Lyme Disease, is a bacterial infection that enters a human host through the bite of the blacklegged tick. The bacteria (Borrelia burgdorferi) is carried by the ticks, who get it from biting infected mice or deer. The blacklegged tick is very small, and can be difficult to spot clinging to a person’s body. There are three stages of Lyme Disease:
Stage I – Early Localized Lyme Disease: The infection has not spread throughout the body, and is instead concentrated in the area surrounding the tick bite. Symptoms occur a few days to a week after infection.
Stage II – Early Disseminated Lyme Disease: The infection has begun to spread throughout the body. Symptoms occur a few weeks to a month after infection.
Stage III – Late Disseminated Lyme Disease: The bacteria are located throughout the body. Symptoms occur several months or even years after infection.
Lyme Arthritis
If lyme disease goes untreated, or reaches stage III, it can cause long-term joint inflammation called lyme arthritis. Arthritis is the wearing down or degeneration of articular cartilage in a joint. Articular cartilage helps the joint surfaces slide freely over each other, enabling movement of the body.
Causes
Lyme Disease is caused by a bite from the blacklegged tick. However, there are several factors that increase the likelihood of exposure:
- Outdoor activities like gardening or hiking
- Having a pet that might bring ticks indoors
- Walking in high grasses, particularly without the right clothing and footwear
Symptoms
Untreated lyme disease can spread to the brain, heart and joints.
- Itching
- Chills and Fever
- Headache and Light-headedness
- Muscle Pain or Joint Pain
- Stiffness in the Neck
- A “bulls eye” rash or redness where the tick bite occurred
- Abnormal muscle movement
- Weakness
- Numbness and tingling
- Neurological impairments, like speech problems
Physical Therapy Interventions
Physical Therapists are professionals, educated and trained to administer interventions. As defined by The Guide to Physical Therapist Practice, interventions are the skilled and purposeful use of physical therapy methods and techniques to produce changes consistent with the diagnosis, prognosis and the patient or client’s goals.
If after treatment with antibiotics, lyme disease has caused lyme arthritis, your physical therapist will perform a thorough evaluation to assess and determine the following:
- Joint: a series of measurements will be performed to determine which joint is involved and the extent to which the inflammation is acute
- Strength: resisted testing is performed to determine if there is associated weakness or strength imbalances
- Flexibility: range of motion measurements will be taken to determine if there is reduced joint movement
- Technique and ADL: the therapist will review what activities you have difficulty with and will help you make modifications in technique to reduce stress on the involved joint.
- Gait, Balance and Alignment: the therapist will assess your gait and balance on even and uneven surfaces. An assistive device such as a cane or walker may be indicated to improve safety, gait and reduce stress on the effected joint.
Physical therapy for lyme arthritis must remain conservative at the onset to avoid aggravating the condition. Emphasis will be placed on rest, reducing the inflammation, protecting the joint and increasing the blood circulation for healing. Once the initial inflammation has reduced, a program of stretching and strengthening will be initiated to restore flexibility and improve strength to reduce stress on the joint.
Treatments
- Manual Therapeutic Technique (MTT): hands on care including soft tissue massage, stretching and joint mobilization by a physical therapist to improve alignment, mobility and range of motion of the affected joint. The use of mobilization techniques also helps to modulate pain.
- Therapeutic Exercises (TE) including stretching and strengthening exercises to regain range of motion and strengthen muscles of the joint and affected extremity to support, stabilize and decrease the stresses place on joint cartilage.
- Neuromuscular Reeducation (NMR) to restore stability, retrain the affected extremity and improve movement techniques and mechanics (for example, running, kneeling, squatting and jumping) of the involved extremity to reduce stress on the joint surfaces in daily activities. Gait and balance training may be indicated in those that have issues with walking.
- Modalities including the use of ultrasound, electrical stimulation, ice, cold, laser and others to decrease pain and inflammation of the involved joint.