Physical Medicine and Physiotherapy

Physical medicine is the branch of healing arts that serves in the rehabilitation of people with injuries or diseases affecting muscles, joints, nerves and bones. Physical medicine utilises physical procedures such as heat, cold; massage or mechanical devises to diagnose disease or to treat disabled and help rehabilitation.

Physical therapist works under the direction of a physician to administer therapy through the use of the therapeutic exercise and massage and various types of treatment with heat, water, light and electricity. Physical therapy has been invaluable in the treating of victims of poliomyelitis, cerebral palsy, arthritis and muscular dystrophy.

As told earlier physical therapy is invaluable in the treatment of various nerve, bone, joints and muscles conditions, treating diseases such as spondylosis (or spondelitis), low back pain and cervical spondylosis, poliomyelitis, arthritis, cerebral palsy, muscular dystrophies and spinal and sports injuries.

The procedures used in physiotherapy usually include heat, traction, muscle exercises, message, acupressure, stoppage of movement by some special gadgets such as cervical collar and lumber belt for substituting the action of the lumber muscles. Let us then try to know a little bit about physiotherapy intervention in various injuries and diseases:

Sports Injuries :

Immediate treatment for almost all sports injuries consists of rest, ice, compression and elevation (RICE). The injured part is rested immediately to minimise internal bleeding and selling and to prevent the injury from becoming worse. Ice causes blood vessels to constrict, helping limit inflammation and reduce pain. Wrapping the injured part with tape or an elastic bandage (compression) and raising the injured part above the heart (elevation) help limit swelling. Ice may be used in the form of ice cubes or a commercial ice pack or a bag of crushed or chipped ice which confronts to body contours better than ice cubes, can be placed on a towel over the injured part for 10 minutes, then reapplied after to minutes intervals over a period of 1 to 2 hours. For sports injuries the physical therapists may incorporate heat, cold, electricity, sound waves, traction, or exercising in water into a treatment plan in addition to the therapeutic exercise.

Osteoarthritis :

Apprppriaxe. exercises including stfetehing; strengthening, and postural exercises help maintain healthy cartilage, increase a joint's range of motion, and strengthen surrounding muscles so that they absorb shock better. Exercise must be balanced with rest of painful joints, but immobilising a joint is more likely to worsen osteoarthritis than to improve it. Using excessively soft chairs, recliners, mattresses, and car seats may worsen symptoms, using straight backed chairs, firm mattresses and bed boards is often recommended. For osteoarthritis of the spine, specific exercises sometimes help, and back supports or braces may be needed when problems are severe. Physical therapy, often with heat treatment can be helpful. For example, using hot paraffin wax mixed with mineral oil at temperatures of 118 to 126 F, dipping the hand in a paraffin bath, and taking hot or warm baths may be recommended for finger pain. Splints or supports can protect specific joints during painful activities. Massage by trained therapists, traction, and deep heat treatment with diathermy or ultrasound may be useful when certain types of osteoarthritis affect the neck.

Post-stroke Physiotherapy :

Required for hemiparesis following or as a consequence of stroke. Early and repeated appraisals of the patient's condition (status) by physician, physiotherapist and nursing staff allow a remedial programme to be designed. Major strokes can lead to prolonged, and crippling illnesses, often involving loss or sensation in certain parts of the body, disturbances of speech, vision or memory, and loss of locomotion. In such cases occupational and physical therapy should emphasise using affected limbs and achieving proficiency in eating, dressing, toilet functions and other basic needs. Massage and exercise etc. are usually tried with greater success.

Muscular Dystrophies :

Duchenne's and Becker's muscular dystrophies - the most common muscular dystrophies - are diseases that cause weakness in the muscles closest to the torso. Physical therapy and exercise help prevent the muscles from contracting per-cerebral Palsy: Cerebral Palsy can not be cured; its problems are lifelong. However, much can be done to give a child as much independence as possible. Physical therapy and braces may improve muscle control and walking.

Physical Therapy for Jaw Muscle Pain and Tightness :

Ultrasound is a method of delivering deep heat to painful areas when warmed by the ultrasound, the blood vessels dilate, and the blood can more quickly carry away the accumulated lactic acid that may cause muscle pain.

Elertromyographic biofeedback monitors muscle activity with a gauge. The patient attempts to relax the entire body or a specific muscle while watching the gauge. In this way, the patient learns control or relax particular muscles.

Spray and stretch exercises involve spraying a skin refrigerant over the cheek and temple, so the jaw muscle can be stretched.

Friction massage consists of rubbing a rough towel over the cheek and temple to increase circulation and speed lactic acid removal. Transcutaneous electrical nerve stimulation involves using a device that stimulates the nerve fibres that do not transmit pain. The resulting impulses are thought to block the painful impulses the patient has been feeling.

Now let us talk about a couple of diseases where physiotherapy is used with immense benefit. These are cervical spondylosis and lumbago sciatica syndrome (the most prominent low back pain.)

Cervical Spondylosis :

In case of intense pain in the neck due, to cervical spondylosis associated with painful or painless weakness in the arm stoppage of neck movement is immediately required. There is a lot of vibrations and jerks in the neck during travelling and it is advisable to stop travelling and stay away from office /institution /academy for a few days. A cervical collar is advisable to restrict undue movements of the neck. Whenever there is pain in the joints, the muscles encircling that joint become tight and reduce the mobility of the joint as a protective mechanism. When the tension in the muscle becomes too much, they generate pain; Heat is the best agent to relax the muscles. Many gadgets and home remedies can be used, i.e., hot water bags, electrical heating pads, infrared lamps etc. The more preferable heat treatments are short wave diathermy (WD) and ultrasound heat. They provide deep penetrating heat.

Traction (cervical) is quite effective when a slipped disc presses a nerve root. Traction increases the intervertebral disc space and therefore the pressure of disc on the nerve root is released. Traction can be intermittent or steady traction kept up for some time. If traction fails to reduce pain in 24 to 48 hours, there is little reason to insist on the use of traction any further.

Sciatica :

Use of physiotherapy in Sciatica is similar to that in retroviral spondylosis. It means the., heat, traction, massage muscle relaxing exercises are used. In case of Sciatica pelvic traction is given and lumber belt is worn. Heat treatment used are similar to that of spondylosis, i.e., short wave diathermy and ultrasound. Massage may be used. Massage is a very effective way for relaxing the tense muscles of the neck. Accupressure is an effective way of relaxing and soothing the muscles on the both sides of the spine.

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