List of Physical Therapy Procedures & Modalitues
Physical therapy for Scoliosis
Physical therapy is the best non-invasive treatment of scoliosis. Usually muscles on one side are weak and extended, and tense and shortened on the other side. It causes rotation of the vertebras.
The goals of physical therapy are:
1. Improve circulation and microcirculation in the area
2. Work with the muscles to relax them on one side and improve their function on other side
3. Optimization of nerve and muscle work
Physical therapy includes:
1. Manual therapy 20-30 minutes
2. Electrical stimulation of weak muscles 10-12 minutes
Various types of electrical stimulation exist: microcurrents, interferential, Russian current, functional electrical stimulation, high-voltage pulsed stimulation and variable muscle stimulation.
Electrical stimulation uses electrical current to provide active exercise to muscles that are incapable of voluntary contraction. Electrical stimulation promotes blood flow to the muscle to maintain nutrition, slow the atrophy process, decrease fibrotic muscle changes and decrease muscle spasm.
In addition, it can strengthen healthy muscle, increase range of motion, promote circulation and provide proprioceptive input. For someone with upper trapezius tightness, e-stim can decrease muscle trigger points and increase circulation.
Electrical stimulation offers numerous advantages. The electrodes can be used multiple times, the intensity and type of current can be individualized, and treatment can be done in the clinic or at home with a home unit. Most insurance companies will pay for home units. On the flip side, an electrical stimulation machine for the clinic can be expensive, and uninnervated muscles will atrophy over time.
3. Short wave therapy to the affected area 10-12 minutes
Shortwave diathermy uses high-frequency electric current to produce heat using either a condenser field or an induction field. The condenser field uses the patient's tissues as the dielectric between two electrodes. With the induction field, the patient is in the electromagnetic field so that current flows between the patient's conductive tissues.
Shortwave diathermy heats the tissue by causing oscillations of electromagnetic energy of high frequencies. With the changes in the new diathermy units, therapists can now provide treatment over pins and screws, prostheses and other noncircular metals. These areas were previously contraindicated.
Shortwave diathermy can reach deep tissue, a primary advantage of this modality. The diathermy head is approximately 25 times the size of an ultrasound head, thus allowing therapists to treat a large muscle group in less time.
Producing a variety of physiological changes, diathermy increases local metabolism and white blood cell concentration to the injured area. It also removes bacteria and toxins with increased cell membrane permeability, reduces muscle spasm and sedates nerve endings. In addition, it increases connective tissue elasticity, body temperature, respiratory and pulse rates and decreases blood pressure.
Diathermy is indicated for subacute and chronic inflammatory conditions of superficial joints, subacute and chronic traumatic muscle inflammation, indirect heating for peripheral vascular disease, contusions and post-surgery sites, sprains, strains, bursitis and tendinitis. It also can enhance epithelialization.
Very young and very old patients aren't candidates for diathermy. Nor are those who are pregnant, have cardiac disease, a known cancer, an infection, an existing fever or a tendency to hemorrhage. Diathermy can't be used over any metal that forms a circular pattern or has the same circumference as the diathermy coil. It also shouldn't be used over the epiphyses of growing bones.
Therapists must remove electronic or magnetic equipment from the condenser field or induction field. Be careful with patients who are poor judges of heat, are obese and have sensory impairment. Avoid ischemic areas, open wounds or moist dressings, uneven spacing of the electrodes and uneven pressure of the electrodes.
4. Low frequency magnetic therapy 10-15 minutes
Magnetic therapy is not new! For thousands of years, the beneficial powers of magnets have been used to promote healing. Magnetism is the basis of commonly known diagnostic tools such as the MRI (Magnetic Resonance Imaging).
Today, the effectiveness of safe, convenient self-care magnetic products is being recognized by health care professionals around the world and they have become the "therapy of choice" for millions of people.
Magnetism is a Wholly Natural Event
The Earth is in fact a giant magnet and all living organisms exist in, depend on, and respond to its magnetic field.
Continuing scientific research is adding invaluable data to the growing body of knowledge regarding the effect of magnetic fields on the nervous and circulatory systems, as well as every living cell whether animal, plant or human. Magnetic Therapy itself does not cure ... but it can provide the magnetic conditions in which the body’s healing forces operate at their optimum level.
How Do Magnets Work?
* It effects increasing blood and oxygen circulation along with the nutrient carrying potential of the blood.
* It is able to effect pH balance (acid-alkaline) which is often imbalanced in disease tissues.
* It positively speeds up the migration of calcium ions to facilitate the healing of nervous tissue and bones.
* It can powerfully influence the production of certain hormones from the various endocrine glands.
* It stimulates and fosters enzyme activity and other related physiological processes.
5. Ultrasound 5-6 minutes each side
Ultrasound is a form of deep heat generated through a piezo-electric crystal soundhead. Sound waves cause vibration of the cells in the soft tissue, therefore increasing temperature and inducing vasodilatation. Ultrasound can separate collagen fibers, thereby increasing tissue extensibility, or it can increase membrane permeability, increasing ion exchange. Ultrasound waves can cause thermal and nonthermal effects.
As a thermal agent, this modality can increase the tissue temperature to depths of 5 cm or more. By increasing collagen tissue extensibility, it promotes circulation, relaxes tight muscles, changes nerve conduction velocity, reduces pain and decreases inflammation.
In rehabilitation, ultrasound serves many uses. For the patient with joint contracture, ultrasound can help raise tissue temperature. The combined effect of heat and stretch will promote greater tissue extensibility, thus increasing range of motion.
Ultrasound is indicated to treat soft tissue shortening (joint contractures, scarring); subacute and chronic inflammation; painful conditions, including muscle guarding; neuroma; trigger points and warts.
Ultrasound is contraindicated in people with poor arterial circulation. It can't be used over an area with bleeding or infection, on someone who is pregnant or doesn't know she's pregnant, on someone who has known cancer, over the spinal cord after a laminectomy and over the carotid sinus or cervical ganglia.
6. Scoliosis exercises
Unfortunately, this condition is chronic and progressive without the treatment. It requires at least 2 courses a year with 12-15 sessions each. During the course, treatment has to continue everyday or every other day. In between patient has to follow instructions and continue exercising.
Physical Therapy: TENS, Ultrasound, Heat and Cryotherapy
Transcutaneous Electrical Nerve Stimulation (TENS)
Transcutaneous electrical nerve stimulation (TENS) has been used to treat a variety of pain conditions. Success rates range greatly due to many factors including electrode placement, chronicity of the problem, and previous treatments. It is generally used in chronic pain conditions and not indicated in the initial management of acute low back pain. Documentation of greater than 50% reduction in pain with a treatment trial may help substantiate its true beneficial effects as opposed to a placebo response.
High voltage pulsed galvanic stimulation has been used in acute low back pain to reduce muscle spasm and soft tissue edema (swelling). It is commonly used despite the lack of hard scientific evidence for its efficacy. Its effect on muscle spasm and pain is felt to occur by its counter-irritant effect, effect on nerve conduction, and a reduction in muscle contractility. Use of electrical stimulation should be limited to the initial stages of treatment, such as the first week after injury so that patients may quickly progress to more active treatment, which includes a restoration of range of motion and strengthening. It may often be combined with ice or heat to enhance its analgesic effects.
Ultrasound is a deep heating modality that is most effective in heating tissues of deep joints. It has been found to be helpful in improving the distensibility of connective tissue, which facilitates stretching. It is not indicated in acute inflammatory conditions where it may serve to exacerbate the inflammatory response and typically provides only short-term benefit when used in isolation. It is perhaps best used to improve limitations in segmental spinal range of motion following recurrent or chronic low back pain as an adjunct in facilitating soft tissue mobilization and prolonged stretching by a skilled manual therapist.
The use of ultrasound is contraindicated over a previous laminectomy or peripheral nerve secondary to alterations in membrane stability. It should be discontinued as segmental motion is improved with the patient then moved into an active strengthening program and eventual transference to an independent home exercise program.
Физиотерапия в Израиле:
PTs utilize an individual's history and physical examination to arrive at a diagnosis and establish a management plan, and if necessary, will incorporate the results of laboratory and imaging studies. Electrodiagnostic testing (e.g. electromyograms and nerve conduction velocity testing) may also be of assistance.
Physical therapy has many specialties including cardiopulomnary, geriatrics,neurologic, orthopaedic and pediatrics to name some of the more common areas. PTs practice in many settings, such as outpatient clinics or offices, inpatient rehabilitation facilities, extended care facilities, homes, education or research centers, schools, hospices, industrial workplaces or other occupational environments, fitness centers and sports training facilities.
Educational qualifications vary greatly by country. The span of education ranges from some countries having little formal education to others requiring masters and doctoral degrees.
The integration of research evidence into practice has been, and continues to be, a challenge across the scope of medicine and Physical Therapy is no exception to this
Treatment through the 1940s primarily consisted of exercise, massage, and traction. Manipulative procedures to the spine and extremity joints began to be practiced, especially in the British Commonwealth countries, in the early 1950s. Later that decade, physical therapists started to move beyond hospital based practice, to outpatient orthopedic clinics, public schools, college/universities, geriatric settings (skilled nursing facilities), rehabilitation centers, hospitals, and medical centers.
Specialization for physical therapy in the U.S. occurred in 1974, with the Orthopaedic Section of the APTA being formed for those physical therapists specializing in Orthopaedics. In the same year, the International Federation of Orthopaedic Manipulative Therapy was formed, which has played an important role in advancing manual therapy worldwide ever since. In the 1980s, the explosion of technology and computers led to more technical advances in rehabilitation. Some of these advances have continued to grow, with computerized modalities such as ultrasound, electric stimulators, and iontophoresis with the latest advances in therapeutic cold laser, which gained FDA approval in the U.S. in 2002.
- Cardiovascular and pulmonary rehabilitation physical therapists treat a wide variety of individuals with cardiopulmonary disorders or those who have had cardiac or pulmonary surgery.
- Geriatric physical therapy covers a wide area of issues concerning people as they go through normal adult aging, but is usually focused on the older adult. There are many conditions that affect many people as they grow older and include but are not limited to the following: arthritis, osteoporosis, cancer, Alzheimer's disease, hip and joint replacement, balance disorders, incontinence, etc. Geriatric physical therapy helps those affected by such problems in developing a specialized program to help restore mobility, reduce pain, and increase fitness levels.
- Neurological physical therapy is a discipline focused on working with individuals who have a neurological disorder or disease.
- Orthopaedic physical therapists diagnose, manage, and treat disorders and injuries of the musculoskeletal system including rehabilitation after orthopedic surgery. This specialty of physical therapy is most often found in the out-patient clinical setting. Orthopedic therapists are trained in the treatment of post-operative orthopaedic procedures, fractures, acute sports injuries, arthritis, sprains, strains, back and neck pain, spinal conditions and amputations. Joint mobilization and manipulation, therapeutic exercise, neuromuscular reeducation, hot/cold packs, and electrical stimulation (e.g., cryotherapy, iontophoresis, electrotherapy) are modalities often used to expedite recovery in the orthopedic setting. Additionally, an emerging treatment in this field is the use of sonography for diagnosis and to guide treatments such as muscle retraining.
In the United States, training in physical therapy culminates in either a masters degree or a doctor of physical therapy (MSPT, or DPT) from an accredited physical therapy program. All US programs used to grant the BSPT degree before transitioning to the MSPT degree. All US programs are now transitioning to grant the DPT degree nationwide. There are still many physical therapists currently practicing in the US who were trained with a BSPT degree. Physical therapist education includes clinical internships. All states also require physical therapists to pass the National Physical Therapy Examination before they can practice. Each state regulates licenses for physical therapists independently.
In the United Kingdom, university degrees tend to be three rather than four years in length, as British students historically specialise earlier in their education than in most other developed countries. In order to qualify, students are required to complete 1000 hours of clinically based learning: this typically takes place in the final two years; however, some courses also have clinical placement in the first year.
Physical Therapy Modalities
Ultrasound machines are a treatment modality used by physical therapists that utilize high or low frequency sound waves. These sound waves are transmitted to the surrounding tissue and vasculature. They penetrate the muscles to cause deep tissue/muscle warming. This promotes tissue relaxation and therefore is useful in treating muscle tightness and spasms. The warming effect of the sound waves also cause vessel vasodilatation and increase circulation to the area that assists in healing. The physical therapist can also adjust the frequency on the machine to use waves that will decrease inflammation
TENS: A TENS unit stands for transcutaneous electrical nerve stimulation. It is a small battery operated machine that uses electrical transmission to decrease pain. Electrodes are applied to the affected area. The machine is turned on and an electrical current is sent through the electrodes. A tingling sensation is felt in the underlying skin and muscle. This signal disrupts the pain signal
that is being sent from the affected area to the surrounding nerves. By breaking this signal, the patient experiences less pain.