physiotherapy By; DR DHIREN B BHOI

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PHYSIOTHERAPY Presented by: Dr. Dhiren B. Bhoi M.V.Sc. Veterinary Gynaecology and Obstetrics E. Mail:-drdhirenvet@gmail.com

DEFINITION : 

DEFINITION Physiotherapy is treatment of diseases using physical agents like fresh air, water, heat, cold, electric current, sound waves etc. (e.g. fomentation, firing, diathermy, ultrasonic massage)

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Fomentation done with moist heat(using cloth dipped in hot water & squeezed) or dry heat (Using heated rice bran or sand bundled in a cloth.) But moist heat is generally preferred because it has a soothing effect. FOMENTATION :-

Massage : 

Massage Massage improves local circulation of blood and lymph reabsorption and prevents to certain extent muscular atrophy.

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Methods:- By rubbing the skin with the tipsof fingers or the hands in circular manners. By methodical pressure consist of applying firm pressure on the tissue with the fingers of the hand or with the closed fist. By individual compression of muscles. Muscles by percussion consist of superficial or deep percussion of the tissue by striking the part perpendicularly with the fingers or with the closed fist. Massage is done towards direction of venous and lymphatic flow massage is continued for 5-10 mins at a time.

Firing (Thermo-cautery) : 

Firing (Thermo-cautery) Firing is done under regional or local infiltration anesthesia. The piece of iron used for firing is called as firing iron. Three types of firing iron can be used viz. Line firing iron, Bud point firing iron and Pin-point or needle point firing iron.

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Methods Superficial line firing. Bud point firing. Needle point firing. Mixed firing. Firing in cattle will have to be done mere deeply since the bovine skin is more thicker than horse. In dog firing is very rarely used.

Chemical Cauterization : 

Chemical Cauterization Chemical cauterization is done by touching the area of skin at different points (1/2 ’’ to 3/4 ’’ apart) with a cork deeped in sulphuric acid. The effect is almost similar to bud point firing.

Diathermy : 

Diathermy Diathermy is a method of heating the tissues in depth by passing through them modified high frequency electric current. The alternating current (sinusoidal current having 5 lac cycles/sec) is used in arthritis, certain skin diseases, neuralgia, muscular atrophy, paralysis etc.

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1) Long wave Diathermy – Oldest, now-a- days not using.. 2) Short wave Diathermy- most commonly used method, oscillations from 10 to 100 million per second applied through a spacing of air or rubber. This can be produced by tube apparatus. 3) Micro wave Diathermy – Oscillations of 3000 millions per second which are used by focusing single beam of electro magnetic ray from some distance to the region to be heated. This can be produced by magnetron oscillator.

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Effects of Diathermy : - Thermal Effects: - 1)The temperature distributed by the high frequency electrical energy is modified by physiological factors such as the temperature of the tissues. 2) As diathermy is applied an increase in blood flow may occur locally as a result of changes in the tissue temperature.

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METHODS OF APPLICATIONS:- 1) Heating in the electrical field 2) Heating in the electro magnetic field 3) Microwave heating

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III. CLINICAL EFFECTS: - 1. Effects on circulation: - Local Effects: - Active arterial hyperemia In increased flow of lymph b) General Effects: - Rapid dilatation of peripheral blood vessels increase in the pulse rate,respiration,perspiration,general body metabolism. 2) Effects on nervous tissue: - Diathermy exerts a marked sedative effect on the irrigative conditions of sensory nerves ( spasms and cramps)

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CLINICAL USES: - Placing of the electrodes directly over the heated parts prevents cooling by evaporation. Deep hyperemia causes an increased arterial flow with more oxygen and improved nutrition while the greater venous flow carries away larger degree the products of local metabolism. It promotes disintegration of inflammatory exudates and assist in their resort form by decreasing the swelling , relief of pain and restoration of the function clinically. The pain and spasm relieving effect of diathermy makes its use indicated in irritation of sensory and motor nerves.

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In traumatic and inflammatory conditions of bursae, bones and joints after the acute stage. In painful and exuberant callus formation and fibrous ankylosis, joint injuries. In post operative adhesions in extremities. Spastic conditions of the stomach. In the treatment of neuritis and certain conditions of neuralgia or myalgia In the treatment of chronic infections.

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Contra Indications: - In acute inflammatory process accompanied by fever and suppuration In tendency to hemorrhage recent hemoptysis In malignant tumors.

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Buoyancy of Water: These can be used to relieve pressure on affected parts. Used in downer cow syndrome if no muscle damage . Whirlpool Hydrotherapy: It is essentially a water bath in which an extremity or the entire body is submerged in either warm or cold swirling water. Irrigation: Irrigating the affected part with a stream of water through a house pipe is a simple and cheap method. HYDROTHERAPY: Precautions:- Animal with recent skin grafts Acute edema Fever Marked circulatory disturbances should not be treated

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. Indications: Acute congestion, Acute inflammation Septic lesions with diminished blood supply. Effects: Hypothermia of tissues induces Vasoconstriction and decreases extravasations of blood . Pain, muscle spasms and tissue metabolism are also reduced. A)COLD WATER APPLICATION:

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Methods of Application: It is generally combined with compression bandage and rest, to limit the swelling. It is used during the first 24 – 48 hrs after trauma. Each application should last for 10 – 30 minutes with one hour application. For deep seated lesions like sprains, water at a lower temperature may be applied. Methods: Cold effect may be produced by Blowing air Evaporation of volatile liquids Applications of ice packs By running cold water on the affected part

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Techniques: Running stream Whirlpool tube Wille boots Housing Cold bandaging Cotton wool pads Ice massage

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B) HOT WATER APPLICATION Indications: 1)Subacute and chronic inflammations 2)Recent inflammation after the acute stage has passed 3)Septic lesions in which the vitality of tissues lowered and they are threatened with deaths. Effects: 1) Analgesia by softening and relaxing the tissues. 2) Hyperemia exudation interstitial infiltration leucocytosis phagocytosis. 3) Reabsorbing of exudates.

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Methods: The temperature gradually rose from 30 – 1130 F or even 1220 without scalding. At temperature 1130 F moist heat diminishes the resistance of the tissues. Hot applications must be frequently renewed by adding, occasionally, more hot water. It is impossible to maintain a local superficial temperature equal to that of the blood. Hydro thermo-regulator regulate temperature of 107 – 1130 F maintained for 12 – 24 hours with excellent effect.

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Application: Baths Fomentations Compressor Poultices, etc.,

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Sub acute and chronic inflammatory conditions Sprains , contusions , sprains and myositis To hasten the suppuration process Ex.: abscess maturation. THERMOTHERAPY Indications:

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Heat increases the tissue temperature which leads to sedation and analgesia. Heat produce vasodilatation and promote phagocytosis, helps in the healing process. Heat enhances metabolism and lymph flow . Effects: Increased permeability of blood vessels leading to tissue edema Increased absorption of toxins. Heat should not be applied if infection is present due to spread bacteria and toxic products in tissue. Thermo therapy should not be used during the initial 24 to 48 hrs after trauma. Adverse Effects:

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I.CONDUCTIVE HEAT: Conductive heat is superficial and does not penetrate beneath the skin so helps in reducing, swelling because of its higher osmotic property Hot water bottles Hot water bottles Hot moist pack Hot water bath Fomentation Poultice Electrical Heating Pads electrical blankets Paraffin Bath Hot water poultices e.g. II. RADIANT HEAT: A) Infrared Therapy: wave length of 770 to 1,00,000 µ 1) Long wave infrared: 1500 to 12,000 µ 2) Short wave infrared: 770 – 1500 to 1800 µ B)Ultraviolet therapy. (2000-4000 A.U.) Near Ultraviolet radiation Far ultra violet radiation Natural: Artificial: a) Mercury Vapor Lamp b)Fluorescent Sun Lamp c)R.S.types sun lamp (Reflector).

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Clinical Uses Of Infrared rays :- Sub acute and chronic traumatic and inflammatory conditions such as contusions and muscle strains, traumatic synovitis and tenosyno- vitis , sprains, dislocations and fractures. Various forms of arthritis and rheumatic conditions, neuralgia. Acute, sub acute and chronic catarrhal conditions of the mucous membranes/Conjunctivitis coryza, sinusitis . Circulatory disturbance of the extremities Infections of the skin, folliculitis,furunculous and deep abscess in the skin. As preliminary heating to other physical measures, like massage, voluntary and passive exercise.

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DOSAGE: The erythemal response of the individual patient serves as a guide for dosage for general irradiation the first dose is usually one that causes minimal erythema. The principle factors of dosage are distance of burner and duration of exposure. These very according to the efficiency of the operators, the individual sensitivity of the patient and the progress of the treatment. Distance of the Burner: It is advisable to start treatment at a standard skin / burner distance of 30 inches with a calculated exposed time. It is better to keep the distance factor constant, there is less chance of confusion or error. Duration of Exposure: Local : 3 to 5 minutes, Systemic:15 minutes -5 days usually 20 exposures are required to effects a complete cure.

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General tonic effect. (2) Chronic Ulcers. (3) Tuberculosis. (4) Skin conditions a) Psoriasis b) Acne (5) For Diagnosis – In dermatological cases with the aid of woods lamp to detect fungal infection. Clinical Uses of UV rays :-

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Dangers Of UV Irradiation: Dermatitis due to UV energy – It forms a simple erythema to bulbous eruption with pain, chills, fever and shock. Local ulceration: impetigo, folliculitis etc., Excessive irradiation of a large area of a skin may cause death from general toxemia. Exposure for a longer period produces atrophy, wrinkling and small warty Excretions result in a basal or squamous cell .

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ELECTRO THERAPY Electricity employed for the diagnosis of certain nerves and muscular legions is called as Electro Diagnosis and the treatment of different affections by electricity is called electro therapy . Electro Diagnosis Electricity used in this respect reveals information on the degree of contractibility of muscles, the integrity of alterations of motor nerves. To ascertain the degree of contractibility of muscles, the continuous and reducing currents are applied. ۞Indications mainly in case of paralysis and muscular atrophy

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TECHNIQUE: - The positive electrode is usually placed at the level of spinal cord in the anterior part of the dorsal vertebrae for the examination of the muscles of the forelimb and in the lumbar region for the examination of the hindlimbs.The other electrode is placed on the motor nerves or the muscles to be examined. The excitement is said to be direct when it acts on the muscle itself and indirect when it acts on the motor nerve. Diagnosis of the affections will depend upon 1) Whether there is hyper excitability or hypo excitability. 2) Whether contractions are produced with both faradic (AC) and Galvanic (DC) currents or by DC or only by AC. 3). Whether any difference in the contractions (excitability) is noticed by stimulation with galvanic current after inter change of the electrode.

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ELECTRO THERAPY: Continuous currents (DC) Galvanization Induced currents (AC) Faradization. High frequent currents – Dorsonavalisation Electrical sparks and flashes – Fulguration.

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1. Physical Properties: - ULTRASONIC THERAPY A molecule set in motion will cause its neighbour to move, and in turn its neighbour, until the vibration has propagated throughout the material. Propagation of vibratory motion is the basic element of sound wave production. b) The vibratory frequency of sound wave affects its absorption into body tissue. c) The higher the frequency, the less the sound waves diverge. Sound waves at greater than the audible sound range (20-20000 Hz) appear to spread out in all directions. d) Physical therapy devises products – beam of sound at a frequency of one million cycles per second (1 MHz) that is sufficiently collimated to penetrate to selected target tissues.

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e) As sound wave frequency increases, its absorption by the tissue increases. As absorption increases there is less sound energy available to propagate further through the tissues. f) Therapeutic frequencies of 1 MHz penetrate as deep as 4 – 6 cm into the tissues. Tissues with a high fluid content, such as blood and muscle, will absorb sound waves better than less hydrated tissues g) Nerve tissue has a high coefficient of ultrasound absorption. This expands treating possibilities to sounding nerve roots that are associated with peripheral conditions

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An increase in point range of motion i) Stiffness and a decrease in flexibility must be addressed with stretching exercise to region normal point function. Stretching exercises are facilitated by the heating effects of ultrasound. ii. Elevating the tissue temperature before passive or active stretching will enhance the effects of the stretch. iii. Preheating connective tissue before it is stretched produces a greater residual increase in tissue length with less potential damage. iv. Heating of the deep tissues alters the elastic properties of collagen tissue and its molecular bonding. Deep tissues surrounding a joint are rich in collagen. Because ultrasound selectively heats this type of tissue, it is the ideal modality for pre-streatch heating. v. Scar tissue is rich in collagen and more dense than the surrounding tissue. It can be selectively targeted by ultrasound. Therapeutic Effects Of Ultrasonic Therapy: -

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B. Decrease in pain and muscle spasm:- It reduce pain following injury or surgery. ii. Ultrasound has an effect on nerve fiber conduction iii. Ultrasound therapy was used successfully on painful neuromas and post –operative scars. iv. It is useful in back pain and herniated intervertebral disc syndrome. C. Calcium deposits : Ultrasound can be used to stimulate the resorption of calcium deposits splints. D) Wound healing: - i) Wound healing is more rapid when wounds are traeted with ultrasounds. Acoustics streaming may play a part tissue repair. ii) Ultrasound promotes the healing of pressure sores increase the rate of protein synthesis by fibroblasts, increased lysosomal permeability. iii) It enhances tendon repair.

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Conclusions

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۞ Physiotherapy can be effectively used for various deseased conditions of musculo-skeletal systems & integumentary systems. e.g.. Diathermy, Electrotherapy, thermotherapy etc. ۞ For some of the physiotherapies skilled personnel are required and some can be performed at home. e.g. Massage, exercise etc. ۞ Ultraviolet radiation therapy has some metabolic effect & can be used in patients having rickets & hypocalcemic tetany.

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THANK YOU

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