Gout

Gout is a conditions characterized by presence of crystal in and around the joint, bursae, and tendons.  This is a disorder of purine metabolism characterized by Hyperuricaemia, deposition of monosodium urate monohydrate crystals in joints and per articular tissues and recurrent attacks by synovitis.
Urate crystals are deposited in minute clumps in connective tissues including articular cartilage. The common sites are the small joints of hands and feet, metatarsophalangeal joints of big toe, the ankle and fingers and the olecranon bursae.

Causes

• Over production of uric acid can leads to GOUT. Purines are compounds found in certain foods. When the body breaks down purines, it produces uric acid as a byproduct. Foods rich in purines, such as red meat, organ meats (like liver), shellfish, and certain fish (e.g., sardines, anchovies), can increase uric acid.
• A family history of GOUT can increases the risk of this condition.
• Excess weight can lead to higher uric acid production and reduced elimination by the kidneys.
• Some medications, like diuretics, can raise uric acid levels.

Symptoms

·  Severe Joint Pain: Often sudden and intense, usually starting in the big toe.

·  Swelling and Redness: Affected joint may become swollen, tender, and warm to the touch.

·  Limited Range of Motion: The affected joint can become stiff and difficult to movement.

Physiotherapy Treatment

Physiotherapy can play a crucial role in rehabilitation, mobility, and reducing the risk of complications. Physiotherapy treatment for gout primarily focuses on managing pain, improving joint function, and preventing future flare-ups. While medications are often necessary to treat acute gout attacks and manage uric acid levels.

 Pain Management

• Cryotherapy (Ice Therapy): Applying cold packs to the affected joint can help reduce pain, swelling, and inflammation during an acute gout attack. Ice therapy can be effective in the first 24-48 hours.
• Heat Therapy: After the acute phase, heat pads or warm compresses may help relax muscles and alleviate joint stiffness, particularly if the joint is not inflamed anymore.
• Transcutaneous Electrical Nerve Stimulation (TENS): This involves using low-voltage electrical currents to reduce pain perception in the affected joint area.

Range of Motion Exercises

• After the pain of an acute gout attack subsides, physiotherapists can guide gentle exercises to improve range of motion and prevent joint stiffness. These exercises help maintain the flexibility of the affected joint and prevent long-term damage.
• Gentle Stretching: Stretching exercises may be recommended to maintain the mobility of the joints, especially after an attack.

Strengthening Exercises for gout

• Weakness and muscle atrophy can occur if the affected joint has been immobilized for an extended period. Physiotherapists will often guide you through exercises to strengthen the muscles surrounding the joint, which can help provide more support and reduce the risk of further injury or strain.
• Isometric exercises (where the muscle contracts without movement) can be useful during acute phases when motion is limited.

Stretching Exercises

• Gentle stretching exercises for the muscles around the affected joint are essential to prevent joint stiffness and promote flexibility. Stretching helps increase blood circulation and can reduce the chances of deformities caused by muscle tightness.

Joint Protection and Techniques

• Physiotherapists can teach you joint protection techniques to avoid stress on the affected joints during daily activities. This can include recommendations for using assistive devices (like canes or splints), altering posture, or using better body mechanics when moving.
• Proper Footwear: In cases where gout affects the feet (e.g., the big toe), physiotherapists may suggest footwear modifications, such as arch supports or cushioned insoles, to reduce pressure on the joint and ease walking.
• Avoiding excessive weight-bearing on the affected joint is essential during acute flare-ups to allow the joint to heal and reduce further inflammation.

Manual Therapy

• Soft Tissue Mobilization: Gentle massage techniques may help reduce muscle tightness around the affected joint.
• Joint Mobilization: In some cases, a physiotherapist may use hands-on techniques to mobilize the affected joint (after the acute inflammation has decreased) to restore normal function and alleviate stiffness.

Postural and Gait Retraining for gout

• Postural Education: Gout attacks, particularly in the lower limbs, may cause people to adopt abnormal postures or movement patterns to protect the affected joint. A physiotherapist can train the patient to maintain proper posture during daily activities, reducing strain on other joints.
• Gait Training: If the person is limping or using an abnormal gait due to pain or stiffness, gait retraining may be needed to restore normal walking patterns and reduce stress on other joints.