Theme 9. Elementary physiotherapy methods.

What is physiotherapy?

Physiotherapy (also known as Physical therapy) is defined as the assessment, evaluation, and treatment and prevention of physical disability, movement dysfunction and pain resulting from injury, disease, disability, or other health related problems. A person who is engaged with these activities is known as physiotherapist.

Physiotherapy, as a profession, may briefly be defined as a science that seeks to alleviate movement dysfunction, to promote optimal health and functions of the human body. It involves the treatment of patients through exercise therapy and other therapeutic agents, including heat radiations, electricity, sound water and message, and is used to cure weak muscles, difficulties in the movement of shoulder and knee joints, paralysis, inborn and acquired deformities, gynecological ailments and other such disorders. Patients with such problems are referred by medical practitioners to physiotherapists who then take on the responsibility of restoring them to health.

"Physiotherapy is a health care profession concerned with human function and movement and maximising potential:

it uses physical approaches to promote, maintain and restore physical, psychological and social well-being, taking account of variations in health status

it is science-based, committed to extending, applying, evaluating and reviewing the evidence that underpins and informs its practice and delivery

the exercise of clinical judgement and informed interpretation is at its core."

The above definition is taken from the CSP curriculum framework (January 2002).

Physiotherapists work in a wide variety of health settings such as intensive care, mental illness, stroke recovery, occupational health, and care of the elderly. Physiotherapy can be useful in the diagnosis and management of a wide range of injuries, disease processes, and other conditions, including:

• sports injuries

• back and neck pain

• postural problems

• occupational injuries

• arthritis

• amputee rehabilitation

• spinal cord injuries

• chronic airways disease

• rehabilitation following cardiac surgery

• stroke rehabilitation

• asthma management

• developmental and paediatric problems

• neurological conditions

• impaired mobility

• women's health

• incontinence

• geriatric problems

• specific children's conditions

Where do Physiotherapists work?

Physios work in many different places and situations, including:

• Hospitals

• Private practices

• Medical centres

• Rehabilitation centres

• Nursing homes

• Sports clinics

• Sports clubs

• Gymnasiums

To build a better picture of the range of conditions that physiotherapists can treat, see our A-Z of physiotherapy:

How can physiotherapy help me? Physiotherapy can help individuals by: Identifying the problem area and treating this directly. Physiotherapists treat a wide variety of injuries and problems using many different techniques. In many cases, the causes of pain and dysfunction are obvious, but sometimes things are not so black and white, especially when symptoms are inconsistent or difficult to describe. Physiotherapists can perform a wide range of tests to help locate the source of the problem and implement the appropriate treatment strategy. Identifying the causes and predisposing factors. Physiotherapists are not only interested in the problem, but factors which contribute to the problem. Identifying factors such as poor posture, improper techniques, muscle imbalances, poor work practices, or other bad habits allow interventions to be made to correct these factors. This will reduce the risk of the same thing happening again in the future. Providing Rehabilitation following occupational or sporting injuries. Physiotherapists can help you get back to work or sport more quickly by providing rehabilitation programs and advice on how to prevent a recurrence of the injury. Providing rehabilitation and exercise before and after surgery. If you are having or have had major surgery, physiotherapists are often involved in pre-operative and/or post-operative programs to help get you moving again, making sure your length of stay in hospital is not unexpectedly extended. Providing advice on exercise programs. If you have the urge to get fit and stay healthy, one of the best ways to do this is by through regular exercise. However if you have not done any serious exercise for a while, it may be advisable to seek assistance to devise an appropriate program for your needs, and ensure you are not at risk of injury. Providing or advising on special equipment. With different conditions or disease processes, special equipment may be required. Physiotherapists can advise on many different types of equipment, including splints, walking aids, wheelchairs, occupational equipment etc.

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What do Physiotherapists do?

A common misconception is that physiotherapists only deal with injuries to backs, necks, joints, muscles and other 'sports' type injuries. While many physios certainly do treat these types of conditions, there are other areas in which physiotherapists are trained and can help you. For simple explanation, physiotherapy can be divided into three broad areas.

• Musculoskeletal physiotherapy

• Cardiothoracic physiotherapy

• Neurological physiotherapy

Musculoskeletal Physiotherapy (Orthopaedics). As the name suggests, this area deals with muscles, bones and joints, and is perhaps the most widely known. Musculoskeletal physiotherapists can deal with many acute or chronic conditions such as:

• back and neck pain or stiffness

• muscle strains/contusions

• joint sprains/stiffness/instability

• arthritis

• muscle imbalances/weakness

• muscle spasm

• tendonitis/bursitis

• rehabilitation following occupational injury, surgery, sporting injuries.

The musculoskeletal physiotherapist 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 mobilisation, manipulation, stretches)

• electrotherapy (ultrasound, interferential, TENS, shortwave, microwave, laser)

• heat and cold

• therapeutic exercise

• correction of posture, lifting techniques, sporting techniques which contribute to the problem

• taping, bandaging, splinting

• hydrotherapy

The musculoskeletal physiotherapist is not only concerned with treating the injury, but with finding the cause and correcting any biomechanical factors which may contribute to the injury.

Cardiothoracic Physiotherapy. Cardiothoracic physiotherapists deal primarily with the function of the cardiorespiratory system. The cardiothoracic physiotherapist, often working in the acute hospital, deals with a variety of situations, some of them being:

• Chronic Obstructive Airways Disease (Emphysema, Asthma, Chronic Bronchitis)

• Following general surgery

• General medical conditions

• Following cardiac surgery

• Following most types of thoracic surgery

• Intensive Care Unit patients

The cardiothoracic physiotherapist aims to optimise the function of the cardiothoracic system and patient comfort, resulting in increased exercise tolerance, a reduced chance of developing complications such as chest infections, reduced shortness of breath, and a reduced length of stay in hospital. Some of the treatment techniques at the physiotherapists disposal are:

• breathing techniques either to reduce shortness of breath or increase lung expansion

• patient positioning

• sputum clearance with percussions, vibrations, coughing, deep breathing, suction

• mobilising, sitting out of bed, or walking

• oxygen therapy

• mechanical ventilators

• medications

• exercise programs

Neurological Physiotherapy. Neurological Physiotherapy, as the name suggests, is concerned with disorders of the nervous system. The neurological physiotherapist is involved in the assessment and treatment of patients suffering conditions such as:

• acquired brain injuries/head injuries

• strokes

• brain surgery

• Parkinson's disease

• multiple sclerosis

• Guillian-Barre syndrome

• balance disorders

• spinal cord injuries

• other neurological conditions

The neurological physiotherapist is involved in determining how these conditions affect the patients movement and function, and implementing strategies to regain maximum function, depending on the type of disorder.

What Does A Physiotherapist Do?

Many people are now just beginning to understand about physiotherapy. If you or a loved one has been injured, or have suffered an illness or undergone an operation, chances are that you have come into contact with a physiotherapist. Many people wonder "What does a physiotherapist do?" There is no set answer as physiotherapy encompasses many different aspects of medicine. A physiotherapist is a medical individual who uses a variety of treatments, including manipulation, massage, exercise therapy and even counseling to help individuals who have been immobilized due to various reasons, to regain their mobility and aid their recovery process. A physiotherapist cannot prescribe medicine, instead, he or she relies on using a variety of techniques that have proven to be just as effective or, in many cases, more effective than medication. Medication often only masks pain. In prior years, those who experienced chronic pain were often prescribed pain medications that were not only physically dangerous when abused, but also very addictive. In most cases, individuals would have to take additional doses of the pain medication to achieve the same relief. Abuse of prescription pain medication is almost an epidemic in this country and accounts for many people who have had to enter rehabilitation centers to rid themselves of this addiction. Other methods doctors prescribed to alleviate pain often involved surgery. Sometimes this surgery had substantial risks, particularly back surgeries. Back pain is the most common reason why people visit the doctor each year. Yet there is little a medical doctor can do but prescribe pain medication and recommend surgery. What does a physiotherapist do to alleviate back pain? He or she finds the root of the pain, most often in the spinal column, and through massage and manipulation can alleviate the pain and in many cases, cure the condition, without the use of surgery or drugs. In the past, people who were recovering from an operation spent quite some time in the hospital, after which, they were sent home under strict bed rest. This can be dangerous, particularly for an older person who runs the risk of developing blood clots in their legs that can travel to their heart or brain. It became advisable to recommend that these patients begin to mobilize at a slow pace. This is where the physiotherapists came in. Now, instead of releasing elderly patients home after operations, many are released to rehab centers where qualified physiotherapists can ease them into mobilization and allow them to make a full recovery.