The definition of Physiotherapy provided by the World Confederation of Physical Therapy (WCPT) is as follows “the services to individuals and populations to develop, maintain and restore maximum movement and functional ability throughout the lifespan. This includes providing services in circumstances where movement and function are threatened by ageing, injury, disease or environmental factors. Functional movement is central to what it means to be healthy”

Physiotherapy / Physical Therapy can be explained as the science of treating people with special physical needs, to help them minimize and / or maintain their basic functional abilities like sitting standing, walking etc and minimize their condition from progressing as much as possible[i].

According to World Physiotherapy (a global body for 121 physiotherapy member organisations), physiotherapy / physical therapy is concerned with identifying and maximising quality of life and movement potential within the spheres of promotion, prevention, treatment / intervention, habitation and rehabilitation.

According to Australian Physiotherapy Council, physiotherapy involves the holistic approach to the prevention, diagnosis and therapeutic management of pain, disorders of movement or optimisation of function to enhance the health and welfare of the community from an individual or population perspective.

According to Canadian Physiotherapy Association, the heart of physiotherapy profession is understanding how and why movement and functions take place. Physiotherapy is anchored in movement sciences and aims to enhance or restore function of multiple body systems.

[i] Batten Disease Handbook, Nancy Carney, Batten Disease and Research, 2004

All movements and changes in movement arise from the action of forces, both internal and external. A change in the force acting on an object is necessary for moving an object from a stationary position or for changing its velocity. Newtons’s laws of motion give a clear relationship between the changing force and the resultant change in movement, and this is applicable to all forms of movement, including human locomotion.

ANATOMICAL MOVEMENT

• Flexion: – Bending movement reduces the angle between the articular surfaces.
• Extension: – stretching movement which increases the angle between articular surfaces.
• Abduction: – Bony segments move away from the midline.
• Adduction: – Bony segments moves towards the midline.
• Medial rotation: – Rotational movement occurs in the articular surface towards the midline (Internal rotation).
• Lateral rotation: – Rotational movements occur in the articular surface away from the midline (External rotation).
• Circumduction: – Combination of flexion, extension and abduction, adduction and medical rotation, lateral rotation.
• Inversion: – Turning inwards. Eg: Moving the sole of the foot inwards, so that each sole of foot faces each other.
• Eversion: -Moving the sole of foot outwards.
• Dorsiflexion: -Bending the ankle in upward direction.
• Plantar flexion: – Bending the ankle in downward direction.
• Protraction: – Forward movement of the mandible or shoulder gridle.
• Retraction: – Backward movement of the mandible or shoulder gridle.
• Supination: – Movement in which the palm facing upwards.
• Pronation in which palm facing downwards.
• Elevation: – Upward movement of body parts.
• Depression: – Downward movement of body parts.

RANGE OF MOTION (ROM)

Movement of the joint can be performed by the internal or external force. The internal force can be produced by the muscles and the external force may be produced by manually or mechanically. The movement of a joint results in angulations of that joint. The angulation of the movements are referred as the range of motion. The ROM will be perfect in one joint if the soft tissues are intact. If any change occurs in any soft tissues results in disturbance or alteration of the range of motion. Generally, in the hypomobile joint the ROM will be less than the normal prescribed ROM of that joint. In hypermobile joint it is vise versa. This ROM can be measured with the help of goniometer.

There are 2 kinds of range of motion, one being the active motion and the other the passive motion.

Active motion: -the ROM which is achieved without any external force, that is by the effort of the patient itself.

Passive motion: – the ROM which is achieved with the help of external force. When comparing to the active ROM, through passive motion, one can achieve a greater ROM.

The ROM may vary from joint to joint and also on individual depending on the size, variety and bony prominence.

(0 – 180* – from zero degree to 180 degree change)

These are the points that can be included under the biomechanics of human movement.

Whenever an increase in muscular activity occurs, there is a need for more Oxygem and RBC supply to the acting muscles. This is achieved by an increase in Heart Rate, Blood Pressure, Cardiac Output, Venous Return, by reducing the blood flow to the inactive muscles and non-vital organs, by redistributing the blood from the non-vital organ to vital organ.

CHANGES IN CARDIOVASCULAR SYSTEM

• Effect on Heart

Prolonged exercise causes the enlargement of heart. Generally, athletes develop hypertrophy of the heart due to sternous exercises. This condition is totally different from that of the diseased enlarged heart. Because of this, hypertrophied heart the athletes will have the strength to work harder.

• Effect on Heart Rate

The enormous increase of the heart rate is observed at the beginning of the exercise and after some time the rasing ration of the heart rate comes down. During the early stage of exercise, the raising of the heart rate due to the cerebral activation on the medullary cardiac centre. Normally while performing exercise atheletes are said tohave a reduced heart rate than a normal person.

• Effect on Cardiac Output

Cardiac output tremendously increases with sternous exercise. In athletes the output may be 30 liters per minute but the same will be around 22 liters per minute for a normal man.

• Effect on BP

Muscular exercise increases the systemic BP. The raise of BP may be due t0 increase in BP, increased cardiac output, increased vasoconstriction in the non vital organ.

CHANGES IN RESPIRATION

• Pulmonary Ventilation

Pulmonary ventilation is so stable up to the severe exercise is done. The pulmonary ventilation is not increasing with the increasing of consumption of the O2 by the muscle tissue or the O2 lack. This pulmonary ventilation increases with the severe increasing of the workload.

• Respiratory Rate

The O2 demand during the strenuous exercise increases the respiratory rate of an individual, it may be due to Increased production of the CO2 by the working muscles, Proprioceptive activation of the joint, Reflex effect by the respiratory centers, Increases temperature, Adrenaline hypersecretion.

• Effect on O2 Exchange

During the normal or moderate exercise the O2 flow to the muscles, lung and the heart is increased. The O2 tension raises in the alveoli and the arteries. Generally, the O2 saturation goes up to 4 lt/min. In the severe exercise the O2 will be lacking due to production of lactic acid by the active muscles. So, the lactic acid quantity increases in the blood plasma and active muscles. To reduce the lactic acid metabolism, excess amount of O2 is needed; this lack is called O2 debt.

Heat application also called as Thermo therapy is typically used in the second phase of rehabilitation to increase blood flow and to promote healing in the injured area. It is the therapeutic application of heat in order to cure various ailments. It is mainly used to control pain, increase circulation, increase soft tissue extensibility and accelerate the healing process. The vasodilatation and the increased circulation results in the influx of oxygen and the nutrients into the area to promote healing of damaged tissues.

INDICATIONS

Mainly thermotherapy is indicated for relief of a variety of painful conditions both subacute and chronic injuries. It can include conditions such as muscular and rheumatic pain, sciatica, fibrositis and lumbago, also indicated for sports or similar injuries.

CONTRAINDICATIONS

Acute inflammation or injuries, Impaired or poor circulation, subacute or chronic pain, impaired or poor sensation, impaired or poor sensation, impaired thermal regulation, malignancy,

MODES OF HEAT TRANSFER

Before studying in detail regarding thermotherapy it is very necessary to understand the modes of heat transfer. It is very much needed for understanding the different types of heat therapy. As we all know heat is transferred from a point of higher concentration to a point of lower concentration. This occurs by 5 different methods.

1. Conduction
2. Convection
3. Conversion
4. Radiation
5. Evaporation

1. CONDUCTION: – in this mode of heat transfer, the heat is transferred by means of molecular excitement within a material without bulk motion of matter. As a result of which the generated heat, can be transferred from one medium to another medium at different temperatures through physical contact. The transfer to heat by conduction occurs till the temperature and speed of molecular movement of both the materials or surfaces becomes equal. If the agent used is cooler than the patients skin (for ex say icepack), the heat will be transferred from the patients skin to the agent and the temperature of the the superficial tissue in contact with the cooling agent will fall. Similarly if the temperature is high for the heating agent, it will result in a spike of temperature of that body part which is in contact.

2. CONVECTION: – here the heat transfer occurs by the result of direct contact between a circulating medium (fluid or air) and another material of a different temperature. Mostly the transmission of heat occurs by the physical movement of the moleciules over the cooler body parts. In this type of heating, the new parts of the heating agents at the intitaltemperatiure keeps coming in contact with the patients body parts. Here the heat transfer is carried out by the bulk movement of the heating agents in play. When comparing with conduction, by convection, there will be more transfer of heat in the same period of time for same material at the same initial temperature.

3. CONVERSION: – in this form of heat therapy, the heat is produced from the conversion of a non thermal form of energy such as mechanical or electrical in to heat energy. The energy transfer occurs in the form of waves. These waves cause vibration resulting in the generation of heat.

4. RADIATION: – is the transfer of energy in the form of IR (infrared waves). It happens without any physical contact between surfaces so is also know as radiant heat. All matter radiates energy in the form of heat. In normal environment the body is warmer than the surroundings so as a result the radiant heat energy is dissipated through the air to surrounding or to a cooler area and vice versa. Shortwave and Microwave diathermy are examples of both radiant energy transfer.

5. EVAPORATION: – heat loss can also occur due to evaporation. For example. Vapo-coolant sprays, spread a liquid over the skin surface which absorbs the heat of the skin and makes the skin cool. Evaporation is also the means by which the body colls itself on a hot day through the evaporation of sweat.

PHYSIOLOGY OF HEAT TRANSFER

Some of the most common physiological effects of heat transfer are as follows.

1. Vasodilation – at a result of vasodialation, there will be an increase in the rate of blood flow. This vasodilation occurs locally in the area whgere heat is applied.
2. Viscosity – As temperature increases, there will be a decrease in the viscosity of the blood, resulting in an increased flow of blood, which accelerates the healing mechanism.
3. Increased nerve stimulation – an increase in temperature will change the nerve conduction velocity and the firring rate of neurons. There will be a decrease in the conduction latency of both the sensory as well as the motor neurons.
4. Increased pain threshold – as a result of increased blood flow, due to vasodilatation, it brings oxygen and nutrients which allows faster healing process, thereby decreasing pain.
5. Changes in muscle strength – muscle strength and endurance is found to decrease during the initial 30 minutes after the application of heating agents. There will be decreased firing rate of the neurons thus by reducing the pain of the patient.
6. Increased metabolic rate – the rate of metabolism increases as an increase in temperature occurs. This will accelerate the healing process.
7. Increased tissue extensibility / effect of collagen tissue. – the extensibilty of the collagen fibers is found to increase at a range of about 40 – 45 degree Celsius.
8. Increased sweating
9. Effect on pulse rate and blood pressure. – Increse in temperature results in vasodialation which in turn revels as a decrease in blood pressure. Along with this there will be an increase in heart rate.
10. Increased rate of breathing.

Superficial and Deep heating therapy: –

In superficial heating therapy the heat is applied over to the external surface of the skin, whereas in deep heating methodology, as the name suggests, the heat penetrates deep into the tissues. Superficial heating is achieved using paraffin wax, fluidotherapy such as whirlpool, contrast bast etc. Whereas coming to deep heating, diathermic instruments and ultrasounds are used for the generation of heat.

In superficial heating the depth achieved is about 0.5 cm, where a prolonged use of about 15 to 30 minutes helps to achieve heating upto about 1 to 2 cms deep. Whereas in deep heating about 5 to 6 cm of height is achieved.

Some of the examples of both are –                 

SUPERFICIAL HEAT THERAPY – Wax Therapy, Moist heat, Contrast bath, Fluidotherapy, Whirlpool Bath, Infra-Red Therapy.

DEEP HEATING THERAPY – Short Wave Diathermy, Microwave Diathermy, Ultrasound Therapy, Ultraviolet Therapy, Laser Therapy.