Your Physical Therapy

Massage is techniques used by physical therapist in some of cases that may needs, In general patient always thinks that massage is a good idea whatever his\her case, but you must know that massage is not always good for you. It can be harmful for some of cases 

Indications of massage is techniques

1- General muscle stiffness 

2- General muscle fatigue

3- Chronic arthritis 

4- Spasm result from central nerve system (CNS) injures such as Cerebral Palsy, Stroke, Head injury

5- Aching pain with activities of daily living 

6- Peripheral edema result from cardiac insufficiency or circulatory problems especially after excision of lymphatic nodes 

7- Peripheral nerve system lesion as in Facial Palsy if its not associated with inflammation

8- Scars resulted from closed wounds or burns

9- For increase skin elasticity and reduce aging signs

10- General relaxation

11- Lower respiratory track infection to remove sputum

12- Stimulation of motor areas in CNS or Peripheral NS lesion

Contraindications of massage is techniques

1- Burning or stumping pain

2- Acute pain result from sudden injury

3- Areas with localized swelling

4- Pain increasing gradually after short time

5- Pain at rest

6- Infected areas

7- Un-heal scars or fractures

8- Sensitive areas such as eyes, carotid arteries ets...

9- Thrombosis, embolism or atherosclerosis

10- Acute stage of inflammation

11- Sport injures such as tendinitis or tendon sprain

12- Tumors

Many different modalities used in physical therapy plan of treatment local heat or local cold is on of this modalities, It was used from long years , The therapeutic uses of heat is know as thermotherapy while the therapeutic uses of cold is know as cryotherapy

A- Local Heat

1- Hot Packs

kept at 70-75 C , requires 2 hours for initial heat and 30 min between uses

Advantage : 

easily , inexpensive
short time required
safe , and there is different shapes

2- Paraffin Paths

The temp of Paraffin Paths 45 - 50 C

Advantage :

maintain good contact,
easily , inexpensive
the part can be elevated

3- Fluidotherapy 

the temp is controlled its dry heating agent that transfers heat by convection

Effect and uses of heat
A- Effect

1- Increase blood flow, application of heat causes Vasodilation ( dilation of capillary )
2- Reduction of muscle spasm and relaxation of muscle contraction
3- heat causes increase extensibility of soft tissues ( stretching )

B- Uses

1- Pain control
2- Increase Rang of motion (ROM)
3- Acceleration of healing

1- Avoid use heat in Acute injury or Inflammation or muscle strain

2- Avoid use heat in hemorrhage cases or over an open wounds or burn
3- Avoid use heat in poor sensation cases
4- Avoid use heat in cases of Thrombosis


1- Cold Packs

temp 0-5 C
duration : 10-15 min, can be repeated after 1-2 hours

Advantage

easy, inexpensive
cover large area of body
can be applied with elevated

2- Ice Massage

Advantage

inexpensive
can be observed during treatment
can be use for small or large area of body

Effect and uses of Cold

A- Effect

1- initial decrease of blood flow then increase in blood flow ( Vasoconstrection then Vasodilation )
2- increase pain threshold and decrease sensation of pain
3- decrease spasticity
4- facilitation of muscle contraction

B- Uses

1- inflammation , acute injury control
2- Edema control by decrease intravascular fluid pressure and increase blood viscosity After trauma using ice with compression and elevation
3- Pain control
4- symptom management in multiple sclerosis

Contraindication of use cold
1- cold hypersensitivity
2- cold intolerance
3- over an area with peripheral vascular disease
4- over an area with circulatory compromise
5- over regenerating peripheral nerve

Before we post 

goniometer for Shoulder joint 

goniometer for Elbow joint  

goniometer for Hip joint

before we post 

goniometer for Shoulder joint 

goniometer for Elbow joint  

goniometer for Hip joint

before we post goniometer for shoulder joint and goniometer for elbow joint  

Part - 3 -Hip Joint

A- Flexion 

1- Patient in supine position with knee flexed to avoid the limitation from tight hamstring and stabilize pelvic to avoid any pelvic tilt or rotate    

2- Place the central of goniometer over the greater trochanter and the stationary goniometer arm parallel to the vertebral spine 

3- Ask the patient to flex his\her hip as much as possible 

4- By moving the other arm of goniometer parallel to femur to form the goniometer angle

5- Read the degrees 

Normal range for hip flexion 

• 121.0o + or - 6.4o (American Academy of Orthopaedic Surgeons)
• 100.0o (American Medical Association)
• 122.3o (mean), 6.1o (standard deviation), (Boone and Azen)

B- Extension

1- Patient in prone position, stabilize pelvic to avoid any pelvic tilt or rotate 

2- Place the central of goniometer over the greater trochanter and the stationary goniometer arm parallel to the vertebral spine 

3- Ask the patient to extend his\her hip as much as possible 

4- By moving the other arm of goniometer parallel to femur to form the goniometer angle

5- Read the degrees

you can see Part -1- Shoulder joint

part -2- Elbow joint

• 141° ± 4.9° (American Academy of Orthopaedic Surgeons)
• 140° (American Medical Association)
• 142.9° (mean) 5.6° (standard deviation), (Boone and Azen)

Shoulder Joint 

A- Flexion 

1- Patient in supine position

2- place the center point of goniometer in the center of shoulder joint just above humerus head

3- ask the patient to flex his\her shoulder joint as much as possible

4- fix one of goniometer arms and moved the other Parallel to humerus

5- then read the degrees 

Normal range for Shoulder flexion 

• 167° ± 4.7° (American Academy of Orthopaedic Surgeons)
• 150° (American Medical Association) 
• 166° (mean), 4.7° (standard deviation), (Boone and Azen) 

B- Extenion

Normal range for Shoulder extension 

• 62° ± 9.5° (American Academy of Orthopaedic Surgeons) 
• 50° (American Medical Association) 
• 62.3° (mean), 9.5° (standard deviation), (Boone and Azen) 

C- Abduction \ ِAdduction 

1- Patient in supine position

2- place the center point of goniometer in front of the center of shoulder joint just above humerus head

3- let the both arms of goniometer run Parallel to the sternum 

4- ask the patient to extend his\her shoulder joint as much as possible 

5- with fix one of goniometer arms and moved the other Parallel to humerus

6- then read the degrees

Normal range for Shoulder Abduction

• 184° ± 7.0° (American Academy of Orthopaedic Surgeons)
• 180° (American Medical Association)
• 184° (mean), 7.0° (standard deviation), (Boone and Azen)

D- Internal rotation

1- Patient in supine position with elbow flixed 90 shoulder abducted 90

2- place the center point of goniometer over olecranon process of ulna

3- let the both arms of goniometer Vertical to the bed

4- ask patient for internal rotation as much as possible

5- with fix one of goniometer arms and moved the other Parallel to ulna 

6- then read the degrees

Normal range for Shoulder Internal rotation 

• 69° ± 4.6° (American Academy of Orthopaedic Surgeons) 
• 90° (American Medical Association) 
• 68.8° (mean), 4.6° (standard deviation), (Boone and Azen) 

E- External rotation

1- Patient in supine position with elbow flixed 90 shoulder abducted 90

2- place the center point of goniometer over olecranon process of ulna

3- let the both arms of goniometer Vertical to the bed

4- ask patient for internal rotation as much as possible

5- with fix one of goniometer arms and moved the other Parallel to ulna 

6- then read the degrees 

Normal range for Shoulder external rotation 

• 104° ± 8.5° (American Academy of Orthopaedic Surgeons)
• 90° (American Medical Association) 
• 103° (mean), 8.5° (standard deviation), (Boone and Azen)

Therapeutic ultrasound is type of sound with frequency of greater than 20.000 cycles per second Hz, Human frequency hearing of sounds is from 16 to 20.000 Hz so we can't hear that sound. Therapeutic ultrasound has physical effects that can be typed as Thermal and Non-thermal. The treatment session for Therapeutic ultrasound is from 5-10 minutes only

What you feel if Therapeutic ultrasound used in you?

Normally patient will feel nothing, sometimes patient may feel slightly hot in the place that physical therapist apply Therapeutic ultrasound . physical therapist will always keep move the head of therapeutic ultrasound and if not, you will feel pain on the area, if you feel that pain directly tell your physical therapist.

Types of Therapeutic ultrasound

A- Thermal Ultrasound 

used for heat deeply in the skin and smaller areas, it can be reach up to 5 cm depth and provide heat effect for joints capsule, ligaments and tendons 

Thermal Effects:

1- Increases metabolic rate 

2- Improve the extensibility of collagen structures 

3- Help in decreases joint stiffness

4- Pain relief 

5- Improve blood circulation for the area

6- Decrease muscle spasm 

B- Non-thermal Ultrasound 

Cavitation, microstreaming and acoustic streaming are the cause if Non-thermal effects of Ultrasound 

Non-thermal Effects:

1- Increase calcium of intracellular 

2- Increase permeability of skin and cell membrane 

General caution for use therapeutic ultrasound

1- Malignant tumor

use therapeutic ultrasound over a limb or body part with a malignant tumor you should consult the referring physician for patient with history of malignant tumor

2- Pregnancy 

use therapeutic ultrasound over the abdomen, low back, or pelvis for females who is or may be pregnant

3- Pacemakers

use therapeutic ultrasound must avoided over the pacemaker area, but can be used over other areas of body

4- Thrombus 

use therapeutic ultrasound must avoided over or near area where thrombus is or may present 

5- Eyes 

use therapeutic ultrasound must avoided to uesd over eyes it can damage patient eyes

Range of motion (ROM) can be measured by goniometer using degrees on it,  there is different types of range of motion and here we going to discuss the types one by one

1- A.R.O.M (active range of motion) 

On of the ROM type, in AROM the patient moves his\her part freely without any help from Physical therapist, assistive device, or gravity. the motion only provide by the power of his\her muscles

3- P.R.O.M (passive range of motion) 

On of the ROM type, that the patient can not move his\her part at all. so this type of motion can't be done without Physical therapist hands, assistive device, or gravity 

4- A.R.R.O.M (active resisted range of motion). 

On of the ROM type, that the patient moving his\her part against the gravity or opposite to physical therapist hands power, assistive device power