This document discusses the principles and techniques of physiotherapy, with a focus on its applications in orthopedics. It outlines the aims of physiotherapy to treat, correct, and prevent disability and deformity. A variety of physical therapy techniques are described, including heat therapy, cold therapy, electrical stimulation, therapeutic exercises, and aquatic physiotherapy. Heat therapy is used to reduce pain and stiffness, while cold therapy aims to reduce pain, swelling, and muscle spasm after injury. Different types of exercises like range of motion, strengthening, functional, and conditioning exercises are covered. The document emphasizes the importance of rehabilitation for all fractures and injuries to restore function.

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. 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. •Aims
• To treat disability and deformity.
• To correct disability and deformity
• To prevent disability and deformity

4. Rehabilitation
• All fracture
may not needs
reduction or
retention but
all fractures
need
rehabilitation.

5. Contd..
• “Orthopaedic surgeon should
never pick up a knife unless
he has a competent
physiotherapist” prof. P.
Chandra, aims.

6. Trauma may cause injury to
1.Soft tissue 2. joints 3.fractures
muscle atrophy stiff joints immobilisation
impaired function
contractures
needs rehabilitation

7. Physical agents in physiotherapy
• Heat therapy
• Cold therapy
• Sound
• Hydrotherapy
• Electrical
stimulation etc.

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. Hemodynamic effect of heat
Temperature
inflammation cutaneous
thermoceptors
vasodilator spinal dorsal root smooth
(histamin,PGs) muscle
relaxation
VASODILATATION

10. Contraindication of heat therapy
• Open wounds.
• Anaesthetic
skin.
• Severe oedema.
• Skin diseases.
• Infection.

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. SUPERFICIAL HEATING AGENTS
• Hydrocollator Packs.
• Infra red ray.
• Paraffin bath.
• Others : hot packs ,hot water
bottles etc.

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. 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. 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. Others

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. 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. 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. 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. 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. 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. 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. Mode of action
• Reduces pain.
• Reduces spasticity.
• Reduces muscle spasm.
• Reduces swelling.
• Promote repair of the damaged
tissues.

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. Initial response
Temperature
vasodilator cutaneous thermoceptors
(PGs,histamin)
smooth muscle dorsal root
blood viscosity contraction ganglion
VASOCONSTRICTION blood flow

27. Later increase in blood flow

28. Technique of applications of cold
therapy
–Ice towels
–Ice packs
–Immersion
–Ice cube massage
–Cold compression units
–Ice spray
–Contrast bath

29. Pain modulation & pain gate

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. 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. 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. IFT
• INDICATIONS:
Rheumatism
Arthritis
Muscle sprain
Neuralgia
Sports injury.

34. Therapeutic exercises
• An unused muscle loses strength @
5% per day to 8% per week.
• To restore a symptom free
movements and functions.

35. Comprehensive exercise program
• ROM exercises.
• Strengthening
exercises.
• Functional
exercises.
• Conditioning
exercises.

36. ROM exercises
• To move joints either
full or partial.
• Prevents developing
contracture.
• Prevents muscle
shortening.
• Prevents adhesion of
capsules,ligaments,ten
dons.

37. Types of ROM exercises
• Full ROM exercises.
• Functional ROM
exercises.
• Active ROM
exercises.
• Passive ROM
exercises.

38. Indications of active & passive
exercises
• ACTIVE PASSIVE
• After trauma * polio
• After surgery * Nerve palsies
• Immobilization in * Stoke
plaster.

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. 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. 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. 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. 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. Conditioning exercises
• Improves overall
cardiopulmonar
y functions.
• Stationary
bicycling,
treadmill etc..

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. 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. THANK YOU ALL