Physiotherapy is the process of the treatment of bodily ailments by the application of physical agents like active and passive exercises, heat, cold, electricity, sound and other methods to assist the patients suffering from pain, stiffness, deformity, and paralysis. It is a therapeutic use of physical agents other than drugs. Very skillful and well performed manipulation or operation may lead to a very disappointing end result, without physiotherapy.
If function of the injured part is not maintained, the whole object of treatment may be spoiled although the operation was successful or the reduction of a fracture was perfect. From the earliest stage of treatment of a patient with fracture or dislocation; every phase of rehabilitation must be practiced: Psychological, social service, muscle development, joint mobilization, and diversional therapy (change of job: Tailoring, repair of shoe, clothes, shoe polish, clerical job etc.) Physiotherapist will work according to the direction of surgeon or physician. "There must be a physiotherapy department connected with the orthopedic department in every hospital."
A study at Department of Epidemiology and Biostatistics, University of Limburg, Maastricht, Netherlands shown that manipulative therapy and physiotherapy are better than general practitioner and placebo treatment. Furthermore, manipulative therapy is slightly better than physiotherapy after 12 months.
Physiotherapy cannot reverse established articular damage, therefore the aims of physiotherapy are to control pain, reduce joint stiffness, limit subsequent joint damage, improve function and health-related quality of life, and educate the patient in self-management, with the least amount of adverse detrimental treatment effects.
The American College of Rheumatology’s (ACR) revised guidelines for management of lower limb OA describe non-pharmacological interventions, including physiotherapy, as “…the cornerstone of osteoarthritis (OA) management and should be maintained throughout the treatment period. Drug therapy is most effective when combined with non-pharmacological strategies.” (Altman et al, 2000)
THERAPEUTIC EXERCISE
Therapeutic (remedial) exercises are extremely valuable for rehabilitation. Exercise should be specifically prescribed and instituted only by those having a thorough knowledge of functional anatomy, the existing pathological conditions and the physiological effects of the exercise. Exercise maintains proper function of cardiovascular, respiratory and muscular and nervous systems. Prolonged bed rest often results in a negative nitrogen balance and other metabolic changes associated with significant loss of calcium, phosphorous and potassium.
Physiotherapists can teach people with multiple sclerosis (MS) how to exercise safely for health and fitness in order to overcome the significant barriers to activity created by the symptoms of the disease. Benefits of therapeutic exercise are:
* Improved range of motion in affected painful joints
* Corrected muscle imbalance and bad posture
* Reduced muscular tension
* Improved elasticity in contracted soft tissue
* Reduced pain
* Accelerated healing
* Increased strength of weak or atrophic muscles
A summary of systematic reviews on therapeutic exercise in physiotherapy showed that exercise is a beneficial intervention for clients and patients across many different areas of physiotherapy. Exercise programs are more likely to be effective when intensive, individually designed, and linked with regular physiotherapist supervision and follow up.
Therapeutic exercise was beneficial for patients across broad areas of physiotherapy practice. Further high quality research is required to determine the effectiveness of therapeutic exercise in emerging areas of practice; according to a study published at pubmed.
Commissioned by the Australian Physiotherapy Association, the study provides high level evidence that the prescription of therapeutic exercise can significantly benefit many of the people seeing health practitioners – such as a physiotherapist – either in a hospital setting, rehabilitation centre or private practice.
Types of exercises:
1) Active exercise.
2) Active assistive exercise.
3) Active resistive exercise.
4) Passive exercise.
Active exercise:
Active exercise is that produced by the patient's voluntary contraction of muscles without external aid.
"Free exercise" vigorous isometric contraction will help to prevent or delay atrophy and maintain circulation. Movement in an involved extremity can be frequently enhanced by the simultaneous active resistive exercises of the opposite extremity. Example; Parallel bar for walking exercise (It is also helpful for exercise of upper extremity), Wooden stair case used for walking & co-coordinating movements of muscles of both lower and upper extremities.
Active assistive exercise:
Active assistive exercise is the patient's voluntary movement added by external assistance, from the therapist or through the use of pulleys and weight. This type of exercise is employed when the patient's muscular strength is insufficient to move the part, satisfactorily also to increase the range of motion (R. 0. M.) this may be due to muscle shortening, contracture, adhesions, stiffness and other disorders in joint.
Active resistive exercise:
Active resistive exercise is produced by the patient's voluntary contraction of muscles against the external resistance. Resistance may be given manually or by spring and weight to produce maximum bulk and strength of muscle, progressive resistive exercise is initiated.
Usually light resistive exercise first improves strength and later endurance. Active resistive exercise is often employed to stretch a shortened antagonist. However it is important that during exercise the part to be moved slowly and rhythmically through the maximum possible range and that each contraction is held for five seconds before relaxing. Example: static bike for exercise of lower extremity.
Passive exercise:
Passive movement is done entirely by the therapist or through the application of external force. The main therapeutic value in passive exercise is the maintenance of range of joint motion by preventing adhesions, contractures and joint fixation.
In peripheral nerve injury with paralysis, normal joint motion is maintained through the passive exercise during nerve regeneration). Therapeutic exercise has great value in asthma, pulmonary emphysema, expulsion of cough, before & after labor, pre & postoperative and other conditions.
GRADING OF MUSCLE POWER:
The Medical Research Council (M.R.C.) scale for grading muscle power in stages from 0 to 5 has been compared with an analogue scale in which power is expressed as a percentage of the maximum expected for that muscle. A record of the outcome of an assessment of the patient's limb muscular strength.
Muscle powers have been used to describe the gait of people without impairments, people with amputations, and patients fitted with a total hip prosthesis. The interaction among muscle powers could reflect specific propulsion and control strategies related to each limb. In gait associated with pathologies, these interactions could be perturbed, resulting in compensatory actions.
IN CASE OF LOSS OF MUSCLE POWER ACCESS: 1. How many extremities are affected, 2. Grading of muscle Power at Present, 3. Grading of Muscle Power at the onset of disease, 4. Duration of loss of muscle power, 5. Any recovery after the onset till date, 6. Most Direct cause of loss of Muscle Power.
Muscle power appears to be a more generalized attribute between the upper and lower limbs than is muscle strength, suggesting that mechanisms underlying velocity of movement, as opposed to force production may be important factors underlying muscle power in elderly persons. Additionally, upper limb muscle power measures may serve as a useful surrogate measure of limb power having implications for clinicians and researchers.
0- No contraction felt or seen.
[muscle power 0 - also known as or related to paralysis (finding), muscle paralysis (procedure), muscle power absent, muscle paralysis, no active muscle contraction (finding)]
1- Flicker of activity either felt or seen.
2- The production of movement with the effect of gravity eliminated.
3- The production of a movement against the force of gravity.
4- The production of a movement against the force of gravity and an additional force, such as spring and sand bag.
5- Normal power with full range of motion (Compare with the sound side).
N.B. - To eliminate the gravitational force generally powder board and suspension apparatus is used.
CERVICAL TRACTION:
Patient with cervical lesion, such as fractures, fracture-dislocation, herniated nucleus pulposus (A herniated nucleus pulposus is a slipped disk along the spinal cord. The condition occurs when all or part of the soft center of a spinal disk is forced through a weakened part of the disk) and cervical arthritis, with this disease the intervertebral space becomes NARROWED and this causes COMPRESSION of nerve root.
Naturally the signs and symptoms will depend on the degree of severity and the level of lesion. Clinically it shows pain to the shoulders and arms, weakness & loss of spinal movements. Decrease of reflexes, sometime shows wasting of muscles, are frequently benefited by properly instituted cervical traction.
Halter traction may be used in lying or sitting position to release the vertebral pressure on the nerve roots. Ordinarily, from 4 to 8 pounds of weight is used. The best results are usually obtained by gradually increasing the weight until a maximum is reached that can be comfortably tolerated by the patient while in lying position. This amount of pull is maintained for long period during which the patient at periodic intervals slowly rotates the head as far as possible to the right and then left. This procedure tends to increase the range of rotation of the head, which is frequently limited.
In true radiculitis (Inflammation of nerve root especially which lies in between the spinal cord and the inter vertebral canal) due to narrowing of the vertebral foramen, the best results from cervical traction occur when the neck is in partial flexion. In this position there is greater widening of the foramen than when the head is in a straight line with the long axis of the body or when it is extended. The exact direction of traction and the amount of force applied should be individualized for the specific conditions under consideration.
Traction may be used continuously or intermittently. It is necessary when applying traction to the neck that the chin should be pointing down towards the chest and never stretched with the chin pointing upward, use a small rolled pillow or towel 3 or 4 inches in diameter under the neck during continuous traction* in lying position.
A study by University of Social Welfare and Rehabilitation Sciences, Tehran, Iran, Toronto, Ontario, Canada shown that the application of cervical traction combined with electrotherapy and exercise produced an immediate improvement in the hand grip function in patients with cervical radiculopathy.
HEAT THERAPY (THERMOTHERAPY):
The value of heat in the treatment of disabilities has been well established. Heat is extremely valuable for both local and systemic effects such as improving blood and lymph circulation, in relieving pain for its beneficial effects in inflammatory conditions and for its relaxing effects. Heat in any form should be used with extreme caution or not at all over areas with impaired sensation or inadequate circulation. Heat is contraindicated over malignant areas, in hemorrhagic diseases and in very acute traumatic lesion. Different types of apparatus are used for heating therapy. They are classified into three groups:
1. External heat applicators: Hot water bottles, hot water pads, chemical pads, wax bath. Hydrotherapeutic apparatus (warm bath, whirl pool baths, contrast bath). These provide a simple but superficial type of heat.
2. Radiant heat generator (Infra-red-rays).
3. Short wave and diathermic apparatus.
One study showed that massaging with ice for 20 minutes, 5 days a week for 2 weeks, improved muscle strength in the leg, the range of motion in the knee and decreased time to walk 50 feet compared to no treatment. Another study showed that ice packs for 3 days a week for three weeks improved pain just as well as no treatment. Another study showed that cold packs for 20 minutes for 10 periods decreased swelling more than no treatment. Hot packs for the same amount of time had the same effect on swelling as no treatment.
CONTRAST BATH:
Contrast bath, whereby the extremity is alternately immersed in warm water (105° F) and cold water (Normal Tape water 65° F). It increases circulation and decreases pain. The affected part is immersed in warm water and all joints are exercised by active movement for three minutes. The part is then lifted from the warm water and immediately dipped into the cold water. Treatment should usually be given for half an hour three times each day.
In larger joints (neck and back, shoulder, elbow, hip and knee) you may simply alternate between a cold pack and a heating pad. The bath is designed as a free standing unit. Each bath tub contains 8 jet pipes with very small openings. This will give a highly effective "spritz" effect.
Heat is applied in particularly in chronic cases where pain is mainly due to joint or muscle tightness/stiffness. Heat is typically used during rehabilitation prior to exercise to decrease muscle stiffness, increase flexibility and range of motion, and thin joint fluid to minimize friction in the joint.
Uses:
Sudeck's Atrophy (Reflex Sympathetic Dystrophy Syndrome), contracture, pain and stiffness. Infra-red-rays, wax bath, contrast water bath all these methods afford superficial heating; such heats cannot penetrate the subcutaneous tissues. Deep penetrating heat can be applied by short wave diathermy and by ultrasound therapy.
Check below link for more other types:
Note:
Different types of Physiotherapy for fracture, dislocation and others (Part2) includes:WAX BATH, INFRARED IRRADIATION, SHORTWAVE DIATHERMY, ULTRASONIC THERAPY, ELECTRIC CURRENT, Hydrotherapy
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