Basic knowledge of Physiotherapy

ByDr.B.Arun Kumar

M.D(Ay)

Introduction• This is a branch of health care science that mainly

concentrates on the physical aspects of an individuals helath care, by treating their physical ailments.

• Physiotherapist must coordinate and work with the other members, throughout rehabilitation period.

Physiotherapy practiceMovement management by:

• Manipulative therapy

• Electro therapy

• Hydro therapy

MANIPULATIVE THERAPY

Physiotherapy during immobilization

1. Reduce edema-

2. Assist the maintenance of circulation to the area.

3. Maintains muscle function by active or static contractions.

4. Maintain joint range where possible.

5. Maintain as much function as allowed by the particular injury and the fixation.

6. Teach the patient how to use special appliances ex;sticks,crutches.

Physiotherapy techniques1.Movement techniques:

passive,

assisted,

active,

free active,

resisted exercises can be given to facilitate activity and to strengthen muscles.

Manipulative therapy

It involves skillful restoration of mobility to soft tissues and joints.

It consists of

• Soft tissues techniques(massage)

• Passive mobilization of joints

• Passive streching of soft tissues

• Auto stretching of soft tissues.

Soft tissues techniques(massage)

1. Stroking

2. Efflurage

3. Kneading

4. Picking up

5. Wringing

6. Skin rolling

7. Frictions

StrokingMassage is the manipulating of superficial

and deeper layers of muscle and connective tissue using various techniques, to enhance function, aid in the healing process, decrease muscle reflex activity, inhibits motor-neuron excitability and promote relaxation and well-being

Effluragea technique in massage in which

long, light, or firm strokes are used, usually over the spine and back. Fingertip effleurage is a light technique performed with the tips of the fingers in a circular pattern over one part of the body or in long strokes over the back or an extremity. Fingertip effleurage of the abdomen is a technique commonly used in the Lamaze method of natural childbirth.

KneadingThe hands are placed on the skin and allowed to mould to the part, then they more in a circular direction with pressure gradually applied over the top of the circle and released towards the bottom of the circle.

Picking upSimilar to kneading but it involves lifting the tissues up at right angles to the underlyingbone,

sqeezing and releasing.

Wringing

It involves lifting the tissues up as in picing up and applying a twist to enchance the stretching effect.

Skin rollingIt involves lifting and stretching the skin between thumbs and fingers so that the skin and subcutaneous tissues are moved on each other and adhesions are stretched.

FrictionsSmall range movements applied with the thumb or fingers starting superficially and working deeper.they applied in one of two ways tranverse or circular.

ContraindicationsSoft tissue manipulation

1. Acute inflammation

2. Weeping conditions

3. Infection

4. Recent fractures

5. Patient preference

IndicationsSoft tissue manipulation

1. Scar tissue

2. Muscle spasm

3. Muscle tightness

4. Fascial tethering

5. Oedema

6. Pain

7. Slow healing scars or ulcers.

Connective Tissue MassageThe term “connective

tissue” in this case refers to the fascia which surrounds, protects, and supports all of the other structures in the body. It is the matrix which binds together the body’s organs and systems, while at the same time providing compartmentalization between them.

Connective Tissue Massage

Indications:• tendonitis

• fibromyalgia

• scoliosis

• chronic fatigue syndrome

• sciatica

• multiple sclerosis

• TMJ

• ALS (Lou Gehrig’s Disease)

• arthritis

• carpal tunnel syndrome

Passive mobilizaiton of joints

Joints restriction factors:

• Pain

• Muscle spasm

• Oedema

• Fibrous contracture of fascia

• Ligaments/capsule

• Cartilage flake trapped between the joint surfaces.

Hydrotherapy

Principles of Treatment1.Stengthening muscles:

They are strengthened by working progressively against graded resistance.in the pool,resistance may be from buoyancy, turbulence,unstreamlining.

2.Buoyancy:

movements downwards in the pool are resisted by buoyancy.floats which may be of different densities may be used to increase the effect of buoyancy.

3.Turbulence:

it is created by movement through water and is increased if the rate of movement is increased.

Principles of Treatment4.unstreamling:

If a broad surface is presented when a body is moved through water the resistance is greater than if the surface is narrow.To progress exercises with a bat, for example, the movement is first performed with the edge of the bat moving through the water and then progressed so that the broad surface is going against the water.

5.Joint mobility:Relief of pain and muscle spasm by the warmth of the water and by support from buoyancy can restore free movement of joints.

6.Coordination and balance:Patients can practice activites in standing,transference of weight,and arm movements.

Methods of Heat Transfer

• Conduction

• Convection

• Radiation

Untoward Effects & Precautions

Untoward Effects:• Chilling

• Sudden changes in blood pressure

• Infections

• Falls inside and outside the pool

• Fatigue of patients or staff.

• Precautions:• Temparature should be 94-98df.

• Chlorine levels should be 1.5-3.0 ppm

• Water PH must be 7.2-7.8.

• Chlorine&PH must check for every 2/3 days

• Bacteriological testing

• Backwashing must be performed regularly.

• Floor of pool must be non slip.

Clinical Indications• Ankylosing spondylitis

• Osteoarthritis

• Rheumatoid arthritis

• Juvenile chr.polyarthritis

• Spondylosis

• Capsulitis

• Mechanical spinal disorders

• Polymyalgia rheumatica

• Major fractures (lower limbs/spine)

• Ortopaedic surgery

• Neurological disorders

• Value for maintaining fitness and relieving backache during pregnancy after child birth.

Hydrotherapy Contraindication

Contraindications:• Infected wounds• Acute skin conditions• Pyrexia• Incontinence• Cardiac disease• DVT• Recent pulmonary embolus• Recent CVA• GIT disorders• Tracheostomy

• Low vital capacity• Kidney disease• Diabetes• Thyroid deficiency• Radiotherapy in the previous 3

months• Careful consideration is

essential for patients with open wounds covered with a waterproof dressing.

• Epilepsy• Vertigo

Electro therapy

Use of Electrotherapy • 1.Pain management

• Improves range of joint movement • 2. Treatment of neuromuscular dysfunction• Improvement of strength • Improvement of motor control • Retards muscle atrophy • Improvement of local blood flow • 3. Improves range of joint mobility• Induces repeated stretching of contracted, shortened soft

tissues • 4. Tissue repair• Enhances microcirculation and protein synthesis to heal

wounds • Restores integrity of connective and dermal tissues

Use of Electrotherapy• 5. Acute and chronic edema

• Accelerates absorption rate • Affects blood vessel permeability • Increases mobility of proteins, blood cells and lymphatic

flow • 6. Peripheral blood flow• Induces arterial, venous and lymphatic flow • 7. Iontophoresis• Delivery of pharmacological agents • 8. Urine and fecal incontinence• Affects pelvic floor musculature to reduce pelvic pain and

strengthen musculature • Treatment may lead to complete continence

Sources of Heat

1. Paraffin wax

2. Infra red radiation

3. Heat pad

4. Hot moist packs

5. Short wave diathermy

6. Microwave diathermy

Paraffin wax• Paraffin wax refers to a white or colourless soft

solid that is used as a lubricant and for other applications.

• It consists of a mixture of hydrocarbon molecules containing between twenty and forty carbon atoms.

• It is solid at room temperature and begins to melt above approximately 37 °C (99 °F).

• Paraffin wax is an excellent material to store heat, having a specific heat capacity of 2.14–2.9 J g−1 K−1 (joule per gram kelvin) and a heat of fusion of 200–220 J g−1.

Infra red radiation• Infrared (IR) light is electromagnetic radiation with

longer wavelengths than those of visible light, extending from the nominal red edge of the visible spectrum at 0.74 micrometres (µm) to 300 µm.

• This range of wavelengths corresponds to a frequency range of approximately 1 to 400 THz,[1] and includes most of the thermal radiation emitted by objects near room temperature.

• Infrared light is emitted or absorbed by molecules when they change their rotational-vibrational movements.

• The existence of infrared radiation was first discovered in 1800 by astronomer William Herschel.

Infra red radiation• Several studies have looked at using infrared saunas in the treatment

of chronic health problems, such as high blood pressure, congestive heart failure and rheumatoid arthritis, and found some evidence of benefit.

• For example it is used in infrared saunas to heat the occupants, and also to remove ice from the wings of aircraft (de-icing).

• Far infrared is also gaining popularity as a safe heat therapy method of natural health care and physiotherapy.

• Strong infrared radiation in certain industry high-heat settings may be hazard to the eyes, resulting in damage or blindness to the user.

• Since the radiation is invisible, special IR-proof goggles must be worn in such places.

Heat Pad• They are plastic covered pads similar to but smaller

than electric blankets.

• A pad has 3 levels of heat and is useful for treating the neck or back.

• Patient lies on it and heat passes to the tissues by conduction.

Hot moist packs

• These bags filled with a hydrophilic substance and stored in a thermostatically controlled cabinet of water between 75 -80 degree C.

• Useful on uneven surfaces because they can be easily moulded to the surface.

• They are heavy causes discomfort.

Short wave diathermy• It is application to the tissues

of electrical fields which oscillate at a frequency of 27.12MHZ and have a wavelength of 11.06M.

• It is used in deep and superficial lesions.

• It produces a greater and more rapid rise in temp.

• Useful for softtissue injuries,degenerative & inflammatory arthopaties,slow healing wounds,sinusitis,deepseated pelvic structures.

Microwave diathermy• Application of

electromagnetic radiations with a wavelength of 12.25cm & frequence of 2450MHz.

• They are produced by a megnetron,which is a special type of thermoinic valve.

• Depth of penetration 3cm.• They are absorbed by fluid

tissues & less by bone,fat.• Degenrative joint disease&

joint lesions are better treat.

ICE THERAPY

Ice Therapy• Cold Compression Therapy combines two of

the principles of R.I.C.E. (Rest, Ice, Compression, Elevation) to reduce pain and swelling from a sports or activity injury to soft tissues and recommended by orthopedic surgeons following surgery.

• The therapy is especially useful for sprains, strains, pulled muscles and pulled ligaments.

• Cold Compression is a combination of cryotherapy and static compression, commonly used for the treatment of pain and inflammation after acute injury or surgical procedures.

Ice Therapy• Cryotherapy, the use of ice or cold in a therapeutic

setting, has become one of the most common treatments in orthopedic medicine.

• The primary reason for using cryotherapy in acute injury management is to lower the temperature of the injured tissue, which reduces the tissue's metabolic rate and helps the tissue to survive the period following the injury.

• It is well documented that metabolic rate decreases by application of cryotherapy.