Physical therapy, commonly called physiotherapy, includes the use of physical agents for treatment, occupational therapy, and rehabilitation. There are a multitude of agents and exercises which are utilized in this field of treatment and are of proved value when properly prescribed. Physiotherapy is often a great adjunct to operations or medications in certain instances. Moreover, it may be the primary therapy in many cases.
Various forms of physical treatment may be prescribed for you by your surgeon. They may be conducted at your hospital bed; you may be taken to the physiotherapy laboratories of the hospital; you may be referred to the department as an outpatient, or you may be instructed in certain forms of physical therapy to be done at home. In any case, your full co-operation is needed to receive the greatest benefit from physiotherapy. In many cases the patient’s role is entirely passive, but in other forms of treatment laborious efforts are required. Make certain that you understand your instructions completely, and then make a concerted effort to perform your part of the treatment.
It is not within the scope of this work to elaborate all the specific tissue effects from all the various agents employed in physiotherapy, but it must be realized that each agent has a definite effect on the tissues, and specific changes are known to be effected by their use. Physical forces furnish as much a basis of all life as do chemical forces. The effects of the sun’s rays on the body, the application of hydrodynamic laws to the blood’s circulation, the atmospheric pressure effects on the body, the electrical charges of nerves and muscles, and the body’s response to temperature changes, are only a few examples of physical forces and their known roles in the human.
The physical forces, if properly mastered, are of inestimable value in treatment of disease and injury in man. The physical agents used in medicine today may exert their effects in a variety of ways. Certain forms of treatment are useful in increasing the blood circulation to an area; this is achieved by dilatation of the blood vessels in the region so that the amount of oxygen-carrying blood that reaches the part is increased. Other physical agents are useful in increasing or decreasing the metabolism (tissue chemical reactions) in certain areas; indeed, a new chemical reaction may even be initiated. Some forms of physiotherapy act by relieving nerve stimulation which may be causing muscle spasm or pain, while other forms may be used to increase nerve function to cause paralyzed or relaxed muscles to contract, or to regain lost sensations. Even growth of germs may be inhibited by certain physical agents, and still others are used to cause pigmentation or even destroy certain tissues. Through these effects correct application of physiotherapy may speed the repair of diseased or injured tissues, restore disturbed functions, relieve pain, or even improve the condition of the entire body.
It is evident, then, that each form of physical treatment has definite effects on tissues, and what may be useful in one case may be useless or even harmful in another. Physiotherapy is a method of treating disease and injury in conjunction with medical and surgical measures. There are definite indications and contraindications to each type of physical treatment, just as there are with any drug or any operation. Physiotherapy can be prescribed only after a diagnosis has been established by examinations and other diagnostic aids. Unfortunately, however, there are cultists who are allowed to practice in this country who base all treatment on physical therapy, regardless of the ailments of the patient, and usually with no conception of the effects of these agents on the tissues. Physiotherapy can be of benefit only when the practitioner knows what condition he is treating, the pathological process of the condition, the effects of the agent he is using, and the correct method of application of the agent. Indeed, some of the most ardent advocates of physical treatment have no medical knowledge whatsoever, and any physical measure that is powerful enough to do good is just as likely to do harm. Physiotherapy has a rightful role in the field of surgery and medicine, but beware of those who have magnified the healing virtues of physical treatments and employ them indiscriminately for every symptom.
The medical profession utilizes several forms of physiotherapy which are of proved value in certain conditions. These accepted forms of treatment are rendered in the physical therapy departments found in most hospitals, by trained technicians called physiotherapists. These assistants are trained in approved schools in the correct application of the physical agents which are acceptable to the medical profession. They render treatments only by prescription from a physician, and under no circumstance should physical therapy be prescribed by anyone else. The simpler types of physical treatments may be given in your doctor’s office or prescribed for you at home.
Thermotherapy, meaning the use of heat for treatment purposes, is one of the oldest forms of physical therapy. The heat may be obtained from a number of sources. Hot water bottles, poultices, the hot bath, and hot compresses are simple devices for thermotherapy, but they are not very efficient because the source of heat is not constant and the heat penetration is limited. Electric heating pads and blankets can be maintained more easily and they are more convenient. Heat lamps and infrared (an invisible form of light) heating units have come into general use because of their simplicity, safety of application, and deep penetration. Diathermy is actually a form of electrotherapy as it is the passage of a high-frequency current through a body part, but it also results in heat production. This is the most penetrating form of local tissue heating. The physiological effects of any form of heating are the same. At the site of application there is dilatation of the blood vessels with increased circulation, increase in the tissue chemical reactions, and relaxation of muscles. The general effects of body heating are increased heat elimination with profuse perspiration, increase in circulation of blood with rise in pulse but lowering of blood pressure, increased elimination through the kidneys with a slight temporary loss of body weight, and decrease in general nervous sensitivity. Heat also increases the blood’s ability to clot. (Artificial fever is occasionally induced by drugs to raise the body temperature above normal to help ward off certain diseases. This is a medical means of producing hyperthermy, or fever, and actually not within the realm of physiotherapy.)
Hypothermy is the application of cold for therapy. Short cold applications as employed in hydrotherapy are used for the stimulation of circulation and the nervous system, while prolonged cold applications are employed with the object of actually lowering the temperature of the parts treated. Cold applied to the body is very penetrating. The effects of much lowered tissue temperatures are a reduction of the local blood flow, lowering of the metabolism, and local anesthesia. The lowered metabolic rate is often an important effect, for as the chemical processes are slowed the oxygen requirements of the tissues are lessened. Local hypothermy is commonly obtained by use of the ice bag, surrounding the part with cracked ice or circulating ice water, or placing the part in a cold air chamber. Local hypothermy has been used much more frequently in recent years in diseases of the blood vessels. Refrigeration anesthesia is discussed in the chapter on anesthesia. General hypothermy of the entire body produces a slowing of all the functions of the body in contrast to increased metabolism from general heat, but general hypothermy is not often used for treatment.
Light therapy includes the use of various forms of light for treatment purposes. Ultraviolet light is an invisible light form which has definite tissue effects. The chief source of ultraviolet light is the sun, but various lamps have been invented which simulate this part of sunlight. The therapeutic uses of ultraviolet light are based on its abilities to cause a mild inflammation of the skin with dilatation of the blood vessels and changes in this tissue’s cells. Ultraviolet light also causes pigment to be increased in the area of exposure, and chemically changes a substance called ergosterol to vitamin D. This latter substance is essential to life, as it is required in the normal chemical reactions of the minerals calcium and phosphorus. Calcium, phosphorus, and vitamin D are most important in normal bone development, and deficiencies result in the disease rickets. Other effects of ultraviolet radiation have been described which generally increase the efficiency of the body with improvement in appetite, better sleep, increased elimination, and mental stimulation. Ultraviolet light has demonstrated an ability to kill germs when given in the correct intensity over a sufficient period of time.
Heliotherapy means the use of the sun’s rays for treatment purposes, and sunlight includes not only ultraviolet light but the visible light and infrared as well. Ultraviolet light penetrates no deeper than the skin, while infrared penetrates much more deeply. Infrared light has the physiological effects of the application of penetrating heat.
Carbon arc lamps produce light similar to sunlight in that it is composed of ultraviolet, visible, and infrared light. Mercury vapor lamps (hot and cold quartz lamps) emit mostly ultraviolet light.
Electrotherapy is the application of an electrical current to a part of the body. These electrical treatments are pleasant and safe. There is a wide variety of electrical currents used for therapeutic purposes. All of them cause more or less heating of the tissue parts, but especially do the high frequency currents, known as diathermy. The low frequency currents, such as faradic current, cause muscular contractions and are used in the treatment of weak or paralyzed muscles. Galvanic currents cause chemical changes in the tissues and are useful in conjunction with medical substances. Static electricity produces a local mechanical effect and general stimulation.
There is nothing mysterious about the effects of these various currents on the body. They are all explained on the basis of their modes of action on the tissues, as a physical or chemical change to which the body reacts with certain functions or sensations. The equipment used in electrotherapy is quite complex. From the complicated electrical device there are conducting cords which serve to convey the current to the electrodes. The electrodes are the parts of the apparatus which are placed over the area to be treated. A great variety of electrodes serve for various types and areas of treatment, and arc most often used in pairs. Various shapes are necessitated for different areas, and some are designed to be inserted into body openings. Electrotherapy is used for many different conditions, including acute and chronic inflammations, certain benign tumors, paralyzed muscles, muscle spasms, unwanted hair, old and new injuries, nerve disorders, circulation diseases, and mental disturbances.
Hydrotherapy includes all the therapeutic procedures dealing with the external application of water to the body. Water as a therapeutic agent depends primarily on its ability to convey certain physical forces. Hydrotherapy is commonly employed as hydrothermal measures, where the temperature effect on the body is utilized. Water has many qualities which make it very useful for thermotherapy, cither hyper- or hypothermy. The therapeutic values and the physiological effects of the application of heat and cold have already been mentioned. Heat or cold is conveniently applied locally by the use of wet packs, wet compresses, and soaks, or may be more generally applied by the use of baths. Cold, hot, and contrast baths are frequently used. The most commonly employed bath is the Sitz bath, where the patient merely sits in a tub of water at a specified temperature for a specified time. It is used for temperature effects of the pelvic and lower abdominal organs and circulation. The sitz bath is often used with rectal surgery. There are many other special forms of baths not commonly used.
Water is also used for hydrokinetic procedures in combination with the thermal effects. Here the pressure and the buoyancy of water are utilized. The common shower, vaginal douche, and enema are examples of hydrokinetic measures. There are other special forms of these but they are not commonly employed. The whirlpool bath is a procedure valuable in the treatment of many conditions. With this the arm or the leg to be treated is placed in a large vessel where the water of a specific temperature is constantly agitated to provide mechanical stimulation of the part.
Therapeutic pools and tanks have recently come into more common usage, especially for the treatment of infantile paralysis but also for other conditions. Underwater exercises (hydrogymnastics) and underwater massage (hydromassage) are the principal uses of such pools. Colonic irrigation is the insertion of a tube into the rectum and applying a stream of water so that the bowel is flushed out. This purging action rarely has any advantage over the ordinary water enema and indeed it may even be dangerous; yet it is used routinely for so-called “toxic conditions” and any other symptoms by practitioners outside the medical profession. Colonic irrigation is infrequently indicated, and should never be given without examination and a good insight into the patient’s condition. To be sure, colonic irrigation is used too freely by many healing arts; moreover, the ordinary enema probably is used too often without just reason.
Hydroelectric and hydrochemical measures are other hydrotherapeutic procedures, but they are not commonly employed.
Massage is one of the oldest forms of physical treatment. In its application the mechanical effects of the hands of the technician are transmitted to the patient. There are numerous types of massage movements, all based on the physical elements of skin friction, pressure, and relative displacements and stretching of tissues. In the normal individual, massage may be either relaxing or invigorating, depending on the application, and as with most other forms of physical therapy there have appeared many massage clinics in recent years. For the normal person these are probably without harm, but the temporary subjective benefits are hardly worth the time and expense. In disease states the use of massage must be intelligently and scientifically based on a knowledge of anatomy, physiology, and pathology.
There are definite indications for the use of massage, but, more important, are the contraindications to its use. One of its greatest uses is with chronic inflammation and the after-effects of infections where there may be adhesions, scars, limited movements of joints, swellings, hardness of the tissues, and excess tissue fluids. In certain cases of muscular weakness and circulatory deficiencies massage may be of benefit. It is routinely used in hospitals for its sedative effects on the back muscles and mechanical stimulation of the skin of the back in patients confined to bed.
Massage is usually to be avoided in acute inflammatory processes, tumors, and neuritis, and to the abdomen in pregnancy.
The physiological effects of massage are a temporary increase in circulation in the area with freer movement of the fluids within the blood and lymph vessels as well as the tissue fluids. The effect on muscles is a temporary increase in work power and retardation of fatigue. Nerves are somewhat stimulated to conduct their impulses more readily. Contrary to popular opinion, massage has absolutely no ability for weight reduction generally or in specific areas. Hand vibrators and other devices have a rightful but limited role in the application of massage.
Exercise has been recognized for many centuries to be beneficial in its preventive and curative aspects, and since the turn of the century it has been more and more stressed. Exercise is essential to good health. A body can be efficient only when there is maintained a muscular system of proper tone, and this depends on the individual muscles. Muscles are designed to alternately contract and relax. The former action forces blood out of the musclcs and the relaxation allows blood to come in. The flow of blood in veins depends on the massaging effect on the vein walls by this muscle action and reaction. There are waste products formed in muscles with each contraction, and, of course, oxygen is consumed; in the untrained individual this exchange often cannot be adequately maintained and fatigue soon ensues. With vigorous exercise the co-ordination of the nervous, cardiovascular, respiratory, and muscular systems is essential. With active exercise the waste products in muscles and the amount of oxygen consumed may be increased five- to ten-fold. The respiratory system works more effectively to supply oxygen to the blood for delivery to the muscles; the entire circulation is speeded to rid the muscles of by-products and supply the oxygen and other fuels; and the nervous system relays the necessary impulses to the muscles as well as automatically controlling the assisting systems. With repeated graded muscle actions there is a greater power developed in the muscles themselves, with a greater efficiency of co-ordination of the other systems as well. Greater general body efficiency then accrues, manifested by a better appetite and digestion, efficient elimination, effective sleep, and a feeling of well-being. However, in the case of overexertion in the individual not accustomed to vigorous exercise, the result may be harmful rather than beneficial. Individuals whose work is sedentary or who have heart disease should never indulge in violent or unaccustomed exercise, and a complete diagnosis is essential to safely prescribe exercises.
The specific exercises and how they are to be graded must be prescribed in detail. Exercises may be classified into physical training and medical gymnastics. The former includes athletic sports and ordinary gymnastics for purposes of increasing the general body efficiency, while the latter has specific aims of correcting deformities, diseases, and injuries through therapeutic exercises.
Physical training has become a part of our educational systems and has rightly been stressed in recent years. Medical gymnastics are of many varieties, too numerous to be described individually in this book, and may be directed at any organ, area, or system. This type of therapy may be used for many types of dysfunction or deformity whether due to injury or to disease. The therapeutic exercises may be directed at improving posture and general body mechanics, as well as corrective measures. For many diseases, exercises are specifically indicated. Needless to say, the results of prescribed exercises can be no better than the determination of the patient in carrying out the exercises faithfully and as directed. Laborious efforts are often required, and usually with gratifying benefits.
Rehabilitation of patients to the fullest physical, mental, social, and vocational usefulness of which they are capable is the purpose of all physical therapy. Occupational therapy is often a means to this end, for not only does it provide practice in dexterity, it also furnishes mental diversion which relieves the anxiety of convalescence. Occupational therapy also teaches individuals how they may successfully adapt to normal life again after certain handicaps have altered their mode of life.