Basicknowledge ofPhysiotherapy By Dr.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 during immobilization1. 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 to softIt involves skillful restoration of mobility tissues and joints.It consists of• Soft tissues techniques(massage)• Passive mobilization of joints• Passive streching of soft tissues• Auto stretching of soft tissues.
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 placedon the skin andallowed to mould tothe part, then theymore in a circulardirection with pressuregradually applied overthe top of the circleand released towardsthe bottom of thecircle.
Picking up Similar to kneading but it involves lifting the tissues up at right angles to the underlyingbone,sqeezing and releasing.
WringingIt involves lifting thetissues up as inpicing up andapplying a twist toenchance thestretching effect.
Skin rollingIt involves lifting andstretching the skinbetween thumbs andfingers so that theskin andsubcutaneous tissuesare moved on eachother and adhesionsare stretched.
FrictionsSmall rangemovements appliedwith the thumb orfingers startingsuperficially andworking deeper.theyapplied in one of twoways tranverse orcircular.
Connective Tissue Massage “connective The term 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.
Principles of1.Stengthening Treatment 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 & PrecautionsUntoward Effects: • Precautions:• Chilling • Temparature should be 94-98df.• Sudden changes in blood • Chlorine levels should be 1.5- pressure 3.0 ppm• Infections • Water PH must be 7.2-7.8.• Falls inside and outside the pool • Chlorine&PH must check for• Fatigue of patients or staff. 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 ContraindicationContraindications: • Low vital capacity• Infected wounds • Kidney disease• Acute skin conditions • Diabetes• Pyrexia • Thyroid deficiency• Incontinence • Radiotherapy in the previous 3• Cardiac disease months• DVT • Careful consideration is essential for patients with open• Recent pulmonary embolus wounds covered with a• Recent CVA waterproof dressing.• GIT disorders • Epilepsy• Tracheostomy • Vertigo
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• 5. AcuteElectrotherapy 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 Heat1. Paraffin wax2. Infra red radiation3. Heat pad4. Hot moist packs5. Short wave diathermy6. 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• Infrared (IR)radiation 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, 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 wavediathermy • 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• Application diathermy 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• 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 tissues 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.