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Principles of physiotherapy in special reference to orthopaedics

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Principles of physiotherapy in special reference to orthopaedics

  1. 1. Principles of physiotherapy in special reference to orthopaedics Speaker : Dr. Siddique Hussanul Ranna PGT,orthopaedics Moderator : Dr. Sapna Pran Saikia Assist.prof. orthopaedics
  2. 2. Introduction • Non pharmacological, exercise oriented natural approach,nonseparable entity from body of orthopedics science. • Can face orthopaedics challenges bcz of its therapeutic, preventive and restorative functions.
  3. 3. •Aims • To treat disability and deformity. • To correct disability and deformity • To prevent disability and deformity
  4. 4. Rehabilitation • All fracture may not needs reduction or retention but all fractures need rehabilitation.
  5. 5. Contd.. • “Orthopaedic surgeon should never pick up a knife unless he has a competent physiotherapist” prof. P. Chandra, aims.
  6. 6. Trauma may cause injury to 1.Soft tissue 2. joints 3.fractures muscle atrophy stiff joints immobilisation impaired function contractures needs rehabilitation
  7. 7. Physical agents in physiotherapy • Heat therapy • Cold therapy • Sound • Hydrotherapy • Electrical stimulation etc.
  8. 8. HEAT THERAPY • Reduces pain. • Increased blood flow. • Relieves stiffness of joints. • Reduces muscle tightness. • Warms up the tissues for future exercises. • Optimal time 20 minutes of application.
  9. 9. Hemodynamic effect of heat Temperature inflammation cutaneous thermoceptors vasodilator spinal dorsal root smooth (histamin,PGs) muscle relaxation VASODILATATION
  10. 10. Contraindication of heat therapy • Open wounds. • Anaesthetic skin. • Severe oedema. • Skin diseases. • Infection.
  11. 11. Types of heat therapy • A) superficial heat therapy. Heats only skin & S.C. tissues. Up to 10mm beneath skin. • B) Deep heat therapy. Heats muscles,tendons,bo- -nes. Up to 30-50 mm beneath skin.
  12. 12. SUPERFICIAL HEATING AGENTS • Hydrocollator Packs. • Infra red ray. • Paraffin bath. • Others : hot packs ,hot water bottles etc.
  13. 13. Hydrocollator packs • Contains silica gel. • Can be contoured to various body regions. • It is a form of conductive heat. • Able to maintain 40 degree for 30 minutes.
  14. 14. Infra red ray • A band of light that we perceive as heat. • Delivered through artificial source. • More comfortable to patient. • No pressure on body. • Area can be inspected. • Optimal time : 20 minutes.
  15. 15. Paraffin wax therapy • 1 : 7 liquid petroleum : paraffin. • Indicated for small area (hands, feet ). • Has the ability to absorb and retain deep heat. • High heat capacity.
  16. 16. Others
  17. 17. DEEP HEATING AGENTS • Acts through electro magnetic or mechanical waves. • Electromagnetic waves generate heat by tissues resistance to electric current.e.g. microwave or short wave diathermy. • Mechanical waves generate heat by causing tissue vibration. E.g. ultrasound therapy.
  18. 18. Short wave diathermy • operate at a frequency of 27.12 MHz. • Indicated for deep muscles,tendons,joint stiffness. • Effective in post fracture contracture. • Contraindicated in pts with implant or pacemaker.
  19. 19. Microwave Diathermy • The clinical microthermy frequency is limited to 2.450 Mc range (10-12 cm wavelength), which is shorter than short wave diathermy. • The clinical indications for microthermy are, more or less, similar to those for short wave diathermy.
  20. 20. Ultrasound therapy • Ultrasound is high frequency sound waves, greater than 20,000 Hz. Therapeutic ultrasound is in the frequency range of 1- 3 MHz. • It has both thermal & mechanical effect. • Used to heal soft tissue and ligaments injury , scar mobilization & edema reduction.
  21. 21. Cold therapy/cryotherapy • application of cold to the body tissues after injury. • skin temperature is reduced to 10 C°. • When ice is applied to the skin, heat is conducted from the skin to the ice in order to melt it.
  22. 22. indications • Acute pain • Chronic pain • Acute swelling (controlling hemorrhage and edema) • Muscle spasm • Acute muscle strain • Acute ligament sprain • Acute contusion • Bursitis • Teno-synovitis • Tendinitis
  23. 23. contraindications 1. Impaired circulation (Raynaud’s phenomenon) 2. Peripheral vascular disease 3. Hypersensitivity to cold 4. Skin anesthesia 5. Open wounds or skin conditions. 6. Infection
  24. 24. Mode of action • Reduces pain. • Reduces spasticity. • Reduces muscle spasm. • Reduces swelling. • Promote repair of the damaged tissues.
  25. 25. Effects of cold therapy • Hemodynamic effects metabolic effect Initial in blood flow. Later in blood flow. Metabolic rate. • Neuromuscular effects  nerve conduction velocity.  pain threshold.  spasticity.  muscle contraction
  26. 26. Initial response Temperature vasodilator cutaneous thermoceptors (PGs,histamin) smooth muscle dorsal root blood viscosity contraction ganglion VASOCONSTRICTION blood flow
  27. 27. Later increase in blood flow
  28. 28. Technique of applications of cold therapy –Ice towels –Ice packs –Immersion –Ice cube massage –Cold compression units –Ice spray –Contrast bath
  29. 29. Pain modulation & pain gate
  30. 30. Transcutaneus electrical nerve stimulation(TENS) • one of the most commonly used forms of electro analgesia. • Uses :  Low back pain  Arthritic pain  Neurogenic pain  Bladder incontinence  Post surgical pain  Ch.musculo skeletal pain
  31. 31. TENS A)HIGH TENS :  Frequency : between 100- 150 Hz.  Pulse width : 100-500 ms  Intensity : 12- 30mA B) LOW TENS :  Frequency : 1- 5 Hz  Pulse width : 100 –150 ms  Intensity : > 30mA
  32. 32. Interferential Current Therapy • Four electrodes are placed in such a way that the two currents produced cross each other in the affected area. Where the two currents meet, they actually 'interfere' with each other; hence the name "interferential".
  33. 33. IFT • INDICATIONS: Rheumatism Arthritis Muscle sprain Neuralgia Sports injury.
  34. 34. Therapeutic exercises • An unused muscle loses strength @ 5% per day to 8% per week. • To restore a symptom free movements and functions.
  35. 35. Comprehensive exercise program • ROM exercises. • Strengthening exercises. • Functional exercises. • Conditioning exercises.
  36. 36. ROM exercises • To move joints either full or partial. • Prevents developing contracture. • Prevents muscle shortening. • Prevents adhesion of capsules,ligaments,ten dons.
  37. 37. Types of ROM exercises • Full ROM exercises. • Functional ROM exercises. • Active ROM exercises. • Passive ROM exercises.
  38. 38. Indications of active & passive exercises • ACTIVE PASSIVE • After trauma * polio • After surgery * Nerve palsies • Immobilization in * Stoke plaster.
  39. 39. Strengthening exercises • To increase the strength of the muscles. • To increase the amount of force, a muscle can generate. • Also improve the co-ordination of the muscle. • Three types : 1. isometric 2. isotonic and 3.isokinetic
  40. 40. Isometric exercises(Static) • Muscle is contracted without joint movements. • Used when active movements of joint not possible. • Used earliest possible time of fracture rehabilitation. • fear of pain of pts about exercises.
  41. 41. Isotonic exercises(dynamic) • Muscle contracts and relaxes about joint movements. • Performed using load or resistance. • Speed of movements is uncontrolled. • Indicated in intermediate & late stages of # rehabilitation.
  42. 42. Isokinetic exercises • Joint movements performed at constant rate & resistance varied according to muscle force. • Used in late united fractures. • Disadvantage : a machine needs for maintain motions.
  43. 43. Functional exercises • Aim to improve the functional activity of patients. • Improve agility, strength and neuromuscular co- ordination. • E.g. stair climbing after femur #. • Ball squeezing after removal of colle”s cast.
  44. 44. Conditioning exercises • Improves overall cardiopulmonar y functions. • Stationary bicycling, treadmill etc..
  45. 45. Group physiotherapy • Treated in a group who are in same situation. • Provides support and reassurance. • Helps in motivation • Very helpful in long term physiotherapy pts.
  46. 46. Aquatic physiotherapy • Practiced in warm water apprx. 34 degree. • Relieves aches, pains, mobilize joints. • The property of water unloads the body weight which reduce stress on joints. Allows freedom of movements. • Physiotherapist should present all times in the water.
  47. 47. THANK YOU ALL

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