PHYSIOTHERAPY AND REHABILITATION

Presenter : Dr. S.V.Hari krishnan(PGT ORTHO)

LEARNING OBJECTIVES

INTRODUCTIONELECTROTHERAPYCRYOTHERAPYEXERCISE THERAPYHYDROTHERAPYREHABILITATIONCONCLUSION

DEFINITION

PHYSICAL THERAPY - evaluating, diagnosing, and treating a range of diseases, disorders, and disabilities by physical means.

Diagnosis and treatment of physical source of the problem; the injured tissues and structures

He must cure himself is the doctrine of physiotherapy.

HISTORY• Hippocrates & later Galenus first

practitioner of physiotherapy (460 BC)

• Per hendrik ling – “father of swedish gymnastics”

• Modern Physiotherapy was established in Great Britain

• Emergence of physiotherapy : World Wars

PHYSIOTHERAPY SPECIALTIES

CARDIO PHYSIOTHERAPY

PAEDIATRIC PHYSIOTHERAPY

GERIATRIC PHYSIOTHERAPY

ORTHOPAEDIC SPORTS NEUROLOGY

ROLE OF PHYSIOTHERAPIST• Assess ,manage & treat a broad range of medical conditions

• Relieve physical pain & heal injuries.

• Increase mobility, build strength, improve balance & enhance Cardiopulmonary performance.

• Use a variety of techniques to strengthen the muscles & joints.

• Make individual independent for his/ her activity of daily living.

• Provides gait training & Posture correction.

• Thus rehabilitation includes prevention of avoidable disabilities Bed-soresVenous thrombosis Urinary infectionRenal stones Muscle wastingJoint stiffness and Contractures early mobilization

ELECTROTHERAPY

Shortwave Diathermy

Microwave Diathermy

Ultra sound

Interferential Current Therapy

( IFT)

Transcutaneous Electrical Nerve

Stimulation ( TENS).

Faradic & galvanic muscle

stimulator

Cervical/ Lumbar Traction Wax bath Infrared

rays

LASER

SHORTWAVE DIATHERMY

• Frequency - 27.12 MHz

• wavelength -11 meters.

• Treatment of deep muscles and joints that are covered with a heavy soft-tissue mass.

• Utilizes two condenser plates that are placed on either side of the body part to be treated.

• Types:– Continous– pulsed

Microwave Diathermy Frequency – 300 – 30,000mhz

Wavelength – 10-12cm(shorter than short wave diathermy)

Strongly absorbed by tissues of high water content(all joints)

Selective heat application

Not suitable for deeper tissues

ULTRASOUND Uses high frequency sound

waves, greater than 20,000 Hz.

Frequency range of 1- 3 MHz

It has both thermal & mechanical effect.

Used to heal soft tissue and ligaments injury , scar mobilization & edema reduction.

INTERFERENTIAL CURRENT THERAPY ( IFT)

Placement of electrodes

two currents produced cross each other in the affected area

Two currents 'interfere' with each other

“INTERFERENTIAL”

This modality addresses the issues of pain, spasm, and inflammation

TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS)

Most commonly used forms of electro analgesia

Goal - block pain signals and to stimulate the release of naturally produced pain killers such as endorphin

Uses: Low Back Pain (LBP) Myofascial And Arthritic Pain Sympathetically Mediated Pain Bladder Incontinence Neurogenic Pain Visceral Pain Postsurgical Pain

FARADIC & GALVANIC MUSCLE STIMULATOR

Generation of impulse by a electic device

Delivered through electrodes on the skin in direct proximity to the muscles

elicitation of muscle contraction using electric impulse

stimulation of blood flow and pain reduction, as well as ionization

CERVICAL/ LUMBAR TRACTION

short term relief of neck pain and low back ache

relieve muscle spasm and nerve root compression by stretching soft tissues

Increases the spaces between vertebrae reducing pressure on intervertebral discs and nerve root

WAX BATH

Application of the molten paraffin wax on the body part(40 – 44˚c)

Methods: Dipping and Wrap, Direct pouring method Toweling or bandaging method

Reduces pain,inflammation,edema and muscle spasm

C/i in ischaemia,haemoorhage,spinal cord injuries, acute trauma

INFRARED RAYS A band of light that we perceive as heat

Decreases muscle spasm and promote relaxation

Promoting healing of superficial wounds

Faster ability to heal from soft tissue

injuries such as tears, pulls, and sprains May cause burns and electric shock

CRYOTHERAPY

Pain and muscle spasm

Stretching of collagen due to tension(tear)

Blood vessels are torn,invagination of fluid in to muscle fibres

Bruises in skin

Application of cold

Reduction in flow of fluid in to fibres

Reduces transmission of pain impulses

Reduces spasm (reduces ability of muscle to maintain contraction)

Swelling and internal bleeding is reduced

Advantages

Usually inexpensive. Quick application with little

preparation. Faster muscle recovery Promotes healthier skin

complexion Effective with chronic pain

management Reduces stress & anxiety

Disadvantages

It is difficult to keep the ice in place

Quickly melts No compression is applied. Can only be applied for short

periods of time (10-20 minutes).

ICE BAGS: simple plastic bags, chemical cold packs or

frozen vegetables. The skin will pass through four stages of

sensation in 10-15 minutes. These sensations in order are:

Cold BurningNumbness

ICE MASSAGE DO NOT hold the ice in one area for more

than 3 minutes since this may cause frostbite.

• Cold therapy should be stopped once the skin feels numb

LASER Light Amplification from the Stimulated

Emission of Radiation (LASER) Increases

healing rate in wounds and burns healing response of fractures regeneration of damaged nerve by

stimulating axon sprouting Decrease inflammatory edema Uses :

Osteoarthritis Rheumatoid arthritis Ankle sprain Chronic Low back pain Chronic ulcers and wounds

EXERCISE THERAPY

Active & Passive Exercises

Resisted exercises

Joint Mobilization techniques.

Suspension therapy

Hydrotherapy

Relaxation techniques Stretching

Proprioceptive Neuromuscular

Facilitation. ( PNF)

Myo Fascial Release

Technique

Muscle Energy Technique

Gait & Balance Training

Posture Correction.

Breathing Exercise

Postural training

ACTIVE AND PASSIVE EXERCISES

• Regain muscle power and then increase the range of joint movement under muscle control

• Active exercise is the keynote of treatment• It strengthen muscles and mobilize joints• prevents bone atrophy, stimulate circulation,

improve co-ordination and restore function

SHOULDER WHEEL EXERCISES

To improve the Range of motion of shoulder joint

FINGER LADDER EXERCISES

PARALLEL BARS

For gait training & posture correction

STAIRS & RAMP

Stair climbing training

WOBBLE BOARD

SUSPENSION THERAPY form of Assisted Exercises(continuous passive motion)

to increase ROM, increase muscle power and support body parts by using ropes and slings.

Aim : Muscle Strengthening Neuro-Muscular Co-ordination

Types :Axial Pendularvertical

SUSPENSION THERAPY

To improve range of movements

QUADRICEPS CHAIR AND STATIC BICYCLE

For Quadriceps Strengthening

GYM BALL EXERCISEFor Back exercise , Neck & trunk control in Baby

OVERHEAD PULLEY & SUPINATOR/ PRONATOR EXERCISE

FINGER EXERCISER

WALKING AIDS• A device designed to assist walking• Improve the mobility of people • Redistribute weight-bearing area

(decreasing force on injured or inflamed part or limb)

• Can compensate weak muscles• Decrease pain• Improve balance

TYPESRIGID FRAMES

FOLDING FRAMES

RECIPROCAL

FRAMES

FOREARM

SUPPORTING FRAMES

WHEELED FRAMES

ROLLATORs

AXILLARY / UNDER ARM CRUTCHES

ELBOW CRUTCHES

(LOFSTRANDS )

FOREARM (GUTTER CRUTCHES)

WALKING STICKS(TETRAPOD

AND TRIPOD)

TYPES

AXILLARY CRUTCHES

ADVANTAGES: Convenience from temporary injuries A large degree of support for the lower

body Available at low cost. perform a greater variety of gait

patterns , ambulate at a faster pace

DISADVANTAGES: Limited upper body freedom crutch paralysis(Radial N.and brachial

plexus injury)

Gutter crutches

PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION

Proprioceptive: sensory receptors that give information concerning movement and position of the body

Neuromuscular: involving the nerves and muscles

Facilitation: making easier

vital element in rehabilitation process of sports related injuries

USES• To increase strength, flexibility,

coordination and functional mobility.

• The main goal of treatment is to facilitate the patient in achieving a movement or posture.

• used in orthopedic rehabilitation for musculoskeletal injuries and in neurological rehababilitation

MYO FASCIAL RELEASE THERAPY Scarring or injury to network of

connective tissues produce pain and impede motion

Gentle blend of streching and massage

Uses hands on manipulation of entire body

Technique to ease pressure in the fibrous band of connective tissue in the body

USES

• Long standing back ache• Fibromyalgia• Sports injuries• Rotator cuff injuries• Sciatica

HYDROTHERAPY

• Hydrotherapy, or water therapy, is the use of water (hot, cold, steam, or ice) to relieve discomfort and promote physical well-being– Hot Water: relaxing, stimulate immune system.– Tepid Water: stress reduction.– Cold Water: reduce inflammation

• Alternating hot and cold water can stimulate the circulatory system and improve the immune system

External Hydrotherapy – involves the immersion of the

body in water

Motion-based treatments– uses water under pressure in the

form of jets, whirlpools or aerated bubbles

– It is used to treat joint and muscle injuries ,stress and anxiety disorders.

Uses:osteoarthritis

rheumatoid arthritisfibro myalgiasciatica

REHABILITATION

• Co ordinated usage of medical ,social ,educational and professional activities for training(retraining) of individual for optimum working ability

• Kinds of rehabilitationMedicalPsychologicalHomeProfessionalSocial

MEDICAL REHABILITATION

OBJECTIVE:The restoration of health of the affected person in optimal

timeIt starts from the place of accident, emergency room of

hospital,specialised rehabilitation centers

EARLY • From moment of trauma and continued during outpatient and in patient department

LATE •Aims at adaption to new environment of persons with disabilities and employment

STAGES OF REHABILATION

• Immobilisation• Medications/

surgeryACUTE

• Specific exercises

• Neuromuscular control

RECOVERY

• Specific functional programes

• Exercises

FUNCTIONAL

SOCIAL REHABILITATION

• Goal:– Recovery of skills in the affected for self catering

and living conditions

PROFESSIONAL REHABILITATION

• Goal :– Restoration (full /partial) or nursing of new

professional skills allowing the sick and disabled patients to return to work

PRINCIPLES OF REHABILITATIONEarly beginning(hospital)Succession(out patient basis)Continuity

PERIODS OF REHABILITATIONHOSPITAL OUTPATIENT POLYCLINICS

CONCLUSION• Orthopaedic surgeon and a doctor of physiotherapy should

be “guides” for the patient during the rehabilitation period

• Rehabilitation of patients rests on accurate diagnosis, proper identification of roles, cooperation among the different disciplines and a potent but practical goal setting

• The patient is always the focus of treatment, and should have a quality of life that is deemed most acceptable

BIBLIOGRAPHY

• Clayton's Electrotherapy - Theory and Practice(8th edition)

• Principles of exercise therapy (M.Dena gardiner)

• Watson – jones fractures and joint injuries (7th edition)

• Orthopaedic physical therapy secrets(jeffrey D.placzek)

THANK YOU

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