Orthopedic Physical Therapy - An Overview

Introduction:

The term “orthos” means straightening, and “pedios” means child. Originally orthopedics referred to correcting deformed limbs in children. Nowadays, it has advanced to include organ replantation. Orthopedic physical therapy refers to treating orthopedic problems using physical therapy techniques. Besides therapy, physiotherapy can also help prevent various sports injuries. The goal of orthopedic physical therapy is to restore the maximum physical independence of the patient and allow the patient to perform daily activities of living without any discomfort or pain.

What Disorders Require Orthopedic Physiotherapy?

Many disorders can be treated using physical therapy. Some of them are

1. Traumatic Disorders: Traumatic disorders include fractures, subluxations, dislocations, multiple dislocations, and fractures, as seen in road traffic accidents. Soft tissue injuries like muscles, ligaments, blood vessels, nerves, skin, fascia, and other connective tissue injuries like joint capsules, synovium, and bursae.

2. Atraumatic Disorders:

• Pathological Fractures: Fractures due to a metastatic lesion, or due to osteoporosis.

• Congenital Anomalies: Congenital absence of bones, scoliosis.

• Developmental Disorders: Paget disease, achondroplasia.

• Infective Diseases: Tuberculosis, septic arthritis.

• Metabolic Diseases: Rickets, osteoporosis.

• Endocrine Disorders: Hypothyroidism, hypopituitarism.

• Inflammatory Disorders: Rheumatoid arthritis, ankylosing spondylitis.

• Neoplasia: Osteoma, osteosarcoma.

• Degenerative Joint Disorders: Osteoarthritis, spondylosis.

• Neuronal and Muscular Disorders: Cerebral palsy, neuropathy, poliomyelitis.

• Regional Musculoskeletal Conditions: Adhesive capsulitis, sports injuries.

What Are the Roles of Physiotherapy in Treating Orthopedic Problems?

1. Prevention: It refers to primary and secondary prevention. Physiotherapy brings about the prevention of traumatic lesions and life-threatening conditions like hypertension, hypercholesterolemia, and coronary heart disease (CHD). Physiotherapeutic measures can prevent the development of complications following a fracture or a disease.

2. Restoration: This focuses on managing the symptoms like pain, swelling, and muscular spasm. Exercise training is added to improve physical fitness. Musculoskeletal conditioning is also focused on in this phase.

3. Rehabilitation: This phase aims to fully restore the anatomy and function of the parts affected. It also provides maximum functional independence within the limits of disease or disability. Strengthening muscle groups to compensate for the weak or paralyzed muscles, provision of assistive devices, and using specialized exercise techniques are included in this phase.

What Are the Various Modalities in Orthopedic Physical Therapy?

1. Thermotherapy: Heat therapy can be used when the inflammation resulting from an injury is reduced. Applying heat can help in promoting tissue extensibility and chronic pain management. Heat application also helps dilate the blood vessels, thus improving the blood flow to the affected site. The blood flow will be rich in nutrients and oxygen, which will help restore the damaged tissue. Hydrocollator, heating pads, radiant heat, and paraffin baths are some examples of superficial heating agents.

2. Cryotherapy: This involves the therapeutic application of cold modalities in the affected area. In an acute injury from 24 to 72 hours, the cold application can decrease inflammation and pain. Cold packs, ice massage, cold water immersion, and vapocoolant spray are the different ways to do cold application.

3. Cold Packs: Ice packs and endothermic gel packs are all examples of ice packs. They are less priced and can be easily used at home. Cold packs can be applied for up to 20 to 30 minutes every one to two hours to reduce pain and swelling.

4. Ice Massage: It involves the direct application of ice to the affected area using stroking motions. This therapy has the therapeutic effects of both massaging and cooling and can be applied for up to ten minutes for the best results. Firstly, the patient feels extreme coldness, followed by a burning or aching sensation. As time passes, the area will become numb and will help provide an analgesic effect.

5. Fluidotherapy: This is a superficial and dry heating method that involves convection. The affected limb is placed in the fluidotherapy machine, which has a fluid medium, and that limb can be made to perform a range of motion exercises. This cannot be used in open or infected wounds.

6. Ultrasound: Ultrasound uses low and high-frequency sound waves to help relieve symptoms. The painful joint and muscles are relaxed while also tissue healing is promoted. Ultrasound should be administered in the affected area for about five to ten minutes in gentle, circular motions. It can also improve tissue extensibility, circulation, and range of motion. Phonophoresis also uses ultrasound to deliver medications for bursitis and tendonitis.

7. Diathermy: Short waves and microwaves used for heat production were used in clinical practice. However, due to many disadvantages, the use of diathermy has been reduced.

8. Hydrotherapy: It involves the application of hot or cold water to treat an illness. They are used for the treatment of arthritis, as well as cleaning and debriding burns and skin injuries.

9. Light Therapy: Low-energy laser therapy, also known as low-power, cold laser therapy, involves light amplification by stimulated emission of radiation. Laser therapy has been used for wound healing, bone healing, and soft tissue healing.

10. Electrotherapy: Electrotherapy helps in stimulating the nerves for muscle activity. They are also used to stimulate sensory fibers and help promote wound healing.

11. Iontophoresis: This is a technique in which medications are applied directly to the skin using an electric current. Local anesthetics, analgesics, antibiotics, and corticosteroids are some medications used in iontophoresis.

12. Neuromuscular Electrical Stimulation: This technique can activate muscles through peripheral nerve stimulation. It has been used in the lower limbs for help in standing and walking.

13. Transcutaneous Electrical Nerve Stimulation (TENS): Electrical stimulation at different frequencies and intensities is applied using electrodes to provide pain relief.

14. Interferential Current Therapy: In this technique, two alternating current signals of different frequencies are presumed to create an interference that will help treat various conditions like urinary incontinence and pain management.

What Are the Benefits?

• Physical therapy helps in decreasing pain and swelling. It also helps in treating inflammation.

• It helps to restore the range of motion, and joint mobility is also improved.

• Muscle contracture and atrophy can be treated with physiotherapeutic modalities.

• Pain and restricted joint motions can be treated and restored to normal muscular movements.

• Strength training can be done through physical therapy, preventing further injuries.

• Functional and sport-specific training is given to athletes and sports persons through physical therapy.

Conclusion:

Orthopedic physical therapy will help in treating orthopedic problems. Recent innovations in physiotherapeutic approaches have effectively helped treat orthopedic issues, and physiotherapy has brought quicker healing. Sports-specific rehabilitation through physical therapy has helped prevent injuries. Physiotherapy can help restore the normal anatomy and function of the affected part and provides independence to the patients.