According to Bird, Green, Hammer, Hammond, Harkess, Hurley, Jeffeson, Pattison and scott (2006) arthritis is not exactly a single condition but can be made up of an assortment of different conditions that affect the joints at any stage of life. In keeping with arthritis research UK (1998-2010) “Arthritis is a term used by doctors to describe inflammation within a joint.” However some patients perceive only pain while most have a combination of the two. The main types can be divided into three main groups known as inflammatory, non-inflammatory and connective tissue arthritis (Bird, et al. 2006).
“In inflammatory arthritis, there is swelling of the soft tissues around a joint. Stiffness is most marked in the morning, when it may last an hour or more. Inflammatory arthritis may be acute, such as gout or chronic, such as rheumatoid arthritis.” (Bird, et al. 2006).
“For reasons no one fully understands, in rheumatoid arthritis, the immune system – which is designed to protect our health by attacking foreign cells such as viruses and bacteria – instead attacks the body’s own tissues, specifically the synovium, a thin membrane that lines the joints. As a result of the attack, fluid builds up in the joints, causing pain in the joints and inflammation that’s systemic – meaning it can occur throughout the body.” (Arthritis foundation, 2011).
Non-inflammatory arthritis includes torn ligaments and osteoarthritis and can cause bony swellings instead of soft tissue swelling. While the third group named before contains lupus and fibromyalgia that affects the connective tissue, (Bird, Et al. 2006).
The NHS (2010), describe the symptoms of Arthritis as pain, stiffness, restricted movements of the joints, inflammation and swelling and warmth and redness of the skin over the joint. Arthritis can affect clients/people in different ways; many of them fall into the categories of physical, physiological and psychological.
The physical side of these could be shown through the pain suffered, the inflammation/swelling and the stiffness felt due to the arthritis. The pain felt is usually the dominant symptom in all types of arthritis, the pain of arthritis can be chronic, meaning it is present most of the time and lasts for long periods of time. Inflammation is when a joint that is inflamed becomes swollen and the stiffness is when the inflamed joints feel stiff first thing in the morning and the stiffness can vary in the length of time it lasts, (Bird, et al. 2006). Consistent with Dictionary.com (2009) physiological is described as; of or relating to normal healthful functioning of an organism. Bird, et al (2006) believe that arthritis can cause the loss of function in joints due to pain, swelling and stiffness, causing them to not work well or move properly and due to this everyday tasks can become hard. Joint damage may also occur and can be caused by persistent inflammation; eventually the damage will become irreversible. There can be damage to the cartilage and bone which can be accompanied by tendon and soft tissue damage, this and the loss of function is a physiological effect of arthritis. Dictionary.com (2009) depicts the definition of psychological as the influencing or intended to influence the mind or emotions. Due to this the symptoms of arthritis described by Bird, et al. (2006) that fall under this category are fatigue; the sensation of unbearable tiredness, reduction of mood or depression. The feeling of fatigue is usually due to poor sleep, weakened muscles and disease which affect the whole body and the mind. A person’s self-perception can be affected by arthritis as it changes but the self-image and actual appearance and this then has the knock on effect of self-perception.
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Arthritis can be treated in different ways including drug treatment, surgical treatments, and there are complementary therapies which may help. Drug treatment can come in the forms of analgesics which would be classed as pain killers, these are for reducing the pain felt and are often used along with other drugs (Arthritis research UK, 1998-2010), and the simplest form is paracetamol, which can be bought over the counter in 500mg doses. (Birds, et al. 2006). These drugs act on the brain and spinal cord to alter the perception of the pain felt, they act like endorphins and stop the transmission of pain signals, (The British Medical Association, 2006). The can however, on a rare occasion irritate the stomach (The British Medical Association, 2006), due to this in reflexology the digestive system would be worked along with the thoracic and lumbar vertebrae along the spine. This is to stimulate digestion, release gastric juices, detoxify the blood and promote regular waste movements, (Norman, 2008).
The next available drugs which can be used are NSAID’s (non-steroidal anti-inflammatory drugs) and these help with the inflammatory component, swollen joints, stiffness and sometimes the heat of the joints too. These are prescribed during early arthritis (Birds, et al. 2006), these can be aspirin and work by acting on the site of pain by blocking the production of the substance prostaglandin which acts like a hormone. These can also create stomach problems, (The British Medical Association, 2006) and during reflexology the same areas as analgesics would have to be worked.
“Disease-modifying anti-rheumatic drugs (DMARDs); this group of drugs is used mainly in the treatment of rheumatoid arthritis but also in some other rheumatic diseases. They reduce pain, swelling and stiffness.” (Arthritis Research UK, 1998-2010). These can be things such as injectable gold, hydroxychloroquine, azathioprine, D-penicillamine, sulphasalazine, methotrexate, cyclosporine and leflunomide (Bird, et al. 2006). These drugs can cause many side effects such as eye damage and reduced blood cell production (The British Medical Association, 2006). To help with any affect upon the eyes the reflex areas which would be worked are all the toes with an emphasis on the brain, the kidneys and on the spine reflexes the clericals’ would be worked, (Norman, 2006).
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“Most people with arthritis won’t need surgery but for those who do, surgery can make a huge difference to their quality of life by reducing pain and improving mobility,” (Arthritis Research UK, 1998-2010). The surgery can be used for many different things, to remove loose fragments from inside the joint, to remove synovium from the joint, to correct deformity or straighten the limb, to fuse and prevent the movement, to replace all or part of the joint with an implant or spinal surgery to relieve pressure, fuse vertebrae or remove affected intervertebral disks (Bird, et al. 2006).
Reflexology has been used to help try and relieve the affects of arthritis, Tianjin Reflexology Association in China (Lingyun, Yuru, Yuehong, 2004) have preformed a study entitled “Analysis on Therapeutic Effects of Reflexology on Rheumatoid Arthritis.” using twenty-three people who suffered from rheumatoid arthritis. Foot reflexology was applied to the patients and the treatments where modified to each of the patient’s syndromes and each session lasted thirty to sixty minutes or longer if needed. The treatment given was one daily session, 10 sessions made one course of treatment with each patient observed for three courses of treatment. Out of these cases the results were as follows, nine showed a marked effect, thirteen showed an effect and only one was ineffective. The Tianjin Reflexology Association descried the results as joint pain and tenderness had improved as well as the swelling as well as functional disturbances had amazingly improved, however, there were no obvious change to deformity. Lingyun, et al (2004) believes that reflexology can bring about satisfactory therapeutic effects on rheumatoid arthritis.
Tianjin Reflexology Association in China (Lingyun, Yuru, Yuehong, 2004), have also preformed another trial entitled “Analysis on the Abnormal Signs on the Feet of Patients with Rheumatoid Arthritis,” on twenty-three people who suffered from rheumatoid arthritis with a history of the disease differing from one to 55 years. They studied abnormal foot signs of the patients so as to select the proper reflex areas for treatment, improve the therapeutic effect, and observe changes of disease. The results of this trial showed that signs and symptoms of abnormal foot conditions were relieved; “foot temperature raised in 90% of the cases, tenderness on reflex areas relieved or disappeared in 80% of the cases; granule, cord, and nodules were reduced in 20% of the cases; corn and cyst of one case disappeared. In rheumatoid arthritis patients, cold feet accounted for 95%; muscular tension 47%; abnormal soles 95%; abnormal toes 65%; and joint impairment 43%,” (Lingyn, et al. 2004). While in the Medical College of Suzhou University in China 130 cases were diagnosed as periarthritis of the shoulder and a trial of “Clinical Observation of Treatment of 130 cases of Perarthritis of Shoulder by Foot Reflex therapy Combined with Acupuncture,” was preformed. These patients were divided into two groups forty two in group A and eighty eight into group B, group A received acupuncture and group B received acupuncture and reflexology.
“Total effective rate of Group A was 83%, while that of Group B was 94%. The therapeutic effect of Group B was better than that of Group A,” (Zhijua, 2002). This shows that Reflexology can help relieve the symptoms of arthritis if used in conjunction with medication prescribed by a professional.
During a treatment upon a client who has arthritis specific areas upon the foot or hands can be worked a little extra to help alleviate pain, relax the client, and encourage movement. According to B and K Kunz (2007) the areas which should be worked are the kidneys, lymphatic glands, the adrenal glands and the solar plexus. It is believed that working these areas (Kidney and lymphatic glands) would help to eliminate waste products from the body, working the adrenal glands would help to reduce inflammation. While working upon the solar plexus reflex can help to relieve tension, (B & K Kunz, 2007). “The direct reflex areas are the affected joints, and direct massage for zone-related areas of the body- elbow for knee, shoulder for hip, toes for fingers, etc,” (Kumar, 2004). Since arthritis is an attack by the immune system upon the body then working the immune system would help to improve symptoms, the areas to work here are the liver, spleen, endocrine glands and the lymph glands, (B & K Kunz, 2007). The endocrine system glands are the cross reflexes which could be worked for those suffering from arthritis, these glands include the pituitary, thyroid/parathyroid, adrenal, pancreas, uterus/prostate and the ovaries/testis, these are worked to reduce stress due to the ability to balance the stress mechanism and the ability to produce hormones (B&K Kunz, 2007). “The associated reflex areas are the parathyroid and adrenal glands, solar plexus, kidney’s and pituitary gland,” (Kumar, 2004). Also while working these other areas should also be added including the coccyx, hips and pelvis, chronic neck, shoulder (dorsal and plantar), spine, intestines, ileo ceacal valve and the sigmoid colon and rectum as with any bone conditions as these can help to eliminate toxins from the body, (Gillanders, 2006). Other areas to work are the spinal reflexes these are the corresponding vertebrae along the spinal area upon the foot to help with different areas of the body. Working the spine on the foot of someone who suffers from arthritis can help with flexibility and normalise nervous responses (Norman, 2008). The corresponding vertebra upon the spine is the thoracic vertebrae 5, as this shall work the liver, solar plexus and the blood (Rice, 2007).
After any reflexology treatment the therapist has a duty to tell the client of certain aftercare procedures to help them feel better once they have received the treatment. Some of these things should be that a significant rest period should be taken place after the treatment, (Marquardt, 2000), as this helps to make the most of the positive effects of the treatment. Plenty of water should be consumed after the treatment, this is important to help flush out the toxins released from the therapy. Caffeine should be avoided after the release of toxins for about twenty four to forty eight hours after treatment, but herbal teas are recommended. Light meals, avoiding spicy foods and alcohol, (Mohamed-Jones, ND). The practitioner cannot tell the patient what they can and cannot do but they can give advice to the client about what might improve and maintain their health, for arthritis it can be recommended that the client might try holistic approaches along with their usual medication and treatments. These could include, fish oils, evening primrose oil, cod liver oil to help alleviate symptoms, cherries to help prevent the crystallization of uric acids also to cut out such things as citrus fruit, meat and eggs, (Gillanders, 2005). Also Gillanders (2005) believes that giving a reflexology treatment to another person might help as it exercise the joints and acupuncture has had a considerable success rare in pain relief.
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