What is physical therapy and rehabilitation?
Physical therapy and rehabilitation is a specialty that aims to improve the quality of life and functional status of people after brain, spinal cord, nerves, bone, joint, muscle, ligament diseases, or injuries. Physical therapy and rehabilitation are responsible for the non-surgical treatment of musculoskeletal diseases. It does this through exercises, medication, physical therapy, orthosis prescription, and injections. Physical therapy refers to the treatment of diseases with the use of physical phenomena such as heat (hot-cold), sound (ultrasound), light (laser), water (hydrotherapy), electromagnetism (TENS, magnetic field treatments), force (traction, massage). Physical therapy is as old as medicine.
Physical therapy goals
Although it varies from patient to patient, physical therapy applications can be performed for the following purposes:
- Enabling the joints to move at their normal range of motion
- Muscle strengthening
- Ensuring joint stability
- Providing muscle flexibility
- Providing independence in daily life activities
- Restoring lost functional skills due to any disease
- Increasing walking distance, mobility
- Improving overall health, helping the person realize their maximum potential
Benefits of physical therapy
Although it depends on the purpose of the treatment, physical therapy can provide the following benefits:
- Reduced pain, reduced need for pain medication
- Eliminating or postponing the need for surgery
- Increasing movement and functionality
- Post-injury treatment
- Returning to normal life after surgery
- Treatment of strokes due to stroke, brain injury, or spinal cord injury
- Preventing falls, improving balance
- Treatment of age-related muscle wasting, joint stiffness, and osteoporosis
Devices used in physical therapy
- Electrotherapy: It provides benefits such as reducing pain and preventing muscle wasting according to the principle of stimulating the nerves or muscles with the electric currents given by the electrodes placed on the skin.
- Ultrasound: By using sound waves, effects such as heating effect in deep tissues, increase in cell membrane permeability, modulation of the activity of immune system cells can be achieved. It may help to deliver some medications through the skin (phonophoresis).
- Shortwave diathermy: Deep tissues can be heated by using electromagnetic waves at specially selected frequencies.
- Microwave diathermy: The working principle is similar to short wave diathermy, the wavelengths used are different.
- Magnetic field therapy: It is accepted that it improves tissues with magnetism.
- Laser: Pain relief, enhancing wound healing, and increasing cell metabolism can be seen with low-power lasers, also called cold laser. It is used for wounds on the skin surface and problems such as enthesitis and epicondylitis close to the surface.
- Traction: In lumbar and cervical disc hernias, mechanical pulling force can be applied with special devices to reduce the stress on the discs between the spinal bones.
- Water treatments (hydrotherapy): Water has been used for treatment throughout history, it is one of the oldest physical therapy practices. In addition to passive treatments such as hot baths and whirlpool baths, there are also water treatments in the treatment pools in which the patient actively participates by exercising. The buoyancy of water reduces the load on the joints and makes it more comfortable for people with muscle weakness compared to land.
- Hot and cold treatments: Perhaps the most common physical therapy methods are hot and cold applications. The cold application reduces edema, inflammation, and pain. Muscle stiffness, called spasticity, can also be reduced with cold therapy. Hot therapy stretches the muscles, ligaments, resolves muscle spasms, reduces pain, and increases circulation. Tools such as cold packs, hot packs, infrared can be used.
- Orthotics and prostheses: Orthoses are auxiliary devices that a person wears on their arms, legs, or body. It can be used to protect joints or to increase function. Prostheses are devices used to replace the lost limb.
- Aids for walking: Devices such as a cane, tripod, wing, and walker can facilitate walking.
Methods used in physical therapy
Massage: It can be performed with different techniques such as scar tissue massage, deep tissue massage, lymphedema massage for purposes such as opening joint restriction, increasing circulation, relieving muscle spasms, and relieving pain.
Taping techniques: Banding techniques such as Kinesio tape can be applied for purposes such as correcting posture disorder and treating muscle-induced pain.
Manual therapy: Using hands, joints, and muscles are examined and treated with various force application techniques.
Therapeutic exercises: It is one of the most important components of physical therapy. In general, active treatments with the participation of the patient are more successful in recovery, and exercise practices are the leading among these treatments. Treatment is performed with specially designed exercises aimed at normalizing joint movements, strengthening muscles, increasing balance and coordination, and increasing heart-lung capacity. Exercises can be performed without requiring any tools or can be performed with simple tools such as various weights, bands, springs, exercise balls, exercise dough, balance board, shoulder wheel, tilt table, parallel bar. High technology such as robotic devices using computer-aided augmented or virtual reality can be utilized.
Injections: Dry needling, trigger point injections, intra-articular injections, injections to the structures around the joint, injections for spinal problems can be applied.
Patient education: Patient education is required to ensure the permanence of the results obtained with physical therapy. This training includes explaining the disease, preventive approaches, and self-administered treatment methods.
Robotic physical therapy and new technologies
Physical therapy and rehabilitation is a rapidly changing and developing field where new technologies are used extensively. Knowledge of exercise physiology, the recovery process of the nerve tissue after injury, the plasticity of the brain is increasing day by day and state-of-the-art facilities are adapted for better rehabilitation methods. Robotic physical therapy and robotic rehabilitation are prominent applications in this sense.
Hand-arm robots: Hand-arm robots are used extensively to heal hand and arm weakness and functional losses in patients with stroke, brain injury, spinal cord injury at the neck level. With robotic systems, the movements that the patient needs to do are done with the help of a machine with the same quality and repetition. With various visual feedback methods, movements can be matched for different purposes and the patient’s motivation and learning speed can be increased.
Walking robots are used in the rehabilitation of stroke, brain injury, spinal cord injury, and many neurological or orthopedic diseases that impair walking.
Walking robot / Non-gravity walking robot – band: The walking robot is used in the rehabilitation of stroke, brain injury, spinal cord injury, and many neurological or orthopedic diseases that impair walking. Patients who cannot stand alone are raised with the help of these devices and a walking simulation is performed. In addition to the side benefits of walking exercises, such as blood circulation, prevention of osteoporosis, bowel movements, it stimulates walking-related nerve circuits by sending sensory signals to the brain and increases plasticity.
Isokinetic test and exercise system – Cybex: Isokinetic exercises have many advantages in muscle strengthening exercises. Special devices are needed for this exercise, which moves at a constant angular speed regardless of the force applied by the muscle. Isokinetic testing and exercise system (Cybex) provides both a detailed and objective evaluation of muscle strength and controlled exercise for performance increase. Professional athletes maximize their potential with isokinetic exercise systems.
Computerized balance training platform: Wearable technologies are used to measure and record body position and movement with high accuracy. The computerized balance platform offers new possibilities in the treatment of balance disorders by being integrated into the virtual or augmented reality environment.
Neuromodulation in physical therapy and rehabilitation
Another area in which high technology is used in the treatment and rehabilitation of diseases related to brain and spinal cord injury and is rapidly developing is neuromodulation. In neuromodulation, the excitability of nerve cells can be increased or decreased. Some of the problems encountered in stroke, brain damage, and spinal cord injuries are caused by the suppression of the relevant nerve tissue, some of the overstimulation of the nerve tissue, and some problems are caused by the imbalances between the stimulation state of various nerve tissues. The excitability of various areas of the brain is regulated by methods such as transcranial magnetic stimulation, transcranial direct current stimulation techniques. These techniques increase the plasticity of the brain and strengthen the effect of other rehabilitation methods under appropriate conditions.
The excitability of various areas of the brain can be regulated by methods such as the transcranial direct current stimulation technique. Thus, the effectiveness of neurorehabilitation can be increased
Three stages of health: prevention, treatment, rehabilitation
Physical therapy and rehabilitation deal with a broad spectrum of health. Health services can be divided into 3 parts. Health services called primary prevention include preventing diseases before they occur. Examples include vaccination activities, a healthy diet, and exercise, as well as reducing the risk of many diseases. Secondary prevention covers the treatment services received when the health institution is applied to the illness. Tertiary protection includes reducing the disability status of people who do not fully recover due to the disease, that is, rehabilitation. Primary prevention mostly falls within the scope of family physicians and community health centers, secondary prevention is mostly covered by specialties (internal diseases, general surgery, etc.).
How many types of rehabilitation are there?
Rehabilitation is congenital diseases such as spina bifida (birth with a waist pouch), nervous system diseases such as brain hemorrhage, spinal cord injury, Parkinson’s disease, multiple sclerosis (MS), after surgery of orthopedic problems such as anterior cruciate ligament rupture or fractures, heart attack It is applied in order to return to normal life afterward, in lung diseases such as COPD, together with cancer treatment or to increase the quality of life and functional independence of the person after treatment.
These topics are examples of pediatric rehabilitation, neurological rehabilitation, orthopedic rehabilitation, cardiac rehabilitation, pulmonary rehabilitation, cancer rehabilitation, respectively. Apart from these, balance rehabilitation in the treatment of balance disorders, hand tendon, Hand rehabilitation after repair operations of vascular and nerve injuries, sports rehabilitation after sports injuries, geriatric (elderly) rehabilitation for problems specific to old age, pelvic floor rehabilitation for women’s health and urinary incontinence problems, amputee rehabilitation for amputees.
Burn patients, diabetic ulcers, care of various wounds are also special topics in the field of rehabilitation. Thus, we see that rehabilitation covers all age groups and many diseases. The care of various wounds is also a special subject within the field of rehabilitation. Thus, we see that rehabilitation covers all age groups and many diseases. The care of various wounds is also a special subject within the field of rehabilitation. Thus, we see that rehabilitation covers all age groups and many diseases.
Ampute rehabilitation is an ongoing process from pre-amputation to permanent prosthesis use.
An example of rehabilitation: rehabilitation of a stroke patient
In addition to the fact that rehabilitation is such a comprehensive subject, each of its subtitles is almost a separate world. Let’s talk about the rehabilitation of a stroke patient as an example. Let’s consider how to rehabilitate a patient who develops paralysis after stroke, which means damage due to vascular occlusion or bleeding in the brain. This person’s swallowing function may be impaired. Swallowing should be evaluated, if it is defective, nutritional solutions should be produced accordingly.
The physiotherapy and rehabilitation specialist decide what consistency of food he/she can swallow or whether he/she should be fed with a tube from the stomach. Speech and comprehension disorders may develop in some patients with paralysis. Speech therapists start early in the treatment of this condition called aphasia. Monitoring of vital signs of the patient during his hospitalization, Rehabilitation nurses are responsible for the prevention of bedsores by changing the appropriate position, regulation of toilet habits, wound care, compliance with general hygiene rules, and administration of medication. The patient is evaluated in terms of urinary problems, constipation, and sexual function problems, and the necessary examinations and treatments are planned by the specialist.
The patient’s mobility is evaluated. Joint range of motion, muscle strength, sensation, and balance are examined. The exercises to be done are determined. Physiotherapists apply the exercises. Physical therapy methods can be used in the treatment of complaints such as shoulder pain, joint stiffness, and muscle weakness in this patient. The physical therapy and rehabilitation physician makes the treatment plan and the physical therapy technicians apply it. The patient is examined and treated for the benefit of robotic rehabilitation in the recovery of hand and arm movements. Muscle stiffness, called spasticity, is evaluated, and if necessary, botox injections are applied by a specialist.
The specific therapy for the patient to increase his skills in daily life activities and return to his professional life is done by the occupational therapist. A specialist doctor prescribes assistive devices that will facilitate the patient’s walking and prevent joint restriction, and an orthosis technician applies. The diet of the patient is regulated by the dietician. A psychiatrist is consulted in terms of psychiatric problems. If there are additional problems such as diabetes, high blood pressure, heart disease, the opinions of the relevant doctors are taken. A social worker contributes to the patient’s return to society and business life.
As can be seen, the treatment of a stroke patient requires the efforts of many healthcare professionals on many different issues. The concept of a rehabilitation team arises from this need. The interlocutor doctor in front of the patient is a physical therapy and rehabilitation specialist, who evaluates the patient holistically, coordinates all this effort towards the goal of recovery. This situation is similar to traumatic brain injury and spinal cord injury. In neurological diseases such as multiple sclerosis and Parkinson’s disease, the diagnosis is made and the regulation of drug treatments is done by a neurologist. However, in today’s conditions, many such neurological diseases do not heal with medication, and rehabilitation approaches are required to increase the patient’s quality of life and to ensure functional independence.
Injection / needle treatment of joints and structures around the joint is among the treatments applied by a physical therapy and rehabilitation specialist.
Musculoskeletal problems are related to physical therapy
Let’s open a little more about the non-surgical treatment of musculoskeletal problems. Spinal problems such as waist, back, neck pain, joint pain such as shoulder, hip, knee, foot, muscle aches, osteoporosis, joint calcification (osteoarthritis), rheumatic diseases (rheumatoid arthritis, ankylosing spondylitis, etc.) physical therapy and rehabilitation fall under his specialty. It is the responsibility of the physical therapy and rehabilitation physician to diagnose spine and joint pain and to arrange non-surgical treatments. There can be many causes of low back pain. Although it may seem simple at first glance to diagnose, plan, and apply the most appropriate treatment by examination and examination methods, it requires volumes of book knowledge when it comes to detail.
Why is the physical therapy and rehabilitation branch less known?
As we have given the examples above, although it is a branch that concerns almost everyone, the awareness of physical therapy and rehabilitation in our country is less than in other specialties. This may be because physical therapy and rehabilitation is not specific specialty for a particular organ. For example, the organs of interest in fields such as eye diseases, ear nose throat, skin, cardiology can be understood by looking directly at their names. However, the field of interest in physical therapy and rehabilitation cannot be summarized in a single word or sentence. Often, patients refer to an orthopedic specialist when there is knee pain, neurosurgery when there is back pain, and neurology when there is neck pain. However, in these cases, the first to be consulted is a physical therapy and rehabilitation specialist
Historical development and names of physical therapy and rehabilitation
The historical transformations of the specialty area may also have an effect on the fact that physical therapy and rehabilitation are not well known among the public. Although physical therapy applications are very old, it is relatively new in the world as a specialty. Rehabilitation approaches developed especially after the Second World War. Although it is accepted that the correct expression is “physical medicine and rehabilitation” as a specialty of medical education, the expression “physical therapy and rehabilitation” has become widespread in our country and is known more. Physical therapy and rehabilitation specialist doctor is called Physiatrist in English and this is translated into our language as Physiatrist. Unfortunately, the word physiatrist is not known by most of the public. As a result, the expressions of physical therapy and rehabilitation specialist or physical therapist are used more frequently among the public.
Positive developments in our country in recent years
In recent years, our country has made rapid progress in the training of other members of the rehabilitation team. Until recently, the number of physiotherapists, occupational therapists, rehabilitation nurses, speech therapists, orthotic prosthesis technicians, and social workers was insufficient in our country. Therefore, it was difficult to provide a quality rehabilitation service. The number of trained and experienced healthcare professionals is increasing, private hospitals are opened for physical therapy and rehabilitation, thus patient treatments are made more effective. Success in the treatment of patients has a positive effect on the perception of physical therapy and rehabilitation in society.
How to become a physical therapy and rehabilitation specialist?
A physiotherapy and rehabilitation specialist is trained in our country with 4 years of specialist training over 6 years of medical education. During the residency training, intensive training, and practice related to the diseases mentioned above and their treatments are made. This training includes methods such as interventional procedures such as joint injections, evaluation of musculoskeletal system diseases by ultrasonography, and examination of nerves and muscles with electroneuromyography. In our country, physical therapy and rehabilitation specialists can also become experts in Rheumatology (rheumatic diseases) or Algology (pain science) with a 3-year subspecialty training.
Knowing physical therapy and rehabilitation is essential for everyone
As a result, basic knowledge of physical therapy and rehabilitation improves public health. Knowing when to contact a physical therapy and rehabilitation specialist will make a difference for your health. It can be a problem like low back pain that everyone experiences very often, or a serious illness that you don’t think of until it happens like paralysis, but once it happens, it can radically change a life. Regardless of the problem, physical therapy and rehabilitation are at your side as a specialty that is patient-oriented evaluates the patient as a whole, and aims to make real gains in life.
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- Hitzig SL, Conn LG, Guilcher SJT, Cimino SR, Robinson LR. Understanding the role of the physiatrist and how to improve the continuum of care for trauma patients: a qualitative study. Disabil Rehabil. 2020 Feb 4. doi:10.1080/09638288.2020.1719215
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- American Occupational Therapy Association. Research: occupational therapy and physical therapy provide significant rehabilitative value in post-acute care. Updated June 23, 2021.