Physical therapy in osteoarthritis

Physical therapy has an important role in treating rheumatic diseases; its goal is to reduced pain, swelling and to keep joints mobile. The properly manage osteoarthritis is nonpharmacological and pharmacological modalities. Physical therapy applied as a remedy for osteoarthritis is a part of multimodal therapy. The basis for physical therapy management is determined by the recommendation of the physical therapeutic science and evidence-based medicine. When making a decision about application of different methods of treatment in physical therapy, it is important to correctly diagnose a structural transformation and functional problem. Systematic review of the scientific, evidence-based, international concensus recommendations for the management of the osteoarthritis published between 2000 and 2010 were identified high-quality evidence therapy practice that is efficient and effective in increasing movement capability function, and reduce pain, disability, medical intake and improved physical function for patients with osteoarthritis     

Physical therapy of arthroses

The physical therapy of arthrosis as a symptomatic and stage-oriented therapy is illustrated in a review. All of the various therapeutic procedures are discussed regarding their effectiveness and applicability in the different stages. There have been some changes within the last few decades and treatments have been introduced with more or less success. Mild thermotherapy of active arthrosis, suggested earlier, has been replaced by cryotherapy, which is more effective. Peloid therapy has now also been introduced into this cryotherapy, which only used to be applied as a type of heat therapy. Naturally, most of the new developments are in the field of electrotherapy. Nevertheless, the newer types have not led to any significant improvement in therapeutic success compared with "classical" electrotherapy (diadynamic, Tr?bert ultrastimulation, interferential current). The only remarkable innovation seems to be therapy with low-frequency magnetic fields, although the basic means of the working mechanism have not been thoroughly investigated. Regarding the most recent publications, laser therapy has not shown complete proof of its effectiveness. Passive physical therapy of arthrosis only shows persistent success when it is combined with a careful amount of physical therapy.     

Physical therapy in rheumatology

Rheumatic diseases are the leading cause of chronic disability. Physical therapy and rehabilitation are an integral part of the strategy of treatment of rheumatic diseases in order to maintain the function of the musculoskeletal system. Early detection of disability provides a more efficient implementation of all measures of physiotherapy treatment. Exercises are the most important form of physiotherapy. Long-term effect of exercise is possible only if patients achieve adherence to the program. Questionnaires activities of daily living asses functional status of patients, can be a guide for planning the rehabilitation program and indicator of the effectiveness of therapeutic intervention as well. Methods of physical therapy and rehabilitation are part of all published guidelines for the management of rheumatoid arthritis, spondyloarthritides, osteoarthritis, osteoporosis, chronic back pain, chronic non-malignant pain and fibromyalgia.     

Physical therapy following peripheral nerve surgeries

Post-operative care of the surgical patient significantly contributes to the success of the surgical procedure. Post-operative physical therapy is directed at reducing pain and inflammation, preventing or minimizing scar tissue, and returning the patient to full function.An individualized and well-planned therapeutic exercise program is an integral part of the post-operative care. Manual therapy techniques are utilized to break up scar tissue and reduce joint stiffness.Pain and inflammation can be addressed by modalities such as ultrasound, laser, and electrical stimulation in addition to cryotherapy.     

Physical therapy rehabilitation of the ankle

Physical therapy intervention following an ankle injury is crucial and essential to returning a patient to his/her prior level of function. Following a physical therapy evaluation, a physical therapy diagnosis is established by relating the physical impairments found (e.g., limitations in range of motion, strength, proprioception, etc.) to functional limitations. The goal of physical therapy intervention is to improve these physical impairments, thereby restoring a patient's normal function. The physical therapist can administer such treatment as joint mobilization, strength training, proprioceptive training, and patient education. Since individuals vary in the extent and severity of physical impairments, physical therapy intervention will also vary on a patient-by-patient basis. Therefore, the purpose of this article is not to serve as a protocol for physical therapy intervention but as a review of evidence-based treatment that is relevant for the impairments found after completing a physical therapy evaluation.     

Physical therapy: its use in podiatry

This paper presents a review of the literature of various modes of physical therapy available to the podiatrist. Included are superficial and deep heating agents, applications of cold, and massage. Their methods of application, physiological responses, indications, and contraindications are discussed.     

Physical therapy in a value-based healthcare world

Musculoskeletal conditions are important contributors to United States healthcare spending and are certain to play an important role in the future as the population continues to age. Almost half of the population of the United States experiences a musculoskeletal condition annually. Meeting the needs of these individuals within a changing healthcare delivery and reimbursement environment prompted a recent Summit sponsored by the United States Bone and Joint Initiative (USBJI). The Summit dealt with a topic critical to the future of healthcare for clinicians, consumers, and payers alike: value. We do not operate within a value-based healthcare system. Our current delivery system continues to reward volumes, not value. Failure to focus on value has had devastating consequences. The challenge of shifting from a volume-based to a value-based system is central to the future of healthcare. Discussion and action will be critical for the physical therapy profession moving into the future.     

Physical therapy and rehabilitation in rheumatic diseases

General principles of physical medicine and rehabilitation of rheumatic diseases are described. In knee and hip osteoarthritis it is important to protect full extension and in evolutive phase treat with drugs, unloading and physical therapy. Rest and ice are efficacious in active rheumatoid arthritis and in chronic phase all procedures and exercises are recommended with respect to pain threshold. Physical therapy for spondy larthropathies is directed to maintenance range of motion exercise for spine and breathing exercises. Swimming is the most appropriate recreational activity for spondylarthropathies.     

Physical therapy and rehabilitation in chondral lesions

Although most patients with articular cartilage defects are asymptomatic, some may have symptoms such as pain, effusion, muscle weakness, and limited range of motion. The goals of rehabilitation in chondral lesions are to relieve clinical symptoms, obtain painless full range of motion and muscle strength, and improve function. The key point in the rehabilitation program is to improve sensorimotor function and decrease pain and disability without increasing cartilage degeneration. Basic principles in the postoperative rehabilitation period are the same as those in conservative treatment. However, the rehabilitation program should be modified depending on the surgical procedure. Each phase of the rehabilitation program should be designed considering the type of surgical procedure, estimated healing time, restoration of joint mobility and muscle strength, and the extent of pain and effusion. Exposing the healing cartilage to shear stress under compression may have adverse effects on the healing process. For this reason, the early stage of rehabilitation (0-6 weeks) is comprised of passive, active-assistive and non-weight bearing range of motion exercises. Postoperative weight-bearing depends on the size, nature, and location of the lesion and the surgical procedure. Restriction in weight bearing is recommended in all treatment procedures except for cartilage debridement. For a successful outcome, open communication should exist between the rehabilitation team and the surgeon and the rehabilitation program should be individualized.