Physiotherapy

Physical therapy also known as physiotherapy, includes evaluating, diagnosing and treating numerous disorders and disabilities through the physical way. This branch of medicine helps people restore, retain and maximize their strength, function, movement and overall well-being.

People who practice this branch of therapy are called physiotherapists. Diagnosis, treatment and rehabilitation of patients are their main areas of work. They primarily work with physical disorders and disabilities. Physiotherapy helps a person

• Become flexible
  
• Improve mobility
  
• Reduce pain
  
• Stay active
  
• Prevent injury
  
• Recover from injury

Physiotherapy helps the human body to remain functional. Physiotherapy is recommended when the human body suffers some physiological trauma. During physiotherapy the patient is examined physically and if required imaging studies are carried out so as to decide the right type of therapy. It is recommended in the following conditions:

• Post injury rehabilitation like fracture recovery, post surgical recovery.
  
• Spine problems like spina bifida, sciatica.
  
• Neck problems
  
• Muscular problems
  
• Joint disorders like osteoarthritis
  
• Neurological disorders like stroke, multiple sclerosis
  
• Backaches
  
• Headaches
  
• Urinary problems like urinary incontinence
  
• Lung and heart disease like chronic obstructive pulmonary disease

Heat therapy: Heat therapy improves the blood flow to the injured area thus speeding up healing. Heat therapy also loosens the tight tissues thereby relieving pain. Various heat treatments include ultrasound, hot pack, infrared heat, Paraffin wax bath, Diathermy

Cryotherapy: Cold therapy helps in minimizing the swelling and pain. It is very useful in acute injuries. Various treatments include ice massage and ice pack application

Strengthening exercises with Physical Therapy: Certain conditions may have caused the muscles to weaken, there are certain types of exercises aimed at strengthening the muscles thereby helping rehabilitation and improving performance.

Range Of Motion exercises: ROM exercises help in improving and maintaining the flexibility of joints. They also help in reducing the stiffness of the joints. Various exercises include:

Passive Range of Motion exercises: (PROM)

Active Range of Motion exercises: (AROM)

Active Assistive Range of Motion exercises: (AAROM)

Soft tissue mobilization/Therapeutic massage:This relaxes the tight muscles thus relieving pain and reducing swelling

Electrical stimulation: This method is used to prevent muscle atrophy in people with paralysis. Electrodes are placed on the surface of the skin thus causing the muscle to shorten.

TENS: Transcutaneous Electrical Nerve Stimulation is a type of never stimulation wherein a low degree electrical current is passed through the surface of the skin to the affected part. This process helps in relieving pain momentarily.

Other types of physical therapy treatment include taping, bandaging, joint mobilization, ergonomic training, postural training, balance exercise, traction, fitting of orthosis, etc. Physiotherapy has various specializations like geriatric, pediatric, orthopedic, neurological, sports, cardiovascular and pulmonary.

Adhesive capsulitis

Adhesive capsulitis is a condition associated with the shoulder. It is also known as frozen shoulder. The indications for the onset of adhesive capsulitis include difficulty in performing day to day activities involving the shoulder. The articulations associated with the shoulder are complex comprising three joints and four groups of muscles which facilitate the movement of the shoulder in various directions. The range of motion of the shoulder is taken into consideration to identify the underlying cause for the onset of adhesive capsulitis. Adhesive capsulitis is also defined as the idiopathic painful restriction of the shoulder. This condition results in the global restriction of the muscles associated with glenohumeral joint. Adhesive capsulitis predominantly occurs in people belonging to the age group of 40-60. Women are prone to adhesive capsulitis than men. Adhesive capsulitis usually lasts for a period of two years and gradually subsides.

Clinical manifestations of Adhesive capsulitis

Adhesive capsulitis occurs in three stages. The first stage is called as the freezing stage where the patient experiences mild pain and discomfort with movements of the shoulder. Increased pain during sleep and muscle spasms are more predominant in this stage. The freezing stage usually occurs for a period of three to four months.

The second stage is called the adhesive or the frozen stage, in which the pain is reduced but movement of the shoulder is restricted to a greater extent leading to stiffness. The second stage is the most difficult stage which can last up to nine months and it involves the restriction of shoulder movements in many angles causing discomfort.

The third stage is the recovery stage or the thawing stage in which the movement is restored only to a certain degree but the patient continues to experience mild pain and movement restriction in certain angles of rotation.

Diagnosis of Frozen Shoulder

The predominant risk groups who are susceptible to adhesive capsulitis are patients who have underlying conditions such as diabetes, Parkinson's disease, hypothyroidism and cardiac conditions. Women are more prone to adhesive capsulitis than men. Patients who have a history associated with injuries or trauma pertaining to the shoulder may experience adhesive capsulitis.

Adhesive capsulitis diagnosis is more symptom-associated than radiological determination. X-rays and MRI do not play a significant role in identifying this condition as it is associated with muscle groups of the shoulder. The common symptoms through which the diagnosis of this condition is done is through the movements pertaining to the shoulder such as ability to reach and touch the back of the shoulder, reaching to the back pocket and also to reach behind the head. The exact cause for the occurrence of adhesive capsulitis is not known. In some cases young people experience this condition without any associated risk factors.

Treatment of Frozen Shoulder

Adhesive capsulitis can be treated upon early discovery of the condition. Patients suffering from frozen shoulder are usually treated by physical therapy for a few months followed by anti-inflammatory medication to relieve pain and restore motion. The primary objective during the physiotherapy is to strengthen the muscle groups of the shoulder to enable movement in various angles. Surgical intervention is done in case of intense pain and loss of movement.

Shoulder arthroscopy is done followed by physiotherapy to restore the motion of the shoulder. In the surgical procedure, the movement of shoulder is rectified by removing the scar tissue under anaesthesia. The range of motion associated with the shoulder is analyzed as a post-operative measure to ensure the accuracy of the procedure. Physiotherapy increases the shoulder movements by strengthening the internal muscles of the shoulder. Patients are also advised to follow few shoulder stretches and exercise patterns to prevent relapse of the respective condition.

Rheumatologist

Rheumatologist is a specialist who specializes in the diagnosis and treatment of arthritis and diseases of the joint, bones, and muscles. Rheumatologists complete medical school, complete another three years training in internal medicine and thereafter complete another three years in rheumatology training.

• Treatment of rheumatoid arthritis.
  
• Treatment of particular types of autoimmune disease.
  
• Treatment of musculoskeletal pain disorders.
  
• Treatment of osteoporosis.
  
• They treat back pain, gout, lupus, tendonitis, and various more such diseases.
  
• They prescribe medications or physiotherapy for patients according to their requirements.

Modern techniques in the field of rheumatology

Treatment for rheumatology has seen a drastic change for the past few years, modern techniques used in the field of rheumatology include

• Using non-steroidal anti-inflammatory drugs (NSAID).
  
• Disease-modifying anti-rheumatic drugs (DMAR) are also prescribed along with NSAID to treat severe conditions of rheumatology.
  
• Early treatment helps in pain management and easy recovery from pain.