What can Physiotherapy help in?

Physiotherapy can help a wide variety of problems that affect an individuals ability to be mobile.
Physiotherapists are trained in the treatment of:

• Musculoskeletal problems------ i.e. sprains, fractures, joint replacements.
• Neurological problems------ i.e. stroke, head injury, cerebral palsy.
• Cardiorespiratory problems------ i.e. heart disease, asthma, pneumonia.

What does a Physiotherapy Appointment involve?

An appointment with a physiotherapist will involve taking a relevant clinical history from the patient. The injured area is then assessed as well as other areas that may be related to the problem. Accordingly, a treatment programme is devised. Treatment may include modalities, i.e. ultrasound, interferential current, “Hands on” treatment, specific exercises, or simply advice on how to manage the problem.

What to do about swollen ankles during pregnancy?

Swollen ankles tend to occur later in pregnancy. The ankles swell when the enlarged womb presses on the veins that come up from the legs; this in turn leads to accumulation of fluid around the ankles. The only thing that can be done is to elevate your feet by putting them on a footstool when you sit down.

What is osteoarthritis?

Osteoarthritis is a common problem for many people after middle age. Osteoarthritis is degenerative, wear and tear of the joint. It may result from an injury to the knee earlier in life. Fractures involving the joint surfaces, instability from ligament tears can cause abnormal wear and tear of the knee joint. The main problem in osteoarthritis is degeneration of the articular cartilage that covers the joint. This results in areas of the joint where bone rubs against bone. Bone spurs may form around the joint as the body's response. The symptoms of osteoarthritis are mainly pain, swelling, and stiffening of the knee. The pain of osteoarthritis is usually worse after activity. Early in the course of the disease, you may notice that your knee does fairly well while walking, then after sitting for several minutes the knee becomes stiff and painful. As the condition progresses, pain can interfere with even simple daily activities. In the late stages, the pain can be continuous.

How is Osteoarthritis treated?

In the early stages, treatment for osteoarthritis is usually directed at decreasing the inflammation in the joint. Anti–inflammatory medications, such as aspirin and ibuprofen, are useful in decreasing the pain and swelling from the inflammation. If the symptoms continue, a cortisone injection may be used to bring the inflammation under better control and ease your pain. Cortisone is a very powerful anti–inflammatory medication, but does have secondary effects. The major drawback in use of intra–articular injection of cortisone is the fact that it may actually speed the process of degeneration when used repeatedly.

There are also braces on the market that can reduce the pressure on the side of the knee that is most involved. These braces have been designed mainly for the more common condition of early wear and tear in the medial compartment (inner half) of the knee. Various kinds of elastic supports do little to improve the pain.

Physiotherapy also has a little role to play in this condition. Its role is like painkiller, while you are on it, it does give you some degree of pain relief but does not necessarily change the course of the condition. Exercises may be helpful to prevent stiffness in a painful joint, but it has no role in improving the condition of the joint.

Arthroscopy
Arthroscopy is sometimes useful in the treatment of osteoarthritis of the knee. Debridment of the knee joint is done. During the debridment any loose fragments of cartilage are removed and the knee is washed with a saline solution. The areas of the knee joint which are badly worn may be roughened with a burr to promote the growth of new cartilage – a fibrocartilage material that is similar scar tissue. Debridement of the knee using the arthroscope is not 100% successful. If successful, it usually affords temporary relief of symptoms for somewhere between 6 months to 2 years.


Proximal Tibial Osteotomy Surgery
Osteoarthritis usually affects the inside half (medial compartment) of the knee more often than the outside (lateral compartment). This can lead to Bow legs, or in medical terms, a genu varum deformity. The result is that the weight bearing line of the lower extremity moves more medially (towards the medial compartment of the knee). (It’s really all in the physics/biomechanics of the situation.) The end result is that there is even more pressure on the medial joint surfaces, which leads to more pain and faster degeneration.

The procedure to realign the angles of the lower extremity is called a Proximal Tibial Osteotomy. In this procedure a wedge of bone is removed from the lateral (outer) side of the upper tibia. This converts the extremity from being bow–legged to knock–kneed. This procedure cannot be expected to be always successful, and generally will reduce your pain, but not eliminate it altogether. The advantage to this approach is that very active people still have their own knee joint, and once the bone heals there are no restrictions to activity level. It is thought that this operation buys some time before ultimately needing to perform a total knee replacement. The advantages of the operation generally lasts for 6–8 years.

Total Knee Replacement
The ultimate solution for osteoarthritis of the knee is to replace the joint surfaces with an artificial knee joint. It is usually considered in people around the age of 60, (although younger patients sometimes require the surgery simply because no other acceptable solution is available to treat their condition). The main reason that orthopedic surgeons are reluctant to perform the surgery on younger individuals, is that the younger the patient, the more likely the artificial joint will fail. Replacing the knee the second and third time is much harder and the relative advantages seem to get less with each surgery.

Artificial knee joints can last between 12 and 15 years in an elderly population. Younger patients are more active and place more stress on the artificial joint, that can lead to loosening and failure earlier.

In total knee arthroplasty. The end of the femur is shaped so that the artificial implant will fit snugly. The tibial surface is then cut flat to accept the bottom portion of the artificial joint. The patella is also cut flat to accept the artificial patellar surface. The femoral surface is placed on the end of the femur. The tibial artificial surface is placed on the top of the cut tibia. The patellar button is then placed on the cut surface of the patella. The end result is that all moving surfaces of the knee are metal against plastic.

What is the difference between a Sprain and Strain?

A strain is an injury to a muscle resulting in partial or total tearing of the muscle. There are three levels: mild or first degree, moderate or second degree, and severe or third degree. They are caused by sudden movement, overuse, forceful stretching, violent contraction or unaccustomed repeated minor trauma.

Sprains are an injury of the joint, in which the bones momentarily come out of alignment such that joint structures i.e. ligaments, joint capsules and possibly tendons, will be torn. There are also three degrees of sprains. Sprains can be caused by a violent, sudden bend or twist beyond the normal range of motion of the joint.

Does the treatment of a strain and a sprain differ?

Treatment for both strains and sprains is very similar. Ice for the first 24–48 hours to decrease inflammation, compression and elevating the area will also help. Massage therapy would help to decrease swelling through lymphatic drainage and other techniques. Ultrasound, [LINK TO ULTRASOUND IN PHYSIOTHERAPY] performed by a physiotherapist, helps to decrease swelling and promote healing. Massage therapy can benefit the unaffected areas and compensating structures to prevent hypertonicity and trigger points.

In the situation of a second or third degree sprain you should first consult with your physician, or physiotherapist prior to starting massage.

Before starting an activity, including a walk, start off slowly to warm up the muscles and other soft tissues, and then gently stretch all the muscles you will be exercising. Also strengthening the muscles surrounding a joint can help to protect it from spraining. Then at the end of your workout always Stretch and cool down. Massage therapy helps to even out muscle imbalances and can reduce increased muscle tension. Both massage and physiotherapists can give you a proper stretching program to help balance muscle.