Rheumatology physiotherapy

The Rheumatology team at Great Ormond Street Hospital (GOSH) treats patients with inflammatory diseases and non-inflammatory diseases that affect joints, muscles and soft tissue.

Our team provides specialist expertise in physiotherapy assessment and management of complex and rare rheumatology conditions. We work closely with the multidisciplinary team to ensure each child has appropriate management.

There is an intensive rehabilitation group which runs all year. It is for patients who have been assessed by our team and who have significant muscle weakness or joint stiffness. The group can be offered as a sole treatment or can be in conjunction with other treatments, such as joint injections or prolonged stretching of a joint using casting.

The aim of this group is to provide an environment where children can learn more about why they have pain, how to deal with it and what their bodies are capable of. We follow a progressive resisted muscle strengthening programme for two weeks, and the children are able to learn from and support each other during this time.

Following the two week group, a home exercise programme will be taught to the child and parents, and follow up will be arranged in our clinics. We are also able to liaise with the child’s school and local services to ensure that the maximum gain from the rehabilitation is achieved.

Inflammatory conditions commonly seen are juvenile idiopathic arthritis (JIA), systemic lupus erythematosus (SLE), juvenile dermatomyositis (JDM), scleroderma and vasculitis.

Non-inflammatory conditions include joint hypermobility syndrome, Ehlers Danlos syndrome (classical and vascular type), complex regional pain syndrome (CRPS) and chronic pain.

In children with inflammatory diseases, the physiotherapist is able to assess how the disease has affected the muscles and joints of the child. They will assess for swelling or inflammation of joints, muscles tightness or weakness and functional ability ‑ how you walk, stand and move around.

This assessment, combined with the medical assessment, will help to decide whether the condition is getting better and what further management might be needed. The physiotherapist will also give advice on exercises to stretch tight joints and muscles, and to strengthen muscles so that the whole body can move in a better way. In some cases where joints have limited movement, the physiotherapist will work with the medical team to provide additional treatment, such as splinting alongside joint injections, and will then give advice or intensive exercise treatment as follow-up from this.

In non-inflammatory conditions, the physiotherapist will complete a thorough assessment of joint movement, muscle strength, and functional ability including walking. They are then able to provide exercises and advice to help the child get stronger, which will help them to return to normal fitness levels.

The exercises that we do in physiotherapy are aimed at increasing muscle strength in key muscle groups, which weaken quickly in inflammatory and non-inflammatory conditions. Weakness in these muscle groups can lead to reduction in energy levels, joint and muscle pains, and decrease in ability to take part in functional activities such as playing, school and socialising. By regaining strength in these muscle groups, children can go on to take part in many, if not all of the same activities as their friends.

The most important thing in our physiotherapy service is exercise. This may mean that you come into a clinic where the physiotherapist will complete an assessment and then teach you a programme of exercises to do at home. This is sometimes a joint clinic appointment with the medical team.

Should the team feel it is required, you may be offered a place in the two week intensive rehabilitation group, where exercises are done in a group setting at the hospital on a daily basis with the physiotherapists.

Some children who are particularly unwell may also be seen on the ward to do their exercises.