CommentaryLettersOpinionsPhysiotherapy in ActionReader Bites

Who are physiotherapists?

by: - July 31, 2016
545 Views   no discussions
Dr Lucia Corriette

Dr Lucia Corriette

By: Dr Lucia Corriette

Physiotherapists or physical therapists are highly-educated, licensed health care professionals who can help patients reduce pain and improve or restore mobility. In many cases this can be done without expensive surgery and often reduces the need for long-term use of prescription medications and their side effects.

Physiotherapists are focused on educating patients and teaching them how they can prevent or manage their condition so that they can obtain long-term health benefits. After evaluating the patient, a treatment plan is developed that will seek to improve movement, reduce pain, restore function, and prevent disability. In addition, physiotherapists work with individuals to prevent the loss of mobility before it occurs by developing fitness- and wellness-oriented programs for healthier and more active lifestyles. Work stations in a variety of settings can also be assessed by physiotherapists to ensure that proper posture and biomechanics are maintained throughout the day.

Patients can be seen in a number of different settings. These settings include hospitals, private practices, outpatient clinics, home health agencies (home visits), schools, sports and fitness facilities, work settings, and nursing homes.

Educational background of physiotherapists
At present, physiotherapists graduate with a bachelor’s degree, master’s degree or doctorate in physiotherapy. Currently, the push within the USA is for all physiotherapists to be doctors of physiotherapy. This is in keeping with the requirements for direct access – the ability to treat patients without a written request from a physician.

Benefits of physiotherapy

Physiotherapy provides a number of benefits. These include:
• Pain reduction
• Improved range of motion
• Improved strength
• Improve balance
• Improved gait/ambulation
• Increased overall function

One main benefit of physiotherapy is improvement of movement. This is important for a number of reasons:

• Movement is essential to physical activity, which in turn is necessary to prevent obesity, which is responsible for at least 18% of US adult deaths.
• Mobility is crucial for physical independence, and studies suggest that walking alone can reduce the risk of heart attack and stroke, hip fractures, and knee arthritis, among other benefits.
• Consistent movement is vital to maintaining good balance, which can help prevent costly falls.

Treatment modalities used in physiotherapy

Physiotherapists utilize many electrical modalities including therapeutic ultrasound and electrical stimulation, along with manual therapy techniques and exercises.

Electrical Stimulation

Electrical Stimulation

Electrical stimulation (specific FDA assignments): For relaxation of muscle spasm, prevention or retardation of disuse muscle atrophy, increasing local circulation, muscle re-education, maintaining or increasing ROM, and for relief of chronic pain, intractable pain, and/or acute, post-traumatic pain. With correct dosing and methodologies, research has shown that electrical stimulation preferentially recruits type II muscle fibers and assists with neuromuscular re-education. This is important for deconditioned and post-operative patients who are unable to generate meaningful voluntary muscle contractions and exercise efforts.

Therapeutic ultrasound

Therapeutic ultrasound

Therapeutic ultrasound (specific FDA assignments): For pain reduction, relaxation of muscle spasm, treatment of contractures, improving local circulation to accelerate healing, increasing collagen extensibility, treatment of tendinitis, arthritis, decreasing joint stiffness and bursitis. Ultrasound can facilitate tissue healing and increase localized tissue temperature.

Manual therapy: From a physiotherapy perspective manual therapy is an essential and commonly used treatment method for the management of tissue, joint and movement dysfunction. Manual therapy includes techniques such as myofascial release and joint mobilizations.

Myofascial release: Fascia is a type of connective tissue that is divided into 3 layers: The superficial layer, a layer of potential space, and a deep layer. Since the fibers of the fascia run in many directions, it is able to move and change with the surrounding tissues. Fascia is believed to be one continuous piece of tissue working in connected “chains” to create balance in the tension of the body. Therefore, when fascia in one area is stretched, it can cause tightness, restriction, and pain in another part of the body. This is similar to pulling plastic wrap across a bowl: When one side is pulled tight, the opposite side becomes even tighter.

Fascia is wrapped around organs, muscles, nerves and other structures. When the fascia is wrapped tightly around these structures, pain is the result. Myofascial release is a manual therapy technique aimed at releasing the tension of the fascia and in so doing, helping to relieve pain.

Image of fascia within the body

Image of fascia within the body

Image of fascia within the body

Image of fascia within the body

Cross hand myofascial release technique

Cross hand myofascial release technique

Joint mobilizations: This technique involves the physiotherapist gliding or moving one bone within a joint. This is used to improve the range of motion or movement at the joint and to reduce pain.

Mobilization of the shoulder

Mobilization of the shoulder

Mobilization of the shoulder

Therapeutic exercises: Movements of the body aimed at correcting impairment, improving musculoskeletal function, or maintaining a state of well-being. The exercises may vary from highly selected activities restricted to specific muscles or parts of the body, to general and vigorous activities. Some of the goals of therapeutic exercises are to:

• Enable ambulation
• Release contracted muscles, tendons, and fascia
• Mobilize joints
• Improve circulation
• Improve respiratory capacity
• Improve coordination
• Reduce rigidity
• Improve balance
• Promote relaxation
• Improve muscle strength
• Improve endurance

Resisted exercises

Resisted exercises

Physiotherapy is primarily concerned with helping people recover function. Therefore, physiotherapists treat patients with a variety of illnesses including orthopedic (disc herniations, sprains, strains, sports injuries), neurologic (stroke, multiple sclerosis, cerebral palsy), and pulmonary (pneumonia, chronic obstructive pulmonary disease) conditions and also following surgical procedures (fractures, tendon repairs). This goal is achieved with the use of a variety of techniques. The ultimate goal is to improve function and as a result, improve overall well-being.

References
1. American Physical Therapy Association. Who are physical therapists? http://www.apta.org/AboutPTs/ Accessed July 20, 2016
2. American Physical Therapy Association. Benefits of physical therapy. http://www.moveforwardpt.com/Benefits/Default.aspx Accessed July 20, 2016
3. Cochrane, C. G. Joint Mobilization Principles. Physical Therapy, 67(7), 1105-1109. http://ptjournal.apta.org/content/67/7/1105. Accessed July 26, 2016
4. Lieberman, J.A., Bockenek, W.L. Therapeutic exercise.
http://emedicine.medscape.com/article/324583-overview Accessed July 28, 2016
5. McKenney K, Elder AS, Elder C, Hutchins A. Myofascial Release as a Treatment for Orthopaedic Conditions: A Systematic Review. Journal of Athletic Training. 2013;48(4):522-527. doi:10.4085/1062-6050-48.3.17.
6. Physiopedia. Maitland’s mobilisations. http://www.physio-pedia.com/Maitland%27s_Mobilisations Accessed July 28, 2016
7. Richards, M. The role of physical agent modalities in therapy. http://physical-therapy.advanceweb.com/Features/Articles/The-Role-of-Physical-Agent-Modalities-in-Therapy.aspx Accessed July 20, 2016