Physiotherapy

Types of Physiotherapy

Exercise

Exercise is anything you do in addition to your regular daily activity that will improve your flexibility, strength, coordination, or endurance. It even includes changing how you do your regular activities to give you some health benefits. For example, if you park a little farther away from the door of the grocery store, the extra distance you walk is exercise. Physiotherapy nearly always involves exercise of some kind that is specifically designed for your injury, illness, condition, or to help prevent future health problems. Exercise can include stretching to reduce stress on joints, core stability exercises to strengthen the muscles of your trunk (your back and abdomen) and hips, lifting weights to strengthen muscles, walking, doing water aerobics, and many other forms of activity. Your physiotherapist is likely to teach you how to do an exercise program on your own at home so you can continue to work toward your fitness goals and prevent future problems.

Getting started on core stability

Manual therapy

Manual therapy is a general term for treatment performed with the hands and not with any other devices or machines.^{1, 2} The goals of manual therapy include relaxation, less pain, and more flexibility. Manual therapy includes:

• Massage, which applies pressure to the soft tissues of the body such as the muscles. Massage can help relax muscles, improve circulation, and ease pain in the soft tissues.
• Mobilization, which uses slow, measured movements to twist, pull, or push bones and joints into position. This can help loosen tight tissues around a joint and help with flexibility and alignment.
• Manipulation, which uses rapid, forceful movements to position the bones and joints. This is a more aggressive treatment. Discuss the pros and cons of manipulation with your doctor or physiotherapist.

Education

Physiotherapy almost always includes education and training in areas such as:

• Performing your daily tasks safely.
• Protecting your joints and avoiding reinjury.
• Using assistive devices such as crutches or wheelchairs.
• Doing home exercises designed to help with your injury or condition.
• Making your home safe for you if you have strength, balance, or vision problems.

Specialized treatments

In some locations, physiotherapists are specially trained to be involved in other types of treatment, including:

• Vestibular rehabilitation, which helps your inner ear respond to changes in your body position. This is helpful if you have problems with vertigo, or a feeling that you or your surroundings are spinning or tilting when there is actually no movement. Rehabilitation can help you get used to the problem so you know when to expect it, and train your body to know how to react.³
• Wound care. Wounds that are very severe or don't heal well, often because of poor blood flow to the area, can require extensive care. This may include special cleaning and bandaging on a regular and long-term basis.⁴ Sometimes hydrotherapy, oxygen treatment, or electrical stimulation is part of the treatment.
• Women's health. Physiotherapists often work with women on exercises to help control urinary incontinence or to relieve pelvic pain.
• Oncology (cancer care), to help if cancer or treatment for cancer causes you to have problems with movement.
• Decongestive lymphatic drainage, which is a special form of massage to help reduce swelling when the lymphatic system is not properly draining fluids from your tissues.¹

Cold and ice

Ice and cold packs are used in physiotherapy to relieve pain, swelling, and inflammation from injuries and other conditions such as arthritis. Ice can be used for 10 to 20 minutes at a time. In some cases, ice may be used several times a day.^{5, 6} For more information, see:

• Using ice and cold packs.
• Ice massage.
• Rest, ice, compression, and elevation (RICE).
• Ice or cold packs for children.

Heat

Heat can help relax and heal your muscles and soft tissues by increasing blood circulation.⁵ This can be especially helpful if a joint is stiff from osteoarthritis or from being immobilized, or to relax the muscles before exercise. However, heat can also increase swelling in an injured area if it is used too soon after the injury. Most experts recommend waiting at least 48 hours after an injury before using heat. For more information, see:

• Heat after an injury.
• Paraffin wax for osteoarthritis.

Hydrotherapy

Hydrotherapy is the use of water to treat a disease or to maintain health. The term "hydrotherapy" (water therapy) can mean either exercise in the water or using water for care and healing of soft tissues.⁷ This type of therapy is based on the theory that water has many properties that give it the ability to heal:

• Water can store and carry heat.
• Water is found in different forms, such as ice, liquid, or steam. Ice may be used to cool, liquid is used in baths and compresses at varying pressures or temperatures, and steam is used in steam baths or for breathing in.
• Water can help blood flow.
• Water also has a soothing, calming, and relaxing effect on people, whether in a bath, shower, spray, or compress.
• Exercise in water takes the weight off a painful joint while also providing resistance.

For more information, see hydrotherapy.

Ultrasound

Ultrasound therapy uses high-pitched sound waves to ease muscle spasms and relax and warm muscles before exercise, to help relieve pain and inflammation, and to promote healing. Although the use of ultrasound is common, some studies show a benefit from this treatment and others do not.⁵ Some physiotherapists do not recommend deep-heating techniques. Discuss the benefits and risks with your physiotherapist or doctor before starting this therapy. This type of treatment is not generally used for children.

Electrical stimulation

Electrical stimulation is the general term that describes the use of electrical current to create an effect in the body. There are several uses for electrical stimulation.⁸

• Physiotherapists sometimes use electrical stimulation at low levels to reduce the sensation of pain. It may work by either "scrambling" pain signals to mask feelings of pain, or by causing the body to produce natural pain-killers called endorphins.
• Physiotherapists can also use electrical stimulation to cause muscles to contract (tense). This type of therapy can help maintain muscle tone when muscles would otherwise lose strength or help teach muscles to contract again. Examples of this type of therapy include:
  • Electrical stimulation after a stroke to maintain some tone in the shoulder muscles so they hold the joint together better and prevent pain.
  • Electrical stimulation to maintain leg strength in a person who has severe arthritis of the knee and whose pain increases with exercise.
  • Electrical stimulation to get muscles at the front of the thigh working in the proper order after knee surgery.
• Electrical stimulation is being studied as a way to help with healing of wounds and broken bones.

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Author:	Shannon Erstad, MBA/MPH Carrie Henley	Last Updated: June 26, 2007
Medical Review:	Martin Gabica, MD - Family Medicine David A. Fleckenstein, MPT - Physical Therapy Kathie Hummel-Berry, PT, PhD - Physical Therapy Donald Sproule, MD, CM, CCFP, FCFP - Family Medicine
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