Managing Polymyositis with Physiotherapy

Polymyositis is a rare inflammatory muscle disease that causes muscle weakness and discomfort. It affects the muscles closest to the trunk of your body, such as the shoulders, hips, thighs and neck. While there is no cure for polymyositis, physiotherapy can play a significant role in managing symptoms, improving muscle strength and enhancing quality of life.

Polymyositis

Polymyositis is part of a group of muscle diseases known as inflammatory myopathies. The exact cause of polymyositis is unknown, but it is believed to be an autoimmune condition, where the body’s immune system mistakenly attacks its own muscle tissue. Key symptoms include:

• Progressive muscle weakness, particularly in the proximal muscles
• Fatigue and difficulty with daily activities
• Muscle pain and tenderness
• Difficulty swallowing and breathing in severe cases

Diagnosis typically involves a combination of medical history, physical examination, blood tests, electromyography (EMG) and muscle biopsy.

The Role of Physiotherapy in Polymyositis

Physiotherapy is essential in managing polymyositis as it helps maintain muscle function, reduce pain and improve overall mobility. The primary goals of physiotherapy include:

• Improving muscle strength and endurance
• Enhancing flexibility and joint range of motion
• Reducing pain and discomfort
• Promoting functional independence in daily activities

Initial Assessment and Diagnosis

A comprehensive assessment is the first step in physiotherapy management of polymyositis. This includes:

• Medical History: Understanding the patient’s medical history, including onset of symptoms, progression, and any previous treatments or interventions.
• Physical Examination: Assessing muscle strength, flexibility, joint range of motion, and functional capabilities. The physiotherapist may use manual muscle testing and functional assessments to evaluate the severity of muscle weakness and functional limitations.
• Pain Assessment: Identifying areas of pain and discomfort, and understanding how pain impacts daily activities and overall quality of life.
• Functional Assessment: Evaluating the patient’s ability to perform activities of daily living, such as walking, climbing stairs, and dressing.

Physiotherapy Treatment Strategies

Physiotherapy for polymyositis is tailored to each individual’s needs and focuses on improving muscle strength, flexibility, and overall function. Key treatment strategies include:

1. Exercise Therapy: Exercise is a cornerstone of physiotherapy for polymyositis. A well-structured exercise program helps improve muscle strength, endurance, and flexibility. Exercises are tailored to the patient’s abilities and may include:
   • Strengthening Exercises: These exercises target weakened muscles and help improve muscle strength and endurance. Examples include resistance band exercises, weightlifting, and bodyweight exercises such as squats and lunges.
   • Aerobic Exercises: Low-impact aerobic exercises, such as walking, swimming, or cycling, help improve cardiovascular fitness and overall endurance. Aerobic exercises are introduced gradually, with careful monitoring of symptoms.
   • Flexibility Exercises: Stretching exercises help maintain joint range of motion and reduce muscle stiffness. Gentle stretches for the major muscle groups are included in the exercise program.
2. Pain Management: Managing pain is a crucial aspect of physiotherapy for polymyositis. Physiotherapists use various modalities to alleviate pain and discomfort, including:
   • Heat Therapy: Applying heat to affected muscles helps relax muscle tissue and reduce pain. Heat packs, warm baths, and heated pads are commonly used.
   • Cold Therapy: Cold therapy, such as ice packs, can help reduce inflammation and numb pain. It is particularly useful during flare-ups.
   • Manual Therapy: Hands-on techniques such as massage, myofascial release, and gentle mobilizations help reduce muscle tension and improve circulation.
3. Functional Training: Functional training focuses on improving the patient’s ability to perform daily activities independently. This includes:
   • Balance and Coordination Exercises: These exercises help improve stability and reduce the risk of falls. Examples include single-leg stands, heel-to-toe walking, and balance board exercises.
   • Task-Specific Training: Practicing specific tasks, such as getting in and out of a chair, climbing stairs, or dressing, helps improve functional independence and confidence.
4. Breathing Exercises: In cases where polymyositis affects respiratory muscles, breathing exercises are essential. These exercises help improve lung capacity and respiratory function. Diaphragmatic breathing, pursed-lip breathing, and incentive spirometry are commonly used techniques.
5. Patient Education: Educating patients about their condition and providing guidance on self-management strategies is a key component of physiotherapy. Patients are taught how to:
   • Pace Activities: Learning to balance activity and rest helps prevent overexertion and manage fatigue.
   • Use Assistive Devices: Using devices such as walkers, canes, or grab bars can enhance safety and independence.
   • Modify Activities: Adapting activities to reduce strain on muscles and joints helps manage symptoms and prevent exacerbations.

Specific Exercises for Polymyositis

Here are some specific exercises commonly included in a physiotherapy program for polymyositis:

1. Strengthening Exercises:
   • Seated Marches: Sit in a chair and lift each knee alternately as if marching. This exercise helps strengthen hip flexors and thigh muscles.
   • Wall Push-Ups: Stand facing a wall, place your hands on the wall at shoulder height, and perform push-ups. This exercise targets the chest and shoulder muscles.
   • Leg Raises: Lie on your back with one leg bent and the other straight. Lift the straight leg off the ground and hold for a few seconds before lowering. Repeat on the other side. This exercise strengthens the hip flexors and quadriceps.
2. Aerobic Exercises:
   • Walking: Start with short, manageable distances and gradually increase as tolerated. Walking helps improve cardiovascular fitness and endurance.
   • Stationary Cycling: Using a stationary bike provides a low-impact aerobic workout that is gentle on the joints.
   • Water Aerobics: Exercising in water reduces the impact on joints and muscles, making it an excellent option for aerobic conditioning.
3. Flexibility Exercises:
   • Hamstring Stretch: Sit on the floor with one leg extended and the other bent. Reach towards the toes of the extended leg to stretch the hamstring.
   • Quadriceps Stretch: Stand and hold onto a chair for balance. Bend one knee and bring the heel towards the buttocks, holding the ankle with the hand. This stretch targets the quadriceps.
   • Shoulder Stretch: Bring one arm across the body and use the opposite hand to gently pull it towards the chest. This stretch helps improve shoulder flexibility.
4. Balance and Coordination Exercises:
   • Single-Leg Stands: Stand on one leg for as long as possible, using a chair or wall for support if needed. This exercise improves balance and stability.
   • Heel-to-Toe Walk: Walk in a straight line, placing the heel of one foot directly in front of the toes of the other foot. This exercise enhances coordination and balance.
   • Balance Board Exercises: Standing on a balance board and performing gentle movements helps improve proprioception and stability.
5. Breathing Exercises:
   • Diaphragmatic Breathing: Sit or lie down in a comfortable position. Place one hand on the chest and the other on the abdomen. Take deep breaths, focusing on expanding the abdomen while keeping the chest relatively still. This exercise helps improve lung capacity and efficiency.
   • Pursed-Lip Breathing: Inhale through the nose and exhale slowly through pursed lips, as if blowing out a candle. This technique helps control breathing and improve oxygen exchange.

Monitoring Progress and Adjusting Treatment

Regular monitoring and assessment are essential to track progress and adjust the treatment plan as needed. Physiotherapists may use various tools to measure improvements in muscle strength, flexibility, pain levels, and functional abilities. Adjustments to the exercise program, intensity, and duration are made based on the patient’s progress and response to treatment.

Challenges and Considerations

Managing polymyositis with physiotherapy presents several challenges. It’s important to consider the following:

• Individual Variability: Each patient with polymyositis is unique, and their response to treatment may vary. Tailoring the physiotherapy program to individual needs and capabilities is essential.
• Flare-Ups: Polymyositis can have periods of flare-ups, where symptoms worsen. During these times, it may be necessary to modify the exercise program to reduce intensity and focus on pain management.
• Multidisciplinary Approach: Collaborating with other healthcare professionals, such as rheumatologists, occupational therapists, and nutritionists, ensures comprehensive care for patients with polymyositis.

The Importance of a Supportive Environment

A supportive environment plays a crucial role in the success of physiotherapy for polymyositis. Encouragement from family, friends, and healthcare providers can motivate patients to adhere to their exercise program and stay committed to their rehabilitation goals. Support groups and community resources can also provide valuable emotional and practical support.

Polymyositis is a challenging condition that requires a comprehensive and individualized approach to management. Physiotherapy plays a vital role in helping individuals with polymyositis improve muscle strength, flexibility, and overall function. Through targeted exercises, pain management techniques, functional training, and patient education, physiotherapists can help patients achieve significant improvements in their symptoms and quality of life. If you or a loved one is living with polymyositis, consider consulting a physiotherapist to develop a personalized treatment plan tailored to your needs and goals. With the right support and commitment, managing polymyositis and living a fulfilling life is possible.