PHYSIOTHERAPY

Physiotherapy deals with the treatment of diseases by physical methods and

rehabilitation means restoration of functional utility of the effected part. Physiotherapy and
rehabilitation accelerate the tissue healing by increasing the normal physiological process so
that the functional normalcy of an affected part is restored faster.
Different methods of physiotherapy are as follows,
1. Cold therapy.
2. Heat or thermotherapy.
3. Hydrotherapy.
4. Massage.
5. Exercise.

1. Cold therapy: The cold therapy is indicated in acute or hyper acute inflammatory
conditions. It can be done by blowing air, application of ice packs, evaporation of
volatile liquid and running cold water on the effected part. Hypothermia of tissue
induces vasoconstriction and decreases the extravagation of blood and reduces the
blood the fluid accumulation. Pain, muscle spasm and tissue metabolism are reduces.
Cold application is generally combined with compression bandages and rest, to limit
swelling 24 to 48 hours of injury. Each application last for 20 to 30 minutes and should
be 1 hour interval between the applications.

2. Heat or thermotherapy: Indicated in sub-acute and chronic inflammatory conditions

like sprain, contusion, strains and myositis. Heat increases the tissue temperature which
leads to sedation and analgesia. It has a vasodilatation effect which increases the
number of phagocytes to the area and helps the healing process. Metabolism and lymph
flow is also enhanced.

Adverse effect: Increase permeability of the blood vessels leading to tissue oedema or
increased absorption of toxins. Heat can spread bacteria and toxic products deep into the
tissues and therefore, should not be applied if inflammation is present.
It should not be used during the initial 24 to 48 hours of trauma. It should be
commonly used in combination with active and passive exercise.
It is three types:
a) Radiant heat.
b) Conductive heat.
c) Conversive heat.

a) Radiant heat: radiant heat includes A) infrared and B) ultraviolet radiation. The
penetration power of the radiant heat is about 7-10mm.

A) Infrared radiation: It penetrates deep into the skin. It is of two types, i) luminous and ii)
non-luminous.

i) Luminous infrared radiation: Luminous infrared radiation is mostly indicated

for young calves. Can also apply in frost bite and maturation of abscess. The
 source of infrared light should be kept at least 25 to 30 cm away from the apart
to be treated, otherwise cause thermal burns and weal formation, oedema and
blistering. Should be applied for 20 to 30 minutes, and if necessary repeated at
hourly interval.

ii) Non- Luminous: Metal coil is heated which radiates infrared light. It is best
as there is no risk of leakage from the bulb.

B) Ultraviolet radiation: An U-V lamp consists of a quartz bulb filled with argon gas, a
small amount of mercury and two electrodes at each end of the tube. The temperature of
the tube goes upto 30000F and hot mercury gives off U-V radiation. When U-V rays
absorbed by the skin, chemical changes takes place in side the body. Too much
radiation results in oedema formation and tenderness. Deep penetration U-V rays has
bactericidal effects and may be used for promoting healing of chronic wounds.

b) Conductive heat: Conductive heat is superficial as it does not penetrate far beneath the
skin. Hot water, hot water bottles, electrically heated pads, whirlpool turbulators and hot
packs are placed.
Hot water poultices and hot water whirlpools are used for application of moist
heat. Various drugs eg. MgSO4 can be added to enhance penetration. MgSO4 @ 2 cups/
5 liters of water helps in reducing swelling because of its higher osmotic tension. After
giving superficial heat, the part may be massaged using alcohol or other mild
rubefacient solution. This solution helps in massaging and causing superficial erythema.
Commercially available hot packs are soaked in water at a temperature of 75 0C;
heat is retained for 20-30 minutes. Adequate padding with a towel should be provided
to prevent burns for hot packs. Exposure to bearable heat for 15 to 20 minutes is
sufficient. Hot packs are more effective when used in combination with other physical
procedures such as massage, exercise or electrical stimulator.

c) Conversive heat: The conductive heat is done by i) Diathermy and ii) Ultrasound
therapy.

i) Diathermy: Diathermy penetrates to a depth of about of 5cm. The tissue gets

heated because of resistance to the electrical energy being passed through it. The
high frequency electrical energy passed from one electrode to the other.
Resistance in the tissues produced a variable increase in tissue temperature. So,
all the tissues will not be heated to the same degree. Greater is the fluid content
of tissues, the increase is the temperature recorded. The bone and tendon have
the lower water content and so do not heat as much as the surrounding moist
tissues. Contraindicated over and near metallic objects like bone screw and pins,
wiring to cause bone necrosis. Diathermy is two types, a) Short wave and b)
Microwave.
a) Short wave Diathermy: High frequency alternating current at a frequency of
approximately 27 million cycles / sec is used (27 MHz). It neither stimulates
motor or sensory nerves nor produces any chemical burns.
 b) Microwave Diathermy: High frequency electro magnetic radiation which is
absorbed by the body tissues resulting in molecular agitation and produces
thermal energy. There is no radiation damage. They can penetrate upto 3-5cm
into the muscles. For therapy frequency used are 900 megacycles / sec are used
for 15 to 20 minutes. Eyes and gonads are most sensitive and hence their
exposure should be avoided.

ii) Ultrasound therapy: It is two types, continuous and pulsed. Pulse ultrasound
is generally preferred. Ultrasound heats the tissues to produce hyperemia which
helps in resolution of chronic inflammatory process. At high intensities
vasodilatation may occur with increased blood flow in the particular area. It also
reduces muscular spasms and pain. The effect of ultrasound is called acoustic
streaming and the effect on the cells is called micro massage.

3. Hydrotherapy: The water helps in checking infections and accelerates wound healing
by removing dart and necrossed tissues. A treatment time of 20 to 30 minutes is
sufficient. Aqua lift system is used to Downer’s cow syndrome if muscular damage is
not occurring. The used is kept at body temperature.
Whirlpool water bath is a hydrotherapy in which an extremity or the entire body
is submerged in either warm or cold swirling water. The water is kept in constant
agitation and mixed with air by the action of turbine thus producing a gentle massage
effect.
Irrigating the effected part with a stream of water through a hose pipe is a simple
and cheap method for removing necrotic tissue.

4. Massage: Manipulation of soft tissues with hand and finger is called massage. It
improves circulation, increases nutritional supply, removes waste products, reduces
oedema and indurations and loosens the contracted tendons, ligaments and muscles.
Indicated for sub-acute and chronic inflammatory conditions. Contraindicated in acute
inflammatory conditions. When there is a danged of haemorrhage or if foreign bodied
are present under the skin or a new growth exists. Massage should be done in the
direction of the muscle fibers or across the fibers. The motion should be rhythmic and
pressure moderate. 10 to 15 minutes massage is sufficient.

5. Exercise: It constitutes active and passive movement of a part or whole of the body to
strengthen or maintain the musculoskeletal function.
Passive exercise: The effected joint is grasped and its flexion and extension is
done for 10 to 15 minutes. The movement should not be forced.
Active exercise: It includes walking, grazing, and slow running up and down
slop.