WHAT IS PHYSIOTHERAPY OR PHYSICAL THERAPY (PT)?
Physiotherapy, also known as physical therapy, is a healthcare profession focused on developing, maintaining, and restoring movement and functional ability, improving a wide range of conditions, from pain and injury recovery to chronic conditions, neurological disorders, and post-surgical rehabilitation. It uses methods like exercise, manual therapy, massage, and modalities such as heat, cold, or electrical stimulation. Physiotherapists use a comprehensive assessment to create personalized treatment plans and help patients improve their overall quality of life.
WHAT IS THE APPROACH TO PATIENTS
PT involves an initial thorough patient assessment consisting of the following:
Grading Pain
VAS (VISUAL ANALOGUE SCALE OF PAIN) is used to grade pain on a scale of 0 to 10 (0 is no pain and 10 is maximum pain).
Recording all presenting complaints meticulously is important
- Observation of Different type of Postures: This includes static posture (body position when still, like sitting or standing) and dynamic posture (body position during movement, such as running or bending). Common postural issues, or types, include forward head posture, kyphosis (hunchback), lordosis (swayback), scoliosis (abnormal sideways, S- or C-shaped curve of the spine), and flat back, which are all deviations from a healthy spine alignment.
- Palpation: Tenderness on the surface or area of pain.
- Examining Range of Motion (ROM): The device which is used to measure this is the Goniometer, where the ROM of various joints of the body which are measured (Shoulder, Elbow, Ankle, Wrist, Knee)
- Manual Muscle Testing: This is done by assessing and grading resistance and comparing it to the other or normal side. It is graded as poor (0), passive assistance (1), active but requires assistance (2), good with active movement possible (3), active with mild resistance (4), active with full resistance (5).
WHAT ARE THE TYPES AND APPLICATIONS OF PHYSIOTHERAPY
Physiotherapy techniques encompass a wide range of approaches aimed at restoring and improving movement and function. These can be broadly categorized into:
Manual therapy
The physiotherapist performs skilled manoeuvres on the patient like:
- joint mobilization (skilled, hands-on techniques to move joints, improving range of motion and reducing pain)
- soft tissue mobilization (techniques like massage, myofascial release and cyriax trigger point therapy to address muscle tension, scar tissue, and restrictions in soft tissues)
- muscle function techniques (involve the patient actively using their muscles against resistance provided by the therapist to improve joint mobility and muscle function)
Exercise therapy
The physiotherapist teaches and trains the patient to perform exercises like:
- Active Range of Motion Exercises (to improve the movement of joints and muscles, enhancing flexibility and reducing stiffness).
- Strengthening Exercises (focus on building muscle strength and endurance, often using Theraband Exercises
Theraband, when used by the physiotherapist for strengthening any particular muscle of a particular joint requires the therapist to explain to the patient that there is a colour code which the patient has to follow strictly. The colour code is decided by the physiotherapist depending on the strength of the muscle. The Theraband is used only as a resistive form of exercise only after the person’s muscle strength is more than power 4 (graded according to Manual muscle testing on the scale of 0 to 5). There is a specific colour code of the Theraband – Yellow, Red, Green, Blue and Black (This colour code is according to Theraband Academy USA). When the physiotherapist starts giving exercises to the patient with the Theraband, the patient should start the exercise with the Yellow Theraband followed by the Red Theraband depending on the strength of the particular muscle. For a general sedentary person Yellow should be followed by Red and Green. For a person whose main occupation is sports and for those wanting to regain their particular sport fitness in a short time, the physiotherapist should train a particular muscle, progressing with Blue and Black Theraband) or bodyweight exercises.
- Core Stability Exercises (designed to improve posture and strengthen the muscles that support the spine and the core abdominal muscles which are essential for overall stability and function).
- Functional Exercises (mimic real-life movements and activities to help patients regain the ability to perform daily tasks).
- Neuromuscular Re-education Exercises (to reduce stiffness and tremors, and improve coordination, balance, and proprioception – awareness of body position in space, useful in patients of Parkinson’s, post-stroke, and other neurological conditions).
- Hydrotherapy involves ‘Aqua therapy’ by exercising in water, to reduce weight-bearing stress on joints and improve muscle relaxation.
Electrotherapy
The physiotherapist utilizes electrical stimulation to manage pain and improve muscle function. These techniques include:
Transcutaneous Electrical Nerve Stimulation – TENS (uses electrical currents to stimulate nerves and reduce pain). TENS is a low frequency current. There are 3 modes of TENS: Continuous (which delivers constant stimulation), Burst (which groups pulses into bursts) and Modulation (parameters like frequency or pulse width change cyclically to prevent nerve adaptation).
Neuromuscular Electrical Stimulation – NMES (uses electrical currents to stimulate muscles, promoting muscle contraction and strength). They have 2 types of currents: galvanic and faradic.
Interferential Therapy: They are medium frequency currents (a deeper form of electrical stimulation used to reduce pain and inflammation).
Ultrasound Therapy
This uses high frequency deep heating modality
Low-Level Laser Therapy (LLLT)
This uses low-intensity lasers to stimulate tissue repair and reduce inflammation.
Other techniques include acupuncture, taping, and heat-cold therapy.
IS PHYSIOTHERAPY ONLY FOR MUSCULOSKELETAL AND NEUROLOGICAL ISSUES?
The perception is that since physiotherapy mainly addresses musculoskeletal and nerve conditions, physiotherapists most commonly work with specialists in orthopaedics, spine, neurology and pain management.
However, physiotherapists can also be of immense benefit to other specialities and conditions as seen with:
- Vestibular Rehabilitation (technique used to treat dizziness, vertigo, and balance problems by retraining the vestibular system).
- Respiratory Physiotherapy (focuses on improving breathing mechanisms and clearing airways in patients with respiratory conditions like COPD, asthma and other chronic lung diseases).
- Cardiovascular Rehabilitation (improves cardiovascular health through exercise programs, cardiac rehabilitation, and lifestyle modifications).
- Fibromyalgia and Chronic Fatigue Syndrome (to manage pain and improve function in these conditions and some types of headaches).
WHAT ARE THE LATEST ADVANCES IN PT/
Virtual Reality Rehabilitation
VR physiotherapy utilizes immersive VR environments to enhance rehabilitation for various conditions. By engaging patients in interactive and personalized exercises, VR can improve motivation, engagement, and ultimately, outcomes in physical therapy. It also helps distract patients from pain through immersive environments, reducing pain perception and enabling more effective participation in exercises. VR provides opportunities for repetitive, task-oriented movements, which can help rewire neural pathways and improve motor skills, especially in neurological rehabilitation.
Therefore, VRR has diverse applications in musculoskeletal injuries, neurological rehabilitation, chronic pain management, and post-surgical rehabilitation.12 VRR can be an immense asset in paediatric practice making therapy more engaging and fun for children, helping them overcome challenges related to conditions like cerebral palsy or developmental delays.
Augmented Reality is a method of projecting visual instructions and focal points to guide patients during home exercises.
Newer advances like wearables, and robotics herald the future.
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