Physiotherapy Introduction

1. Physiotherapy is a branch of healthcare science that improves quality of life without using drugs or surgery. It is a dynamic art wherein the methods of treatment changes constantly. Treatment works on the detailed understanding of human biomechanics.

Physiotherapist utilizes an individual’s history and physical examination to arrive at a diagnosis which can be supplemented by investigations. 

 2. Modes of treatment can be divided into two broad categories: manual and non- manual modes Manual modes include joint mobilization, stretching, therapeutic exercises, soft tissue manipulations, taping, bandaging, strapping, postural drainage, rehabilitation, aerobic fitness.

Non manual modes include short-wave diathermy, ultrasound ,interferential therapy ,paraffin-wax cryotherapy, hydrotherapy,electrotherapy laser,infra-red rays ultra-violet rays, contrast bath traction..

3. Prevention of injuries:

a) A thorough warm up is very essential for prevention of injuries. A time lag exists between the onset of activity and the bodily adjustments needed to meet the physical requirements of the body. Warm ups help to increase the muscle temperature and increases the efficiency of muscular contraction by reducing the muscle viscosity and increasing the rate of nerve conduction. Warm ups help to reduce the muscle tension, increases blood circulation, increases flexibility and mobility, thereby reducing the risk of injury particularly to the connective tissue like the tendons.

b) Use of appropriate kits and equipments: wear protective equipment particular to the sport example knee guards and elbow guards. Use tapes and bandages for vulnerable joints. Ensure that your shoes fit you well (in-soles should match the arch of your foot). Soles should be made from foam material which provides cushioning the heel and will provide for shock absorption. Toe box should provide plenty of wiggle room and the heel grip should hold the heel snugly in place.

c) Diet: A healthy balanced diet is of utmost importance. Lack of muscle energy can lead to muscle fatigue and increase the likelihood of muscle strain.

d) Stay hydrated:  Drink six to eight glasses of water daily.Tea, coffee, alcohol should be minimized as these are diuretics and can lead to dehydration. Exercising when dehydrated increases the chances of overuse injury.

e) Cool down properly. Always end the session with appropriate cool down specific to the exercises performed. This helps to gently return the heart rate, respiratory rate(breathing) and blood pressure to normal and helps in faster recovery, also reduces the risk of soreness and removes waste products from muscle tissue(lactic acid).

Common injuries during exercise

Commonest injuries encountered during exercises are

(a) ankle pain  (b) elbow pain  (c) back pain (d) shin pain (e) shoulder pain

A: Ankle pain: Ligaments of ankle are injured when the foot is bent forward and is suddenly forced inwards or outwards straining the ligaments on the inner or outer side of the ankle.

Symptoms  include  pain, swelling, bruising, loss of function.

Treatment in acute case-

• Cold packs for 20mins
• Compression and support using crepe bandage.
• Rest

In severe injury-

• Pressure bandage
• Rest with limb in elevation
• Use crutches
• Foot should be moved up and down 4-8 times every hour when the limb is elevated.
• Subsequent  treatment  include ultra sound and graded exercise programme.

B: Elbow injuries:  consist of the following –

a) Tennis Elbow: is characterised by pain and acute tenderness on the lateral side of elbow aggravating on gripping and lifting.

Cause: Carrying heavy bags, wrong lifting techniques.

• Treatment:  In acute cases icing for 15-20 minutes
• Rest, using a splint which holds  the wrist in extension/strapping.
• Iontophoresis/ultrasound to relieve pain and inflammation

Once the pain and inflammation reduces, graded stretching of extensors and supinators followed by specific strengthening exercises are recommended.

b) Golfer’s Elbow: is characterized by pain and acute tenderness on the medial side of the elbow.

Treatment: in acute cases apply ice on inner side of the elbow joint for 15-20 minutes and rest the joint by strapping. Iontophoris / ultrasound  can de used to relieve pain.

Once the pain and inflammation is taken care of, graded stretching of flexors and pronators followed by specific strengthening exercises and rehabilitation can be done. As a precaution it is advised to keep the wrist joint in a neutral position or straight position.

C:Back Pain:

Causes:

• Genetic/congenital
• Poor lifting technique
• Poor posture
• Overuse injury

Treatment: in acute stage, follow the methods given below. 

• Rest, taping, mobilization
• Stretching
• Graded strengthening program
• Ergonomic advice

Maintain your spine in neutral position. ie good upright posture with abdominals pulled in.

When lifting weights make sure that you have a firm base and the weight stays inside the base.

Include core muscle strengthening exercise and back strengthening regime.

D: Shin pain-pain at the front of shinCommon among runners and walkers

Causes include:  Excessive training

• Uneven  training  surface.
• Imbalance between the muscles at the front and the rear of the leg.
• Poor foot mechanics.

Treatment: Rest, orthotic  prescription, specific stretching and strengthening.

E:Shoulder pain- The shoulder joint is a very mobile joint and is prone to injuries very often. This is common among swimmers and weight lifters.

In acute cases treatment consists of the following:

• Reduce the intensity/frequency of the exercise.
• Rest
• Precautions must be taken when lifting weights.
• Good posture is also essential.

In severe cases-strapping may be required to immobilize the part followed by graded exercise programme.

We will continue to provide you with more information on the following topics which will be posted soon.

• Sports Injuries
• Rehabilitation
• Heat Therapy versus Cold Therapy