Interventions for Acute Musculoskeletal Pain
In addition to initial interventions such as providing information, assurance and advice to maintain reasonable activity levels, other options (non-pharmacological and pharmacological) exist for the management of acute musculoskeletal pain.
Non-pharmacological Interventions
Evidence for the effectiveness of a range of additional nonpharmacological (i.e. not involving medication) interventions for people with acute musculoskeletal pain is provided in the specific guideline topics. These include active, passive and behavioural therapies. Non-pharmacological interventions may be used in conjunction with pharmacological interventions (NHMRC 1999).
***
***
Pharmacological Interventions
Simple Analgesics (Non-Opioid)
Paracetamol is considered an effective medication for mild to moderate pain and can be used in conjunction with opioids to manage more severe pain.
Generally, paracetamol has few side effects. Paracetamol is contraindicated for people with liver dysfunction. It can be used when NSAIDs are contraindicated. Patients should be warned of the risk of liver damage with the combination of alcohol and paracetamol.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs are considered effective in the management of mild to moderate pain. Concurrent use of opioids and NSAIDs may provide more effective analgesia than either of the drug classes alone. They may also reduce the side effects of opioid medications (NHMRC 1999).
The adverse effects of NSAIDs are potentially serious and all people cannot use them. NSAID use may result in gastro intestinal bleeding, renal dysfunction (particularly in older people), NSAID-induced asthma and impaired blood clotting.
It is imperative that contraindications are identified and respected (e.g. asthma, peptic ulcer) (NHMRC 1999). More recently, Cox-2 selective NSAIDs have become available. Evidence for their efficacy in a number of rheumatological
disorders has been demonstrated. Currently they are not subsidised for acute musculoskeletal pain in Australia.
Pharmacological Interventions
Simple Analgesics (Non-Opioid)
Paracetamol is considered an effective medication for mild to moderate pain and can be used in conjunction with opioids to manage more severe pain.
Generally, paracetamol has few side effects. Paracetamol is contraindicated for people with liver dysfunction. It can be used when NSAIDs are contraindicated. Patients should be warned of the risk of liver damage with the combination of alcohol and paracetamol.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs are considered effective in the management of mild to moderate pain. Concurrent use of opioids and NSAIDs may provide more effective analgesia than either of the drug classes alone. They may also reduce the side effects of opioid medications (NHMRC 1999).
The adverse effects of NSAIDs are potentially serious and all people cannot use them. NSAID use may result in gastro intestinal bleeding, renal dysfunction (particularly in older people), NSAID-induced asthma and impaired blood clotting. It is imperative that contraindications are identified and respected (e.g. asthma, peptic ulcer) (NHMRC 1999).
More recently, Cox-2 selective NSAIDs have become available.
Evidence for their efficacy in a number of rheumatological disorders has been demonstrated. Currently they are not subsidised for acute musculoskeletal pain in Australia.
Opioid Analgesics
Opioid analgesics bind to opioid receptors both within and outside the central nervous system and are used for management of severe pain. All opioid medications have the potential to cause side effects including constipation, urinary retention, sedation, respiratory depression, nausea and vomiting. Titration of medication should occur to optimise the response to the analgesic and to minimise side effects. The following points are highlighted in the NHRMC (1999) acute pain guidelines:
True allergy to opioids is uncommon; people may have side effects that are mistakenly referred to as ‘allergies’. There is no evidence that the use of opioids for the treatment of severe acute pain leads to dependence on, or addiction to, opioid medications.
The dosage should be tailored to each individual and the need for pain relief considered of greater importance than adhering strictly to a specific dose interval.
Muscle Relaxants
Muscle relaxants have the potential for side effects and show some short-term benefit in studies for low back pain. (Bigos et al. 1994; van Tulder et al. 1997).
Adjuvant Agents
There is no evidence to support the use of adjuvant agents, including antidepressants, anticonvulsants and oral corticosteroids, in the treatment of acute musculoskeletal pain.
Acute Pain Management (4) <||> Acute Pain Management (1)
taken from:
Australian Acute Musculoskeletal Pain Guidelines Group;2003; Evidence-based Management of Acute Musculoskeletal Pain; Bowen Hills: Australian Academic Press Pty. Ltd.
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Showing posts with label Artikel berbahasa Inggris. Show all posts
Monday, April 19, 2010
Acute Pain Management (4)
Pain Management
Von Korff (1999) demonstrated that people in pain want to: know what the problem is; be reassured that it is not serious; berelieved of their pain; and receive information. People in pain want advice regarding the management of their pain, including non-pharmacological and pharmacological interventions. They also want advice on how to return to normal activity.
Patients may lack current knowledge of interventions for pain management. For instance, they may believe that xrays
will determine the cause of their pain and that bed rest is indicated. It is important to satisfy the need for knowledge, alleviate fear and to focus on preventing disability due to pain (Main 2002). The use of a preventive approach to shape behaviour is best done at the initial visit. This is particularly important in acute musculoskeletal pain, which may recur.
The following is a suggested framework to manage acute musculoskeletal pain:
1. Elicit a pain history in a biopsychosocial context.
2. Assess for clinical features (‘red flags’) of serious conditions including serious systemic illness, fracture, tumour and infection. If such features are present, further investigation or referral is warranted.
3. Assess for the presence of psychosocial and occupational factors (‘yellow flags’) that may affect the presentation of acute pain, response to treatment and influence the risk of progression to chronic pain.
4. Provide information on the prognosis of acute musculoskeletal pain and discuss options for pain management (pharmacological, non-pharmacological and activity).
5. Develop a management plan in conjunction with the patient, fostering a cooperative environment and reinforcing the importance of self-management.
***
***
Pain Management Plan
The management plan should be tailored to meet the needs of each patient, taking their preferences and abilities into account. It is important to ensure that the patient understands what is involved to facilitate their participation.
Management plans are designed to assist progress through an episode of acute pain and the return to normal function. The plan should include actions that the consumer and clinician may take in the event of an exacerbation or recurrence of pain or slow progress to recovery. The plan should enable the individual to take responsibility for his or her own rehabilitation (bearing in mind that some people will require greater levels of support and assistance) or to seek help from a clinician if necessary.
There are three phases of the management plan:
Assessment
Management
Review
Assessment
A history and physical examination are conducted to assess whether clinical features of serious conditions (‘red flags’) are present and to identify psychosocial and occupational factors (‘yellow flags’) that may influence recovery.
Ancillary investigations are not generally indicated unless features of serious conditions are identified.
In cases where features of serious conditions are present, an alternative plan of management is required.
Management
Provide information — consumers seek an explanation and information about the nature of their pain. The clinician
should use effective communication techniques and use appropriate terms to describe acute musculoskeletal pain.
Provide assurance — the natural history of acute musculoskeletal pain is generally favourable; thus, epidemiological data serves as the basis for assurance that recovery can be expected. Information on the prognosis and the provision of assurance is an integral part of the management plan.
Provide advice to remain active — activity should be encouraged; resumption of normal activity should occur as soon as possible. For each of the conditions covered by these guidelines, activation is a seminal intervention for restoring function and avoiding disability.
Discuss other options for pain management including the addition of non-pharmacological and pharmacological interventions to the management plan to assist return to normal activity. A combination of measures may be used.
The clinician should provide information on the options available, what they are designed to achieve and describe
potential risks and benefits. It is important not to overstate the power of interventions to avoid unrealistic xpectations.
It is also important to avoid the assumption that consumers expect medication each time they visit. On the contrary, any do not want their consultation ended prematurely by the writing of a prescription.
Review
Prescription of a single, one-step intervention is unlikely to be successful. The plan may be iterative, requiring small
amendments or major changes. On subsequent visits, the clinician should enquire whether the plan has been satisfactory and explore questions, concerns and possible alternatives as required. Further explanation and assurance can be provided.
Ongoing review provides an important opportunity to assess for features of serious conditions and psychosocial
factors that may not have been evident on previous visits and to intervene as required.
Review also demonstrates concern that progress has been made. This is particularly important when there was intense pain and distress at the initial presentation. The need for further visits can be discussed at each consultation.
Acute Pain Management (3) <||> Acute Pain Management (5)
taken from:
Australian Acute Musculoskeletal Pain Guidelines Group;2003; Evidence-based Management of Acute Musculoskeletal Pain; Bowen Hills: Australian Academic Press Pty. Ltd.
Von Korff (1999) demonstrated that people in pain want to: know what the problem is; be reassured that it is not serious; berelieved of their pain; and receive information. People in pain want advice regarding the management of their pain, including non-pharmacological and pharmacological interventions. They also want advice on how to return to normal activity.
Patients may lack current knowledge of interventions for pain management. For instance, they may believe that xrays
will determine the cause of their pain and that bed rest is indicated. It is important to satisfy the need for knowledge, alleviate fear and to focus on preventing disability due to pain (Main 2002). The use of a preventive approach to shape behaviour is best done at the initial visit. This is particularly important in acute musculoskeletal pain, which may recur.
The following is a suggested framework to manage acute musculoskeletal pain:
1. Elicit a pain history in a biopsychosocial context.
2. Assess for clinical features (‘red flags’) of serious conditions including serious systemic illness, fracture, tumour and infection. If such features are present, further investigation or referral is warranted.
3. Assess for the presence of psychosocial and occupational factors (‘yellow flags’) that may affect the presentation of acute pain, response to treatment and influence the risk of progression to chronic pain.
4. Provide information on the prognosis of acute musculoskeletal pain and discuss options for pain management (pharmacological, non-pharmacological and activity).
5. Develop a management plan in conjunction with the patient, fostering a cooperative environment and reinforcing the importance of self-management.
***
***
Pain Management Plan
The management plan should be tailored to meet the needs of each patient, taking their preferences and abilities into account. It is important to ensure that the patient understands what is involved to facilitate their participation.
Management plans are designed to assist progress through an episode of acute pain and the return to normal function. The plan should include actions that the consumer and clinician may take in the event of an exacerbation or recurrence of pain or slow progress to recovery. The plan should enable the individual to take responsibility for his or her own rehabilitation (bearing in mind that some people will require greater levels of support and assistance) or to seek help from a clinician if necessary.
There are three phases of the management plan:
Assessment
Management
Review
Assessment
A history and physical examination are conducted to assess whether clinical features of serious conditions (‘red flags’) are present and to identify psychosocial and occupational factors (‘yellow flags’) that may influence recovery.
Ancillary investigations are not generally indicated unless features of serious conditions are identified.
In cases where features of serious conditions are present, an alternative plan of management is required.
Management
Provide information — consumers seek an explanation and information about the nature of their pain. The clinician
should use effective communication techniques and use appropriate terms to describe acute musculoskeletal pain.
Provide assurance — the natural history of acute musculoskeletal pain is generally favourable; thus, epidemiological data serves as the basis for assurance that recovery can be expected. Information on the prognosis and the provision of assurance is an integral part of the management plan.
Provide advice to remain active — activity should be encouraged; resumption of normal activity should occur as soon as possible. For each of the conditions covered by these guidelines, activation is a seminal intervention for restoring function and avoiding disability.
Discuss other options for pain management including the addition of non-pharmacological and pharmacological interventions to the management plan to assist return to normal activity. A combination of measures may be used.
The clinician should provide information on the options available, what they are designed to achieve and describe
potential risks and benefits. It is important not to overstate the power of interventions to avoid unrealistic xpectations.
It is also important to avoid the assumption that consumers expect medication each time they visit. On the contrary, any do not want their consultation ended prematurely by the writing of a prescription.
Review
Prescription of a single, one-step intervention is unlikely to be successful. The plan may be iterative, requiring small
amendments or major changes. On subsequent visits, the clinician should enquire whether the plan has been satisfactory and explore questions, concerns and possible alternatives as required. Further explanation and assurance can be provided.
Ongoing review provides an important opportunity to assess for features of serious conditions and psychosocial
factors that may not have been evident on previous visits and to intervene as required.
Review also demonstrates concern that progress has been made. This is particularly important when there was intense pain and distress at the initial presentation. The need for further visits can be discussed at each consultation.
Acute Pain Management (3) <||> Acute Pain Management (5)
taken from:
Australian Acute Musculoskeletal Pain Guidelines Group;2003; Evidence-based Management of Acute Musculoskeletal Pain; Bowen Hills: Australian Academic Press Pty. Ltd.
Sunday, April 11, 2010
Acute Pain Management (3)
Pain Assessment
Pain History
The elements of a pain history provide information that can alert to the presence of a serious underlying condition. It is important to note that in the absence of a serious cause for the pain (e.g. fracture), it is not necessary to obtain a specific patho-anatomic diagnosis to manage acute musculoskeletal pain effectively.
Site
The anatomical site where the person feels the pain may or may not be the site of origin as in the case of referred pain. The clinician should ask which part hurts the most and whether the pain started there or elsewhere.
Distribution
The regions in which pain is felt should be described. Even a person who initially complains of ‘pain all over’ can usually describe distinct region(s) of pain (possibly large and overlapping). Having the patient draw their pain focus and radiation on a pain diagram clarifies its distribution and can act as a baseline from which to assess response to treatment and changes in pain patterns.
***
***
Quality
The quality of pain may be described in different ways. Somatic pain is usually deep, dull and aching. Radicular pain is mostly sharp and ‘electric’ or ‘shooting’. Neuropathic pain is often ‘burning’. Visceral pain is dull at first but sharp when lining tissues such as the peritoneum become involved.
Duration
By convention, pain present for less than three months is described as ‘acute’ pain. Chronic pain refers to pain present for greater than three months duration. Pain duration will affect pain management.
Temporal Factors
Pain may be constant or intermittent. If pain is constant the history should elicit whether its intensity varies. If pain is intermittent, the history should elicit its pattern in relation to time
of day, activity and duration.
Intensity
The intensity of pain reflects the impact of the experience, not necessarily the degree of nociception. Even though pain is essentially subjective (Merskey and Bogduk 1994) it is important to assess the intensity of the pain. Simple tools can be used to assess pain at the initial and follow-up visits to evaluate progress. There is good correlation between the various types of
scales (Jensen at al. 1986). The Numerical Rating Scale is suitable for many clinical situations because it is simple to apply.
Aggravating and Relieving Factors
Aggravating factors include those that precipitate or worsenpain. Relieving factors are those that alleviate, reduce or abolish pain. People who say that nothing eases the pain can be asked about the posture in which they are least uncomfortable.
Impact on Activities of Daily Living and Sleep
The effects of pain on activities of daily living (ADL) determine
associated disabilities and handicaps (WHO 1986)
Identifying such effects gives the clinician an idea of the impact of pain on the patient’s lifestyle. The effect of pain on sleep should be specifically sought; sleep deprivation is a powerful amplifier of the pain experience.
***
***
Associated Symptoms
These include any symptom apparently associated with the painful condition, in contrast to symptoms associated with other conditions the person may also have.
Onset (Precipitating Event)
The first appearance of the pain and the circumstances in which it started should be assessed. The clinician should distinguish between an event that may have aggravated rather than
precipitated the pain.
Previous Similar Symptoms
Previous experience of similar symptoms suggests a recurrent condition.
Previous Action to Relieve Pain
All measures used for the condition before (and their effectiveness) should be noted. Unwanted effects associated with past treatment should also be recorded. Information on how each
intervention was applied can be helpful, as treatment ‘failures’ may be due to misapplication rather than to true failure of effect.
Current Action to Relieve Pain
All forms of treatment in current use should be noted. The clinician should ask about the use of physical interventions, including self-applied measures, all passive treatments, and all substances whether prescribed or otherwise that the person is taking or applying, with an appraisal of the helpfulness of each.
Pain History
The elements of a pain history provide information that can alert to the presence of a serious underlying condition. It is important to note that in the absence of a serious cause for the pain (e.g. fracture), it is not necessary to obtain a specific patho-anatomic diagnosis to manage acute musculoskeletal pain effectively.
Site
The anatomical site where the person feels the pain may or may not be the site of origin as in the case of referred pain. The clinician should ask which part hurts the most and whether the pain started there or elsewhere.
Distribution
The regions in which pain is felt should be described. Even a person who initially complains of ‘pain all over’ can usually describe distinct region(s) of pain (possibly large and overlapping). Having the patient draw their pain focus and radiation on a pain diagram clarifies its distribution and can act as a baseline from which to assess response to treatment and changes in pain patterns.
***
***
Quality
The quality of pain may be described in different ways. Somatic pain is usually deep, dull and aching. Radicular pain is mostly sharp and ‘electric’ or ‘shooting’. Neuropathic pain is often ‘burning’. Visceral pain is dull at first but sharp when lining tissues such as the peritoneum become involved.
Duration
By convention, pain present for less than three months is described as ‘acute’ pain. Chronic pain refers to pain present for greater than three months duration. Pain duration will affect pain management.
Temporal Factors
Pain may be constant or intermittent. If pain is constant the history should elicit whether its intensity varies. If pain is intermittent, the history should elicit its pattern in relation to time
of day, activity and duration.
Intensity
The intensity of pain reflects the impact of the experience, not necessarily the degree of nociception. Even though pain is essentially subjective (Merskey and Bogduk 1994) it is important to assess the intensity of the pain. Simple tools can be used to assess pain at the initial and follow-up visits to evaluate progress. There is good correlation between the various types of
scales (Jensen at al. 1986). The Numerical Rating Scale is suitable for many clinical situations because it is simple to apply.
Aggravating and Relieving Factors
Aggravating factors include those that precipitate or worsenpain. Relieving factors are those that alleviate, reduce or abolish pain. People who say that nothing eases the pain can be asked about the posture in which they are least uncomfortable.
Impact on Activities of Daily Living and Sleep
The effects of pain on activities of daily living (ADL) determine
associated disabilities and handicaps (WHO 1986)
Identifying such effects gives the clinician an idea of the impact of pain on the patient’s lifestyle. The effect of pain on sleep should be specifically sought; sleep deprivation is a powerful amplifier of the pain experience.
***
***
Associated Symptoms
These include any symptom apparently associated with the painful condition, in contrast to symptoms associated with other conditions the person may also have.
Onset (Precipitating Event)
The first appearance of the pain and the circumstances in which it started should be assessed. The clinician should distinguish between an event that may have aggravated rather than
precipitated the pain.
Previous Similar Symptoms
Previous experience of similar symptoms suggests a recurrent condition.
Previous Action to Relieve Pain
All measures used for the condition before (and their effectiveness) should be noted. Unwanted effects associated with past treatment should also be recorded. Information on how each
intervention was applied can be helpful, as treatment ‘failures’ may be due to misapplication rather than to true failure of effect.
Current Action to Relieve Pain
All forms of treatment in current use should be noted. The clinician should ask about the use of physical interventions, including self-applied measures, all passive treatments, and all substances whether prescribed or otherwise that the person is taking or applying, with an appraisal of the helpfulness of each.
Acute Pain Management (2)
Acute Pain
The term ‘acute pain’ refers to pain that has been present for less than three months (Bonica 1953; Merskey 1979). Successful management of pain in the acute phase is essential to prevent transition to chronic pain, which presents a significant individual, social and financial burden. Chronic pain is pain that has been present for longer than three months (Merskey and Bogduk 1994).
The NHMRC (1999) cites a number of misconceptions about the management of acute pain, including a lack of understanding of the pharmacokinetics of analgesics, mistaken beliefs about addiction, poor knowledge of dosage requirements, concerns about side effects and the concept that pain is not harmful.
***
***
Factors Influencing the Progression from Acute to Chronic Pain
Individuals vary in their potential to develop chronic pain. A combination of behaviours, beliefs and emotions may be involved in the transition from acute to chronic pain (Linton 2002). When pain is unrelieved over time, or if there are recurrent episodes of pain, persistent pain may develop.
The development of chronic pain is likely to be the result of small, cumulative changes in lifestyle that have been made to cope with acute musculoskeletal pain (Linton 2002). The intensity, duration and character of the pain influence the psychosocial response and the psychosocial response in turn influences the course of events.
There is strong evidence that psychosocial factors at work (i.e. occupational factors) are tied to the development of chronic pain. Job satisfaction may protect against the progression from acute low back pain to chronic low back pain. It is essential to identify those at risk of developing chronic pain and to intervene early to prevent this occurrence.
taken from:
Australian Acute Musculoskeletal Pain Guidelines Group;2003; Evidence-based Management of Acute Musculoskeletal Pain; Bowen Hills: Australian Academic Press Pty. Ltd.
The term ‘acute pain’ refers to pain that has been present for less than three months (Bonica 1953; Merskey 1979). Successful management of pain in the acute phase is essential to prevent transition to chronic pain, which presents a significant individual, social and financial burden. Chronic pain is pain that has been present for longer than three months (Merskey and Bogduk 1994).
The NHMRC (1999) cites a number of misconceptions about the management of acute pain, including a lack of understanding of the pharmacokinetics of analgesics, mistaken beliefs about addiction, poor knowledge of dosage requirements, concerns about side effects and the concept that pain is not harmful.
***
***
Factors Influencing the Progression from Acute to Chronic Pain
Individuals vary in their potential to develop chronic pain. A combination of behaviours, beliefs and emotions may be involved in the transition from acute to chronic pain (Linton 2002). When pain is unrelieved over time, or if there are recurrent episodes of pain, persistent pain may develop.
The development of chronic pain is likely to be the result of small, cumulative changes in lifestyle that have been made to cope with acute musculoskeletal pain (Linton 2002). The intensity, duration and character of the pain influence the psychosocial response and the psychosocial response in turn influences the course of events.
There is strong evidence that psychosocial factors at work (i.e. occupational factors) are tied to the development of chronic pain. Job satisfaction may protect against the progression from acute low back pain to chronic low back pain. It is essential to identify those at risk of developing chronic pain and to intervene early to prevent this occurrence.
taken from:
Australian Acute Musculoskeletal Pain Guidelines Group;2003; Evidence-based Management of Acute Musculoskeletal Pain; Bowen Hills: Australian Academic Press Pty. Ltd.
Friday, January 22, 2010
Tennis Elbow
This condition (Tennis Elbow) plagues many a racquet sports player and has been described for over a century, originally being named lawn tennis arm. It is also called lateral epicondylitis. It is certainly not confined to tennis players and can occur with a wide range of activities from carrying groceries to keyboard & mouse use. It must be carefully differentiated from other conditions, which also cause pain around the outside of the elbow.
WHERE IS THE PAINWHERE PAIN?
This injury is an inflammation at the elbow attachment of the muscles, which bend the wrist and fingers backwards. These muscles originate from the bony point on the outside of the elbow and they are strongly activated to stabilize the wrist with any gripping motion. When load onthe muscles becomes more than they can resist, microscopic tears of the tendon can result. These tears cause inflammation that results in sharp pain on the outside of the elbow or in the forearm muscles with any gripping, lifting or carrying activity.
***
Get full information in this leaflet
WHERE IS THE PAINWHERE PAIN?
This injury is an inflammation at the elbow attachment of the muscles, which bend the wrist and fingers backwards. These muscles originate from the bony point on the outside of the elbow and they are strongly activated to stabilize the wrist with any gripping motion. When load onthe muscles becomes more than they can resist, microscopic tears of the tendon can result. These tears cause inflammation that results in sharp pain on the outside of the elbow or in the forearm muscles with any gripping, lifting or carrying activity.
***
Get full information in this leaflet
Tuesday, October 27, 2009
Ultrasound Therapy (Basic : 2)
Ultrasound Transmission through the Tissues
All materials (tissues) will present an impedance to the passage of sound waves. The specific impedance of a tissue will be determined by its density and elasticity. In order for the maximal transmission of energy from one medium to another, the impedance of the two media needs to be as similar as possible. Clearly in the case of US passing from the generator to the tissues and then through the different tissue types, this can not actually be achieved. The greater the difference in impedance at a boundary, the greater the reflection that will occur, and therefore, the smaller the amount of energy that will be transferred. Examples of impedance values can be found in the literature e.g. Robertson et al 2007,Ward 1986.
The difference in impedance is greatest for the steel/air interface which is the first one that the US has to overcome in order to reach the tissues. To minimise this difference, a suitable coupling medium has to be utilised. If even a small air gap exists between the transducer and the skin the proportion of US that will be reflected approaches 99.998% which means that there will be no effective transmission.
us reflect
The coupling media used in this context include water, various oils, creams and gels. Ideally, the coupling medium should be fluid so as to fill all available spaces, relatively viscous so that it stays in place, have an impedance appropriate to the media it connects, and should allow transmission of US with minimal absorption, attenuation or disturbance. For a good discussion regarding coupling media, see Casarotto et al 2004, Klucinec et al 2000, Williams 1987 and Docker et al 1982. At the present time the gel based media appear to be preferable to the oils and creams. Water is a good media and can be used as an alternative but clearly it fails to meet the above criteria in terms of its viscosity. There is no realistic (clinical) difference between the gels in common clinical use (Poltawski and Watson 2007). The addition of active agents (e.g. anti-inflammatory drugs) to the gel is widely practiced, but remains incompletely researched. We are currently evaluating this intervention further.
As a matter of (clinical) interest, the US treatment should be cleaned with an alcohol based swab (not just wiped with tissue) between treatments (Schabrun et al, 2006) to minimise the potential transmission of microbial agents between patients.
In addition to the reflection that occurs at a boundary due to differences in impedance, there will also be some refraction if the wave does not strike the boundary surface at 90°. Essentially, the direction of the US beam through the second medium will not be the same as its path through the original medium - its pathway is angled. The critical angle for US at the skin interface appears to be about 15°. If the treatment head is at an angle of 15° or more to the plane of the skin surface, the majority of the US beam will travel through the dermal tissues (i.e. parallel to the skin surface) rather than penetrate the tissues as would be expected.
Absorption and Attenuation :
The absorption of US energy follows an exponential pattern - i.e. more energy is absorbed in the superficial tissues than in the deep tissues. In order for energy to have an effect it must be absorbed, and at some point this must be considered in relation to the US dosages applied to achieve certain effects (ter Haar, 1999, Watson, 2008, Watson and Young, 2008).us exponential
Because the absorption (penetration) is exponential, there is (in theory) no point at which all the energy has been absorbed, but there is certainly a point at which the US energy levels are not sufficient to produce a therapeutic effect. As the US beam penetrates further into the tissues, a greater proportion of the energy will have been absorbed and therefore there is less energy available to achieve therapeutic effects. The half value depth is often quoted in relation to US and it represents the depth in the tissues at which half the surface energy is available. These will be different for each tissue and also for different US frequencies. The table below gives some indication of typical (or average) half value depths for therapeutic ultrasound. (after Hoogland 1995)
As it is difficult, if not impossible to know the thickness of each of these layers in an individual patient, average half value depths are employed for each frequency
3 MHz 2.0 cm
1 MHz 4.0 cm
These values (after Low & Reed) are not universally accepted (see Ward 1986) and some research (as yet unpublished) suggests that in the clinical environment, they may be significantly lower.
To achieve a particular US intensity at depth, account must be taken of the proportion of energy which has been absorbed by the tissues in the more superficial layers. The table gives an approximate reduction in energy levels with typical tissues at two commonly used frequencies, and more detailed information is found in the dose calculation material
As the penetration (or transmission) of US is not the same in each tissue type, it is clear that some tissues are capable of greater absorption of US than others. Generally, the tissues with the higher protein content will absorb US to a greater extent, thus tissues with high water content and low protein content absorb little of the US energy (e.g. blood and fat) whilst those with a lower water content and a higher protein content will absorb US far more efficiently. Tissues can be ranked according to their relative tissue absorption and this is critical in terms of clinical decision making (Watson, 2008).
Although cartilage and bone are at the upper end of this scale, the problems associated with wave reflection mean that the majority of US energy striking the surface of either of these tissues is likely to be reflected. The best absorbing tissues in terms of clinical practice are those with high collagen content – LIGAMENT, TENDON, FASCIA, JOINT CAPSULE, SCAR TISSUE (Watson 2000, 2008, Watson & Young, 2008, ter Haar 1999, Nussbaum 1998, Frizzel & Dunn 1982)
The application of therapeutic US to tissues with a low energy absorption capacity is less likely to be effective than the application of the energy into a more highly absorbing material. Recent evidence of the ineffectiveness of such an intervention can be found in Wilkin et al (2004) and Markert et al (2005) whilst application in tissue that is a better absorber will, as expected, result in a more effective intervention (e.g. Sparrow et al 2005, Leung et al 2004).
Pulsed Ultrasound
Most machines offer the facility for pulsed US output, and for many clinicians, this is a preferable mode of treatment. Until recently, the pulse duration (the time during which the machine is on) was almost exclusively 2ms (2 thousandths of a second) with a variable off period. Some machines now offer a variable on time though whether this is of clinical significance has yet to be determined. Typical pulse ratios are 1:1 and 1:4 though others are available (see dose calculations). In 1:1 mode, the machine offers an output for 2ms followed by 2ms rest. In 1:4 mode, the 2ms output is followed by an 8ms rest period. The adjacent diagram illustrates the effect of varying the pulse ratio.
The effects of pulsed US are well documented and this type of output is preferable especially in the treatment of the more acute lesions. Some machines offer pulse parameters that do not appear to be supported from the literature (e.g. 1:9; 1:20). Some manufacturers describe their pulsing in terms of a percentage rather than a ratio (1:1 = 50% 1:4 = 20% etc). The proportion of time that the machine is ON compared with OFF is a relevant factor in dosage calculations and further details are included in the dose calculation support material.
klik here to read more about Ultrasound:
source: http://www.electrotherapy.org/modalities/ultrasound%20basics.htm
All materials (tissues) will present an impedance to the passage of sound waves. The specific impedance of a tissue will be determined by its density and elasticity. In order for the maximal transmission of energy from one medium to another, the impedance of the two media needs to be as similar as possible. Clearly in the case of US passing from the generator to the tissues and then through the different tissue types, this can not actually be achieved. The greater the difference in impedance at a boundary, the greater the reflection that will occur, and therefore, the smaller the amount of energy that will be transferred. Examples of impedance values can be found in the literature e.g. Robertson et al 2007,Ward 1986.
The difference in impedance is greatest for the steel/air interface which is the first one that the US has to overcome in order to reach the tissues. To minimise this difference, a suitable coupling medium has to be utilised. If even a small air gap exists between the transducer and the skin the proportion of US that will be reflected approaches 99.998% which means that there will be no effective transmission.
us reflect
The coupling media used in this context include water, various oils, creams and gels. Ideally, the coupling medium should be fluid so as to fill all available spaces, relatively viscous so that it stays in place, have an impedance appropriate to the media it connects, and should allow transmission of US with minimal absorption, attenuation or disturbance. For a good discussion regarding coupling media, see Casarotto et al 2004, Klucinec et al 2000, Williams 1987 and Docker et al 1982. At the present time the gel based media appear to be preferable to the oils and creams. Water is a good media and can be used as an alternative but clearly it fails to meet the above criteria in terms of its viscosity. There is no realistic (clinical) difference between the gels in common clinical use (Poltawski and Watson 2007). The addition of active agents (e.g. anti-inflammatory drugs) to the gel is widely practiced, but remains incompletely researched. We are currently evaluating this intervention further.
As a matter of (clinical) interest, the US treatment should be cleaned with an alcohol based swab (not just wiped with tissue) between treatments (Schabrun et al, 2006) to minimise the potential transmission of microbial agents between patients.
In addition to the reflection that occurs at a boundary due to differences in impedance, there will also be some refraction if the wave does not strike the boundary surface at 90°. Essentially, the direction of the US beam through the second medium will not be the same as its path through the original medium - its pathway is angled. The critical angle for US at the skin interface appears to be about 15°. If the treatment head is at an angle of 15° or more to the plane of the skin surface, the majority of the US beam will travel through the dermal tissues (i.e. parallel to the skin surface) rather than penetrate the tissues as would be expected.
Absorption and Attenuation :
The absorption of US energy follows an exponential pattern - i.e. more energy is absorbed in the superficial tissues than in the deep tissues. In order for energy to have an effect it must be absorbed, and at some point this must be considered in relation to the US dosages applied to achieve certain effects (ter Haar, 1999, Watson, 2008, Watson and Young, 2008).us exponential
Because the absorption (penetration) is exponential, there is (in theory) no point at which all the energy has been absorbed, but there is certainly a point at which the US energy levels are not sufficient to produce a therapeutic effect. As the US beam penetrates further into the tissues, a greater proportion of the energy will have been absorbed and therefore there is less energy available to achieve therapeutic effects. The half value depth is often quoted in relation to US and it represents the depth in the tissues at which half the surface energy is available. These will be different for each tissue and also for different US frequencies. The table below gives some indication of typical (or average) half value depths for therapeutic ultrasound. (after Hoogland 1995)
As it is difficult, if not impossible to know the thickness of each of these layers in an individual patient, average half value depths are employed for each frequency
3 MHz 2.0 cm
1 MHz 4.0 cm
These values (after Low & Reed) are not universally accepted (see Ward 1986) and some research (as yet unpublished) suggests that in the clinical environment, they may be significantly lower.
To achieve a particular US intensity at depth, account must be taken of the proportion of energy which has been absorbed by the tissues in the more superficial layers. The table gives an approximate reduction in energy levels with typical tissues at two commonly used frequencies, and more detailed information is found in the dose calculation material
As the penetration (or transmission) of US is not the same in each tissue type, it is clear that some tissues are capable of greater absorption of US than others. Generally, the tissues with the higher protein content will absorb US to a greater extent, thus tissues with high water content and low protein content absorb little of the US energy (e.g. blood and fat) whilst those with a lower water content and a higher protein content will absorb US far more efficiently. Tissues can be ranked according to their relative tissue absorption and this is critical in terms of clinical decision making (Watson, 2008).
Although cartilage and bone are at the upper end of this scale, the problems associated with wave reflection mean that the majority of US energy striking the surface of either of these tissues is likely to be reflected. The best absorbing tissues in terms of clinical practice are those with high collagen content – LIGAMENT, TENDON, FASCIA, JOINT CAPSULE, SCAR TISSUE (Watson 2000, 2008, Watson & Young, 2008, ter Haar 1999, Nussbaum 1998, Frizzel & Dunn 1982)
The application of therapeutic US to tissues with a low energy absorption capacity is less likely to be effective than the application of the energy into a more highly absorbing material. Recent evidence of the ineffectiveness of such an intervention can be found in Wilkin et al (2004) and Markert et al (2005) whilst application in tissue that is a better absorber will, as expected, result in a more effective intervention (e.g. Sparrow et al 2005, Leung et al 2004).
Pulsed Ultrasound
Most machines offer the facility for pulsed US output, and for many clinicians, this is a preferable mode of treatment. Until recently, the pulse duration (the time during which the machine is on) was almost exclusively 2ms (2 thousandths of a second) with a variable off period. Some machines now offer a variable on time though whether this is of clinical significance has yet to be determined. Typical pulse ratios are 1:1 and 1:4 though others are available (see dose calculations). In 1:1 mode, the machine offers an output for 2ms followed by 2ms rest. In 1:4 mode, the 2ms output is followed by an 8ms rest period. The adjacent diagram illustrates the effect of varying the pulse ratio.
The effects of pulsed US are well documented and this type of output is preferable especially in the treatment of the more acute lesions. Some machines offer pulse parameters that do not appear to be supported from the literature (e.g. 1:9; 1:20). Some manufacturers describe their pulsing in terms of a percentage rather than a ratio (1:1 = 50% 1:4 = 20% etc). The proportion of time that the machine is ON compared with OFF is a relevant factor in dosage calculations and further details are included in the dose calculation support material.
klik here to read more about Ultrasound:
source: http://www.electrotherapy.org/modalities/ultrasound%20basics.htm
Saturday, October 24, 2009
Ultrasound Therapy (Basic : 1)
Ultrasound (US) is a form of MECHANICAL energy, not electrical energy and therefore strictly speaking, not really electrotherapy at all but does fall into the Electro Physical Agents grouping. Mechanical vibration at increasing frequencies is known as sound energy. The normal human sound range is from 16Hz to something approaching 15-20,000 Hz (in children and young adults). Beyond this upper limit, the mechanical vibration is known as ULTRASOUND. The frequencies used in therapy are typically between 1.0 and 3.0 MHz (1MHz = 1 million cycles per second).
Sound waves are LONGITUDINAL waves consisting of areas of COMPRESSION and RAREFACTION. Particles of a material, when exposed to a sound wave will oscillate about a fixed point rather than move with the wave itself. As the energy within the sound wave is passed to the material, it will cause oscillation of the particles of that material. Clearly any increase in the molecular vibration in the tissue can result in heat generation, and ultrasound can be used to produce thermal changes in the tissues, though current usage in therapy does not focus on this phenomenon (Williams 1987, Baker et al 2001, ter Haar 1999, Nussbaum 1997, Watson 2000, 2008). In addition to thermal changes, the vibration of the tissues appears to have effects which are generally considered to be non thermal in nature, though, as with other modalities (e.g. Pulsed Shortwave) there must be a thermal component however small. As the US wave passes through a material (the tissues), the energy levels within the wave will diminish as energy is transferred to the material. The energy absorption and attenuation characteristics of US waves have been documented for different tissues (see absorption section).
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Ultrasound Waves :
FREQUENCY - the number of times a particle experiences a complete compression/rarefaction cycle in 1 second. Typically 1 or 3 MHz.
WAVELENGTH - the distance between two equivalent points on the waveform in the particular medium. In an ‘average tissue’ the wavelength @ 1MHz would be 1.5mm and @ 3 MHz would be 0.5 mm.
VELOCITY - the velocity at which the wave (disturbance) travels through the medium. In a saline solution, the velocity of US is approximately 1500 m sec-1 compared with approximately 350 m sec-1 in air (sound waves can travel more rapidly in a more dense medium). The velocity of US in most tissues is thought to be similar to that in saline.
These three factors are related, but are not constant for all types of tissue. Average figures are most commonly used to represent the passage of US in the tissues. Typical US frequencies from therapeutic equipment are 1 and 3 MHz though some machines produce additional frequencies (e.g. 0.75 and 1.5 MHz) and the ‘Longwave’ ultrasound devices operate at several 10’s of kHz (typically 40-50,000Hz – a much lower frequency than ‘traditional US’ but still beyond human hearing range.
The mathematical representation of the relationship is
V = F.l
where V = velocity, F = frequency and l is the wavelength.
US Waveform
The US beam is not uniform and changes in its nature with distance from the transducer. The US beam nearest the treatment head is called the NEAR field, the INTERFERENCE field or the Frenzel zone. The behaviour of the US in this field is far from regular, with areas of significant interference. The US energy in parts of this field can be many times greater than the output set on the machine (possibly as much as 12 to 15 times greater). The size (length) of the near field can be calculated using r2/l where r= the radius of the transducer crystal and l = the US wavelength according to the frequency being used (0.5mm for 3MHz and 1.5mm for 1.0 MHz).
As an example, a crystal with a diameter of 25mm operating at 1 MHz will have a near field/far field boundary at : Boundary = 12.5mm2/1.5mm » 10cm thus the near field (with greatest interference) extends for approximately 10 cm from the treatment head when using a large treatment head and 1 MHz US. When using higher frequency US, the boundary distance is even greater. Beyond this boundary lies the Far Field or the Fraunhofer zone. The US beam in this field is more uniform and gently divergent. The ‘hot spots’ noted in the near field are not significant. For the purposes of therapeutic applications, the far field is effectively out of reach.
One quality indicator for US applicators (transducers) is a value attributed to the Beam Nonuniformity Ratio (BNR). This gives an indication of this near field interference. It describes numerically the ratio of the intensity peaks to the mean intensity. For most applicators, the BNR would be approximately 4 - 6 (i.e. that the peak intensity will be 4 or 6 times greater than the mean intensity). Because of the nature of US, the theoretical best value for the BNR is thought to be around 4.0 though some manufacturers claim to have overcome this limit and effectively reduced the BNR of their generators to 1.0.
A couple of recent papers (Straub et al, 2008 and Johns et al 2007) have considered some of the inaccuracies associated with current machines and Pye (1996) presents some worrying data with regards the calibration of machines in clinical use in the UK.
source: http://www.electrotherapy.org/modalities/ultrasound%20basics.htm
Sound waves are LONGITUDINAL waves consisting of areas of COMPRESSION and RAREFACTION. Particles of a material, when exposed to a sound wave will oscillate about a fixed point rather than move with the wave itself. As the energy within the sound wave is passed to the material, it will cause oscillation of the particles of that material. Clearly any increase in the molecular vibration in the tissue can result in heat generation, and ultrasound can be used to produce thermal changes in the tissues, though current usage in therapy does not focus on this phenomenon (Williams 1987, Baker et al 2001, ter Haar 1999, Nussbaum 1997, Watson 2000, 2008). In addition to thermal changes, the vibration of the tissues appears to have effects which are generally considered to be non thermal in nature, though, as with other modalities (e.g. Pulsed Shortwave) there must be a thermal component however small. As the US wave passes through a material (the tissues), the energy levels within the wave will diminish as energy is transferred to the material. The energy absorption and attenuation characteristics of US waves have been documented for different tissues (see absorption section).
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Ultrasound Waves :
FREQUENCY - the number of times a particle experiences a complete compression/rarefaction cycle in 1 second. Typically 1 or 3 MHz.
WAVELENGTH - the distance between two equivalent points on the waveform in the particular medium. In an ‘average tissue’ the wavelength @ 1MHz would be 1.5mm and @ 3 MHz would be 0.5 mm.
VELOCITY - the velocity at which the wave (disturbance) travels through the medium. In a saline solution, the velocity of US is approximately 1500 m sec-1 compared with approximately 350 m sec-1 in air (sound waves can travel more rapidly in a more dense medium). The velocity of US in most tissues is thought to be similar to that in saline.
These three factors are related, but are not constant for all types of tissue. Average figures are most commonly used to represent the passage of US in the tissues. Typical US frequencies from therapeutic equipment are 1 and 3 MHz though some machines produce additional frequencies (e.g. 0.75 and 1.5 MHz) and the ‘Longwave’ ultrasound devices operate at several 10’s of kHz (typically 40-50,000Hz – a much lower frequency than ‘traditional US’ but still beyond human hearing range.
The mathematical representation of the relationship is
V = F.l
where V = velocity, F = frequency and l is the wavelength.
US Waveform
The US beam is not uniform and changes in its nature with distance from the transducer. The US beam nearest the treatment head is called the NEAR field, the INTERFERENCE field or the Frenzel zone. The behaviour of the US in this field is far from regular, with areas of significant interference. The US energy in parts of this field can be many times greater than the output set on the machine (possibly as much as 12 to 15 times greater). The size (length) of the near field can be calculated using r2/l where r= the radius of the transducer crystal and l = the US wavelength according to the frequency being used (0.5mm for 3MHz and 1.5mm for 1.0 MHz).
As an example, a crystal with a diameter of 25mm operating at 1 MHz will have a near field/far field boundary at : Boundary = 12.5mm2/1.5mm » 10cm thus the near field (with greatest interference) extends for approximately 10 cm from the treatment head when using a large treatment head and 1 MHz US. When using higher frequency US, the boundary distance is even greater. Beyond this boundary lies the Far Field or the Fraunhofer zone. The US beam in this field is more uniform and gently divergent. The ‘hot spots’ noted in the near field are not significant. For the purposes of therapeutic applications, the far field is effectively out of reach.
One quality indicator for US applicators (transducers) is a value attributed to the Beam Nonuniformity Ratio (BNR). This gives an indication of this near field interference. It describes numerically the ratio of the intensity peaks to the mean intensity. For most applicators, the BNR would be approximately 4 - 6 (i.e. that the peak intensity will be 4 or 6 times greater than the mean intensity). Because of the nature of US, the theoretical best value for the BNR is thought to be around 4.0 though some manufacturers claim to have overcome this limit and effectively reduced the BNR of their generators to 1.0.
A couple of recent papers (Straub et al, 2008 and Johns et al 2007) have considered some of the inaccuracies associated with current machines and Pye (1996) presents some worrying data with regards the calibration of machines in clinical use in the UK.
source: http://www.electrotherapy.org/modalities/ultrasound%20basics.htm
Wednesday, September 30, 2009
Golf injury
Golf is a popular sport and offers a range of health benefits. Regular golf can help improve stamina, cardiovascular fitness and muscular endurance. For example, the average golfer playing an 18-hole game walks about seven kilometres.
While the risk of injury from playing golf is low compared to other sports, common golf injuries include injuries to the lower back, shoulder, elbow, wrist, head and eye.
Risk factors
Some of the factors that can increase your risk of injury include:
Time spent playing — generally, the more often you play, the higher your risk of injury. Golfers who spend more than six hours per week in competitive play are at increased risk of overuse injuries, as are professional golfers.
Unsupervised children — injuries to children under the age of 10 years are often the result of inadequate adult supervision: for example, children getting hit in the face by swinging clubs.
Incorrect technique — examples include poor swing style and hitting the ground instead of the ball. Incorrect technique dramatically increases the risk of injury. Golfers who perform correct technique are less likely to injure themselves.
Failure to warm up and cool down — warming up and cooling down are extremely important to reduce the risk of muscle and joint injuries.
Previous injury — golf can aggravate existing injuries.
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General health and safety suggestions
Suggestions include:
Warming up is very important
Muscle strains and sprains are more likely to occur if you fail to warm up properly before play. A study of golfers undertaken by the Sports Injury Prevention Unit at Deakin University, Victoria, found that less than three per cent of Victorian golfers warm up properly, while nearly half don’t warm up at all. Suggestions include:
Disclaimer
Physiotherapy and you articles are provided for general information only and should in no way be considered as a substitute for the advice and information your physiotherapist will supply about your particular condition.
While every effort has been made to ensure that the information is accurate, the Australian Physiotherapy Association and the authors and the editors of the articles in this magazine and on this web site accept no responsibility and cannot guarantee the consequences if patients choose to rely upon these contents as their sole source of information about a condition and its rehabilitation.
taken from: http://physiotherapy.asn.au/index.php/physiotherapy-a-you/sports-injuries/golf-injury
While the risk of injury from playing golf is low compared to other sports, common golf injuries include injuries to the lower back, shoulder, elbow, wrist, head and eye.
Risk factors
Some of the factors that can increase your risk of injury include:
Time spent playing — generally, the more often you play, the higher your risk of injury. Golfers who spend more than six hours per week in competitive play are at increased risk of overuse injuries, as are professional golfers.
Unsupervised children — injuries to children under the age of 10 years are often the result of inadequate adult supervision: for example, children getting hit in the face by swinging clubs.
Incorrect technique — examples include poor swing style and hitting the ground instead of the ball. Incorrect technique dramatically increases the risk of injury. Golfers who perform correct technique are less likely to injure themselves.
Failure to warm up and cool down — warming up and cooling down are extremely important to reduce the risk of muscle and joint injuries.
Previous injury — golf can aggravate existing injuries.
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General health and safety suggestions
Suggestions include:
- Make sure equipment, such as clubs and shoes, are professionally fitted.
- Be sun smart. Wear a broad-brimmed sunhat and use sunscreen factor 30+ on all exposed skin. Sunscreen and insect repellent should be carried in your golf bag at all times.
- Drink non-alcoholic fluids before, during and after the game. Take drinks with you in your golf bag to avoid dehydration during play.
- Practice the rules and etiquette of the game; for example, make sure that no one is standing too close when you’re about to swing and always call out ‘fore’ to warn others before you take your shot.
- Obey all safety instructions when driving a motorised golf cart.
- Postpone play if lightning strikes are possible.
- Avoid placing hands in holes / areas where spiders or other dangerous insects might inhabit.
- Supervise young children on the golf course at all times. For example, make sure they don’t stand too close when someone is teeing off and don’t allow them to fool around with golf clubs.
- Ensure adequate rest between games.
- Carry a mobile phone, wherever possible, in case of emergency.
Warming up is very important
Muscle strains and sprains are more likely to occur if you fail to warm up properly before play. A study of golfers undertaken by the Sports Injury Prevention Unit at Deakin University, Victoria, found that less than three per cent of Victorian golfers warm up properly, while nearly half don’t warm up at all. Suggestions include:
- Walk briskly for a couple of minutes to raise your heart rate.
- Warm up your neck and upper back by dropping your chin to your chest, gently rolling your head from side to side in slow half-circles.
- Warm up your shoulders. Hold a golf club horizontal to the ground, keeping your hands about shoulder width apart. Slowly raise the club overhead, hold for a few moments, and lower. Hold the golf club in a similar way but this time behind your back. Raise as high as you can, hold for a few moments, then lower.
- Warm up your torso with side bends. Slide your hand down your leg to support the weight of your torso.
- Twist through the waist; gently and slowly turn from one side to the other.
Disclaimer
Physiotherapy and you articles are provided for general information only and should in no way be considered as a substitute for the advice and information your physiotherapist will supply about your particular condition.
While every effort has been made to ensure that the information is accurate, the Australian Physiotherapy Association and the authors and the editors of the articles in this magazine and on this web site accept no responsibility and cannot guarantee the consequences if patients choose to rely upon these contents as their sole source of information about a condition and its rehabilitation.
taken from: http://physiotherapy.asn.au/index.php/physiotherapy-a-you/sports-injuries/golf-injury
Thursday, July 9, 2009
Physio's Dictionary : E
Physio's Dictionary : E
Eccentric
Controlled, active lengthening contraction of a muscle.
Ecchymosis
Bruising.
Effusion
Swelling, with particular reference to joints and their related superficial structures.
Electrical stimulation
Provides a situation whereby there is an electrical generation of action potentials, giving rise to therapeutically significant physiological responses e.g. increased muscle strength, stmulated lymph and blood flow, analgesia, kinaesthetic awareness and autonomic nervous system responses.
Electrotherapy
Modalities used in the treatment of musculoskeletal disorders e.g. ultrasound, short wave diathermy, interferential therapy, biofeedback, transcutaneous electrical nerve stimulation and laser.
Electromyography
Quantified information regarding overall muscle performance and function.
Endfeel
Physiotherapist appreciation of the "feel" at the end of the range of motion, either of joint or other tissue. This is a sensation felt during passive movement, by the Therapist.
Endorphins
These are endogenous biomechanical substances implicated in the alleviation of pain, produced as a result of body stress.
Entrapment neuropathy
Pathological situation where a nerve is trapped in an abnormally produced anatomical or physiological site.
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Erector spinae
Muscles of the spine that lie posteriorly. These are commonly known as the "anti-gravity" muscles.
Ergonomics
The account of how the workplace relates to the human and its function.
Extra-articular
That which lies external to the joint.
Extraneural
That which lies external to neural tissue.
taken from : http://members.optusnet.com.au/physio/glossa_m.html
Wednesday, July 1, 2009
Physio's Dictionary : D
Physio's Dictionary : D
de Quervain's disease
Inflammation of the tendons and sheath of abductor pollicis longus and extensor pollicis brevis, in the first dorsal compartment of the wrist, with subsequent thickening and stenosis.
Deep transverse frictions
Cross fibre, deep massage. Often a technique utilised on scar tissue and chronic tendon disorders.
Deep vein thrombosis (DVT)
Blockage of the deep veins, particularly common in the calf. Often mistaken for calf strain, the DVT is characterised by sharp pain in the calf, swelling, worsening with foot dependency and relief with elevation, tenderness and possibly some ecchymosis.
Dermatome
Area of skin supplied by one spinal segment.
Disc herniation
Often used interchangeably with disc prolapse, disc bulge, slipped disc etc. Disruption to the normal integrity of the intervertebral disc, causing the nucleus pulposus to breach the annular fibres internally. There are varying degrees, from minor bulging, to bursting through the outer annular fibres into the spinal canal.
Discectomy
Surgical removal of prolapsed nucleus pulposus.
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Double crush syndrome
Defined as a serial impingement of a nerve tract. An initial injury to a nerve (e.g. nerve injury in the neck) may lead to a secondary lesion (e.g. median nerve in the carpal tunnel).
Dupuytren's contracture
A fibrous proliferation in the palmar fascia of the hand, that gradually produces a flexion deformity of the metacarpophalangeal and proximal interphalangeal joints.
Dura mater
Thickest, outermost covering of the spinal cord and spinal nerves. Also lines the inside of the skull.
Dynamometer
Mechanical instrumentation that allows for measurement of concentric and eccentric muscle action, muscle endurance and muscle balance ratios. Usually associated with isokinetic testing, providing variable, accomodating resistance.
taken from : http://members.optusnet.com.au/physio/glossa_m.html
Monday, June 29, 2009
Physio's Dictionary : C
Physio's Dictionary : C
Calcaneal spur
Also called calcaneal enthesiopathy, where there is repetitive microtrauma at the attachment of the Achilles tendon resulting in the formation of a spur, extending from the calcaneum into the tendon.
Carpal tunnel
A "tunnel" formed at the wrist, by the flexor retinaculum and the carpal bones.
Carpal tunnel syndrome
Where there is compression of the median nerve in the carpal tunnel, resulting in sensory and motor disturbances of the hand.
Cauda equina
Lower end of the spinal cord.
Cavitation
Production of gas from liquid.
Central nervous system
The brain, spinal cord and spinal nerves.
Cervical spine
Seven vertebrae - C1 - C7. Articulate with the occiput superiorly and the T1 vertebra inferiorly. Commonly known as the neck.
Chondromalacia patellae
Common name given to softening of the articular cartilage on the undersurface of the patella. Commonly seen in adolescents and commonly associated with functional and biomechanical deficiencies of the patello-femoral joint.
ChoPat strap
An infrapatellar strap, commonly used in the treatment of patellar tendinitis or chondromalacia patellae.
Clarke's test
Compression of the patella with resisted knee extension. Commonly used as a test of chondromalacia patellae but has not been shown to be reliable.
Cloward's spots
Areas of referred pain in the thoracic spine, close to the scapulae, secondary to cervical spine disorders.
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Coccydynia
Pain around the coccyx. Often caused by local trauma, but may also be a referred pain syndrome from the lumbar spine.
Colle's fracture
A common fracture to the distal radius, usually brought about by a fall onto the outstretched hand.
Compartment syndrome
Exercise, or effort, induced pain syndrome, whereby the pain is due to the inability of the muscles within the compartment to expand. Often confirmed by using catheter pressure testing.
Conjoint tendon
The common tendinous insertion of transversus abdominis and internal oblique at the pectineal line.
Contusion
A bruise, often associated with blunt trauma.
Continuous passive motion (CPM)
A form of passive mobilisation, assisting in the recovery of cartliage. Used commonly following knee reconstructions.
Coronary ligament
Lies on the anterior aspect of the knee and attaches the anterior horn of the medial meniscus to the tibial plateau.
Corticosteroids
Anti-inflammatory medication. Can be taken orally (not common) or as an injectable, particularly in superficial tissues undergoing inflammatory pathology.
Cortisone
See Corticosteroids.
Costochondral junction
Junction between rib and costal cartilage. Commonly disrupted in contact sports.
Crepitus
A grinding noise or sensation within a joint. Commonly felt in knees, particularly on change of position after a long period of time.
taken from : http://members.optusnet.com.au/physio/glossa_m.html#C
Monday, June 15, 2009
Physio's Dictionary : B
Physio's Dictionary : B
- Baker's cyst
- Bursitis of the semimembranosus or the medial gastrocnemius bursa. Often presents as a large soft tumour mass in the posterior knee and may be associated with degeneration of the knee.
- Bankart lesion
- An anterior pouch that is formed when the humeral head dislocates anteriorly, and remains following reduction, leaving a deficit in the anterior restraining mechanisms.
- Biarthrodial muscles
- Muscles that span over two joints and have a function over those joints e.g. biceps brachii - shoulder flexion and elbow flexion.
- Biofeedback
- The use of instrumentation to bring covert physiological processes to the conscious awareness of the individual, usually by visual or auditory signals.
- Blood doping
- In its usual form, this involves withdrawal of blood from an athlete, followed by re-infusion after a suitable period of time, usually 4 - 8 weeks, during which time the level of red blood cells had returned to its pre-withdrawal state. The addition of the extra blood would increase the amount of cells available to carry oxygen. This practice has been used to improve endurance. This is a banned practice at elite levels of sport and may be potentially dangerous.
- Bone density
- A description of bone mass and is diminished in osteoporosis. Bone density has also been seen to be diminished in hormone deficiency syndromes, particularly oestrogen depletion.
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Bruxism
Grinding of the teeth, which may be a predisposing factor to temporomandibular joint (TMJ) dysfunction.
Bucket handle tear
A description given to a type of tear of the meniscus of the knee joint, usually medial. The tear is one that extends along the length of the meniscus, within the body of the meniscus. This tear allows for the internal portion of the torn meniscus to slip into the joint. A common cause of a "locked" knee.
Bursa
A fluid filled sac, usually located at areas of friction e.g. between tendon and bone.
Bursitis
Inflammation of the bursa, usually caused by overuse or direct trauma.
taken from : http://members.optusnet.com.au/physio/glossa_m.html#B
Thursday, June 11, 2009
Physio's Dictionary : A
Physio's Dictionary : A
Accessory movement
Joint movements which cannot be performed voluntarily or in isolation by the patient.
Achilles tendinitis
Inflammation of the Achilles tendon, particularly the peritendon. It may be predisposed to this type of condition because of biomechanical, muscular, training and footwear factors.
Acromio-clavicular (AC) joint
Joint between the acromion process of the scapula and the clavicle.
Acupuncture
Needle, laser, electroacupuncture or pressure (shiatsu) can be beneficial in treatment and management of a variety of conditions, primarily to alter pain threshold and/or pain perception.
Adductor tendinitis
Commonly occurring in athletes and horse riders, with localised pain over the tendinous origin of adductor longus from the pubis or at its musculotendinous junction.
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Anabolic steroids
Derivatives of the male sex hormone testosterone and are used as performance enhancing, to increase muscle bulk and strength. Can be taken orally or as an injectable.
Analgesia
Pain relief which may be achieved by use of medication (e.g. aspirin, paracetamol or codeine), modalities (e.g. ultrasound, interferential and laser) or acupuncture.
Ankle sprain
Usually an over stretch of the lateral (outside) ligament of the ankle joint. Can be of varying degrees, from minor over stretch to complete rupture.
Ankylosing spondylitis
A disease process of unknown aetiology, characterised by the presence of bilateral sacroiliitis with inflammatory changes in the spinal joints. The onset is most common in males in their late teens to early twenties. As the name suggests, it is a process which results in a gradual stiffening of the axial skeleton, sacroiliac joints and pubic symphysis.
Annulus fibrosis
This is the peripheral portion of the intervertebral disc, consisting of collagen fibres arranged in a highly ordered pattern. The posterior fibres of the collagen lamellae are thinner and more tightly packed, hence the posterior aspect of the annulus fibrosis is thinner than the rest of the annulus.
Anterior cruciate ligament (ACL)
Intra-articular ligament of the knee, attaching on the anterior portion of the tibial plateau extending upwards and posteriorly to the medial aspect of the lateral femoral condyle. Very frequently injured during twisting type sports (e.g. Australian Rules football, soccer), or those that involve rapid deceleration (e.g. netball). Extrinsic trauma also has a large part to play in ACL injuries.
Anti-inflammatory medication
See Non Steroidal Anti-Inflammatory Drugs (NSAIDs).
Apley's test
A test of meniscal integrity comprising a compression of the knee (in 90� of flexion, with patient lying prone) and then performing both medial and lateral rotation.
Apophyseal joint
See Zygapophyseal joint.
Apprehension test
A test that places the joint in a position that would simulate subluxation or dislocation, with the degree of "positivity" being judged by the level of "apprehension" on the patient's face.
Arthroscopy
Using an intra-articular camera to assist, this less invasive procedure allows the Orthopaedic Surgeon to assess, repair or reconstruct various tissues both within and around joints. Now used preferentially to "open" procedures, when permitted.
Articular cartilage
Covers the ends of bones and allows the distribution of compressive loads over the cross section of bones, as well as providing a near frictionless and wear resistant surface for joint movement.
Atrophy
Usually attributed to muscle, it is a shrinking in size, usually following a period of disuse or immobility.
Avascular necrosis
Death of tissue due to complete depletion of blood supply. Commonly seen with fractures of the femoral neck, leading to death of the head of the femur. May also be seen in scaphoid and navicular fractures.
Avulsion
Usually caused when a muscle is forcefully stretched beyond its freely available range of motion, or when it meets a sudden unexpected resistance while contracting forcefully. Can also occur in ligament injuries, where the insertion of the ligament may pull some bone off when it is damaged.
Axon
This is the main outgrowth of a neurone and is dependent on the cell body.
Axoplasmic flow
This is continually moving cytoplasm within the neurone and provides material synthesized by the cell body to meet the physiological requirements of the cell body, the axon and the target tissues. Disruption to axoplasmic flow results in diminished performance of the neurone.
taken from : http://members.optusnet.com.au/physio/glossa_m.html
Thursday, February 5, 2009
Do You Know Of The Little Known Physiotherapy Method That Has Helped Millions Around The World?
Do You Know Of The Little Known Physiotherapy Method That Has Helped Millions Around The World?
What is McKenzie Physiotherapy And How Can It Help Your Back Pain?
Most people have heard of physiotherapy. The Australian Oxford Pocket Dictionary defines it as "treatment of disease or injury by exercise, massage, heat, light, electricity etc, not by drugs." In some countries such as the USA, physiotherapy is known as physical therapy.
So what do you expect when you go to a physiotherapist with back pain? Obviously as human beings we are all different so we look at things with our own unique perspective and past experiences. The other thing to consider is the therapist. They all have different training and expertise. The other thing to consider is that there are many different theories and treatment methods out there for the treatment of such a common problem. You could go to 100 different therapists and you would probably get 100 different reasons to the cause, the structure that is causing the pain and the treatment that is required in order for you get better.
So, going back to physiotherapy and back pain - when you attend you expect that you will lie on the bed and the therapist will actually do something to you i.e. push or pull and then you may expect a machine that tingles, a hot pack that warms you up a bit and maybe a bit of ultrasound which means the therapist puts abit of gel on the area where you feel the pain and then they move a metal hammer like object over the painful area. At the end of the session, you will probably be shown some exercises. There could be 2 or there could be 4 or 5 different ones. The question is....will you do them? Will you have time in your busy schedule? If you are like most people you probably won't because you may question whether they will really work or you don't see the value of them and they will interrupt you already busy schedule.
So, what is McKenzie Physiotherapy and how is it different? McKenzie Physiotherapy involves some aspects of standard physiotherapy such as exercise and posture but it does not involve machines or massage. It has some very unique aspects to it that make it a very powerful system which means whether you are seeking treatment from a McKenzie therapist in the UK, Japan, the USA or Australia, all McKenzie therapist are speaking the same language and the treatment or management strategies follow a proven and established path.
So, what should you expect when you consult with a McKenzie therapist? What typically happens is the therapist will ask you a number of questions in order to identify a pattern to your problem. The unique aspect is you will then undergo a repeated movement assessment which means you will perform a number of movements in one direction and then repeat a number of movements in another direction. This enables the therapist to find out the big picture of what is happening and to classify your pain problem according to one of 3 mechanical syndromes. The most common syndrome is called a derangement syndrome which means an "internal derangement causes a disturbance in the normal resting position of the affected joint surfaces. Internal displacement of articular tissue of whatever origin will cause pain to remain constant until such time as the displacement is reduced. Internal displacement of articular tissue obstructs movement." What this means in simple language is that clinically some movements will generally make you feel better therefore reducing the internal derangement or displacement and some movements will make you worse thereby increasing the displacement. The aim of the repeated movement testing is to find out what one exercise you need to do and the movements you need to avoid (in the case of the derangement syndrome which is the most common.) Performing this one exercise may result in an immediate reduction in pain and increase in movement. I.e. as you repeated the movement the pain gets less and less and you find it easier and easier to move and therefore function.
The patient is then instructed to perform this one exercise every few hours during the day. The exercise provides is analogous to pain medication. If you are hurting, do the exercise with the aim of reducing the pain. Patients are motivated to do the one exercise because they typically feel an immediate reduction in pain (with the derangement syndrome) and in this instant gratification world, an immediate benefit is what we are all looking for.
Postural correction using a McKenzie lumbar roll in the small of the back is typically another important element in the treatment of the derangement syndrome.
The unique system of classifying a patients pain according to their response to repeated movement was developed by and amazing man; New Zealand physiotherapist Robin McKenzie back in the 1950's. He is internationally acclaimed and spent the last 40 years or so developing, teaching and involved in research in the system known as "Mechanical Diagnosis & Therapy." In 1990, he was named Office of the Most Excellent Order of the British Empire (OBE) by Queen Elizabeth II and in January 2000 in the New Year Honors, the Queen appointed him to an even higher order, naming him a Companion of the New Zealand Order of Merit (CNZM). To see him speak about how he accidentally began to develop the system, go to: http://tvnz.co.nz/view/page/488120/1035239
The McKenzie Method of Mechanical Diagnosis & Therapy (MDT) is now taught in 34 countries around the world. Physiotherapists trained in the MDT have basic level training (credentialed) or advanced level training (diploma). The McKenzie Institute International website: www.mckenziemdt.org has a list of trained therapists.
Sandra McFaul - McKenzie Physiotherapist - ADVANCED level
Committed to Controlling Back Pain Using McKenzie Physiotherapy
She is one of 15 therapists in Australia and one of around 400 world-wide with this level of expertise. Her passion is helping people who suffer with chronic & recurrent spinal pain at her clinic ATA...Physiotherapy that Empowers! based at 95 Corunna Rd, Stanmore - the Inner West of Sydney, NSW, Australia.
taken from : http://www.physiozilla.com/
Physio and having a baby
Physio and having a baby
Change to muscles, ligaments and joints during and after pregnancy affect the whole body. Physiotherapists help women manage these changes, providing expert care and advice during pregnancy, childbirth and beyond.
CHILDBIRTH PREPARATION CLASSES
When preparing for childbirth and parenthood, women and their partners benefit from learning a range of physical techniques and coping skills.
Physiotherapists have the expertise to teach these skills, which include positioning, rhythmic movement, massage, relaxation and breathing awareness.
FITNESS CLASSES
Exercise during pregnancy assists a return to normal body shape, muscle tone and strength after the baby is born.
Physiotherapists run ante-natal and post-natal low impact exercise classes (some in water) specifically for pregnant women and new mothers. These classes are designed to strengthen muscles, relieve pain and improve general fitness. Exercise in water has a number of particular benefits such as relieving swollen legs and promoting relaxation.
BACK AND NECK PAIN
The weight of a growing baby causes changes to posture and puts strain on the back, pelvis, neck and shoulders. After the birth, everyday activities like lifting, carrying and feeding the baby can also lead to muscle soreness and joint problems.
Physiotherapists help women prevent and overcome pain in these areas through safe and effective therapies, including specific strengthening and stretching exercises, posture correction, gentle spinal movement and massage.
ABDOMINAL MUSCLE WEAKNESS
During pregnancy, the abdominal muscles are stretched and weakened. They may also separate down the midline.
Abdominal muscle weakness results in poor muscle control and backache.
Physiotherapists are trained to prescribe specific abdominal exercises to assist full recovery.
BREAST PROBLEMS
Blocked breast ducts and mastitis cause pain and breastfeeding difficulties.
Physiotherapists use ultrasound and massage to help mothers continue breastfeeding.
INCONTINENCE AND PROLAPSE
The pelvic floor muscles help support the pelvic organs. Pregnancy and childbirth may weaken these muscles, increasing the risk of incontinence (uncontrolled loss of urine or faeces) and prolapse (pelvic organs bulging into the vagina). Straining from constipation can also damage the pelvic floor muscles.
With expert assessment, treatment and instruction in self-help techniques, physiotherapists can help women prevent or reduce those problems.
taken from : http://www.physiotherapy.asn.au/
Monday, February 2, 2009
Pediatric Disorders and Physiotherapy to Help Them
Pediatric Disorders and Physiotherapy to Help Them
Most of us find illness and injuries to children uniquely distressing. We instinctively seek to protect children from harm and suffering. But we have to accept the reality that many pediatric disorders do occur. Fortunately, physiotherapy (physical therapy) can often help.
Among the many pediatric disorders, a few common examples are: scoliosis, torticollis, Osgood-Schlatter, sports and traumatic injuries, reluctant walkers, developmental disorders, cerebral palsy, and genetic disorders.
Physiotherapy for scoliosis - a curvature of the spine - consists of exercises to strengthen the back. Electrical stimulation is used for this type of pediatric disorders. The stimulation goes directly to the skeletal muscles. Chiropractic is also used in an effort to straighten the spine.
Torticollis is a type of pediatric disorders of the neck. There is a problem with one of the muscles of the neck so that the child is not able to hold his head up straight. The head will be tilted to one side. This chin will jut out on the opposite side of the neck. Physiotherapy can stretch this muscle so that the child can hold his head more normally.
Spinal cord injuries as pediatric disorders are difficult to treat. Children often do not want to do the work that is required to stay ahead of the deterioration that can be caused by this condition. Physiotherapy personnel are challenged to keep the child's spirits up as they teach them how to exercise with and without special equipment.
Brain injuries, including cerebral palsy and strokes are pediatric disorders that must be managed delicately. The neurological system is often not as sturdy as the skeletal or muscular systems. However, brain injuries also involve these other systems as well.
A new treatment for these pediatric disorders like brain injuries is using hyperbaric oxygen therapy (HBOT). In an atmosphere of high pressure oxygen, certain disfunctional areas of the brain may sometimes be revived.
Pediatric disorders such as sports injuries and traumatic injuries require different types of physiotherapy based upon the location and severity of the injury. If a child has repeatedly sprained the same ankle, therapy will necessarily focus on that ankle, as well as any body part that supports or counterbalances that ankle. Overall strength is important.
Traumatic injuries require a certain amount of psychological training, as the subject of the accident or other ordeal may bring on such distress that the child does not want to work. A good physiotherapist will be able to work with such a child. Traumatic injuries can also be severe enough that the physiotherapist plans a lengthy course of therapy to overcome them. Pediatric disorders like this require patience from everyone involved.
The list of pediatric disorders is long and varied. Not all of them can be helped by physiotherapy at this time. Presently, physical therapy can be used in many cases to relieve symptoms or even to reverse damage. Physiotherapy performs a valuable function in helping children live more normal lives.
Source : http://thephysiosite.com/
The Benefits of Physiotherapy for Amputee Rehabilitation
The Benefits of Physiotherapy for Amputee Rehabilitation
Losing a limb is a devastating blow for anyone. It requires a team of professionals to make the adjustment to life without the limb. A physician, a prosthetist, nurses, and a psychologist are all needed. Add to that list a physiotherapy service, which will help with amputee rehabilitation.
The benefits of physiotherapy for amputee rehabilitation are numerous. For one, amputees will need help in overcoming phantom pains. These are pains where the limb used to be. The sensation really is in the nerve that would lead to that limb if it were still there. Physiotherapy can use its own techniques to treat this pain.
Most amputees will be getting a prosthetic limb. Some feel that it should be enough to learn how to put it on. It is not an automatic thing to get used to a prosthetic limb. Many patients have them for years without ever having normal functioning with them. This is one reason amputee rehabilitation is so important.
Physiotherapy can benefit amputee rehabilitation by gradually getting the patient accustomed to using a prosthetic limb. The physiotherapy plan for this will be based upon the needs and abilities of the patient.
The patient will probably need help during amputee rehabilitation to learn balance all over again. This is especially true is the affected limb is a foot or leg. However, having an arm that is of a different weight than the other may be unbalancing as well. Physiotherapy can help with these problems too.
One thing people going through amputee rehabilitation need to realize is that gait is a good deal of the battle. If one walks correctly, people will not even be able to detect one's limp, even with a prosthetic leg. This skill can be learned from physiotherapists.
If a patient has waited a long while before seeking physiotherapy after surgery, a problem may arise. Certain muscles may become overdeveloped and others weakened. This happens because, without proper amputee rehabilitation, the patient relies on one set of muscles to the exclusion of others. A proper plan of physiotherapy can address this issue.
People who have lost a limb will need an individualized exercise program. Physiotherapy can provide such a program during amputee rehabilitation. This will take into account the different movements needed by amputees to perform normal exercises.
Manual therapies, such as massage, are a part of amputee rehabilitation with physiotherapy. This can relieve much pain and tension in the muscles that are overworked in getting used to their new situation. Other treatments can be used. Some of them are heat, acupuncture, ultrasound, and electrical stimulation.
There is a need for physiotherapy in amputee rehabilitation that no other discipline can fill. It is a basic kind of help that anyone who has lost a limb can use. Some amputees decline treatment because they do not think it is necessary. Others feel overwhelmed by their loss. If there is a way to convince amputees to get physiotherapy to help them with their rehabilitation, they will find recovery a much smoother path.
Source : http://thephysiosite.com/
Types of Physiotherapy That Help Lower Back Pain
Types of Physiotherapy That Help Lower Back Pain
Lower back pain plagues Americans to the extent that 80% will suffer from it at some time in their lives. It is one of the most common reasons people visit the doctor. For many, the problem is more than a passing incident; they need physiotherapy.
Physiotherapy of different types can be used to treat lower back pain. Acupuncture is fast becoming an important method for the relief of such pain. The doctor has the patient lie face-down and inserts the acupuncture needles across the back. The doctor then finishes the procedure for lower back pain. Pain relief after a series of treatments usually lasts months.
Massage is also used for lower back pain. The massage used must be done by someone well-versed in the treatment of lower back pain. A massage done by an untrained person may do more harm than good.
These methods are called passive therapies, or modalities. They are done to the patient and not by the patient. There are other modalities that are commonly used. Heat and ice packs are a well-known form of passive physiotherapy. They can be used separately, or they can be used alternately by a person who is suffering from acute lower back pain.
A transcutaneous electrical nerve stimulator (TENS) can be used as another modality for lower back pain. The patient will feel the sensation of the stimulator instead of his pain. If the TENS unit seems to work well for him, he will be sent home with one to use at his convenience.
Ultrasound is especially useful as a passive therapy for anyone with acute lower back pain. It delivers heat deep into the muscles of the lower back. This not only relieves pain. It can also speed healing.
Back exercises may be assigned by a physiotherapist. These exercises will help with lower back pain if one does them correctly and faithfully. The only exception is if the back is in an acute condition requiring emergency care or surgery.
The exercises that will help with lower back pain the most will be assigned and supervised by a physiotherapist. They may be done at home, but it will be necessary to follow instructions and check in frequently.
These exercises include ones for lower back pain that stretch or extend the back and ones that strengthen it. One is an exercise where one lies prone and moves as if swimming. This protects the back while giving the surrounding muscles a workout.
Lower back pain exercises called flexion exercises strengthen the midsection to provide support for the back. If the lower back pain is reduced when one sits, these exercises are important. One is a knee-to-chest exercise.
Aerobic exercise such as walking is excellent for reducing and preventing lower back pain as well. Massage and acupuncture can be counted on to relieve pain for most patients. Exercises can make the back stronger to both relieve and prevent lower back pain. Any physiotherapy that can help relieve lower back pain will help millions of people.
Source : http://thephysiosite.com/
Why Physiotherapy Can Help Women's Health
Why Physiotherapy Can Help Women's Health
The subject of women's health encompasses a range of issues that can be treated by physiotherapy. From pregnancy back pain to incontinence problems faced by older women, physiotherapy is there to help.
Bladder incontinence is a problem for 13 million Americans on any given day. Although some men have this problem, it is present in much greater numbers in the area of women's health.
There are several different kinds of incontinence. Stress incontinence happens when the person coughs or sneezes and urge incontinence means the person has sudden urges to use the restroom, for example. Organ prolapse, such as a tilted uterus, can lead to incontinence, as well as sexual dysfunction. This is another area of women's health physiotherapy can help.
Physiotherapists who work in the field of women's health can correct nearly 70% of incontinence problems. The major exercise used is the Kegel. It is a very specialized exercise, and at least half the people who try to do it on their own fail miserably. It takes biofeedback for many to get it right.
Many of the problems of women's health can be traced to the pelvic floor. The Kegel is the exercise that addresses this part of the anatomy. However, other therapies are used as well. Electrical stimulation is only one of the methods used. Soft tissue manipulation is another treatment that has been tried.
Pelvic pain affects many women's health. It may come from a variety of sources. It can be due to vulvodynia or abdominal surgeries, for example. One can have pelvic pain after falling, especially if one lands on the tailbone. These conditions often curtail sexual activities and lead to an overall deterioration in women's psychological health. Physiotherapy offers many treatments to help these problems.
No discussion of how physiotherapy helps with women's health would be complete without a word about pregnancy. Women who are pregnant know that their bodies go through various changes that can be painful. Low back pain is only one of them.
Physiotherapists can help with this. Gentle exercises can be taught to relieve tension in the back. One is to lie on the floor with the knees up and press the small of the back to the floor. This gives a great feeling of relief. Other exercises strengthen the woman's back, but few people besides physiotherapists know how far to go with exercising when pregnant. Women's health is important at this time, and so is the baby's.
Physiotherapists can also give instructions on what amount of exercise is best for pregnant women. After delivery, physiotherapy is a boon to women's health. It can help get women back into shape and instruct them in taking care of their new child while preventing back problems. Another area of postpartum women's health is the treatment of women who have had cesarean sections.
Physiotherapy can help women's health because there are so many conditions that women suffer. Many of these conditions will respond to physiotherapy. It is only natural that women would turn to a tried and true method for relief.
Source : http://thephysiosite.com/
The History of Physiotherapy
Introduction to Physiotherapy
(The History of Physiotherapy)
Physiotherapy is as old a medicine itself, dating back to Ancient Greece in the era of Hippocrates. Since then, physiotherapy has evolved from simple massage to a complex portfolio of therapies with many specialized applications.
In Ancient Greece circa 460 BC, Hector practiced a physiotherapy technique called "hydrotherapy" - which is Greek for water treatment. Physiotherapists today still employ hydrotherapy, now evolved and adapted specifically to various patient conditions.
In 1894, the UK recognized physiotherapy as a specialized branch of nursing regulated by a Chartered Society. In the succeeding two decades, formal physiotherapy programs were established in other countries including New Zealand (1913) and the USA (1914).
The first record of American physiotherapy was at Walter Reed College and Hospital of Portland, Oregon where nurses with physical education experience worked as "reconstruction aides". These "reconstruction aides" contributed vitally to the recovery and rehabilitation of many WWI vets.
In 1921, Mary McMillan formed the Physical Therapy Association in the USA. Subsequently renamed the APTA, this organization profoundly influenced development of physiotherapy in America.
The polio epidemic of the 1920's was a landmark turning point for the physiotherapy profession. Sister Kinney, of the Mayo Clinic achieved national reknown for work with polio victims. The Georgia Warm Springs Foundation was established in 1924 in response to the polio epidemic and provided physiotherapy for these polio patients.
After the polio epidemic subsided, physiotherapy treatments comprised mainly exercise, massage and traction. From 1950, chiropractic manipulations were also introduced, most commonly in Great Britain initially. The Orthopedics specialty within physiotherapy also emerged at about the same time.
From that date, physiotherapy expanded from hospitals out to other areas of medical care. Physiotherapists now work also in clinics, nursing homes, private practice and schools.
Research has long been a feature of modern physiotherapy, dating from the first USA research study publication in 1921. Research continues actively today in a wide range of specialties.
A significant force in the recent evolution of physiotherapy has been the International Federation of Orthopaedic Manipulative Therapy. Notable individuals driving change in technique and training have included Mariano Rocabado (Chile); Freddy Kaltenborn (Norway/USA); and Geoffrey Maitland (Australia).
During the 1980's, technology became the focus of change in physiotherapy. Novel procedures featured computers, electrical stimulation, ultrasound and other new equipment. However, led by Freddy Kaltenborn, interest reverted to manual therapy in the following decade.
Throughout development of the Physiotherapy profession, training and technique have continued to change and improve. Gifted pioneers have contributed richly to the profession's literature and field organizations. In consequence, Physiotherapy now commands wide recognition and well-earned respect, with many young people expressing interest in making their career in the profession.
Source : http://thephysiosite.com/
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