MEER | Orthopedic Physical Therapy
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Orthopedic Physical Therapy

This branch of physical therapy focuses on diagnosis, management and treatment of injuries and problems the muscular skeletal system (muscles, bones, ligaments or tendons) and rehabilitating them immediately after orthopedic operations. This branch particularly deals with treating postoperative joints, acute injuries due to sport activities, arthritis and amputations by using techniques and approaches that make recovery faster as strengthening exercises, hot/cold packs, joint mobilizations, electrical stimulation and therapeutic ultrasound.

Orthopedic physical therapy is essential to restore the patients’ activity, strength and motion right after injuries or surgery. Orthopedic patients usually have deficiencies and weaknesses which could be eliminated or at least alleviated via particular targeted exercises designed to restore and enhance functions or, at least minimize the problems.

There are lots of rehabilitation tools used in this branch of physical therapy among these are stretching, strengthening (closed chain, proprioceptive…etc.), ice and heat therapy, ultrasound, etc. Stretching exercises are critical for dealing with stiff joint that affect normal activities. Proper stretching exercises can assist preserve such functions. Strengthening exercises aid patients in improving their muscle functions, increasing endurance and maintaining or improving the normal range of motions. Closed chain exercises assist the strength of muscles whereas proprioceptive exercises assist patients who lost the sense of knowing where a body part is in space due to a sprain for example, relearn how to control the position from the respective injured joint.

The cold/heat therapy contribute to stimulation of blood circulation and decrease swellings. Therapeutic ultrasound improves blood flow by stimulating and warming up deep tissues.

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Ankle joint

One of the commonest injuries is ankle sprain that happens by missing footing or slipping, in which the foot turns-in and the lower leg doesn’t. The fibers of the ligament are over-stretched to varying degrees depending on the involved force. There will be an inflammatory response (redness and swelling) at the time of injury. Inflammation is the body’s defense response to injury, the ankle will be tender to touch and there will be pain during movement. A normal healthy inflammatory response is, if anything, rather overdone, so it is important to reduce swelling which in turn reduces pain and support the injured tissues, enough to make movement more comfortable and allow the ligament to. As the ligament heals it is important to keep the fibers approximated so that the ligament heals at the appropriate length – not too long or the ankle will be unstable after repair, not too short or the ankle will lack its normal flexibility. The ankle ligament contains loads of proprioceptors: nerve endings sensitive to position which feed up to the brain and inform balance reactions in the leg muscles. It is important to retrain these balance reactions after ankle injury, otherwise the ankle performs poorly on uneven ground or in complex rapid movements and the ligament will be vulnerable to re-injury.

Low back pain

Typically, younger individuals (30 to 60 years old) are more likely to experience back pain from a lower back muscle strain or from within the disc space itself – such as a lumbar disc herniation or lumbar degenerative disc disease.

Symptoms: Severe or aching pain in the lower back that starts after activity, sudden movement, or lifting a heavy object.

These lower back pain symptoms include any combination of the following:

  • Difficulty moving that can be severe enough to prevent walking or standing
  • Pain that also moves around to the groin, buttock or upper thigh, but rarely travels below the knee
  • Pain that tends to be achy and dull
  • Muscle spasms, which can be severe
  • Local soreness upon touch

Symptoms: Low back pain that travels to the buttock, leg and foot (sciatica)

Sciatica includes any combination of the following symptoms:

  • Pain typically is ongoing (as opposed to flaring up for a few days or weeks and then subsiding)
  • Pain may be worse in the leg and foot than in the lower back
  • Typically felt on one side the buttock or leg only
  • Pain that is usually worse after long periods of standing still or sitting: relieved somewhat when walking
  • More severe (burning, tingling) vs. dull, aching pain
  • May be accompanied by weakness, numbness or difficulty moving the leg or foot

Patients suffering from most types of low back pain are often referred for physical therapy for four weeks as an initial conservative (nonsurgical) treatment option before considering other more aggressive treatments, including back surgery. The goals of physical therapy are to decrease back pain, increase function, and teach the patient preventive programs to avoid future back problems.

Common forms of physical therapy include:

  1. Passive physical therapy (modalities), which includes things done to the patient, such as heat application, ice packs and electrical stimulation. For example, a heating pad may be applied to warm up the muscles prior to doing exercising and stretching, and an ice pack may be used afterward to sooth the muscles and soft tissues.
  2. Active physical therapy, which focuses on specific exercises and stretching. For most low back pain treatments, active exercise is the focus of the physical therapy program.
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Neck Pain (Cervical Pain)

Most episodes of neck pain are due to muscle strain or soft tissue sprain (ligaments, tendons), but it can also be caused by a sudden force (whiplash). These types of neck pain often improve with time and non-surgical care such as medication and physical therapy. But if neck pain continues or worsens, there is often a specific condition that requires treatment, such as cervical degenerative disc disease, cervical herniated disc, cervical stenosis, or cervical arthritis.

Elbow

Tennis elbow is a common injury of elbow joint. It tends to be precipitated by a periods of repetitive use of the joint. Many people get tennis elbow without ever having played tennis! It has become a common term for elbow pain associated with difficulty in gripping.

Pain can arise from irritation of a number of structures around the elbow joint: inflammation can occur around the tendon(s) at the point of attachment to the bone, or at the junction between tendon and muscle fibers; the mobility of the elbow joint can deteriorate, particularly the articulation between the head of the radius and the humerus. There can be restriction of the passage of nerve fibers, particularly the radial nerve, through the soft tissues around the elbow.
Some research has shown that in the majority of cases there will be some degree of dysfunction in the neck, contributing to elbow pain, particularly if the condition has been persistent.
All of these structures need to be accurately examined and treated to resolve tennis elbow. If you have had tennis elbow for any length of time you will probably hear about all sorts of different treatment approaches which may or may not have worked; this is because it is a condition which can have a number of differing underlying causes.

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Headaches

Tension headaches, as they are called, can arise from irritation of the structures between the base of the skull, and the top two vertebrae: the atlas and the axis.

Hip

Hip pain often arises from reduced mobility in the hip joint. This joint is extremely mobile but sedentary western living makes hardly any use of the available range. The ball and socket mechanism of the hip joint needs to be lubricated across the entire surface to ensure nutrition of the cartilage. Otherwise the cartilage surface tends to deteriorate. Without use the muscles, ligaments and tendons around the hip become distorted and weak. It’s a good example of the “use it or lose it” adage.
Where the hip is the primary source of pain, restoration of movement and muscle power is essential to reduce pain and improve function. Not all hip pain comes from the hip though ! Sometimes there will be pain around the hip, even including tenderness in the muscles, yet it is the lower back ( lumbar spine) that is at fault, giving rise to “referred” pain into the hip.

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Knee & Kneecaps

The knee can be described as a hinge joint, its main movements being flexion and extension (i.e bending and straightening). It is vulnerable to torsion which can damage a) the ligaments (running from bone to bone) either on the inner or outer aspect of the knee b) the cartilages (washer type structures inside the knee) c) the cruciate ligaments inside the knee – these are designed to hold the knee steady from front to back – so they are more likely to become injured when the knee is “sheared”.
Some sports are particularly tough on knees, football for instance. Knees that have taken a lot of trauma over the years will tend to get arthritic. This means that the actual cartilage surface on the femur and the tibia gets ragged and irregular. Normal cartilage surfaces slide on each other incredibly smoothly, like ice on ice. When this surface deteriorates, movement of the knees can be more restricted, certainly more noisy, but not necessarily painful. The mechanism of injury often suggests the structures most likely to be damaged. The physiotherapist can then confirm the problem by careful (and gentle) testing in the clinic. It is common practice to use expensive scanning procedures for many injuries these days, but a good physiotherapist can often identify the injury in the clinic by examination.

Kneecaps

A common cause of pain around the knee, not only for sporty types, is retro patellar pain, (pain behind the kneecap). The kneecap is actually enclosed within the tendon of the quadriceps muscle (four muscles on the front of the thigh) The balance between the muscles needs to be just right so that the knee cap sits centrally over the knee. If the balance goes off then the muscles tend to pull the kneecap sideways (usually towards the outer aspect) on the knee. This causes friction between the back of the kneecap and the front of the femur, leading to inflammation.
Alternatively the knee can hyper extend (when standing with the knees locked straight, they don’t just straighten, they go past straight and bow backwards) this can cause the kneecap to rub excessively against the knee joint, setting up a low grade inflammation which will become painful.
Typically the pain is more noticeable when sitting for a long time, (for instance, in the car or at the cinema), or when the knee works under load – e.g down or upstairs. For some, kneeling is impossible. Physiotherapy assessment will include muscle testing, measuring the “lie” of the patella, working out how to correct the position and retrain the muscles to restore balance.

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Shoulder

The shoulder or gleno humeral joint is an intricate arrangement – loads of movement is available in just about every direction, but stability is limited, so this has to be provided by the muscles and ligaments surrounding it. The head of the humerus (the long bone of the upper arm ) moves on the glenoid, a slightly convex surface on the outer aspect of the shoulder blade. The collar bone also connects up with a part of the shoulder blade called the acromion. The muscles surrounding the joint, running between the humerus and shoulder blade are known as the rotator cuff.
Shoulders dislocate relatively easily, once the dislocation is treated it is important to get all the muscles back in good working order. Shoulders can become painful and restricted seemingly out of the blue, and the term frozen shoulder is quite often used.
Shoulder problems need really careful examination, they can be very difficult to diagnose because the whole mechanism is so intricate. Not only that, a significant number of pain patterns will appear to be arising from the shoulder when in fact the problem lies in the neck and the pain is actually referred to the shoulder, shoulder blade or down the arm.

Wrist & Hand

Common problems around the wrist and hand can arise from repetitive activities such as using a keyboard. Factors which can contribute include unusually prolonged periods of time using the keyboard, or using the keyboard in an awkward position (too high, too low, at an awkward angle etc) or switching from one type of use to another – (keyboard to mouse, scrolling etc.)
Pain can arise from local inflammation in the tendons and / or small joints of the hands and wrist. There may also be irritation of the nerves supplying the hands/ wrist/ forearms.
Careful examination will identify the source of symptoms. Treatment can include improving the mobility of the soft tissues: muscles, tendons, ligaments; the joints of the hand and wrist. The use of low dose pulsed ultrasound will reduce inflammation. Clearly it is often worth reviewing the working environment to prevent recurrence of this sort of problem.

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