Physical therapy and rehabilitation is a non-surgical branch of medicine that provides treatment by exercises and a set of physical means during treatment of various diseases. It is widely used in movement system disorders in particular.

Areas of Interest of Physical Therapy

Lumbar Disc and Cervical Disc Hernias

There are discs made of connective tissue between bones making up the spine, i.e. vertebral bones, which facilitate movement and ensuring the spine to be resistant. Herniated discs compress adjacent tissues, including the spine and nerve roots. Such compression causes pain and limitation of movement. Muscle weakness , urinary and fecal disorders may also accompany the pain. 

A majority of lumbar disc and cervical disc herniations can be treated without surgery.  However, in very few patients, especially those with stroke symptoms, treatment involves surgical operations. 

The following devices and methods are used during physical therapy:

• Electric currents

• Laser

• Local injections

• Exercise physiotherapy

Bursitis and Tendonitis

Bursitis

Bursitis is seen as painful swelling of the joints. Bursa is a small sac filled with fluid forming on the soft tissue covering a joint or bone. Bursitis is the inflammation of one of these sacs. This common painful condition can become an acute or chronic condition if inflammation is not prevented. 

Tendinitis

Tendinitis is an inflammation of the connective tissues, called tendons.  Connective tissues convey muscle movements to a bone, ensuring that the bone moves.  They exist throughout the body. There are small tendons in the body such as those in the hand as well as big tendons like Achilles tendon in the heel. Tendinitis is the result of an injury frequently recurring in the affected area. Both conditions are also related to age. Aging can compromise the integrity of the tendon and makes it more prone to injury.

The first step in treating these conditions is to reduce pain and inflammation.  For this, in the acute phase, ice application, avoiding active use of aching region as well as allowing it to rest using various bandages and orthoses, painkillers, cortisone injections to aching region, regional massage and physical therapy methods are utilized. Along with these treatments , stretching, relaxation and strengthening exercises should be performed.  

Lower Back and Neck Flattening

Our spine is made up of bones called vertebrae and they constitute the most important supporting element of our motion system. If you look from one side, 3 curvatures are seen in the spine.  Those in neck and lower back region are inwards and the curvate in the back region is outwards. Our spine gains strength against impacts and weight-lifting by the courtesy of these curvatures. 

In the case of lower back and neck pain which doesn’t heal in a couple of days, you should consult a specialist physician and have necessary examinations carried out.  Flattening in lower back and neck regions can be easily identified by conventional x-ray films. After determining the degree of flattening, a physical therapy program of 15 – 20 sessions with muscle relaxant drugs will provide a significant reduction of symptoms. After treatment, the most important issue is to continue neck and lower back exercises.  Measures such as preventing wrong posture – sitting posture, improving working conditions, avoiding leaning forward too much, adjusting the height of work table should be taken.  

Cruciate Ligament Injuries

One of the most important joints in our motion system is the knee joint. The knee joint, which is made up of three bones, allows us to stand in one side and to sit down and get up on the other.  For a knee joint to be able to respond to the most difficult conditions, the bones making up the joint are connected to each other via four solid ligaments.  When the joint suffers hard blows or in the case of awkward movements, bruises and tears may occur in these ligaments.  

At the time of the initial tear, tenderness and swelling accompanied by severe pain may develop in the knee joint and motion becomes very difficult.  In this case, motion should be avoided and the knee should be immediately fixed.

In the case of partial tears, the tear heals after a certain time as a result of necessary treatments. 

Full tears cannot heal by themselves and require surgery. After surgery, the patient should immediately start a comprehensive rehabilitation program on the next day so that his knee regains its former functions and easily moves. 

Hip Problems

Hip joint is one of the largest and most important joints of the body. Each hip joint has to carry half of the body weight and this load is further increased during movements such as walking, running, climbing stairs, and squatting, and it can rise up to several times of the body weight. 

After the cause of hip pain is identified, a treatment aimed at eliminating such cause should be applied.  Some patients are treated with medications. After the acute phase of the illness or following hip surgery, physical therapy and rehabilitation needs to be started.  In suitable patients, exercise therapies with gait training in the pool accelerate recovery time.

Fibromyalgia

Fibromyalgia is a chronic pain syndrome in which generalized muscle pain, sleep disturbance and fatigue are often found together.  It is a musculoskeletal system illness with widespread significant pain especially in the back, neck, shoulders and hips. While the disease can occur at any age and in both sexes. 

According to the state of the patient, painkillers, antidepressants, muscle relaxants and sleep-regulating drugs are used to treat fibromyalgia. Physical therapy agents and exercise programs, which cover the most important place in the treatment, are implemented. Also, ozone therapy, acupuncture and trigger point injections are also quite effective in fibromyalgia treatment.

Nerve Compression (Carpal, Cubital Tunnel Syndromes)

Nervous system is made up of nerves that convey messages and transmit necessary orders from the body to the brain and from the brain to the body. Nervous system is divided into two systems which are central nervous system (brain and spinal cord) and the peripheral nervous system (nerves associated with spinal cord). Peripheral nerves pass through muscles in the body and arms and legs. Along this process, they go through fine and narrow passages in certain body parts. However, in certain cases, nerves undergo compression while going through such passages and nerve compressions may take place. 

The most common type of nerve compression is known as “Carpal Tunnel Syndrome” and affects fingers along with wrist. This diseases emerges as compression at the level of the wrist of the nerve going into the first four fingers of the hand and is mostly seen in housewives and those frequently using their hands because of their occupation. Its most important symptom is numbness of the hand. Sometimes there can be pain.   Patients indicate relief when they shake their hands. Strength of fingers decreases with time and items held by hand begin to fall. 

Osteoporosis

Commonly known as bone loss, osteoporosis means reduced strength of the bone due to its reduced mineral content. In other words, it is bone mass loss exceeding the fracture threshold.   Contrary to popular belief, in osteoporosis, bones would not melt away, only the risk of fractures increases. 

Although it is seen at any age in adults, it is most common in menopausal women. The most striking symptom of osteoporosis is fractures. Occasional bone pain may be experienced.  

Osteoporosis is a disease that is preventable and treatable.  The disease is treated with drugs used for a long time and annual controls. The most basic way to prevent osteoporosis is to do exercise and eat calcium -rich foods. An hour of walking per day is an enough exercise. Plenty of calcium-rich foods, i.e. milk, yogurt and cheese should be consumed before and after menopause.  For the prevention of osteoporosis, it is very important to consume milk and dairy products during childhood. 

 

Diagnostic Methods Used in Orthopedics

X-Ray

X-ray examination is a fast and painless procedure that allows display of structures, especially bones in your body.

Ultrasonography

Ultrasound uses sound waves to view internal organs of the body.  Frequency of the sound waves used is so high that a human ear cannot hear. The amount of sound reflected by each tissue will be different so the image perceived will be different. Thus, tissues and organs will be seen on the screen of ultrasound device. By this method, different images can be detected for tissues like a cyst or tumor.

Computed tomography

It is a special imaging technique that gives a cross-sectional image of the tissues and organs of the body using x-rays.  In comparison to ordinary plain radiographs, CT provides more detailed information about head injuries, brain tumors and other brain disorders. Bone , soft tissues and blood vessels can also be displayed by CT.

MR

MR i.e. Magnetic Resonance Imaging is a painless diagnostic technique which doesn’t utilize rays that may cause harm, such as x-rays, in other words, which doesn’t involve radiation. Giving successful results especially in the display of soft-tissues, MR involves creation of an image by means of radiofrequency waves in a strong magnetic field.   Due to its success in the case of soft tissues, cancerous areas which can not be identified in other diagnostic methods  can be detected. 

Bone Scintigraphy

It allows examination of the whole body in one go. It is preferable while investigating whether a tumor has spread to other bones in the body. In the first step of the examination, a radioactive substance is administered to the body by intravenous injection. Then, it is periodically checked in which area of the skeleton the radioactive substance has become concentrated. Any inflammation identified in the bone may be associated with a tumor as well as other causes, such as trauma, infection, etc. 

EMG (Electromyography)

It is a technique that examines muscles and nerves.  It consists of 2 steps.

The first stage is transmission study in which how fast the nerves transmit is calculated. A very mild electrical impulse is given to the nerve by an electrode placed on the muscles. 

In the second stage, very fine needles are inserted into the corresponding muscles to check activity of these muscles. In this stage, there is no electrical impulse. It is administered to patients with pre-diagnosis such as lumbar disc and cervical disc hernias, muscle diseases, motor neuron disease, neuropathies, and nerve compressions.  

Bone Scan Test (Bone Densitometry Test)

A significant portion of the bone structure consists of minerals such as calcium and phosphorus.  The aim of bone density measurement methods is to determine the quantitative ratio of this mineral part of the bone. The higher the loss of minerals in the bone, the lower the density.

Treatment Methods Used in Physical Therapy and Rehabilitation

Exercise

Exercises correct posture, strengthen muscles, provide flexibility, and increase strength and aerobic capacity. 

Exercise program is exclusively planned by a physical therapist according to the needs and dysfunctions of the patient. Physical therapist teaches planned exercises to the patient and ensures that the patient does these exercises correctly under his/her supervision.  Doing the exercises correctly is essential for reduction of pain as well as the patient’s safety.

Exercise therapy can be divided into 2 as preventive exercise and therapeutic exercise.

• Preventive Exercise: It is a tailor- made exercise program in order to protect the individual’s physical functions, prevent injuries, and ensure general wellbeing and fitness.

• Therapeutic Exercise:  It is applied to relieve pain and treat physical dysfunctions such as muscle weakness, limited joint mobility, wrong posture, balance and gait disorders.

Hot Therapy

By hot therapy: 

• Blood flow is increased.

• Pain is reduced.

• Muscle spasm is resolved.

• Joint stiffness is reduced.

• Nerve conduction is accelerated.

• In addition, flexibility of tissues is increased, facilitating exercise and treatment in joints with limitation of motion.  

Hot packs, heating pads, paraffin, ultraviolet and infrared rays are used as superficial heating tools. 

Cold Treatment

Cold application is made with cold pack.  Cold therapy has pain relieving, muscle relaxing and sometimes anti-inflammatory effects especially in the acute phase.  It is utilized in many joints with postoperative limitation, during rheumatoid disease attacks, periods as well as post- trauma treatments. 

Hydrotheraphy

Water movement provided by an engine, hydrostatic pressure and buoyancy of water are utilized, while a hydrotherapy environment suitable for exercise is created by heating effect of hot water. It is especially used to treat edema.

Ultrasound

It is a method causing heat in muscles, tendons and deep tissues such as bones. Ultrasound is high frequency sound wave. Sound wave is absorbed by the tissue is converted into thermal energy and heats deep tissues.

Laser

Low density laser without heating effect is used in physical therapy.  It increases circulation , enhances biological activity , regulates intercellular interactions and accelerates tissue healing.

It is especially used in the case of tennis elbow , heel spurs. 

Intermittent Pneumatic Compression Therapy

It enables the fluid in the venous and lymphatic vessels pumped from arms or legs to the heart by intermittent application of pressure. It helps regulate blood circulation. It is applied during edema and lymphatic edema treatment.

Electrical Stimulation

It is a pain relieving electric current applied through surface electrodes placed on the skin. It is used to reduce pain, strengthen muscles, resolve muscle spasm and treat edema. 

Traction

It is one of the oldest treatment methods efficiently used to treat lower back, neck and back pain.  It is a technique for stretching soft tissues and separating joint surfaces and bone structures from each other by tractive power. It can be manual, mechanical, motorized or hydraulic.

Traction is used to treat hernias. 

It is not applied in the presence of severe osteoporosis, multi level herniated disc associated with arthritis, spinal fracture, serious spinal cord compression, and inflammation and tumors.

Massage

It is applied as part of the treatment to loosen the rigid tissues.  Massage is a complementary action during physical therapy practices and it should not be seen as a stand-alone treatment.

Orthotics

An orthosis is a device used to support, correct the body, prevent its movement or provide functional movement.

In FTR field, neck, lower back corsets, hand-wrist splints and walking orthoses are frequently prescribed. The purpose of walking orthoses is to help patient get up and enable him/her to walk in the most similar way to normal walking.