appointment?

The first appointment is an evaluation. The PT will chat with you, take down your history, and figure out what your goals are.

After the evaluation, we develop an exercise program for the patient and probably do some hands-on therapy — manual therapy or soft tissue manipulation, just to work on any affected joints. We could do some balance training or gait training to help improve walking and standing if that’s relevant.

But basically, the first appointment is just about figuring out what the patient needs and then working with them through exercises, manual therapy, posture education, and education in general. If they’re having trouble sleeping, we figure out how to use props or develop a nighttime routine.

The first session is a lot of patient education. All the day-to-day stuff and what they can expect moving forward.

How many times does someone need to see a PT?

Typically, the frequency of seeing a physical therapist is two to three times a week. If you aren’t having too many problems, you could see somebody once every few weeks and work on a lot of exercises at home. If you’re having a lot of trouble, you could see your PT three times a week.

It all depends on the severity of your symptoms.

What exercises can someone try to get started?

People with PsA often have a lot of hand, foot, finger, and toe pain. A lot of people are really affected in the morning when first getting out of bed. Their feet and ankles are really swollen and painful, so getting up and walking can be difficult at first.

A couple of easy exercises you can do in bed are:

• Ankle circles: Roll your ankles 10 times clockwise and then counterclockwise.
• Ankle heel pumps: Pump your feet up and down 10 or 20 times.
• Toe lifting and spreading: Just to loosen up the joints in your toes.

Once you’re standing, you can do a couple of other easy exercises, like:

• Calf stretches: Hold onto the countertop with one foot back in a lunge position. Shift your weight forward to stretch the calf.
• Heel raises: Move up onto the balls of your feet and back down 10 to 20 times.

The takeaway

The main goal of PT is to improve your quality of life — everything from sleeping to performing everyday tasks to work activities. PT will be unique to each patient’s individual treatment goals.

You may think that movement is counterproductive when you’re in a lot of pain, but gentle movement is actually great for joint health.

However, nothing you do should cause pain or make you feel worse, so if you’re having pain after a session, talk with your PT about changing your exercises. They’ll work with you to find the right treatment plan.