[Evidence-based physiotherapeutic strategies for musculoskeletal pain]

[Physiotherapy in rheumatology]

Inflammatory and non-inflammatory rheumatic as well as degenerative disorders have a tendency to progress resulting in morphological and functional deficits and thus cause impairment of physical health. To inhibit this debilitating development, physiotherapeutic and exercise strategies are indispensable and in exceptional cases can be necessary for the whole lifetime. This article presents a current overview of the aims of treatment, methods and techniques, modes of action, indications and contraindications and application modalities, as well as the current underlying scientific evidence.

[Preservation of ability to work and securing vocational participation : non-pharmaceutical support options for rheumatologists]

For patients of working age with chronic rheumatic diseases preservation of the ability to work and therefore for equal participation in professional life is of particular importance. Significant supporting actions by rheumatologists include non-pharmaceutical and non-medical interventions in addition to drug therapy. Measures aiming at sustained working capacity such as physiotherapy, occupational therapy, medical rehabilitation and stepwise return to work have to be utilized. This support can include referral to a counseling service and assistance with the application for medical or vocational rehabilitation programs. In order to ensure sustainable success of the initiated measures it is essential that follow-up care and function-related interventions are supervised by a rheumatologist.

[Molecular physical medicine]

A multimodal treatment of inflammatory rheumatic diseases without physical medicine is almost always incomplete. The mechanisms underlying the positive effects of physical medicine are only partially understood. Modern molecular medicine offers new insights into pivotal mechanisms and mediators of the inflammatory process and into interactions between cells of the immune system and the bone. Investigating the potential influences of different methods of physical medicine on the central regulatory processes of inflammatory rheumatic diseases is of great interest, highly fascinating and opens up new avenues of research for the future. This article focuses on the first novel results of molecular physical medicine in rheumatic and degenerative diseases.

[Physiotherapy and ergotherapy are indispensable. Concrete prescription of remedies - without recourse]

Physical therapy and occupational therapy are essential for the treatment of inflammatory rheumatic diseases equal in rank to any drug therapy. They have enough evidence and are part of all current guidelines even if mostly not specified. In the German social security system the doctor prescribing physical therapy or occupational therapy has to act according to the different rules and forms as described in the current "Heilmittel Richtlinie" (Remedy directive) effective since July 2011. The multiple formal conditions and requirements of prescriptions are described in detail. Of special interest is that the global diagnosis of rheumatoid arthritis can no longer be used as the reason or justification for the individual prescription but detailed sub-diagnoses, regarding the essential ICF domains of structural damage, functional impairment, activity limitation and participation restriction as well as individual context factors are necessary. Of special interest is the fact that the prescribing doctor is no longer responsible for the formal correctness of prescriptions but the performing therapist, who will not be reimbursed if the prescription shows even minor formal errors. Another important improvement is the newly introduced long-term prescription of physical and occupational therapy. This facilitates the application of these therapies in the multimodal treatment regimen of rheumatic diseases.