Can gentle movement truly ease the pain of rheumatoid arthritis—or does exercise risk making it worse?
That was the exact question I asked a senior rheumatologist during a multidisciplinary clinic round a few years ago, after watching several patients with rheumatoid arthritis (RA) hesitate at the idea of physiotherapy. Their fear was understandable. When joints are swollen, stiff, and painful, movement feels counter‑intuitive. Yet, over time, clinical evidence and lived patient experience have shown something remarkable: the right kind of physical therapy does not damage arthritic joints—it protects them.
Rheumatoid arthritis is not simply “joint wear and tear.” It is a chronic autoimmune disease that affects the synovial lining of joints, leading to inflammation, pain, fatigue, and progressive joint damage if left unmanaged. Medication remains essential, but physical therapy is one of the most underused yet powerful non‑pharmacological tools for preserving function, independence, and quality of life.
This article brings together clinical evidence, expert insights, and real‑world practice to explain how physical therapy helps rheumatoid arthritis, what actually works, and how you can apply it safely.
Understanding Rheumatoid Arthritis Beyond Pain
Rheumatoid arthritis affects approximately 1% of the global population, with women being two to three times more likely to develop it than men. Unlike osteoarthritis, RA is driven by immune‑mediated inflammation that can affect:
- Hands, wrists, knees, ankles, and feet
- Tendons and ligaments
- Fatigue, cardiovascular health, and mental wellbeing
Unchecked inflammation leads to joint erosion, deformities, muscle weakness, and reduced mobility. While disease‑modifying antirheumatic drugs (DMARDs) control inflammation, they do not restore lost strength, flexibility, or movement confidence. That is where physical therapy becomes indispensable.
Why Physical Therapy Is Essential in Rheumatoid Arthritis Management
Physical therapy is not about pushing through pain. It is about guided, adaptive movement that respects inflammation while preventing long‑term disability.
Evidence That Physical Therapy Works
A large systematic review published in The Cochrane Database of Systematic Reviews found that therapeutic exercise improves muscle strength, physical function, and aerobic capacity in people with RA without increasing disease activity.
Similarly, the European League Against Rheumatism (EULAR) recommends exercise and physical therapy as a core component of RA management across all disease stages.
As one consultant physiotherapist specialising in inflammatory arthritis explained during a clinical workshop:
“The greatest damage I see isn’t from movement—it’s from fear of movement. When patients stop using their joints, stiffness and weakness accelerate far faster than inflammation alone.”
Core Goals of Physical Therapy in Rheumatoid Arthritis
Rather than a one‑size‑fits‑all approach, physical therapy in RA focuses on four interconnected goals:
- Reducing pain and stiffness without provoking flares
- Maintaining joint range of motion to prevent deformity
- Improving muscle strength and endurance to support joints
- Preserving independence in daily activities
Each goal is addressed through specific, adaptable interventions.
Types of Physical Therapy Used in Rheumatoid Arthritis
Therapeutic Exercise: The Foundation
Exercise prescriptions for RA differ from general fitness programmes. They are progressive, individualised, and symptom‑guided.
Range‑of‑Motion Exercises
These are gentle movements designed to maintain joint flexibility, particularly during early morning stiffness.
- Hand opening and closing
- Wrist circles
- Knee bends while seated
Patients often report that five to ten minutes of daily mobility work significantly reduces morning stiffness, making medication and daily tasks more effective.
Strengthening Exercises
Contrary to outdated beliefs, strength training is safe in RA when inflammation is controlled.
Isometric and low‑resistance exercises help:
- Stabilise joints
- Reduce fatigue during daily tasks
- Prevent muscle wasting (rheumatoid cachexia)
Clinical trials show that moderate resistance training two to three times per week improves strength without worsening joint inflammation.
Aerobic Conditioning
Low‑impact aerobic activity such as walking, cycling, or water‑based exercise improves:
- Cardiovascular health
- Fatigue
- Mood and sleep quality
Importantly, cardiovascular disease is a leading cause of mortality in RA, making aerobic fitness a long‑term protective strategy rather than an optional extra.
Manual Therapy: When Hands‑On Care Helps
Manual techniques such as soft tissue mobilisation and gentle joint gliding can temporarily reduce pain and improve movement confidence.
However, evidence suggests manual therapy is most effective when combined with active exercise, not used in isolation.
Hydrotherapy (Aquatic Therapy)
Warm‑water therapy remains one of the most patient‑preferred interventions for RA.
The buoyancy of water:
- Reduces joint load
- Allows freer movement
- Relaxes muscle spasm
A controlled trial in Rheumatology reported significant short‑term improvements in pain and wellbeing among RA patients participating in aquatic exercise programmes.
Assistive Devices and Joint Protection Training
Physical therapists also play a crucial role in teaching:
- Joint protection techniques
- Energy conservation strategies
- Safe use of splints and assistive devices
Simple adjustments—such as altering grip technique or task sequencing—can dramatically reduce daily joint strain.
Physical Therapy During Flares vs Remission
One of the most common misconceptions is that physical therapy must stop during flares.
In reality:
- During flares: focus shifts to gentle range‑of‑motion, positioning, and pain‑relief modalities
- During remission or low disease activity: strength and endurance training are emphasised
A skilled physical therapist continually adjusts the programme based on symptoms, blood markers, and patient feedback.
Real‑World Patient Experience: What Actually Changes
One patient with ten years of RA shared this after six months of guided physiotherapy:
“My pain didn’t disappear overnight. But I noticed I could open jars again, walk longer without fear, and stop planning my day around stiffness.”
This reflects what clinicians consistently observe: physical therapy improves function first, pain second, and confidence last—but all three matter equally.
Addressing Common Myths About Physical Therapy in RA
“Exercise will wear out my joints.”
Research consistently shows the opposite when exercise is appropriate and supervised.
“I should rest as much as possible.”
Prolonged rest increases stiffness, weakness, and fatigue.
“Physiotherapy only helps early RA.”
Patients at all disease stages benefit, although goals shift with progression.
Actionable Steps You Can Apply Immediately
- Begin with daily gentle mobility exercises, especially in the morning
- Use pain as a guide, not a barrier—mild discomfort is acceptable, sharp pain is not
- Aim for two to three structured exercise sessions per week when disease activity allows
- Discuss flare‑adjusted exercise plans with your therapist
- Combine physical therapy with medication, not instead of it
Physical Therapy for Rheumatoid Arthritis at Cure on Call
At Cure on Call, we provide evidence‑based physical therapy for rheumatoid arthritis through personalised, clinician‑guided programmes. Our approach integrates rheumatology‑informed exercise prescription, joint protection education, and long‑term self‑management strategies—delivered both in‑person and via tele‑rehabilitation. By aligning therapy with your disease activity, lifestyle, and medical treatment, we help you move safely, confidently, and independently without aggravating inflammation.
Frequently Asked Questions (FAQ)
Can physical therapy cure rheumatoid arthritis?
No. RA has no cure, but physical therapy significantly reduces disability, improves function, and supports long‑term joint health.
Is it safe to exercise during active inflammation?
Yes, with modification. Gentle movements are encouraged, while high‑load exercises are avoided during flares.
How often should someone with RA see a physical therapist?
This varies, but many patients benefit from structured therapy during diagnosis and flares, with periodic reviews thereafter.
Does physical therapy replace medication?
No. It complements medical treatment and improves outcomes when used together.
Final Thoughts: Movement as Medicine
Rheumatoid arthritis may be unpredictable, but loss of movement does not have to be inevitable. When guided by evidence, experience, and empathy, physical therapy becomes more than exercise—it becomes a strategy for reclaiming autonomy.
If you’re living with RA, or supporting someone who is, consider this: the goal is not to move perfectly, but to keep moving wisely.
Have you tried physical therapy for rheumatoid arthritis? What helped—or held you back? Share your experience or questions below.
Read Also: What Is the Best Treatment for Arthritis in the Lower Back?
