JIIU’S INDIAN INSTITUTE OF MEDICAL SCIENCES & RESEARCH. Warudi, Talq.Badnapur, Dist.Jalna. N O O R H O S P I TA L DEPARTMENT OF PHYSIOTHERAPY CME BASICS OF PHYSIOTHERAPY 02TH April 2014 What is Physical Therapy? Prevents, identifies, corrects, and alleviates acute or prolonged movement dysfunction of anatomic or physiologic origin. The primary objective of physical therapy is to promote optimum human health and function. The APTA Physical therapy or physiotherapy (sometimes abbreviated to PT) is a health care profession primarily concerned with the remediation of impairments and disabilities and the promotion of mobility, functional ability, quality of life and movement potential through examination, evaluation, diagnosis and physical intervention. It is carried out by physical therapists (known as physiotherapists in most countries) and physical therapist assistants (known as physical rehabilitation therapists or physiotherapy assistants in some countries). Our Beginnings Establishment of the Profession • Established by the Surgeon General in 1917 • Founded by Mary McMillan • Called “Reconstruction Aides” Present Academics Bachelor of Physiotherapy 4-1/2 years Masters of Physiotherapy 2 or 3 years Ph.D. 4-6 years Fellow ship programmes Where is Physical Therapy Practiced? Treatment • • • • • Hospitals Private offices Nursing homes Schools Out Patient clinics • Private Homes Prevention • • • • • Schools Sports Centers Workplaces Public facilities Health Clubs What do PTs do? • Movement Specialists • Restore function • Improve mobility Physical therapists are experts at analyzing human movement. They help restore and enhance normal movement patterns following injury and disease using a variety of techniques, procedures and modalities. Misperceptions about Physical Therapists Just give massages Aerobics instructors Never see blood Only treat healthy people who are injured. Future Outlook for the profession Life expectancy People living longer, healthier lives Greater number of older people – more cases of arthritis, stroke, heart disease, etc… A Systems Approach PT: A Systems Approach Musculoskeletal The musculoskeletal system includes: Bones Muscles Joints Tendons Ligaments And other soft tissue Cervical (PIVD, Spond. etc.) Frozen shoulder, TOS, Sprains, Strains Tennis & Golfers elbow Wrist pains Rheumatoid Arthritis Thoracic (BP, PIVD, #, etc.) Lumbar (LBP, PIVD, Spond. etc.) Sacroiliac joint dysfunctions Hip dysfunctions Knee Osteoarthritis Ankle Sprain, Strain ACL, PCL, reconstruction surgeries Various fractures of Head, Trunk, Upper & Lower limbs Sports trauma Oral fibrosis Bed sores Wound healing PT: A Systems Approach Neurological This systems includes: Brain Spinal cord Nerves Movement, sensation, balance. Patients treated within this system include: Head injuries Strokes Parkinsonism Carpal Tunnel Syndrome Peripheral neuropathies Multiple Sclerosis Muscular Dystrophy Cerebral Palsy Polio PT: A Systems Approach Cardio pulmonary The system includes: Heart Lungs Blood vessels Patients treated within this system include: Heart disease Bronchitis Heart Transplants PT: A Systems Approach Integumentary System This systems includes the skin Patients treated within this system includes Burns Wounds Diabetes Role of the Physical Therapist Evaluation & Treatment Types of tests Evaluate Patient History Examination Perform Tests Types of Tests Range of motion Strength Balance Coordination Posture Respiration Treatment Treatment strategy Identify purpose/outcomes Pain reduction Swelling reduction Range of Motion Interventions Electrical stimulation Adaptive devices (crutches, wheel chairs/prosthetics) etc.. Modalities: To reduce pain and inflammation including electrical stimulation (IFT, TENS), heat superficial (IRR, Hydro collator packs, Heating Pads), deep heat (SWD, Ultrasound, Laser) and icing, etc… Manual therapy: Including joint and soft tissue mobilization. Exercise programs: To improve flexibility, strength, endurance, power and coordination. MODALITIES Electrotherapy Short Wave Diathermy Interferential Ultrasound TENS Electrostimulation IRR Hydrocollator Packs Whirlpool Bath Paraffin Bath Combination therapy Shortwave Diathermy It penetrates up to 2 inches. Indications Bursitis Capsulitis Osteoarthritis Deep muscle spasm and strains Spondylosis, etc. SWD Electrode placement Low Level Laser Therapy Light Amplification by Stimulated Emission of Radiation. Indications Pain and inflammation reduction Collagen synthesis Control of microorganisms Increased vascularization Equipment Helium-neon and gallium-arsenide lasers are used. Ultrasound Therapy Ultrasound Therapy Modality which stimulates repair of soft tissue and pain relief Form of acoustic energy used for deep tissue heating Indications Tendinitis Bursitis Sprain Strain Trigger points Heel pain Osteoarthritis Neck pain Back pain Burn contracture Scars Interferential therapy It acts on pain gate mechanism. Indications Lumber spondylosis Shoulder pain Cervical spondylosis Knee pain Back pain Rheumatoid arthritis Neck pain Ankylosing spondylitis Transcutaneous Electrical Nerve Stimulation (TENS). It acts on pain gate mechanism. Indications Cervical Radiculopathies Lumbar Radiculopathies Trapezius myalgia Tingling, Numbness in Upper and lower limbs Myofascial pain syndrome Trigger pain Pregnancy TENS for pain over different parts of the body. Hydrocollator Packs It maintains heat for 20-30 minutes Silicate gel pads submersed in 160-170o F water Indications Reduction of pain, spasm, hypoxia and ischemia General superficial muscle relaxation. Whirlpool Bath Equipment Tank with turbine that regulates water flow Agitator controls amount of movement of water by emitting air Varying sizes of tanks used to treat respective body parts. Indications Swelling, muscle spasm and pain Provides conduction and convection. Paraffin wax Bath Equipment A paraffin wax and mineral oil combination, heated to 126-130o F, paper towels and towels. Indications Useful in treating chronic injuries Effective for angular areas of body such as hands, wrists, elbows, ankles and feet. Application Body part is cleaned and dried Soak technique Body part remains in wax 20-30 minutes without moving it. Dip and wrap technique Hand dipped 6-12 times, wrapped in a plastic bag and then draped with a towel to maintain heat for 30 minutes. Cryotherapy Used as first aid treatment for on field trauma in sports and in other musculoskeletal system conditions. RICE (rest, ice compression, elevation) may be used for the initial days of and injury and continue up to 2 weeks after injury. Mechanical Modalities Traction Drawing tension applied to a body segment Indications Spinal nerve root impingement Decrease muscle guarding, treat muscle strain Treat sprain of spinal ligaments Relax discomfort from normal spinal compression Physiological Effects Produces separation of vertebral bodies impacting ligaments, capsules, paraspinal muscles Increases articular facet separation, and relief of nerve root pain Decreases central pressure of vertebral disks Increases proprioceptive changes Relief of joint compression. Intermittent Compression Units Equipment Utilizes nylon inflatable sleeve Sleeve is inflated to specific pressure using either water or air Utilized to facilitate movement of lymphatic fluids Parameters Able to adjust on-off time, pressure and treatment time Indications Used for controlling or reducing swelling after acute injury Good for pitting edema, which develops several hours after injury Elevation of extremity is critical to effective treatment With electrical stimulation, muscle pumping can be incorporated to facilitate lymphatic flow Cryo-Cuff Uses both compression and cold simultaneously Elevation of cooler results in increased cuff pressure Also allows for circulation of cooler water Portable and easy to use Game Ready System Circulates water with compression. Can be adjusted for various time, temperature and compression settings. Time for some Musculoskeletal conditions Frozen Shoulder Frozen shoulder (adhesive capsulitis) is a disorder characterized by pain and loss of motion or stiffness in the shoulder. It affects about two percent of the general population. It is more common in women between the ages of 40 years to 70 years old. Cause: Idiopathic Frozen Shoulder Various exercises for frozen shoulder Strengthening exercises for shoulder Strengthening exercises for shoulder Osteoarthritis What is osteoarthritis? Osteoarthritis is a form of arthritis that features the breakdown and eventual loss of the cartilage of one or more joints. Cartilage is a protein substance that serves as a "cushion" between the bones of the joints Risk Factors You Can Control This includes sports that have a high rate of injury and jobs that require repetitive motion, such as bending the knees to install flooring. Obesity is another risk factor – it has been linked specifically to osteoarthritis of the knees and hips. Hamstring Stretch Calf Stretch Straight Leg Raise Quadriceps Set Seated Hip March Pillow Squeeze Heel Raise Side Leg Raise Sit to Stand One Leg Balance Step Ups Walking Low-Impact Activities Being active may also help you lose weight, which takes pressure off joints. Other exercises that are easy on the knees: biking, swimming, and water aerobics. Water exercise takes weight off painful joints. Supportive Devices Various Exercises for Neck pain Various Exercises for Low back pain Exercises with Theraball Aquatic Physical Therapy Aquatic Physical Therapy includes but is not limited to treatment, rehabilitation, prevention, health, wellness and fitness of patient populations in an aquatic environment with or without the use of assistive, adaptive, orthotic, protective, or supportive devices and equipment. The buoyancy, support, accommodating resistance and other unique properties of the aquatic environment enhance interventions for patients/clients across the age span with musculoskeletal, neuromuscular, cardiovascular or pulmonary, and integumentary diseases. Resistance training Weights Exercises Chest Press Shoulder Press Seated Row Lateral Pull Down Lunge Squat Abdominal crunch Back extension Flexibility Triceps and Upper Back Stretch Rear Deltoid and Upper Back Stretch Pectoral and Upper Back Stretch Quadriceps Stretch Hamstring Stretch Adductor Stretch Calf Stretch GENERAL PHYSICAL FITNESS PROGRAMME Mon - steady run Tue - weights Wed - fartlek Thu - flexibility Fri - steady run Sat - weights Sun - flexibility What is Physical Activity..? Any thing that keep you moving..! Making Physical Activity a Part of Your Life. There are 1440 minutes in every day Schedule 30 of them for physical activity. THANK YOU Any Questions. . . ??