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Orthopedic Physiotherapy

How Orthopedic Physiotherapy can help you alleviate pain?

Physiotherapy is a recognized health profession that evolves through integrating critical appraisal of new knowledge with research, education, and practice to help patients restore, maintain and increase their physical mobility, strength, and function.

It is highly effective in the management of many health conditions and populations seen in Primary Health Care, including arthritis, obesity, cardiovascular disease, cancer, stroke, and musculoskeletal disorders.

It also helps in the rehabilitation of patients suffering from Parkinson’s, Paralysis, Stroke, Multiple Sclerosis, and Cerebral Palsy. Furthermore, physiotherapists can heal both chronic and acute problems by treating patients at home.

Physiotherapists are primary health care professionals with a significant role in health promotion and treatment of injury and disease. They combine their in-depth knowledge of the body and how it works with specialized hands-on clinical skills to assess, diagnose and treat symptoms of illness, injury or disability “Canadian Physiotherapy Association”.

“But physiotherapy is not limited to rehabilitation of injury and the effects of disease or disability. A physiotherapist also provides education and advice for health promotion, disease and injury prevention (Canadian Physiotherapy Association)”

Today we will be talking about Orthopedic or MUSCULOSKELETAL PHYSIOTHERAPY (MSK)

Musculoskeletal (MSK) Physiotherapists are better able to help patients regain mobility, as they have a better understanding of how the body works and are trained in clinical skills to assess, diagnose and treat disabilities. Physiotherapists can help patients recover from injuries and disabilities ranging from back pain, neck pain, knees pain to ligament issues.

Role of Physiotherapy for MSK Conditions

MSK conditions encompass a broad range of disorders that affect the bones, joints and connective tissue, and include arthritis (and related conditions) and trauma. Physiotherapists assess and treat patients with MSK conditions in order to reduce and eliminate pain and address muscle weakness, loss of stability and limited functional abilities.

One in ten Canadians with an MSK condition consults with a physiotherapist. Patients with MSK conditions account for the majority of outpatient physiotherapy consultations, with care delivered in private clinics, through on-site physiotherapy programs in the workplace and in the home.

11 million Canadians over the age of 12 years old are affected by musculoskeletal (MSK) conditions annually. Strong evidence exists to support physiotherapy in their treatment. Physiotherapy contributes to improved physical function, allowing individuals to return to healthy living, including the return to work and recreational activities.

This is the branch of physiotherapy concerned with the treatment of injuries or disorders of the skeletal system and associated muscles, joints, and ligaments. Orthopedic Physiotherapy also includes pre and post-operative rehabilitation of hip, shoulder, and knee.

An orthopedic Physiotherapy is a scientific approach to treatment following Evidence-Based Guidelines. Initially, the physiotherapist will carry out a clinical assessment and this is followed by appropriate treatments. It is important to get to the source of the problem and prevent a re-occurrence.

The treatment goal of an orthopedic physiotherapist is to provide pain relief, increase joint range, improve strength and flexibility and restore the patient to full function Orthopaedic Conditions treated include:

  • Ligament Strain, Sprain or tear
  • Fracture Rehabilitation
  • Inflammation of tendons or Bursa
  • Osteo -Arthritis
  • Rheumatoid – Arthritis
  • Osteoporosis
  • Ankylosing Spondylitis
  • Scoliosis
  • Spondylolisthesis
  • Spondylolysis
  • Surgical Rehabilitation of Hip, Shoulder, Knee and Foot/Ankle

Pre-operative physiotherapy can help to strengthen a patient physically and cardiovascular. In the case of a joint, physiotherapy can help maintain and improve a range of movements prior to surgery and educate the client on their post-operative rehabilitation. This will facilitate the client to recover from surgery at a faster rate. Following orthopedic surgery, our team of physiotherapists will liaise closely with your surgeon to follow the recommended clinical protocol.

Physiotherapy treatments of orthopedic conditions may include the following:

  • Manual Therapy: This is a carefully graded system of moving the joints to reduce pain and restore normal mobility of the joints. It includes mobilization, manipulation, and other related techniques.
  • Massage-Techniques: vary from relaxing light pressure massage to deep friction massage to breakdown scar tissue in muscle or ligaments.
  • Ultrasound Therapy: An electrical machine produces ultrasonic waves that are transmitted into the affected area using conducting gel. This, in turn, causes a micro-massage effect which promotes circulation, reduces pain and increases regenerative powers of tissues and helps muscle relaxation. It is very helpful in the treatment of soft tissue injuries.
  • Interferential Therapy: This is an electrical current delivered to the injured part via 2 or 4 electrodes. It sends two interfering currents into the body part which feels to the patient like pins and needles. It can be used to relieve pain. Reduce swelling and optimize the healing process.
  • Neuromuscular Stimulation: An electrical machine with variable currents which is applied using electrodes to strengthen very weak muscles. This is very useful following knee surgery to strengthen the muscles that support the knee. A portable version is now available to rent or buy.
  • Dry-needling: This is a western medical technique and involves the insertion of fine needles into dysfunctional muscles. Dry needling works by changing the way your body feels pain and by helping the body heal trigger points. Myofascial trigger points are tender nodules within taut bands of muscle. There are electrical and biochemical changes associated with dry needling that assist in the healing process.
  • Acupuncture: This is based on Traditional Chinese Medicine. It involves the insertion of fine needles. It can be used to treat a variety of conditions. In the area of orthopedic physiotherapy, it is used to reduce pain and normalize movement. It complements other physiotherapy treatments.
  • Taping for joint support/alignment: This will ease pain and facilitate normal movement.
  • Program of Rehabilitation Exercises: Home Exercises are scientifically designed to help your posture, improve the mobility of your spine and joints, stabilize and strengthen the muscles that support your bones. This will be Taylor made and graded so you will reach your full potential. This is a critical part of your journey to return to full health.

Physiotherapy’s role when it comes to chronic pain 

An estimated 1 million people live with severe chronic pain. To get insights into the matter we delve on the topic, and  discuss the role of physiotherapy in the management of chronic pain.

Chronic pain has been defined as – “the pain that persists for 3 months or longer, considered chronic and, while not necessarily mal-adaptive, often leads to physical decline, limited functional ability, and emotional distress.”

So, this means that chronic pain can be pain that exists beyond the normal tissue healing process or where there is no evidence of tissue damage or biological reason for the pain symptoms. Chronic pain thus becomes a disease of the central nervous system.

There are a couple of different kinds of chronic pain, which can present with

  • hyperalgesia  a heightened sensitivity to pain
  • allodynia, sensitivity to pain response of non-painful stimuli
  • dysaesthesia, a response to irregular abnormal sensations.

For many, chronic pain can have a detrimental effect on daily life. It will impact sleep, work, home life, leisure activities, and the ability to interact with children, family, and friends. In cases where the pain is severe, chronic pain can stop sufferers from participating in social events or even affect the ability to work or play.

There are closely associated psychological factors, such as anxiety, depression, and stress, to chronic pain. It’s estimated that between 30-45% of people who suffer from chronic pain also suffer from depression. Negative emotional events can create a sensation of pain in the absence of tissue damage, which can worsen the symptoms of pain.

From a physiotherapy point of view, treating chronic pain requires a multi-dimensional approach, combined with efforts from GPs, pain management consultants, psychologists, orthopedic specialists, and rheumatologists to give greater benefits from treatment.


How physiotherapy can treat chronic pain?

  • Patient Education: Education and increasing the patient’s understanding of chronic pain is an important step in the management of the condition.
  • Exercise Therapy: Often, due to the severity of chronic pain, participation in exercise declines due to fear of worsening symptoms. Patients are often advised not to move through pain due to fear of increased pain. Physiotherapists will be able to advise and prescribe exercises that are pain-free or pain-reducing in order to get the patient’s mobile again. The physiotherapist can create a program of a graded approach to exercise based on the individual’s needs, as well as aiming to improve strength and flexibility.
  • Manual Therapy: With reduced movements or limited exercise due to chronic pain, joints can become stiff and irritable. Your physiotherapist can help by manipulating or mobilizing joints, which will restore movement.
  • Soft Tissue Treatments: Your physiotherapist may decide to perform massage, trigger point therapy, myofascial release and stretching to improve movement and reduce pain. Soft tissue treatments can desensitize the area of pain.
  • Pilates or Postural Exercises: Physiotherapy-lead Pilates can be an excellent treatment option, especially for chronic neck or back pain as it is low intensity and helps to build strength and control. Physiotherapists can also give patients a home exercise program of postural exercises.
  • Cognitive Behavior Therapy: Specialist Physiotherapists can be trained in the management of chronic pain by using cognitive therapy and pain management approaches. This can be done on one to one basis or in group settings.
  • Acupuncture: This ancient Chinese medicine can be a useful alternative treatment option for chronic pain. The National Institute of Health found studies which suggest that acupuncture is effective in chronic pain associated with the neck and back, headaches and osteoarthritis of the knee. Physiotherapists may have completed additional training in acupuncture and can offer this as a treatment option.
  • Electrotherapy: Treatment options can be effective in decreasing the sensation of pain. You can read more about electrotherapy in a previous blog post.
  • Heat & Cold Therapy Treatment: This can be effective in the desensitizing of pain. The heat helps the muscles to relax, encourages circulation and increases blood flow to the area, which can reduce pain. Cold therapy reduces the blood flow to the area, numbing the area and slowing down the pain messages sent from your nerves to your brain.

By using a combination of treatment options, patients suffering from chronic pain can begin to control their pain and resume participation in daily activities. The goal of physiotherapy is to enable and empower the individual to gain back control of their life and reduce the fear and avoidance associated with chronic pain.

The inter-relationship between musculoskeletal physiotherapy & orthopedics

Physiopedia discusses the inter-relationship between “musculoskeletal and orthopedics” as follows:

“Musculoskeletal Physiotherapy is the term used to describe the field of physiotherapy,  which relates to disorders of the musculoskeletal system. and it  refers to muscles, bones, joints, nerves, tendons, ligaments, cartilage, and spinal discs.

Musculoskeletal Physiotherapy utilizes the basic sciences of anatomy, physiology, and biomechanics as background theory in the assessment and management of patients. 

This makes sense that orthopedic physiotherapy is the foundation that physiotherapists acquire as they further develop their  practice to focus on unique areas of interest and populations. There is a lot to know about the body, how it functions, and how it is meant to move. If the basic framework of the body cannot sustain itself then all other systems struggle.

An example of this is when someone has a decreased lung capacity – whether from disease or deconditioning. If they require an exercise program to improve their lung function but have limited ribcage expansion for example – then just simply having the patient do cardiovascular exercises may not be a satisfactory rehabilitation plan. This type of person would benefit from seeing an orthopedic physiotherapist help mobilize (“move”) the joints in and around the ribcage, release or retrain the muscles of the diaphragm and spine that connect to the ribcage. Combined with the orthopedic treatment, the cardiovascular system has a better chance of optimizing its function and recover.

For the youngster and their development, orthopedic physiotherapy is crucial in ensuring how the body develops, moves, and learns how to adjust to the demands of growth and sports. That simple ankle sprain needs skilled hands-on treatment and positive education and exercises to get it back on track so it does not impede other optimal body parts from doing their function – now and as the child grows.

When it comes to pelvic health physiotherapy, a complete orthopedic examination is pertinent to the situation. There may be postural deficits or sub-optimal pelvic positioning that is impairing the ability for the organs and muscles of the pelvis to work properly. We use our orthopedic physiotherapy skills to address these deficits which will have a positive impact on the pelvic floor.

As you can see, orthopedic physiotherapy is the most important component of our physiotherapy practice as it extends across all ages, conditions, and abilities. With advanced coursework and experience, our physiotherapists have made a big difference in the freedom of movement, quality of life, and pain-free living in so many patients.

The role of an Orthopedic Physiotherapy is:

  • Impaired posture
  • Impaired muscle functions
  • Impaired joint mobility
  • motor function
  • Muscle performance
  • Range of motion associated with Connective tissue dysfunctions
  • Localized inflammation, such as in Muscle pain, Strain, and Muscle tear
  • Joint stiffness
  • Joint inflammation in case of osteoarthritis
  • rheumatoid arthritis etc.

Physiotherapy plays an integral role in the care and treatment of patients with MSK conditions. Treatment for patients with MSK conditions promotes injury recovery and functional improvements, with a focus on self-management and independence. Physiotherapy for MSK conditions is particularly effective for injury prevention and detection prior to the condition becoming incapacitating for the patient. Outpatient physiotherapy programs for patients with MSK conditions are cost-effective and result in earlier return-to-work and return to pre-injury activities.

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