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What is Physiotherapy and what are its types?

Physiotherapy or physical therapy is a healthcare specialty that remediates impairments and promotes mobility, function, and quality of life through evaluation, assessment, examination, diagnosis, prognosis, and physical intervention (therapy using mechanical force and movements)


Professionals in the field are known as physiotherapists also known as physical therapists in some countries.


Background of physiotherapy

Although the use of exercise as part of a healthy lifestyle is ancient in its origins, yoga is an example for use of exercise in ancient world. Modern physical therapy appears to have originated in the 19th century with the promotion of massage and manual muscle therapy in Europe. In the early 20th century, approaches in physical therapy were used in the United States to evaluate muscle function in those affected by polio. Physical therapists developed programs to strengthen muscles when possible and helped polio patients learn how to use their remaining musculature to accomplish functional mobility activities. About the same time, physical therapists in the United States were also trained to work with soldiers returning from World War I; these therapists were known as “reconstruction aides.” Some worked in hospitals close to the battlefields in France to begin early rehabilitation of wounded soldiers. Typical patients were those with amputated limbs, head injuries, and spinal cord injuries. Physical therapists later practised in a wide variety of settings, including private practices, hospitals, rehabilitation centres, nursing homes, public schools, and home health agencies. In each of those settings, therapists work with other members of the health care team toward common goals for the patient.

Methods for diagnosis can vary, depending on the situation, though physical examinations and testing are often employed for evaluation. Treatments can include a wide range of practices, including massage, applications of heat or electricity, and assistance with using mobility devices such as walkers and crutches.

Physiotherapy Assessment

Every physiotherapy regime begins with an assessment of the patient's condition. This includes a review of a patient's medical history and a physical examination (subjective as well as objective).

Physiotherapists often consider the medical history review a subjective examination, since the patient's opinions or past experiences may influence it. Then physical examination, which is be more objective is made, as observable and verified symptoms are the primary concern.

The assessment stage may involve diagnostic tests to better evaluate the patient's condition and formulate a proper treatment plan.

Physiotherapy treatment

Assessment is followed by treatment based on its findings. Based on the needs of the clients, physiotherapists may employ various physiotherapeutic treatment options. Treatment includes musculoskeletal, cardiopulmonary, and integumentary or "skin-based" physiotherapy techniques.

Common forms of treatment may include application of massage, use of heat or cold to relax and help heal muscles. Mild electric currents can also be used to stimulate muscles, which can help in recovery for some individuals. Recovery from accidents or surgery also require physiotherapy rehab to make sure that no further damage is caused.

Model performing physiotherapy exercise
Model performing physiotherapy exercise

Types of Physiotherapy treatments

1. Therapeutic exercises: Exercises are core of any physiotherapy regime. Exercises make be active or passive, assisted or resisted, stretching or strengthening, self or with or with someone's help, aerobic or anaerobic etc.

Physiotherapy exercises are important part in the recovery of patients or clients with musculoskeletal conditions or disorders. There are various physiotherapy exercises that your physiotherapist will include in your rehabilitation program, often, in combination with other treatment options.

Types of Physiotherapy Exercises

The type of physiotherapy exercises that you will perform depends on the stage of your recovery. 


A) Range of motion exercises
Range of motion (ROM) exercises can be performed either with the assistance of your personal physiotherapist or you do it on your own with the guidance of your therapist. Sometimes, you may have tightness in your joint or muscle, which can limit the available range of motion for your joint. In this case, your physiotherapist may use a heating modality to help loosen tight tissues prior stretching to improve your joint range.


Types of Range of Motion Exercises
There are three types of ROM exercises: passive, active –assistive, and active range of motion exercises.
i. Passive range of motion exercise (PROME)
In PROME, the physiotherapist moves the body part along the joint range. This is often performed on patients who are unable to move their limb.
ii. Active-assistive range of motion exercise (AAROME)
This range of motion exercise is done on the patients who are able to move their limb but needs assistance from the physiotherapist to complete the joint range. The physiotherapist assists the patient to complete the movement or just beyond the point of pain. The pain should not persist or worsen when motion is stopped.
In this type of ROM exercise, there is minimal assistance from the physiotherapist.
iii. Active range of motion exercise (AROME)
The client performs the movement without physical assistance from the therapist. The physiotherapist may still verbally instruct the client on the proper execution of the exercise.
Strengthening exercises are done to improve the strength of the weakened muscles. It may also be done as part of the client’s general conditioning exercise program. Having normal muscle strength help prevents future injury and improves performance.


B) Strengthening exercises

Strengthening exercises are done to improve the strength of the weakened muscles. It may also be done as part of the client’s general conditioning exercise program. Having normal muscle strength help prevents future injury and improves performance.


C) General conditioning exercises

General conditioning exercises involve a combination of exercises including range of motion, strengthening, and walking exercises to help maintain or improve your

  • Cardiopulmonary fitness;
  • Muscle and joint flexibility; and
  • Muscle strength.

D) Balance exercises

Balance exercises may be a part of your rehabilitation program if you have problems with your balance. Proprioceptive and balance exercises teach your body to control the position of a deficient or an injured joint. A common example of a proprioceptive or balance exercise is the use of a balance or wobble board after an ankle sprain.

The unpredictable movements of the balance board re-educates your body to quickly react to the wobbly movements without having to think about these movements.

That is, your natural balance and proprioceptive reactions that we are attempting to retrain make the transition from a conscious to a subconscious state. A quality subconscious proprioception and balance system is important in everyday life and particularly in sport.

Depending on your specific needs and level of fitness, your physiotherapist may start from where you are most stable. For example, if you can sit without support, your therapist may suggest that you do balance exercises using parallel bars. Once you are able to do the exercises easily, you may start doing them without parallel bars.

2.  Ultrasound

Therapeutic ultrasound is a commonly used treatment modality in physical therapy. It is used to provide deep heating to soft tissues in the body. These include muscles, tendons, joints and ligaments.

Effects of ultrasound

Deep heating effects: Ultrasound is often used to provide deep heating to soft tissue structures in the body. Deep heating tendons, muscles or ligaments increases circulation to those tissues, which is thought to help the healing process. Increasing tissue temperature with ultrasound is also used to help decrease pain. Deep heating can be used to increase the "stretchiness" of muscles and tendons that may be tight. If you have shoulder pain and have been diagnosed with a frozen shoulder, your physical therapist may use ultrasound to help improve the extensibility of the tissues around your shoulder prior to performing range of motion exercises.

Non-thermal effects (cavitation): Ultrasound introduces energy into the body. This energy causes microscopic gas bubbles around your tissues to expand and contract rapidly, a process called cavitation. It is theorized that the expansion and contraction of these bubbles help speed cellular processes and improves healing of injured tissue.

Common Injuries Treated with Ultrasound

  • Bursitis

  • Tendonitis

  • Muscle strains and tears

  • Frozen shoulder

  • Sprains and ligament injuries

  • Joint contracture or tightness

3. TENS

A TENS unit is a type of therapeutic modality typically used in physical therapy clinics. TENS stands for transcutaneous electrical nerve stimulation. TENS is a method of electrical stimulation which primarily aims to provide a degree of symptomatic pain relief by exciting sensory nerves and thereby stimulating either the pain gate mechanism and/or the opioid system. TENS can be used to help manage both chronic and acute pain; your physical therapist can help determine the best use of TENS for your condition.

TENS is used by applying small electrodes to your body with an adhesive. The electrodes should be over the area that is causing you pain. A tingling sensation is felt in the underlying skin and muscle. You can slowly and carefully increase the intensity of the stimulation provided by the TENS. The intensity should be raised until the sensation provided underneath the electrodes feels strong, but comfortable.

TENS should be applied for 15 to 30 minutes, and it can be used several times per day

4. Spinal Traction

Spinal traction is a form of decompression therapy that relieves pressure on the spine. It can be performed manually or mechanically. Spinal traction is used to treat herniated discs, sciatica, degenerative disc disease, pinched nerves, and many other back conditions.

To use lumbar traction, you must be strapped into a mechanical machine. There is a vest that helps support your ribs, and another device that wraps around your pelvis. The vest and pelvic device are stabilized with straps, and a mechanical force is applied with a machine.

Cervical traction is applied in either the sitting or lying position. If sitting, a harness is attached to the head and a pulley system is used with a small weight attached. The weight provides the traction force while you sit comfortably in a chair. In lying, or supine, traction, a specific device is used. 

5. Joint Mobilization

Joint mobilization occurs when your physical therapist passively moves the joints of your body in specific directions. This can help to decrease pain and improve mobility. While we often think of our joints moving as hinges, there is a gliding motion that also occurs between the joints of the body. This gliding motion is increased during joint mobilizations. The degree to which your therapist moves each joint depends upon the amount of pressure and the direction of force applied to the joint.

Joint mobilization is helpful in cases where pain and joint tightness limit motion, as in the case of adhesive capsulitis or frozen shoulder. Joints of the elbow, wrist and hand, where tightness is present, also benefit from this technique. It is also used to relieve low back pain and re-establish accessory motion in the lumbar segments. Along with joint mobilization of the spine, stretching of the muscles that directly affect spinal function may be undertaken. Some of these muscles are the hamstrings, gastrocnemius and soleus (calf muscles) and the rectus femoris of the quadriceps.


6. Massage

Massage is using the hands to knead the injured tissues of your body to help decrease pain, improve circulation, and decrease muscle tension.

Massage uses pressure to direct venous and lymphatic flow back towards the heart. It is therefore important that the movement is always in this direction so that there is no undue pressure on the closed valves in the veins. These valves prevent backflow of blood by only allowing blood to move in one direction (i.e. toward the heart). As the pressure from the heart pumping subsides and the blood moves back, the valves close and prevent any further back flow.

 

Massage may also be used to stretch muscle fibres. In this case, the direction is not as important as the strokes are much shorter and therefore pressure in the wrong direction is not significant enough to cause damage.

There are many massage techniques, including effleurage, pettrisage, and trigger point massage.

7. Heat Therapy (Thermotherapy)

Heat therapy, also called thermotherapy, is the use of heat in therapy, such as for pain relief and health. Applying heat can help improve your blood flow especially at the site of injury, thus, speeding up healing. In addition, it can help soften tight tissues and relieves pain. There are several heating modalities and devices available including:-

  •  Hot packs
  •  Paraffin wax bath
  •  Infra red heat
  •  Ultrasound (US)
  •  Diathermy
  •  Relaxes tight muscles causing tissues to relax.
  •  Decreases pain caused by muscle tension or spasms.
  •  Causes vasodilatation of the blood vessels which increases circulation to the area.
  •  Increased circulation to your injured body part helps to bring in nutrients, oxygen, and cells that help to promote healing.

Hot packs

Moist heat, or hot packs, may be applied to your body if you have an injury. The heat helps to increase circulation to the injured tissues, relax the muscles, and provide pain relief.

In a physical therapy clinic, hot packs are kept in a device called a hydrocollator. This is a large tank of hot water. The hot packs are cloth packs filled with a sand, clay and silica mixture. The hot pack absorbs the hot water, and then it is wrapped in terry cloth covers and towels before being applied to your body. The hot pack is usually kept on the injured body part for 15 to 20 minutes.

Benefits of Hot Packs

The heat provided by the hot packs has several important benefits. These may include:

Who Benefits from Using Hot Packs?

Patients with certain conditions typically benefit from using hot packs in the physical therapy clinic. These conditions may include:

  • Arthritis

  • Chronic pain

  • Joint contracture

  • Muscle spasms

  • Chronic injury where increased blood flow is desired


After injury, heat helps to increase tissue extensibility and improve the way your muscles move, so just about anyone can benefit from using heat and hot packs as part of a physical therapy program.


Who Should Avoid Using Hot Packs?

There are certain conditions where using moist heat and hot packs should be avoided. These may include:

  • In areas of impaired or altered sensitivity (like have numbness or tingling)

  • In people with impaired mental capacity

  • Over open wounds

  • After acute injury

  • Over joint with acute hemarthrosis

  • In persons with multiple sclerosis who are sensitive to heat

8.  Ice (Cryotherapy)

If you have an injury, cold packs or ice may be applied to your body to help decrease pain and control inflammation. Ice is usually used during the acute or initial phase of injury to limit localized swelling around tissues. Cold packs are usually applied for 15 to 20 minutes. Like hot packs, care must be used to prevent skin damage from getting too cold.


9. Laser or Light Therapy

Light therapy involves using light at a specific wavelength to help improve the healing process of injured tissues. The treatment is painless and usually lasts for approximately one to three minutes. To apply light therapy, your physical therapist will hold the light emitting wand directly over your injured body part and press a button to activate the light. Laser therapy can be used in the treatment of chronic pain, inflammation, or wound healing.