Many patients treated in hospital wards pass literally through the hands of the physiotherapist. The very young in the Special Care Baby Unit, the very old in the Geriatric Rehabilitation Ward, the teenage motorcyclist with a fractured thigh, the middle-aged housewife with a broken wrist or ‘slipped’ disc, the stroke victim, the paraplegic, the patient with a lung or heart condition: all will probably undergo physiotherapy. Any of these might continue to attend as an out-patient after leaving hospital in which case they will join patients with less acute injuries or disorders such as neck and back pains, arthritic hands and hips, and sporting injuries.
Physiotherapy comprises a group of treatment techniques, such as massage, manipulation, exercises in water and in the gymnasium, heat application and electrical therapies, which can be applied to a variety of complaints and disorders. Physiotherapists work in close collaboration with members of the medical profession. The doctor usually diagnoses the underlying problem faced by the patient and refers him or her to the physiotherapist, who selects the appropriate treatment.
Physiotherapy has been variously called paramedical, supplementary, complementary, or allied to mainstream medicine. It became formalized at the end of the nineteenth century as an offshoot of nursing, and has developed rapidly in the second half of this century into a fully accepted adjunct to medicine and surgery.
Assessment and aims
The primary aim of the physiotherapist is early restoration of his or her patient’s ability to live an independent, useful life. This may involve no more than easing an intractable physical problem or suggesting an alternative method of performing a necessary physical activity which the patient finds difficult. An assessment of each patient’s individual problem precedes the choice of treatment, and a treatment plan setting out attainable treatment objectives is made. In some cases the patient’s complete return to full independence is the target; in others less ambitious (but realistic) aims are formulated. Even patients who have sustained irreversible damage may still benefit by treatment from a physiotherapist. It is a question of making the best of what is available.
Heat has long been used to alleviate aches and pains. Physiotherapists use sophisticated methods of heat treatment such as the heated hydrotherapy pool, radiant heat lamps, heated wax or mud baths, and so on. In addition other heat-producing procedures are used such as ultrasound and shortwave and microwave diathermy, which enable localized heating of the target tissue – muscles, ligaments and so on – to relieve pain and promote healing. Formerly used in isolation as a treatment in its own right, heat therapy is now more often the prelude or sequel to more active rehabilitation programmes.
Physiotherapists are concerned with the preservation or restoration of mobility in joints, strength in muscles and co-ordination in movements. The scope and power required by, for example, an octogenarian, and a young athlete at the peak of his career differ widely, but both may seek the physiotherapist’s help to maximize their potential and each will have a scheme devised to meet his or her needs. The principles of muscle-strengthening and joint mobilization remain the same, but their application is adjustable and so is the medium in which they are used. A graduated programme of physiotherapy may begin with a series of assisted limb movements which ensure muscles retain their full strength and do not shrink as they waste. These are followed by exercises encouraging free movement by the patient, progressing to resistance exercises against a force or surface. The programme may last for many months before full recovery is obtained.
Massage and manipulation
Treatment by rubbing and moving the body has been recorded since ancient times and is one of our most primitive responses to physical pain. The use of therapeutic massage reached its peak in the early part of the twentieth century when wide-ranging claims were made for its effectiveness; however these failed to make a lasting impression and it is less widely used in present-day practice. Techniques of demonstrable value, such as striking a patient’s chest to free secretions trapped in the lungs, are still very much in use. The parents of children with cystic fibrosis or bron- chiectasis are taught how to perform such procedures for home use.
Manipulation, on the other hand, has increased in its usage. No longer the prerogative of a few medical practitioners or the bone-setter, osteopath and chiropractor, it is now widely employed in many forms. As students, physiotherapists learn simple – and safe -passive mobilizing techniques for joints in the spine and limbs; many go on to extend their knowledge and practise these skills as a sub-speciality.
In the 1950s and 1960s muscle-stimulating currents, radiation and diathermy treatments were in general use. However, the move away from passive towards more active forms of therapy led to a reduction in their application. Yet recently there has been renewed interest in pulsed magnetic fields, interferential currents and laser therapy to stimulate tissue-healing and relieve pain. It is not fully understood how some of these techniques work and some doctors and physiotherapists are sceptical about the use of certain aspects of electrotherapy. Nevertheless its use is becoming more widespread.
For a patient to recover muscle power, stamina, and pain-free, controlled movements is in itself desirable, but these are only components of a whole. Great emphasis is laid on retraining patients in the activities of daily living so that they can resume a near normal life as quickly as possible. This is an area in which the physiotherapist works closely with the occupational therapist in the interests of the patient. Once a series of basic achievements has been established the patient can re-train for more specific tasks, gradually progressing to work, travel and fuller living.