Physiotherapy & the physical therapy are two sides of the same coin. It is a health
care profession primarily concerned with remediation of impairments and disabilities
and the promotion of mobility, quality of life, and movement potential through examination,
evaluation, diagnosis and physical intervention. Now a days, physiotherapy plays
a very vital role in everyone's life.
Physical therapy involves the interaction between therapist, patients or clients,
other health care professionals, families, care givers, and communities in a process
where movement potential is assessed, diagnosed and goals are agreed upon. Physical
therapy is performed by a best physiotherapist and sometimes services are provided by a physical
therapist assistant (PTA) acting under their direction. Physical therapists and
occupational therapists often work together in conjunction to provide treatment
for patients. In some cases, physical rehabilitation technicians may provide physiotherapy
Physical therapy by Best Sports Physiotherapist has many specialties including sports, wound care, EMG, cardiopulmonary,
geriatrics, neurology, orthopedic and pediatrics. PTs practice in many settings,
such as outpatient clinics or offices, health and wellness clinics, rehabilitation
hospitals facilities, skilled nursing facilities, extended care facilities, private
homes, education and research centers, schools, hospices, industrial and workplaces
or other occupational environments, fitness centres and sports training facilities.
- Ortho physiotherapy
- Neuro physiotherapy
- Sports physiotherapy
- Peaidiatrics phsysiotherapy
- Chest physiotherapy
- Vestibular rehabilitation
Widely we can divide this into two parts:-
1) Excersise therapy
Excersise therapy- aprc excesise protocols are cutomised for patient to patient
and as per ethical international standards.
In day to day process we are using the following techniques:-
EXCERSISE THERAPY EQUIPMENT:-
- Mulligans technique
- Maitland technique
- Tapping technique
- PRE�s (progressive resisted excersise)
- Oxford technique
- Dlorme technique
- Vestibular rehabilitation (for vertigo)
- Patrica davis approach(U.S.A) for hemiplegia
- Brombley�s approach for SCI patients.
2) Electro therapy
Electro therapy modalities-
- Ankle execersiser
- Heel excerciser
- Static cycle
- Physio ball
- Motorized tredmill
- Finger ladder
- Shoulder wheel
- BAPS(bi-lateral ankle platform system)
- Multi gym
- balanced board
- grip execersise
- gel ball
- weight cuff
- cross trainer
- mobilization belt
- motorized balanced board
- Hydrocolateral pack
- Traction- cervical, lumbar
- Laser-class IV (U.S.A)
- Ceragem-radiant spinal therapy(south korea)
- Short wave diathermy
- Russian currents
- Faradic stimulation
- Emg stimulator-bio move 3000
- Parafin wax bath
- Whirlpool bath
Backachewhich was known as an ancient curse is now known as a modern international
epidemic. 80% of the population are affected by this symptom at sometime in
life. Impairments of the back & spine are ranked as the most frequent cause
of limitation of the activity in people younger than 45 yr. In 2% of the
population backache is the presenting complaint in the general practitioners
clinic. In 78% & 89% women specific cause was not known. It was believed
that bad posture was responsible for most of these cases. The cost is the
society & the patient for treatment, compensation etc. is very high.
It is a very common problem & has an ubiquitous distribution among the galaxy
of causative factors both spinal & extra spinal the most common cause of
low backache seems to the lumbar disc disease. Bad posture plays a very
significant role in the genesis of this disease.
Modification in activities of daily living:
Carrying luggage while travelling - The luggage to be carried while travelling should be
light. Carrying two suitcase of approximately equal weight, instead of one will
put equal pressure on both the shoulders.
- It is advisable to use suitcases with built in rollers
- Kitchen standing habits house wives working in the kitchen, should stand erect & place
on of their legs on a footstool. The legs should be alternated on the footstool when standing
for a long time
- Mattresses- the mattresses should be firm to support the physiological curves of the back.
If too soft the back will sag & if very hard will cause more pressure. It is better to keep a small
pillow beneath the knees or sleep on the sides with the knees bent.
- Proper driving habits while driving a car observe the following:
- Sid close to the steering as is comfortable
- Place a small pillow beneath the lumbar curve to preserve the normal Lordosis
- Use the rear view mirrors frequently & do not turn back to see vehicles
- Keep the knees bent
This is the most important aspect of the management of backache. Like in all other diseases so in
backache (lumbar pain) preservation is better than curve. Backache can be prevented to a large extent
by observing the following measures.
Adopting proper posture & creating an awareness that it is in the erect position that the back
can withstand strain the best
Back education stress on the back is less when is is properly used during sitting, walking etc These
proper habits have to be cultivated with practice.
Back exercise. These aim to strengthen the abdominal, pelvic back & thigh muscles. Strong healthy
muscles reduces load on the disc & other structures.
To avoid all sports including the aerobic ones. Swimming & walking are encouraged.
Remember the Do's & Don'ts for backache
- Forward bent attitude
- Body weight born on the heels
- Proper weight lifting as shown earlier
- Sit with buttocks tucked under
- Flex the knees & hip when lying on the side
- Turn to the side & then get up
- Sleep in the prone position
- Rise from the sitting postion suddenly
- Bend over a washbasin
- Wear high heels as pelvis is thurst forward & the spine bends backward
- Use too high a chair
- Use soft mattress which increases the lumbosacral extension. A firm mattress encourages lumbar spine to be straight.
Knee Pain (Joint Pain Physiotherapy Treatment):
The knee joint is the major weight bearing joint of the body and it is a superficial joint, hence more prone to injuries.
It is a joint whose stability is dependent, primarily on the ligaments & hence the ligament injury is common.
A number of orthopedic diseases such as osteomyelitis and sarcoma occur around the knee.
The following are the usual presenting complaints:
- Pain in the knee
Most deformities related to arthritis are painful.
Painless deformities may occur in paralydiseases (eg Polio) or if the joint is completely destroyed and fused. Deformity in arthritis is the flemon deformity.
Varus (bowing of legs) & valgus (knock knees) deformities may be present.
Recurvatum (hyperertension) deformity may occur in Polio, or due to a fracture in the region of the Knee.
The knee is therefore affected in a wide variety of orthopaedic conditions.
These can be divided in to trauma-related and non traumatic.
Observe the gait of the patient. A deformity of the knee will be obvious. Recurvatum deformity can be best
appreciated when the patient walks.
A patient with weakness of the quadriceps muscles may walk with hand knee gait. Ie he supports his knee
on the front with his hand when he takes weight on the leg.
Deformities of the knee:
- knock knee (Genu Valgum)
- Bow Legs (Genu Valgum)
- Abduction (Valgus) stress test
- Abduction (Varus) stress test
- Anterior drawer test
- External rotation recurvatum test
- Lachman's test
TENS H.P., stretching strengthening exercise
The hip joint thickly covered & soft tissues. There are number of diseases enclusine to the hip,
for example penthes disease slipped femoral epiphysis.
The deformities at the hip eg: the flexion deformity is masked by forward tilting of the pelvis.
The common complaints of a patient & hip disease are as follows:
- Pain in the groin: In the front of the thigh or sometimes a pain from the hip is often referred to the knee. Pain in the groin can be referred pain upper lumbar spine.
- Inability to squat: This is due to stiffness of the hip. The stiffness may be due to painful spasm of the muscles around the hip or because of the adhesions & in or around the hip
- Limp: This may be painless as in CPH or Cona Vana or painful as in early arthritis
- Inability to walk: This may be painful condition or due to mechanical failure in the region of the hip (eg: fracture neck of the femur, polio etc)
Pain in the Groin infront of the thigh outerside of the hip
Pain in the gluteal region is not from the hip, it is usually from L.S spine or S.I. joints.
Pain from the hip radiates to the knee
Duration of the pain:
Short duration pains are due to trauma, acute infections, acute arthritis etc
Long duration pain due to chronic infections, chronic arthritis, sec. osteoarthritis, tumours etc.
Observe the gait of the patient.
Stiff hip gait: lifts the pelvis & swing it forward & leg in one piece.
T.B. hip, Rheumatoid hip, A.S.
Flexion deformity is the common deformity of the hip
- Faber's test
- Leg length test
- Thomas test
- Trendelenburg's sign
Low back pain radiating to leg
If a pain radiating from lower back to leg it can be diagnosed as Sciatica or sacroillitis
But in clinical cases mostly lower back pain radiating to leg is diagnosed as Sciatica as in only few cases of Sacroillitis we can see the radiating pain
from low back to leg
Sciatica is form of lower back pain which runs down from low back to one (or) both legs causing pain, numbness, and tingling in the leg
This is caused due to the irritation along the course of the nerve root or compression of the nerve.
Pain shoots along the course of the nerve depending on the level of compression
Sometimes even causes weakness of the muscles
Passive straight leg raising test
In this patient should lying on his back & therapist passively raise the leg of patient and also perform the dorsi flexion of the ankle.
If the pain aggravates along the course of the nerve then the test is positive.
TENS, Ice packs, Hot pack
Exercise's Recommended are:
Therapist should mainly concentrate on the stretching, strengthing exercise's of lower back and gluteus mucles.
Manual therapy can produce the maximum positive results
The inflammation of one or both of the sacroiliac joints is known as sacroillitis
A sudden impact such as a fall or vehicle accident that affected the pelvis, lower spine
An infection of the S.T joint
Low back pain that is primarily unilateral
Stiffness in lower back, buttocks or thighs
Thatwarness & walking
Sacroillitis can be difficult to diagnose as there isn't one test for it
Test can be done static or dynamic
This test is performed & the patient lying supine while the examiner places the lateral portion of the patient foot on the opposite knee
The examiner provides gentle forces at the patient knee moving the flexed lower extremity into abduction and external rotation while stabilizing the
The test is positive if sacrovilae pain is generated
Seated flexion test
Long sitting test
This test is performed & when the patient standing while the examiner stands behind the patient palpating the area directly under pisc and the sacral
tubercle simultaneously. The patient stands on one leg while flexing the contralateral hip and knee towards their chest.
The test is positive if the pisi does not move caudally.
Illiotibial band syndrome
Illiotribial band syndrome is the result of inflammation and irritation of the distal portion of the illiotribial tendon as it rubs against the bursa that
lies underneath the tendon and lateral femoral condyle.
This could also occur because of a back of flexiblility of the illiotibial band.
Treatment includes stretching and strengthening of the affected limb.
Protection: immobilize of the knee
Rest: avoid all activities
Compression: wraping elastic band
Elevation: knee elevation to avoid swelling
Hip flexor stretch
Sidelying illiotibial stretch
Standing squat with abduction
Hip abduction / adduction
Tenderness while walking, running or using stairs
Sometimes creptitus (clicking sound)
Costochondritis is a condition in which there is inflammation and tenderness of the cartilage that attaches the sternum to the front of the ribs most
commonly the second and third ribs
The inflammation can involve cartilage on the both sides of the sternum but more commonly involves when we expand our chest with deep breath
Direct injury to the chest or ribs
Unusual physical activity
Repetitive movements of the ribs
Upper respiratory infections
The chest pain associated with costochondritis is often sharp but can be dull and growing. It is frequently made worse by activities that alter the
position of the ribs such as lying down rolling. Coughing, sneezing or taking deep breath
When the pain of costochondritis is associated with swelling in the area of the inflammation. It is reffered to as Tietze's syndrome
The diagnosis costochondritis can usually be made base on person's symptoms and physical exam findings.
Chest stretching exercises
Dr Kulwinder Kaur
Low Back Pain
Low backache is a very common problem in present time. Almost 80% people suffering from this disease.
This problem is present in 78% in women and 60% in men. Mostly cause for this problem postural & traumatic
Back pain could be a feature of an extra spinal disease like genitor-uninary or gynecological.
Types of Lower Back Pain
1) Acute lower back pain-in case of trauma or injury patient present with
- Back strain
- Acute disc problems
- Fracture of vertebra
- Lumber strain due to overactivity
2) Chronic lower back pain-chronic pain happens in two conditions:
- Pain improve with rest or during activity
- Mechanical back pain
May be due to some specific condition
- Chronic disc prolapsed
patient suffer with pain & complaing pain in early morning. It improves with activity & may also called inflammatory
back pain with
- Ankylosing spondylitis
Causes of lower back pain
Sprain, strain, vertebral fractures, prolapsed disc, osteoarthritis
This is usually associated with lower back pain but may be sole presenting problem.
Sciatica pain usually in lower back radiating to sacroiliac region, gluteal & thigh is below of the knee, calf & lateral of the foot.
Mostly patients complain of pain during long time sitting, radiating pain during walking.
This problem mostly compression of the nerve.
Disc prolapsed, degenerative arthritis, injured herniated disc, dislocated hip, pressure from uterus during pregnancy.
Back pain : Eighty percent of the population are affected from back pain. The most common cause of back ache is bad posture & traumatic. Almost