Basic

knowledge of
Physiotherapy
By
Dr.B.Arun Kumar
M.D(Ay)

Introduction
This is a branch of health care science that mainly
concentrates on the physical aspects of an
individuals helath care, by treating their physical
ailments.
Physiotherapist must coordinate and work with the
other members, throughout rehabilitation period.

Physiotherapy practice
Movement management by:
Manipulative therapy
Electro therapy
Hydro therapy

MANIPULATIV
E THERAPY

Physiotherapy during
immobilization
1. Reduce edema2. Assist the maintenance of circulation to the area.
3. Maintains muscle function by active or static
contractions.
4. Maintain joint range where possible.
5. Maintain as much function as allowed by the
particular injury and the fixation.
6. Teach the patient how to use special appliances
ex;sticks,crutches.

Physiotherapy
techniques
1.Movement techniques:
passive,
assisted,
active,
free active,
resisted exercises can be given to facilitate
activity and to strengthen muscles.

Manipulative
therapy
It involves skillful restoration of mobility to soft
tissues and joints.
It consists of
Soft tissues techniques(massage)
Passive mobilization of joints
Passive streching of soft tissues
Auto stretching of soft tissues.

Soft tissues techniques(massage)

1.
2.
3.
4.
5.
6.
7.

Stroking
Efflurage
Kneading
Picking up
Wringing
Skin rolling
Frictions

Stroking
Massage is the manipulating of superficial
and deeper layers of muscle and
connective tissue using various
techniques, to enhance function, aid in the
healing process, decrease muscle reflex
activity, inhibits motor-neuron excitability
and promote relaxation and well-being

Efflurage
a technique in massage in which
long, light, or firm strokes are
used, usually over the spine
and back. Fingertip effleurage
is a light technique performed
with the tips of the fingers in a
circular pattern over one part
of the body or in long strokes
over the back or an extremity.
Fingertip effleurage of the
abdomen is a technique
commonly used in the Lamaze
method of natural childbirth.

Kneading
The hands are placed
on the skin and
allowed to mould to
the part, then they
more in a circular
direction with pressure
gradually applied over
the top of the circle
and released towards
the bottom of the
circle.

Picking up
Similar to kneading
but it involves lifting
the tissues up at right
angles to the
underlyingbone,
sqeezing and releasing.

Wringing
It involves lifting the
tissues up as in
picing up and
applying a twist to
enchance the
stretching effect.

Skin rolling
It involves lifting and
stretching the skin
between thumbs and
fingers so that the
skin and
subcutaneous tissues
are moved on each
other and adhesions
are stretched.

Frictions
Small range
movements applied
with the thumb or
fingers starting
superficially and
working deeper.they
applied in one of two
ways tranverse or
circular.

Contraindications
Soft tissue manipulation
1.
2.
3.
4.
5.

Acute inflammation
Weeping conditions
Infection
Recent fractures
Patient preference

Indications
Soft tissue manipulation
1.
2.
3.
4.
5.
6.
7.

Scar tissue
Muscle spasm
Muscle tightness
Fascial tethering
Oedema
Pain
Slow healing scars or ulcers.

Connective Tissue
Massage
The term connective

tissue in this case refers

to the fascia which
surrounds, protects, and
supports all of the other
structures in the body. It
is the matrix which binds
together the bodys
organs and systems,
while at the same time
providing
compartmentalization
between them.

Connective Tissue
Massage

Indications:

tendonitis
fibromyalgia
scoliosis
chronic fatigue syndrome
sciatica
multiple sclerosis
TMJ
ALS (Lou Gehrigs Disease)
arthritis
carpal tunnel syndrome

Passive mobilizaiton of
joints

Joints restriction factors:

Pain
Muscle spasm
Oedema
Fibrous contracture of fascia
Ligaments/capsule
Cartilage flake trapped between the joint surfaces.

Hydrotherap
y

Principles of
1.StengtheningTreatment
muscles:
They are strengthened by working progressively against
graded resistance.in the pool,resistance may be from
buoyancy, turbulence,unstreamlining.
2.Buoyancy:
movements downwards in the pool are resisted by
buoyancy.floats which may be of different densities may be
used to increase the effect of buoyancy.
3.Turbulence:
it is created by movement through water and is increased if
the rate of movement is increased.

Principles of
Treatment
4.unstreamling:
If a broad surface is presented when a body is moved through water
the resistance is greater than if the surface is narrow.
To progress exercises with a bat, for example, the movement is first
performed with the edge of the bat moving through the water and then
progressed so that the broad surface is going against the water.

5.Joint mobility:
Relief of pain and muscle spasm by the warmth of the water and by
support from buoyancy can restore free movement of joints.
6.Coordination and balance:
Patients can practice activites in standing,transference of weight,and
arm movements.

Methods of Heat
Transfer
Conduction
Convection
Radiation

Untoward Effects &

Precautions
Untoward Effects:

Precautions:

Chilling
Sudden changes in blood
pressure
Infections
Falls inside and outside the pool
Fatigue of patients or staff.

Temparature should be 94-98df.

Chlorine levels should be 1.53.0 ppm
Water PH must be 7.2-7.8.
Chlorine&PH must check for
every 2/3 days
Bacteriological testing
Backwashing must be
performed regularly.
Floor of pool must be non slip.

Clinical Indications

Ankylosing spondylitis
Osteoarthritis
Rheumatoid arthritis
Juvenile chr.polyarthritis
Spondylosis
Capsulitis
Mechanical spinal disorders
Polymyalgia rheumatica
Major fractures (lower limbs/spine)
Ortopaedic surgery
Neurological disorders

Value for maintaining fitness and relieving backache during

pregnancy after child birth.

Hydrotherapy
Contraindication
Contraindications:

Infected wounds
Acute skin conditions
Pyrexia
Incontinence
Cardiac disease
DVT
Recent pulmonary embolus
Recent CVA
GIT disorders
Tracheostomy

Low vital capacity

Kidney disease
Diabetes
Thyroid deficiency
Radiotherapy in the previous 3
months
Careful consideration is
essential for patients with open
wounds covered with a
waterproof dressing.

Epilepsy
Vertigo

Electro
therapy

Use of
Electrotherapy
1.Pain management

Improves range of joint movement

2. Treatment of neuromuscular dysfunction
Improvement of strength
Improvement of motor control
Retards muscle atrophy
Improvement of local blood flow
3. Improves range of joint mobility
Induces repeated stretching of contracted, shortened soft
tissues
4. Tissue repair
Enhances microcirculation and protein synthesis to heal
wounds
Restores integrity of connective and dermal tissues

Use of
5. Acute Electrotherapy
and chronic edema

Accelerates absorption rate

Affects blood vessel permeability
Increases mobility of proteins, blood cells and lymphatic
flow
6. Peripheral blood flow
Induces arterial, venous and lymphatic flow
7. Iontophoresis
Delivery of pharmacological agents
8. Urine and fecal incontinence
Affects pelvic floor musculature to reduce pelvic pain and
strengthen musculature
Treatment may lead to complete continence

Sources of Heat
1.
2.
3.
4.
5.
6.

Paraffin wax
Infra red radiation
Heat pad
Hot moist packs
Short wave diathermy
Microwave diathermy

Paraffin wax
Paraffin wax refers to a white or colourless soft
solid that is used as a lubricant and for other
applications.
It consists of a mixture of hydrocarbon molecules
containing between twenty and forty carbon atoms.
It is solid at room temperature and begins to melt
above approximately 37 C (99 F).
Paraffin wax is an excellent material to store heat,
having a specific heat capacity of 2.14
2.9 J g1 K1 (joule per gram kelvin) and a
heat of fusion of 200220 J g1.

Infra red
Infrared (IR)radiation
light is electromagnetic radiation with
longer wavelengths than those of visible light, extending

from the nominal red edge of the visible spectrum at 0.74

micrometres (m) to 300 m.
This range of wavelengths corresponds to a frequency
range of approximately 1 to 400 THz,[1] and includes most
of the thermal radiation emitted by objects near room
temperature.
Infrared light is emitted or absorbed by molecules when
they change their rotational-vibrational movements.
The existence of infrared radiation was first discovered in
1800 by astronomer William Herschel.

Infra red
radiation

Several studies have looked at using infrared saunas in the treatment

of chronic health problems, such as high blood pressure, congestive
heart failure and rheumatoid arthritis, and found some evidence of
benefit.
For example it is used in infrared saunas to heat the occupants, and
also to remove ice from the wings of aircraft (de-icing).
Far infrared is also gaining popularity as a safe heat therapy method
of natural health care and physiotherapy.

Strong infrared radiation in certain industry high-heat

settings may be hazard to the eyes, resulting in damage or
blindness to the user.
Since the radiation is invisible, special IR-proof goggles
must be worn in such places.

Heat Pad
They are plastic covered pads similar to but smaller
than electric blankets.
A pad has 3 levels of heat and is useful for treating
the neck or back.
Patient lies on it and heat passes to the tissues by
conduction.

Hot moist
packs

These bags filled with a hydrophilic substance

and stored in a thermostatically controlled
cabinet of water between 75 -80 degree C.
Useful on uneven surfaces because they can be
easily moulded to the surface.
They are heavy causes discomfort.

Short wave
diathermy

It is application to the tissues

of electrical fields which
oscillate at a frequency of
27.12MHZ and have a
wavelength of 11.06M.
It is used in deep and
superficial lesions.
It produces a greater and more
rapid rise in temp.
Useful for softtissue
injuries,degenerative &
inflammatory arthopaties,slow
healing
wounds,sinusitis,deepseated
pelvic structures.

Microwave
Application diathermy
of
electromagnetic radiations

with a wavelength of
12.25cm & frequence of
2450MHz.
They are produced by a
megnetron,which is a
special type of thermoinic
valve.
Depth of penetration 3cm.
They are absorbed by fluid
tissues & less by bone,fat.
Degenrative joint disease&
joint lesions are better treat.

ICE
THERAPY

Ice Therapy

Cold Compression Therapy combines two of

the principles of R.I.C.E. (Rest, Ice, Compression,
Elevation) to reduce pain and swelling from a sports
or activity injury to soft tissues and recommended
by orthopedic surgeons following surgery.
The therapy is especially useful for sprains, strains,
pulled muscles and pulled ligaments.
Cold Compression is a combination of cryotherapy
and static compression, commonly used for the
treatment of pain and inflammation after acute
injury or surgical procedures.

Ice Therapy
Cryotherapy, the use of ice or cold in a therapeutic
setting, has become one of the most common
treatments in orthopedic medicine.
The primary reason for using cryotherapy in acute
injury management is to lower the temperature of
the injured tissue, which reduces the tissue's
metabolic rate and helps the tissue to survive the
period following the injury.
It is well documented that metabolic rate decreases
by application of cryotherapy.