♪- Bob and Brad ♪
♪the two most famous ♪
♪physical therapists ♪
♪on the Internet. ♪
- Hi folks. I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- Because we are the most
famous physical therapists
on the Internet.
- In our opinion, of course, Bob.
- Rheumatoid arthritis.
We're gonna talk
about 10 best exercises
you can do for this.
That's kind of a sticky one.
Isn't it, sometimes? Rheumatoid.
- Right. Yeah. It's, I think,
people don't really understand.
They say they got rheumatoid and you know,
maybe it's not,
maybe it is a typical
degenerative joint disease.
- Right.
- But rheumatoid affects all the joints
in the whole body.
It's systemic.
- It's systemic.
It affects all the joints
and it even can affect you other ways as far
as fatigue and,
- Right.
- Just, yeah.
There's that overall aching.
- Right.
Where typical osteoarthritis
will typically be one or two joints that,
- Right.
- from mechanical forces that wears
out typically is the reason for it.
- So, it's a lot more difficult to treat
- Right.
- and you gotta be
a little more careful with it,
I would say, Brad.
- It presents itself mostly in smaller joints.
A lot of times the fingers
and the hands and the feet,
the toes,
that's where it presents more pronounced.
- Which makes it more difficult,
even to some extent.
- Exactly. There are a few new people.
- Oh yeah. Brad.
I noticed them too.
They just wandered in. Hi!
- I'll go open a door for them, Bob.
- Thanks for coming in.
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- Yeah.
- All right.
Arthritis
- Let's get started.
- So how prevalent is this rheumatoid arthritis?
A little less than 1% in the United States.
I'm not sure how it is worldwide.
I didn't get that research in,
that's about 1.3 million Americans have it.
- Okay.
- Commonly starts between the ages of 30 and 50.
Okay, when they, you know.
- My mother-in-law has it.
- Sure.
- And that's about when it started.
- Right.
The key thing with it is
you need to get after it,
as far as range of motion,
the physical therapy effort.
You have to keep moving
and get the joints moving.
Do not let them become
stagnant and freeze up.
- Right. I think in fairness though, Brad
it can get to the point though
where it gets so bad
that you don't do any movement anymore.
You know, I'm just saying like,
I'll use the shoulder as an example.
You want to keep that thing moving
as much as possible
but it's gonna get to a point where
if it gets so bad that it hurts so much
that you hear the noise every time you move it.
- Yeah.
- That's about the time where, I'm sorry,
it's either shoulder replacement or...
- But we're talking when you still can move it.
- Yeah.
- These are good exercises.
The number one thing to do
from the research I've read
and I think personal experience
and most therapists would agree
is if you have a pool,
- Yeah.
- or water available,
get in the water and,
you know, get up to the chest or,
you know, shoulder level
and start doing, actually a lot
of the same exercises that we're gonna show.
If you can do them in the water
you get more range of motion.
The body works better.
You got the temperature element.
- It'd be nice if the water's warm.
- Right?
Yeah. Not cold water.
You got non-weight bearing because the water displaces
that a little bit, so...
- Right. It's not as much weight on the joints.
Yeah, yeah.
- So we're just gonna get started
with the hands, okay?
- Okay. All right.
- We talked about the small joints
that are affected in the hands.
And, the first thing to do is
just get them going.
I think a lot of people,
they'll have a hard time making a complete fist.
- Sure.
- If it's flared up
so you're gonna work
on that complete fist.
And if you're gonna take the other hand
and stretch it.
- Give it a little stretch.
- Yep. You're not gonna force it
all in one time.
Repetition is the key.
Work it, and it will, you know, overcome it.
- Just like a lot of things.
This is a great thing to do.
Not just, you know, I mean
it's nice to do it at the same time every day.
Cuz usually it becomes a habit then.
- Sure.
- But this is one you can do throughout the day.
- Right?
- I mean, yeah.
- Exactly.
Yep. You don't have to do it and then,
forget about it.
- Right.
- And then the next thing to do is
once you get the range of motion going
later in the day,
you want to keep the strength going in there.
Here, let me get them the ball right here.
If you got a ball about this size
and it's important
that it is gonna be squishy.
- Sure.
- You don't want, like a tennis ball would not work.
- Right.
- It would be too firm.
You want something that you can actually
get some range of motion through.
So this works really well.
One of these balls work really well is too,
these kind that have the fluid in.
- Oh yeah.
- And they squish out,
you really get some range of motion
and it depends on the strength of your hand
and you're gonna do 10 to 20 reps of these, you know.
- Not enough to flare it up.
- Right.
- Don't fire things up.
- Exactly.
- So you may have to do, you know,
a few less the first time,
- Yep.
- just to gauge what you're able to do.
- You morning exercises may not be as good as
later in the day,
because you're warmed up more.
- So we're moving on to the wrist, Brad?
- Yeah, we're going right up.
The wrists, we're just gonna go
start out flexion and extension,
which would be,
Bob's doing it that direction.
I'm doing it here.
You can have your fingers up
or you can keep them closed.
If your fingers are out,
you'll get a little more flexion, more motion.
That's just the natural body mechanics of it.
Okay. And if you wanna put a little
passive range of motion on there,
you can otherwise press it.
Again, you're not gonna press these real hard
to make a lot of severe pain.
You want to be somewhat gentle with it
and over repetition
get it to move more and more.
- I do like this one too, Brad, though.
- Oh yeah.
Well, yeah.
We could put that one in there.
- Little squeeze.
- Yep.
- Little squeeze out like that.
- And there we got another one similar to that,
and, just, I think, some circles is good.
- Sure.
- You know, clockwise, counter clockwise,
work that both directions.
And then we're gonna go to the elbow
and this one's almost like that.
Elbows bent like this,
palms up, palms down.
Up, down, up, down.
and just do that 10 to 20 times.
Then, of course, the elbow.
Make sure we get all the way down.
- Sure, especially straight.
- Exactly.
So we're here
and back
and you may only get this far to start out with
but just continue to work it.
If you wanna take the other hand
give a little stretch and push in.
If it's being a little stubborn in one direction.
Again, don't overdo it,
but give it a little stretch in,
you know, within your tolerance.
- Yeah. We can get a little pressure
on when you're going into bending.
- Right. And then shoulders.
One of my favorite ones for this one is the pulleys.
- Is the pulleys.
- Yeah. If you got some pulleys
at home or if you can purchase some.
- You can get a set of pulleys for very inexpensive.
- Right. Yeah.
- They have them online.
- Yeah. And if you got someone handy at home
we actually have a video
on how to make pulleys for
you can make them for, you know,
just a few dollars literally.
- And you can get a nice pulley.
- These are homemade right here.
And these are,
this is better than pulleys you can buy.
- Yeah.
- It's got a brass pulley versus a plastic one.
- Yeah. That's these are always cheap when
you buy a pulley set online usually.
- Yep.
- And this is a nice one that he got
from the hardware store.
- Exactly. And then the rope was
better rope.
Overall, it's better just to make your own
but you gotta have someone that can do it.
So I'm going flexion here
and you're gonna need
to adjust the pulley
or the height of the pulley
so that it goes up as high
as you're comfortable.
The height of the chair.
If I get a shorter chair, that'll give me more flexion.
But right now this would be good for me.
- Now, usually Brad, when I have them doing,
maybe you do the same.
I just have them warm up a little bit.
- Sure. Yeah.
- And then I have them do stretches.
- Yeah. Then.
- Yep.
- And also you can do,
- you can go out to the sides too.
- Yep. The walls here a little bit
then, little abduction.
- And you can even turn your thumb
like that and go out like that.
- Yep. Yep.
That's what's really nice about these homemade ones.
- Yeah. They flip real nice.
- Yeah. They flip really nice.
And you can't get that on those bought ones,
I haven't found it in anyways.
And you know,
I don't know,
you could,
depending on the person,
how flexible they are.
If it's a younger person,
you can also do this.
- Get the external.
- There we go.
- Internal rotation.
- Yep. If you can get your hand to do it.
And then you just,
which is good
because when you're trying to
get dressed in the morning,
you're trying to reach or put a belt on.
If your shoulder is too tight to get back here,
this'll be one that will help.
- It's one of the motions that tends to go away, right away.
- Yep.
- And so it's a good one to work on.
- And it's nice that the pulleys
could have so much control.
- Yeah.
- I mean, you're not gonna overdo it.
You're just, very controllable.
- Yeah, if you can do it again.
How you feel with it, you know
you wanna use it
within your pain guidance.
Okay. You're the ball.
- Then the ball.
We're not gonna jump in,
jump on the ball and,
do things like that.
A lot of times people say,
what do you do with the ball?
And they always think
you have to sit on it.
Well, it works great for shoulders.
All right, now I'm just gonna roll
and get a little elbow in there too.
- Yeah.
- And I'm gonna stretch that shoulder right out like that.
And I'm gonna get this over here
so we can get a better view.
Of course you do it on both shoulders.
- And you get your elbow straightened too,
at the same time.
- Yeah, exactly.
- And elbow bending at the same time.
- Yeah. And you can work the hand.
You can really?
- Yep. You can do all of it right there.
- You can be creative with it.
You can play catch with someone.
Then this.
- Oh yeah.
- You want to get that motion this way?
Like you're driving a car,
which is another great thing.
The ball...
- Internal, external rotation.
- Yeah. And these usually aren't,
you can get them online for,
you know, 20 bucks or so.
- Yeah.
- We've got a number of videos
on other things
you can do with the ball.
But as far as this,
this is a wonderful shoulder exercise.
I use it on a lot of rehab for shoulders, Bob.
- Yep.
- All right.
That was kind of fun, huh?
- Yeah. There we go.
- You want to give it a go?
- No, that's alright.
Let's go on the next one.
Let's not bore people.
- Yeah, we've got more work to do.
Okay.
Then you talk about the lower extremities, the hips.
Why don't you lay down, Bob?
- Okay.
- I've been doing everything since...
- On my back?
- On your back.
Yeah. Let's just do double knees to chest.
- Okay. Well I'd probably start off with single knee.
- Yeah. I was gonna put single knee in here
but we said 10 and that would make it 11.
- So then we go up to double knee,
again, stretching the back a little bit,
actually putting the knee into flexion,
and flexing the hip all at the same time.
- Right. That's what's nice about this.
You're getting two joints
at the same time.
You might as well throw in
some hook rotation too.
- Sure.
- You're there.
- Now you're getting some rotation
at the hips and
you're getting rotation at the back.
- Right? Exactly.
- So this is a good universal one.
- Right.
- We have so many patients
start with this in the morning.
- Right.
- Don't they,
they wake up and that's the movement they do.
- These, the ones laying down
and you can do in your bed just as well.
You don't have to get down on the floor.
A bed for these,
a little softer surface is just fine.
Shall we continue on?
- Yeah, let's go. Ankles?
- Ankles.
Yeah. Actually just laying right there, Bob.
You can be in bed.
- You can, waking up in the morning.
- Yeah. Just lay your legs right out flat.
Actually, if you go off the edge of the bed.
There, then you have a little more range of motion
because otherwise your ankles dig in.
And this is just a little bit.
There you go.
Circles.
- And both ways.
- You bet.
- Keeping those moving.
- Now, a strengthening exercise for
that'll get the shoulders,
the legs, the knees, the hips
and give you some core strength.
Now this one isn't gonna work for everyone.
But if, if you're feeling aggressive
and you're younger perhaps,
I want you to bring
your hands back like this, Bob,
and then reach all the way up
and touch your toes.
- Then up?
- Bend your knees, bend your knees.
- Oh.
- Reach between your legs.
Touch your toes.
Get them up there.
- Oh, like this!
- There you go!
- Okay, I thought you were
gonna have me do a sit up.
I'm like, I don't wanna do a sit up, so this.
- Yeah, this is impromptu at its best.
- Okay. Yeah.
I didn't know where he was going with this.
- And go all the way.
Flatten yourself.
Right. Way off for the real aggressive.
- All the way out here.
- There you go, stretch.
And you don't have to do these fast.
This is something you would do slow.
Take your time.
- This is a good exercise actually.
- Oh absolutely.
It's, I thought I'd just throw this one in at Bob.
- I'm kind of surprised you came up with this one, Brad.
- Bob!
He's surprised.
Huh?
- It's aggressive though.
You might have to start off with that way.
- Yep. Good.
One side.
And then you get the whole idea.
- Because it I mean you gotta have a little abstract
to do this, Brad.
- Yeah. You do.
Stomach is crucial.
- I can feel it right now.
- But if you can start to do it,
it's good for you.
- Yeah.
- Okay. The other thing is just walking,
getting out and walking,
but, make sure you have some decent shoes.
They should be if they're cushioned a little bit,
so that impact through your ankle,
hips and knees is reduced
and walk as tolerated.
- Sometimes they even recommend
those rocker bottom ones.
Right?
- You remember those?
Because it helps promote the proper walking pattern.
- Right. Right.
- So.
- I'm not sure if I'm sold on that, but they
they sell them that way.
- I remember having a class on it and they
they recommended it.
- They liked it.
- Yeah.
- Oh really?
- They did, yeah.
- Okay. Good.
- For arthritis.
- I wasn't sure if that was a marketing thing or
if it was proven.
- No, they had some studies on it, so.
- Okay. Good. Excellent. All right.
- All right.
- So very good!
Good luck with your range of motion,
arthritis and movement.
- Yep. Thanks a lot.