Physio­therapy – Information for Patients

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.