Physical Therapy Guide to Juvenile Idiopathic Arthritis
What Is Juvenile Idiopathic Arthritis?
JIA is an autoimmune disease involving joint inflammation that arises before a person’s 16th birthday. Symptoms include swelling, warmth, and stiffness of the joints that last at least six weeks.
The exact cause(s) of JIA are unknown, but it begins when the immune system is more active than normal. The increased immune reactions lead to inflammation. Treatments for JIA are available despite there being no cure. Most children can achieve remission or periods of improved wellness with treatment.
Types of JIA
JIA has multiple “types” and can involve a varying number of joints. Three of its four types are more common in girls. The four types are:
Oligoarticular. This type of JIA, which affects fewer than four joints, is the most common. It typically affects the larger joints of the knees, ankles, and elbows.
Polyarticular. In this type, five or more joints are affected, usually on both sides of the body.
Enthesitis-related. This type most commonly affects the back of the ankle (at the Achilles tendon) and the knee. This type is more common in boys.
Systemic. This type affects the whole body. It often occurs with a high fever and rash that lasts over two weeks.
What Is Juvenile Idiopathic Arthritis?
Symptoms of JIA may come and go. Periods when symptoms last for days are known as “flares.” A child may show symptoms of one type of JIA, and then another type later. The most common symptoms include:
- Joint pain or stiffness. These may be worse when first waking up or after staying in one position for a long time.
- Red, swollen, warm, tender joints.
In addition to joint problems, other symptoms may include:
- Feeling tired or run-down.
- Blurry vision and eye inflammation (uveitis).
- Rash or skin changes.
- Decreased appetite.
- High fever.
How Is It Diagnosed?
Diagnosis of JIA most often depends on physical findings during an exam, the child’s medical history, and the ruling out of other conditions.
A doctor will usually:
- Ask about the child’s symptoms and when they began.
- Inquire about a family history of autoimmune diseases.
- Check the child’s skin and joints.
- Watch the child’s movement.
- Check the child’s eyes and lymph nodes.
The doctor may order blood tests and imaging (such as an X-ray) to aid in determining the type of JIA or to rule out other problems. They may prescribe medications to help with the inflammatory process. They also may refer your child to a rheumatologist for further assessment and ongoing medical treatment.
The doctor will also likely recommend seeing a physical therapist for further assessment. A physical therapist can aid in pain reduction and decrease joint stiffness and help your child maintain or improve their quality of movement.
Physical Therapist Evaluation
Your physical therapist will perform a complete evaluation to assess your child’s condition. They also can assess any injuries or secondary complications and determine any factors that may contribute to the symptoms. They will gather information about your child’s health history, and may ask you questions such as:
- How long has the pain been occurring?
- Is there a time of day that pain seems to be worse?
- Is there redness/swelling around the affected area?
- How have symptoms affected your child’s function at home or school?
- Has your child reduced or limited their participation in any activities? Which activities do they avoid?
Your physical therapist also will conduct a physical exam that includes tests for:
- Range of motion of the joints.
- Strength.
- Walking pattern (gait).
- Functional movement.
- Endurance.
They also may recommend imaging tests, depending on your child’s symptoms.
How Can a Physical Therapist Help?
A physical therapist is a crucial part of the health care team working to improve and manage JIA and allow the child to keep a healthy lifestyle. A physical therapist can provide guidance on activity to help relieve pain. They also will help your child safely return to age-appropriate play or sports participation. Your child’s physical therapist can provide pain-reducing activities and education on stretching. In addition, they will help your child strengthen muscles to protect joints, and work with them on how they walk, for improved control and endurance. They can help to prevent complications such as joint deformities.
Your child’s physical therapist will use the best available evidence to develop a treatment program for their specific needs, challenges, and goals. They will work with your child to:
- Restore, maintain, and improve function and gross motor skills (such as walking, running, throwing, and kicking).
- Help manage pain with activity modification (changes in the way they do everyday activities).
- Restore and improve joint range of motion.
- Maintain fitness and overall health.
- Prevent or minimize flares and joint changes.
- Present or minimize secondary complications such as joint deformities.
Your physical therapist also will partner with other members of your health care team as needed to address any related problems.
Your physical therapy program may include:
Patient and family education. Your physical therapist will provide education on JIA and recommendations for activity modification and progression. In times of a flare, your physical therapist can suggest ways to improve your child’s independence for activity as needed. They may suggest more rest or the use of certain equipment. Your physical therapist also can teach your child gentle stretching and other activities to work on at home.
Hands-on (manual) therapy. Your physical therapist may use their hands to assess joint function and provide gentle stretching and joint mobility exercise to promote increased range of motion and pain relief.
Balance and gait training. Your physical therapist may work with your child to improve their balance and promote independence, such as standing on one leg to get dressed and taking part in appropriate play. Your physical therapist will assess how your child walks and provide training to reduce risk of injuries.
Muscle strengthening. Strengthening is an important part of managing JIA and for recovery from any injuries. Your physical therapist may work with your child on activities such as using stairs, or getting on and off the floor. They can help them progress to safe jumping and running when appropriate. Your physical therapist can design a specific program to help your child develop or maintain strength related to their needs and activity interests.
Aquatic therapy. Your physical therapist may have access to a pool to provide aquatic therapy. The buoyancy of water can allow for pain-free movement to mobilize joints and help keep them from becoming stiff. Movement also is important to reduce and avoid pain. If you have access to a pool, your physical therapist will help you learn exercises and activities for your child to do in the water.
Taping or bracing. Your physical therapist may use taping techniques to help reduce pain and promote balance. Some evidence suggests taping may be useful to supplement physical therapy.7 Your physical therapist will determine if taping may benefit your child.
If Surgery Is Needed
Surgery for JIA is not likely to be needed. According to a recent 2023 study, in rare cases, despite the typical medications and conservative treatment, severe pain, joint deformities, and disability develop that may require surgery. People who have surgery will benefit from physical therapy to aid recovery.
Can This Injury or Condition Be Prevented?
A physical therapist is a crucial part of the health care team working to improve and manage JIA and allow the child to keep a healthy lifestyle. A physical therapist can provide guidance on activity to help relieve pain. They also will help your child safely return to age-appropriate play or sports participation. Your child’s physical therapist can provide pain-reducing activities and education on stretching. In addition, they will help your child strengthen muscles to protect joints, and work with them on how they walk, for improved control and endurance. They can help to prevent complications such as joint deformities.
Your child’s physical therapist will use the best available evidence to develop a treatment program for their specific needs, challenges, and goals. They will work with your child to:
- Restore, maintain, and improve function and gross motor skills (such as walking, running, throwing, and kicking).
- Help manage pain with activity modification (changes in the way they do everyday activities).
- Restore and improve joint range of motion.
- Maintain fitness and overall health.
- Prevent or minimize flares and joint changes.
- Present or minimize secondary complications such as joint deformities.
Your physical therapist also will partner with other members of your health care team as needed to address any related problems.
Your physical therapy program may include:
Patient and family education. Your physical therapist will provide education on JIA and recommendations for activity modification and progression. In times of a flare, your physical therapist can suggest ways to improve your child’s independence for activity as needed. They may suggest more rest or the use of certain equipment. Your physical therapist also can teach your child gentle stretching and other activities to work on at home.
Hands-on (manual) therapy. Your physical therapist may use their hands to assess joint function and provide gentle stretching and joint mobility exercise to promote increased range of motion and pain relief.
Balance and gait training. Your physical therapist may work with your child to improve their balance and promote independence, such as standing on one leg to get dressed and taking part in appropriate play. Your physical therapist will assess how your child walks and provide training to reduce risk of injuries.
Muscle strengthening. Strengthening is an important part of managing JIA and for recovery from any injuries. Your physical therapist may work with your child on activities such as using stairs, or getting on and off the floor. They can help them progress to safe jumping and running when appropriate. Your physical therapist can design a specific program to help your child develop or maintain strength related to their needs and activity interests.
Aquatic therapy. Your physical therapist may have access to a pool to provide aquatic therapy. The buoyancy of water can allow for pain-free movement to mobilize joints and help keep them from becoming stiff. Movement also is important to reduce and avoid pain. If you have access to a pool, your physical therapist will help you learn exercises and activities for your child to do in the water.
Taping or bracing. Your physical therapist may use taping techniques to help reduce pain and promote balance. Some evidence suggests taping may be useful to supplement physical therapy.7 Your physical therapist will determine if taping may benefit your child.
If Surgery Is Needed
Surgery for JIA is not likely to be needed. According to a recent 2023 study, in rare cases, despite the typical medications and conservative treatment, severe pain, joint deformities, and disability develop that may require surgery. People who have surgery will benefit from physical therapy to aid recovery.
Can This Injury or Condition Be Prevented?
JIA may fluctuate with flares or periods of more intense symptoms. You will need regular visits with your health care providers to manage JIA. Your physician will monitor flares and manage your child’s medication as appropriate. Your physical therapist will help manage flares with activity modification, equipment such as assistive devices (cane, walkers, etc,), stretching, and other guided activity. In addition, in periods of wellness, your physical therapist can guide your child through strengthening and cardiovascular activity to promote improved well-being and function.
What Kind of Physical Therapist Do I Need?
All physical therapists are trained through education and experience to evaluate, manage, and treat various symptoms and conditions. However, you may want to consider seeing a physical therapist who is:
- Experienced in treating pediatrics and arthritis.
- A board-certified clinical specialist in pediatric physical therapy, or who has completed a residency or fellowship in pediatric physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your child’s condition.
- A practice/clinic that focuses on pediatric physical therapy.
You can find physical therapists in your area with these credentials and clinical expertise through Find a PT, a tool built by the American Physical Therapy Association.
General tips when you’re looking for a physical therapist (or any other health care provider):
- Get recommendations from family, friends, or other health care providers.
- Ask about the physical therapist’s experience treating JIA before you make an appointment.
- Be prepared to describe your child’s symptoms in as much detail as possible. Make a note of what makes these symptoms worse or better.
Therapycare Physical Therapy
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