PHYSIOTHERAPY IN ORTHOPEDIC PRACTICE

Polyclinic Therapy Department

Flávia Teixeira da CunhaGroup 7

Kursk - 2012

PHYSIOTHERAPY Physiotherapy is a healthcare support

service, which assists the medical service in dealing with different aspects of treatment, rehabilitation and prevention of disorders utilizing exercise and electrotherapy procedures. It begins with an assessment of the patient's condition including medical history and physical examination.

PhysiotherapistPhysiotherapist helps people of all ages who have

physical problems caused by illness, accident or ageing.

They relieve pain, rehabilitate muscles alignment and increase mobility in order to promote health and well-being. They educate the patients in proper body alignment as postures and work habits. The patient's education is a key to success of the physiotherapists.

The physiotherapist is trained to treat symptoms of injury and disease by physical means, heat and pressure.

Orthopaedic PhysiotherapyOrthopaedic Physiotherapy is the oldest

branch of physiotherapy and is oriented towards the treatment of Musculo – Skeletal ailments. It involves regaining appropriate health and function of structures surrounding the Joint regions and normalizing the Biomechanics following any injury or Orthopaedic disease. The rehabilitation of Orthopaedically disabled individuals is also a major area of function.

Role Impaired posture, Impaired Muscle functions Impaired Joint Mobility, Motor function,

Muscle performance, and range of motion associated with Connective tissue dysfunctions Localized inflammation as in

Muscle pain, strain. Muscle tear. Muscle imbalances. Muscle spasm.

Primary prevention /Risk reduction for skeletal demineralization Joint stiffness. Fractures. Ligament sprain, tear. Inflammation of tendons and bursa. Joint pain. Poor posture.

Joint inflammation in case of osteoarthritis or rheumatoid arthritis Back and neck pain. Contractures. Joint dislocations. Body mechanics assessment. Other biomechanical faults. Rehabilitation following occupational injury, surgery, sporting injuries, fractures.

Physiotherapy & Rehabilitation Center uses a variety of different treatment methods to help speed up the healing process and reduce the likelihood of the same thing happening again.Some of the techniques include: Manual techniques (massage, joint mobilization , manipulation,

stretches). Electrotherapy (ultrasound, interferential currents, TENS,

shortwave diathermy, microwave diathermy, laser). Heat therapy (IRR , Hot packs , Wax therapy). Cryotherapy. Graded Therapeutic exercises. Correction of posture, lifting techniques, sporting techniques

which contribute to the problem . Taping, Bandaging, Splinting. Hydrotherapy. Contrast bath. Suspension therapy. Traction techniques.

CryotherapyCryotherapy is the local or general use of low temperatures in medical therapy. Cryotherapy is used to treat a variety of benign and malignant lesions.

The term "cryotherapy" comes from the Greek cryo (κρυο) meaning cold, and therapy (θεραπεια) meaning cure. Cryotherapy has been used as early as the seventeenth century.

What does Cold Do? Pain and muscle spasms are common responses to injury. Tendons and ligaments

are tissues that connect muscles and bones to each other and to other tissues. The basic building material of muscles, tendons, and ligaments is a protein called collagen. Under normal conditions, collagen acts like a rubber band: It stretches when tension is applied (as when we pull a rubber band) and returns to its normal length when the tension is released. However, when the collagen is stretched too far, it tears. In this tearing process, blood vessels are torn and blood cells and fluid escape into the spaces among the muscle fibers. This is sometimes visible on the surface of the skin as a swollen, bruised area.

Cold applied to the area decreases the flow of this fluid into the tissues and slows the release of chemicals that cause pain and inflammation. Cold decreases feeling in an area by reducing the ability of the nerve endings to conduct impulses. It may also reduce pain by "countering" the injury. For example, you might counter the pain of a sore tooth by pinching yourself hard in the leg.

Cold also decreases the activity of cells to reduce swelling and internal bleeding at the site of acute injury. Cooling the deep tissue also reduces muscle spasm by reducing the muscle's ability to maintain a contraction (contractility).

Types of cryotherapyIce bags Ice massageThis technique uses simple

bags such as a plastic bag, a hot water bottle, chemical cold packs or frozen vegetables. Technique- Dry the area first. Apply a dry terry cloth towel over the area to prevent direct contact of the ice to the skin. Apply your choice of cold to the area for no more than 20 minutes. The skin will pass through four stages of sensation in 10-15 minutes. These sensations in order are: 1.) Cold 2.) Burning 3.) Aching 4.) Numbness ** Cold therapy should be stopped once the skin feels numb.

Ice massage is another cyrotherapy technique. Place clean tap water into a foam cup and place in your freezer until it is completely frozen. Peel back a small amount of the top of the cup and massage this onto area of pain using constant circular motion. 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.

Advantages Disadvantages Easily available

materials found in most homes.

Usually inexpensive.Quick application with

little preparation.Good for minor injuries

that only require cold therapy for a day or two.

The ice easily falls off the joint. It is difficult to keep the ice in place

The ice quickly melts and can create a mess especially if in bed.

Ice is applied to limited surfaces of the joint.

No compression is applied.Can only be applied for short

periods of time (10-20 minutes).

Very frustrating to use for more major injuries or after surgery for the above reasons.

BenefitsFaster muscle recoveryPromotes healthier skin

complexionInvigorates the mindImproves sleep patternAssists with cellulite

reductionEffective with chronic

pain managementFaster surgical recoveryReduces stress & anxiety

These benefits start with the reduction of inflammation, pain relief, and improved mobility.

decreases cellular metabolism, increases cellular survival, decreases inflammation, decreases pain and spasm, and promotes vasoconstriction and vasodilatation which leads to increased levels of oxygenated blood delivered to damaged tissue.

In the cold temperatures, the blood vessels quickly constrict forming a protective layer while the core body temperature is maintained.

The process naturally stimulates blood circulation as the body's hormone, immune, and nervous systems are activated. 

Indications ContraindicationsReduce of general resistance

all organisms;Prevention for acute

respiratory disease;Prevention for

cardiovascular and bronchopulmonary diseases;

Prevention for peripheral vessels disease;

Polyarticular rheumatoid arthritis with prior join affection in active (3 extent ) and not active phase;

Ankylosing [rheumatoid] spondylitis;

Skin diseases (eczema, psoriasis, neurodermatitis).

General grave condition of patient; Decompensation chronically

cardiovascular disease; Acute myocardial infarction and

subsequent discharge ; Cerebral impulse; Essential hypertension at 2 extant; Cardiac decompensation at 2

extant; Prognostic negative disturbances

of cardiac rate and conductivity; Fever; Active pulmonary tuberculosis; Cancerous growth; Hysteric neuroses; Individual intolerance of coldness; Hemorrhagic diathesis.

Donjoy ArcticFlow Knee Wrap with Cooler What is the Donjoy ArcticFlow Knee Wrap with

Cooler? The Donjoy ArcticFlow Knee Wrap with Cooler is a

fantastic value for money continuous ice therapy and compression device.

When can I use it? Ice therapy and compression are the treatment of

choice for knee swelling and pain that is common with all knee ligament injuries, torn cartilage, knee arthritis and following all types of knee surgery.

Size One size fits all. How does it work? It's incredibly simple to use at home. Just fill the

Donjoy ArcticFlow Cooler with ice and water. It holds 3.5 litres of water and ice - enough for three hours of ice therapy - a much longer therapeutic period than an ice pack. The Cooler is attached to the latex free elastic Donjoy ArcticFlow Knee Wrap which snugly fits the knee joint. Simply elevate the Cooler above knee height to fill the Wrap with ice cold water to provide ice therapy and compression.

Donjoy ArcticFlow Shoulder Wrap with Cooler What is the Donjoy ArcticFlow Shoulder Wrap with

Cooler? The Donjoy ArcticFlow Shoulder Wrap with Cooler is a

fantastic value for money continuous ice therapy and compression device.

When can I use it? Ice therapy and compression are the treatment of choice for

Shoulder swelling and pain that is common with a shoulder sprain, shoulder bursitis, rotator cuff injury, dislocated shoulder, shoulder separation, broken Collar bone, shoulder tendonitis and following Shoulder surgery.

Size One size fits all. How does it work? It's incredibly simple to use at home. Just fill the Donjoy

ArcticFlow Cooler with ice and water. It holds 3.5 litres of water and ice - enough for three hours of ice therapy - a much longer therapeutic period than an ice pack. The Cooler is attached to the latex free elastic Donjoy ArcticFlow Shoulder Wrap which snugly fits the shoulder joint. Simply elevate the Cooler above shoulder height to fill the Wrap with ice cold water to provide ice therapy and compression.

Aircast Ankle Cryo/Cuff with Cooler What is the Aircast Ankle Cryo/Cuff with Cooler? The ultimate ankle ice therapy/cryotherapy device. Provides

compression to minimise bleeding and swelling, and cold to minimise pain following ankle injury.

When can I use it? Many elite athletes use this product following ankle injuries and ankle

surgery. Anyone with an ankle injury can also benefit from using this product. It can be used at home for the treatment of all ankle injuries, such as sprained ankle; dislocated ankle; ankle arthritis; Talar dome lesions; Osteochondral lesions; Avulsion fractures; and following ankle arthroscopy and ankle surgery.

Size The Ankle Cryo/Cuff™ with Cooler is one-size for adults. How does it work? The Aircast Ankle Cryo/Cuff™ with Cooler is an easy to use device that

circulates ice cold water to provide cold therapy in the treatment of injuries. This version is specific for the ankle and offers the very best option in ice and compression therapy.

The Aircast Ankle Cryo/Cuff™ with Cooler combines the therapeutic benefits of controlled compression to minimise bleeding and swelling in the ankle, and cold to minimise pain. The cuff is anatomically designed to completely fit the ankle providing maximum benefit.

The Cooler element is Universal to all Cryo/Cuff™ models. The Cryo/Cuff™ Cooler holds water and ice needed for six to eight hours of cryotherapy - much longer than an ice pack. The durable cooler comes with a tube assembly and insulation disk and is labelled with simple-to-follow directions for use.

Aircast Elbow Cryo/Cuff with Cooler What is the Aircast Elbow Cryo/Cuff with Cooler? The ultimate elbow ice therapy/cryotherapy device. Provides

compression to minimise bleeding and swelling, and cold to minimise pain following elbow injury.

When can I use it? Many elite athletes use this product following elbow injuries and elbow

surgery. Anyone with a elbow injury can also benefit from using this product. It can be used at home for the treatment of all elbow injuries, such as sprained elbow; dislocated elbow; elbow arthritis; Golfers Elbow; Tennis Elbow; elbow fractures; and following elbow arthroscopy and elbow surgery.

Size The Elbow Cryo/Cuff™ with Cooler is one-size for adults. How does it work? The Aircast Elbow Cryo/Cuff™ with Cooler is an easy to use device that

circulates ice cold water to provide cold therapy in the treatment of injuries. This version is specific for the elbow and offers the very best option in ice and compression therapy.

The Aircast Elbow Cryo/Cuff™ with Cooler combines the therapeutic benefits of controlled compression to minimise bleeding and swelling in the elbow, and cold to minimise pain. The cuff is anatomically designed to completely fit the elbow providing maximum benefit.

The Cooler element is Universal to all Cryo/Cuff™ models. The Cryo/Cuff™ Cooler holds water and ice needed for six to eight hours of cryotherapy - much longer than an ice pack. The durable cooler comes with a tube assembly and insulation disk and is labelled with simple-to-follow directions for use.

The Elbow Cryo/Cuff™ with Cooler is one-size for adults.

Aircast Hand & Wrist Cryo/Cuff with Cooler What is the Aircast Hand & wrist Cryo/Cuff with Cooler? The ultimate hand & wrist ice therapy/cryotherapy device. Provides

compression to minimise bleeding and swelling, and cold to minimise pain following hand & wrist injury.

When can I use it? Many elite athletes use this product following hand or wrist injuries and

hand surgery. Anyone with a hand or wrist injury can also benefit from using this product. It can be used at home for the treatment of all hand & wrist injuries, such as sprained wrist; dislocated wrist; hand & wrist arthritis; broken hand; broken wrist; Carpal Tunnel Syndrome; and following wrist arthroscopy and hand & wrist surgery.

Size The Hand & wrist Cryo/Cuff™ with Cooler is one-size for adults. How does it work? The Aircast Hand & wrist Cryo/Cuff™ with Cooler is an easy to use device

that circulates ice cold water to provide cold therapy in the treatment of injuries. This version is specific for the hand & wrist and offers the very best option in ice and compression therapy.

The Aircast Hand & wrist Cryo/Cuff™ with Cooler combines the therapeutic benefits of controlled compression to minimise bleeding and swelling in the hand & wrist, and cold to minimise pain. The cuff is anatomically designed to completely fit the hand & wrist providing maximum benefit.

The Cooler element is Universal to all Cryo/Cuff™ models. The Cryo/Cuff™ Cooler holds water and ice needed for six to eight hours of cryotherapy - much longer than an ice pack. The durable cooler comes with a tube assembly and insulation disk and is labelled with simple-to-follow directions for use.

Aircast Thigh Cryo/Cuff with Cooler What is the Aircast Thigh Cryo/Cuff with Cooler? The ultimate thigh ice therapy/cryotherapy device. Provides

compression to minimise bleeding and swelling, and cold to minimise pain following thigh injury.

When can I use it? Many elite athletes use this product following thigh injuries and thigh

surgery. Anyone with a thigh injury can also benefit from using this product. It can be used at home for the treatment of all thigh injuries, such as thigh strain; bruised thigh; dead leg; quads strain; hamstring strain; and following thigh surgery.

Which size do I need? Measure around the thigh: Regular 43-58cm (17"-23") X-Large 51-69cm (20"-27“) How does it work? The Aircast Thigh Cryo/Cuff™ with Cooler is an easy to use device that circulates ice cold

water to provide cold therapy in the treatment of injuries. This version is specific for the thigh and offers the very best option in ice and compression therapy.

The Aircast Thigh Cryo/Cuff™ with Cooler combines the therapeutic benefits of controlled compression to minimise bleeding and swelling in the thigh, and cold to minimise pain. The cuff is anatomically designed to completely fit the thigh providing maximum benefit.

The Cooler element is Universal to all Cryo/Cuff™ models - you fill this up with ice and cold water. The Cryo/Cuff™ Cooler holds water and ice needed for six to eight hours of cryotherapy - much longer than an ice pack. The durable cooler comes with a tube assembly and insulation disk and is labelled with simple-to-follow directions for use.

Precautionsa. Hypertensioni. Careful monitoring is needed because of transient increases that can occur in systolic and diastolic blood pressure.ii. Treatment should be discontinued if increase in blood pressure is seen.

b. Elderly patientsi. Decreased efficiency with vasoconstriction.ii. Therefore, they have decreased ability to conserve heat.

c. Length of treatmenti. Do not use cold gel packs longer than 15-20 minutes directly on skin, and do not apply any cryotherapy directly to skin for > 1 hour continuously.ii. Extended treatment may lead to neurapraxia or axonotmesis of superficial peripheral nerves.

Testemonial I've used icing as a way to reduce swelling

and speed up recovery since I started running marathons ten years ago. Ice is a great recovery tool, US Cryotherapy’s technology is amazing! The localized machine gets the skin temperature lower than just using ice packs and saves valuable time. Having US Cryotherapy on Run It Forward, running from Chicago to Santa Monica, aided me in being able to get back out and hammer out the miles day after day and still have enough energy to run with the kids as well!

-Kate Martini FreemanUltra Runner, Run It Forward Runner, 3:04 marathoner

Testemonial Coming into the Run It Forward program I had

a left Achilles issue and a right calf issue. By the fourth day of running full marathons in a row my body was broken. I was hurting so bad, and my sore Achilles was now making it so it even hurt to walk. I was very concerned as I somehow still needed to be able to run another 15 days straight. Dr. Mike started the US Cryotherapy machine on it, and within a few times it was much better. I was able to run faster and it made my pain almost subside. This machine is miraculous in healing sports injuries. I came home from Run It forward totally injury free, and have been training about 100 miles a week getting ready for my next big 100 mile race. Such a great piece of equipment!!

Keira Henniger, Ultrarunner and Race Director

ConclusionCryotherapy is a safe and easy to use

treatment to destroy many benign and malignant lesions.

The cryotherapy operator must be aware of the complications associated with this modality; for example, a complication is hypopigmentation (dark-skinned individuals are prone to hypopigmentation).

One needs to be aware of the fact that lesions may need to be treated multiple times before resolution.

PerspectivesThus, this cryotherapy treatment suits for the

treatment of almost all known diseases. Exceptionally wide range of positive cryotherapy effects is confirmed by many recent published announcements on this topic. For example, Chernyshev in his manual points out the following promising fields of applied medicine: pulmonology, gynaecology, combustiology (burns treatment), general surgery (proctology and traumatology), gastroenterology, neuropathology and vertebrology, cosmetology and sports medicine.