A BASIC IDEA OF PHYSIOTHERAPY IN ORTHOPAEDICS

1. PHYSIOTHERAPY AND
REHABILITATION
Presenter : Dr. S.V.Hari krishnan(PGT ORTHO)

2. LEARNING OBJECTIVES
INTRODUCTION
ELECTROTHERAPY
CRYOTHERAPY
EXERCISE THERAPY
HYDROTHERAPY
REHABILITATION
CONCLUSION

3. 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.

4. 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

5. PHYSIOTHERAPY SPECIALTIES
CARDIO
PHYSIOTHERAPY PAEDIATRIC
PHYSIOTHERAPY
GERIATRIC
PHYSIOTHERAPY
ORTHOPAEDIC SPORTS NEUROLOGY

6. 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.

7. • Thus rehabilitation includes prevention of
avoidable disabilities
Bed-sores
Venous thrombosis
Urinary infection
Renal stones
Muscle wasting
Joint stiffness and
Contractures
 early mobilization

8. 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

9. 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

10. 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

11. 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.

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

19. 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

20. 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).

21.  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
Burning
Numbness
 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

22. 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

23. 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

24. 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

25. SHOULDER WHEEL EXERCISES
 To improve the Range of
motion of shoulder joint
FINGER LADDER EXERCISES

26. PARALLEL BARS
 For gait training & posture correction

27. STAIRS & RAMP
 Stair climbing training
WOBBLE BOARD

28. 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
Pendular
vertical

29. SUSPENSION THERAPY
To improve range of movements

30. QUADRICEPS CHAIR AND STATIC
BICYCLE
For Quadriceps Strengthening

31. GYM BALL EXERCISE
For Back exercise , Neck & trunk control in Baby

32. OVERHEAD PULLEY & SUPINATOR/ PRONATOR
EXERCISE

33. FINGER EXERCISER

34. 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

35. TYPES
RIGID 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

36. AXILLARY CRUTCHES

37. 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)

38. Gutter crutches

39. 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

40. 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

41. 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

42. USES
• Long standing back ache
• Fibromyalgia
• Sports injuries
• Rotator cuff injuries
• Sciatica

43. 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

44.  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 arthritis
fibro myalgia
sciatica

45. REHABILITATION
• Co ordinated usage of medical ,social
,educational and professional activities for
training(retraining) of individual for optimum
working ability
• Kinds of rehabilitation
Medical
Psychological
Home
Professional
Social

46. MEDICAL REHABILITATION
OBJECTIVE:
The restoration of health of the affected person in optimal
time
It starts from the place of accident, emergency room of
hospital,specialised rehabilitation centers
• From moment of trauma and
continued during outpatient and
in patient department
EARLY
• Aims at adaption to new
environment of persons with
disabilities and employment
LATE

47. STAGES OF REHABILATION
• Immobilisation
• Medications/surgeryACUTE
• Specific exercises
• Neuromuscular
control
RECOVERY
• Specific functional
programes
• Exercises
FUNCTIONAL

48. SOCIAL REHABILITATION
• Goal:
– Recovery of skills in the affected for self catering
and living conditions

49. PROFESSIONAL REHABILITATION
• Goal :
– Restoration (full /partial) or nursing of new
professional skills allowing the sick and disabled
patients to return to work

50. PRINCIPLES OF REHABILITATION
Early beginning(hospital)
Succession(out patient basis)
Continuity
PERIODS OF REHABILITATION
HOSPITAL
OUTPATIENT POLYCLINICS

51. 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

52. 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)

53. THANK YOU
“Happiness is a state of mental,physical
and spiritual well-being. Think
pleasantly,engaged sport and read daily
to enhance your well-being.”