Physical therapy starts with an expert therapist. Much like a trainer, the physical therapist will design a program to increase the flexibility and strength of the injured areas. The therapist must understand your situation. They must know the procedures you went through if you had surgery. They also must know the physiology of your body and its related mechanics. Most of the programs require stretching and massage for flexibility and exercise for strength. They use specialized equipment in order to target specific areas or individual muscles. Massage chairs are particularly effective in loosening tight areas and enhancing blood circulation.

One of the first things you will do in physical therapy is to sit down with your therapist. You will go over in detail your physique and injured areas. The therapist understands surgeries and there affect on your muscle and skeletal systems. They will design a specific program with you. You will be put through a regimen of stretching. They will want you to gain more strength. You may need to do exercises or use specialized exercise equipment. They may rub down or massage certain areas of your injuries. They may have you receive massage therapy in a massage chair recliner. All these therapies are designed to help your recover fully.

One of the key areas when you start is to make your muscles more pliable. When an injury occurs, the body immobilizes the affected area. Your body has redundant systems for most everything. If your leg is injured, it will want the other leg to take over. The body does not want the injured leg used and tries to shut it down to heal it. This is good, but your muscles become stiff and tight. They actually hurt when you start to bend them. Stretching is an important part of the physical therapy routine to build back flexibility.

Exercises are important to help rebuild strength. When we have an injury, we tend to protect that area. Protecting that area is usually to isolate and immobilize it. In other words, we tend not to use the injured area. This helps to prevent further injury, but at the expense of strength and conditioning. To help rebuild the body, exercises help to build up strength, endurance and agility. Physical therapy clinics have a wide array of exercise equipment from treadmills, stationary bikes, weights and more. These help you focus building up a particular set of muscles.

Some of the problems encountered in the physical recovery process are scar tissue. Scar tissue forms harder than the original tissue. This needs recurring kneading and pressing massage to restore flexibility. The muscle tissue breaks down into shorter lengths when physically stressed. The muscles tissues need the fibers to be elongated to restore further flexibility. Massage therapy targets these two important areas. Some physical therapy clinics use massage therapists and may also use massage chairs. In either case, the focus is on increasing the longer term flexibility. Massage therapy is effective in loosening the muscles and scar tissue while increasing the blood and nutrient flow accelerate the healing process.

If you push your limits, you may sometimes go too far and suffer an injury. Or they may just happen. Either way, you just want to be fully recovered. The physical therapies being offered utilize top notch technology and methodologies. From massage chair recliners to treadmills, you will be exposed to a range of treatments designed for your full recovery.

Hopefully needed not require Physical Therapy, but if needed then research what massage therapy most benefits you. A massage chair can be an excellent investment in your health. Massage Chair Therapy offers many techniques

The examination will include the ability of the nervous and vascular system to supply the requirements of the arm, with most of the deficiencies involving the lower nerves of the brachial plexus. Compression of the veins in the armpit area results in an arm which is bluish in colour and swollen, whilst if the part of the vascular system which is compressed is an artery this makes the arm cooler, lacking in a pulse and often having a lower blood pressure of 20 mmHg or more compared to the normal arm.

In the case of thoracic outlet syndrome due to neurological compression the finding are often of weakness and wasting of the small muscles of the hand. There may also be reduced sensation in the areas supplied by the ulnar nerve, which again reflects the fact that the lower nerves of the brachial plexus are most often involved. The last type of this syndrome, that of non-specific thoracic outlet syndrome, has widespread but less precisely located pain, with less precise and clear examination findings, making the diagnosis unreliable at best.

Thoracic outlet syndrome can be brought on by a large number of neck and shoulder anatomical structures and this is reflected in the numbers of diagnostic tests which have been developed to investigate this problem. A significant problem with these tests is the occurrence of false positive and false negative tests. False negatives mean that the test shows the problem not to be present when it really is and false positives mean the test indicates the tested problem to be present when in reality it is not.

A typical test is Roos stress test, where the patient keeps their arms up in a "hands up" position, opening and closing the fist. If the symptoms come on or the arms feel heavy or tired then the test may be taken to have a positive result. The reasons for thoracic outlet syndrome can either be due to bony structures or soft tissue structures. Bony structures which might cause compression or obstruction include cervical ribs and bony outgrowths on the ribs or collar bone. Soft tissue structures involved include abnormal fibrous bands or abnormally large muscles in weight training athletes.

Trauma to the neck and mechanical stressors may combine with any abnormalities in neck anatomy such as cervical ribs to increase the likelihood of developing thoracic outlet syndrome. Obstruction of the blood supply is an emergency and should be speedily assessed and surgically decompressed with repair to the arteries or veins. Most people with this syndrome are however treated conservatively with anti-inflammatory drugs, transcutaneous electrical nerve stimulation (TENS) and assessment and mobilisation or exercise prescription by a physiotherapist.

Many patients are helped by conservative management and those whose pain continues to be troublesome may eventually be considered for surgery. Physiotherapists look at the postural attitude taken by patients and muscle imbalances which may be present around the neck and shoulders. Patients who maintain static postures for long periods or continually return to one particular posture may develop dysfunctions.

Abnormalities of posture can elevate local tension or compressive forces and cause chronic compression of the nerves in the area. Maintenance of muscles in a shortened position can cause them to shorten permanently and then react with pain when they are put on a stretch. The idea of muscle imbalance implies that some muscles are stretched by the person's function and become weaker whilst others become shorter in consequence and so stronger, perpetuating abnormal function. Management of these conditions starts with patient education as understanding is vital if they are to make long term postural changes.

Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about Physiotherapists, physiotherapy, Physiotherapists in Coventry, back pain, orthopaedic conditions, neck pain and injury management. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.

Amateur and professional athletes alike both know that injury comes hand in hand with sports. Sports by its very nature are geared to push the limits of individuals to remain competitive. As boundaries are pushed, limits will be crossed. This is when injuries happen. However, the body is very resilient and with the help of the physical therapy programs recovery times are minimal. These advanced therapy programs build a regimen of activities to restore health and vitality to the affected areas. Many programs require the use of exercise equipment, massage chairs and stretching elements.

If you start a physical therapy program, then you will be assigned a physical therapist. The therapist is a trained professional to help restore your strength, motion and activity. The therapist understands the mechanics of your body and will help design a treatment program for you. You will learn specific stretches, exercises and other specialized techniques to help your body recover. You may also use specific equipment that can address particular issues. Massage therapy has become an important tool in the recovery arsenal and many clinics are making use of massage chair recliners.

Your therapist is trained in different surgeries, treatments and rehabilitation techniques and goals. The therapist will design a recovery treatment targeting the areas of your body that needs greater flexibility or strength. If you are recovering from surgery, then the therapist will be knowledgeable about different surgical procedures. The therapist will help in setting goals as you work through the initial limitations of your physique. Some of the important physical therapy tools are stretching, exercises and massage therapy.

Stretching is important to help regain lost flexibility. The muscles may be tight, the joints stiff and you may have scar tissue. These reduce your range of motion and decrease flexibility. Stretching helps to elongate the muscles. This helps to stretch the muscles helping their elasticity. A frequent and continuous regimen of daily stretching helps to speed recovery. Your therapist will design a stretching routine which will help focus on restoring the range of motion.

Exercises are important to help rebuild strength. When we have an injury, we tend to protect that area. Protecting that area is usually to isolate and immobilize it. In other words, we tend not to use the injured area. This helps to prevent further injury, but at the expense of strength and conditioning. To help rebuild the body, exercises help to build up strength, endurance and agility. Physical therapy clinics have a wide array of exercise equipment from treadmills, stationary bikes, weights and more. These help you focus building up a particular set of muscles.

When you are recovering from surgery most likely you will have new scar tissue. Scar tissue needs to be made more pliable through time. This will enhance the flexibility of the affected area. The mobility of the muscle and also the skin is at stake here. Massage therapy has been shown to increase the flexibility of muscles. Your muscles when injured may also have the muscle fibers break into short units. This reduces their flexibility. The muscles need to be more pliable by elongating the muscle fibers. Massage chairs use kneading and pressing massage techniques to relieve tight muscles and elongate the muscle fibers to restore their flexibility.

Whether you are a professional tennis player or a beginner skier, injuries can happen to anyone. If you do find yourself in physical therapy, work on setting goals to recover. Find yourself an excellent physical therapy clinic. Make sure they have qualified people, proper exercise equipment and massage therapy. And if you need massage therapy, make sure a massage chair is part of your recovery plans.

If used for permanent fixation pins and wires are usually chosen if very little load is going through the fracture site or they are adding to the stability of a plate or an external fixator. Typical uses for wires or pins are to fix finger fractures, hand fractures, shoulder fractures and wrists. K-wires are often used to assist with the fixation in fractures of the patella, elbow and ankle. A device known as an image intensifier is often used to insert the device under x-ray guidance, allowing insertion of the pin or wire through the skin without operation.

Steinmann pins, being larger and which can be threaded are mostly used for applying skeletal traction to a fracture of the long bones. They are passed through a bone and a stirrup device attached to a weight provides the traction to keep the bone in alignment until a sufficient amount of healing occurs. This technique has largely been superseded by the use of more advanced techniques of internal fixation which means that long term traction, with its many negative side effects due to the patient being kept in bed for weeks or months, is rarely required.

Bone Screws

Using bone screws is a basic technique of modern orthopaedic and trauma management, used either on their own or as part of another implant technique. Screws can be self tapping or need tapping beforehand. The force needed to pull a screw out of the bone is affected by various factors and the main determining factor is the density of the bone into which it is inserted. The total area of contact between the bone and the threads is also important and self tapping screws are typically used. Screws are inserted clockwise either straight in or along a path already drilled and once the screw head hits the cortical bone it generates tension with screws typically inserted at a force equivalent to 80 percent of the force which would strip them.

Bone is an active and dynamic body organ and can adapt to the stresses formed by the application of the screws, allowing a gradual reduction in fixation force with time. However, the fracture is usually healed before the fixation is likely to loosen. The two main kinds of screws available are cancellous and cortical bone screws, the denser bone of the cortex being fixed with cortical screws and the more honeycomb bone of the bone ends fixed with cancellous screws. The surface areas of contact between thread and bone are greater in cancellous screws, allowing cancellous screws to achieve purchase in less dense bone.

Pre-drilling or tapping is not generally needed in cancellous bone due to its porosity and ease of insertion. Lack of tapping is often better as the insertion of the screw compresses the bone and may increase the local density of the bone, making the screw purchase more secure. Positional screws are used to attach an implant device such as a plate to the bone by compressing between the bone and the plate. Typical insertion involves drilling a pilot hole with a matching bit for the screw size and an appropriate thread tap is used unless self tapping screws are to be inserted.

A degree of compression can be produced by inserting lag screws across the line of a fracture to increase alignment and stability of a long bone fracture and to produce and maintain reduction of a fracture across a joint. To provide the greatest degree of stability requires the screw to be placed at right angles to the line of the break. It is unlikely that lag screws will give sufficient stability alone so they are often supplemented with added stability from an external fixator or a plate.

In a percutaneous technique often used for hip fracture fixation, cannulated screws can be inserted along the previously inserted guide wire which has been located under the control of x-ray guidance, completing the fixation started by wiring. As surgeons always try to minimise the size of operations and the resulting damage to soft tissues and bone membranes, cannulated screws are typically used in limited open surgery. Screws are now typically self drilling and self tapping although they are much more expensive than normal screws.

Total hip replacement rehabilitation is not a complex process but it is useful for a skilled eye to be kept on the progress of the patient if the outcome is going to be optimal. The muscles around a painful joint weaken due to lack of use and this reduces the support of the joint given by them. Tightness may develop in the joints due to the restrictions in the movements which are limited by the pain and so the patient may develop an abnormality of gait to cope with the pain and tightness.

Pre-operative education and rehabilitation is important so the person knows what they are trying to achieve with their exercises and gait practice. Range of motion and strengthening exercises can be given along with gait correction. If the gait cannot be easily corrected by instruction, consideration should be given to using a walking aid. Either a stick or a crutch can be used depending on the degree of support needed, held in the opposite hand to the arthritic joint. If the patient walks with a good pattern this is sufficient, but if they still walk poorly they may need two sticks or crutches to achieve a reasonable gait pattern.

After the operation patients are routinely reviewed by a physiotherapist the day following the procedure. Initial instruction will be in regular contraction of the buttock and quadriceps muscles to reactivate their use and restore some joint movement. Range of motion exercises of the hip might include gentle hip flexion, sliding the heel towards the body as the knee rises. This is a functional movement patients need to be able to perform to move themselves around the bed. Ankle movements are also encouraged to aid circulation, although this effect may be small.

The ability to move the operated leg about is produced by instruction to perform muscle contractions and joint range of movements hourly in the bed. The physiotherapist and an assistant will get the patient out of bed and walking with a frame or crutches. Early sitting in a moderately high seat for the patient is routine, to prevent hip flexion attaining too great a level. The lateral incision up the side of thigh can inhibit patients from stretching that area when they bend their knees in sitting so they need to be encouraged to slide their feet towards themselves regularly while they are sitting.

Giving the patient confidence to independently perform a safe and relatively normal gait pattern is the initial goal of mobilisation. This progresses into teaching a walking technique which approximates as closely as possible to normal walking. Once this has been well learned the patient should walk with a pattern very close to a natural gait, with an observer only understanding they have a restriction by the presence of crutches. The natural sequence of muscle activation is promoted by an involuntary and repetitive function such as walking and this reduces the energy cost of walking and facilitates return of muscle power.

If a patient does not gain in muscle strength which is required then specific exercises can be performed. Initially the patient can be in standing and holding on to a high table or back of chair for balance. The operated leg is bent up gently with the knee coming up forwards for five repetitions, increasing as it gets easier with time. The second movement is to move the straight leg out to the side which strengthens the stabilising muscles of the buttock. The third movement is to move the straight leg backwards and behind without bending the body forwards to activate the large hip muscles.

In some cases these exercises will need to be supplemented by harder ones or by prescribing hydrotherapy. Pool therapy is very useful for patients after their joint replacement as they feel supported and in control of the leg but the water gives significant resistance to muscular activity. Resistance can be increased by using floats attached to the foot and the water resists the practice of the gait pattern, resisting the whole process. Care must be taken not to exercise hip replacements unduly or this can loosen the cement-bone interface and reduce the life expectancy of the replacement.

When we have our first episode of low back pain our back is rarely stiff unless we are just like that, having a tendency towards stiffness. Mostly our back moves like the well designed machine it is. The discs separate the vertebrae and allow movement to occur, with thicker discs in areas of greater movement. The facet joints control and limit movement of the segments and prevent abnormal displacement of the spine under the shearing loads it must cope with. The muscles are all in good condition and working in the most functional patterns. Until, at least, an episode of back pain occurs and it all changes.

Initially back pain causes an inhibition and a wasting of the core muscles which provide stability to the segments and to the whole back. This allows instability to occur which may predispose to future back pain episodes if nothing is done to correct it. With time and repeated episodes of pain and degenerative changes which occur in the discs and facet joints, the back can become stiff and develop chronic back pain. Gravity tends to force fluid out of the disc under load and is counterbalanced by an absorbing force which is more active when lying.

Discs will narrow and lose part of their hydration under the forces of compression which occur in normal life, the disc becoming stiffer and narrower. X-rays can show up this narrowing when it reaches a certain level, but many discs will be troublesome long before this stage. The intervertebral disc and the two vertebrae each side of it are referred to as a vertebral segment and an abnormal stiff segment will move in such a way as to impose inappropriate levels of load upon structures not adapted to take them. The stiffness of individual spinal segments can be felt by a physiotherapist palpating the spine.

Muscle spasms are a typical reaction to an acute injury and has a protective function, stopping the damaged segment from moving while it is so inflamed and thereby giving it some freedom to heal. As the pain settles and the injury heals the back spasms should gradually settle and allow normal movement to be restored. Unfortunately this does not always happen, with some muscles remaining over protective and eventually forming a contracture, an abnormally shortened tissue structure which maintains an abnormal joint position.

Sitting for extended periods can increase the likelihood of suffering from increased compression of the lumbar discs with consequent fluid loss. Repeated flexion maintains the regular cycle of fluid uptake and avoidance of this movement interferes with this important process for disc health. The maintenance of abnormal posture and lack of strength in the abdominal muscles are also important factors.

Chronic segmental stiffness is usually indicated by a history of back pain and general backache with some leg referral also possible. Since many and variable areas of the spine can be stiff or mobile, the stiffness which contributes towards the painful problem might have been present for some time. The pain is worse on sitting for long periods or doing bent over activities, anything which stresses the stiff segment towards the end of its available range of motion. The facet joints become stuck in an extended position and the segment tightens up by adaptive shortening, losing its ability to flex or maintain flexion comfortably. My back problems are like this and can be quite troublesome on stressing, leading me to avoid heavy work such as lifting objects of any weight.

Sarah Key, a physiotherapist who is well known in the UK, has produced the Sarah Key's Back Sufferers Bible, a book in which she sets out her views of what is going on in this most common of musculoskeletal syndromes. She does acknowledge that it is hard to bring solid evidence for many of her interpretations but seems to have many good and practical therapy ideas to approach the back pain problem with. She covers the main syndromes which typically occur, giving treatment routines for self management of each one, all of which I have found very useful for my own lower back pain. Now I have something I can do about it rather than accept it as a fact of life.

Muscle strength is very important for all of our functional activities, from heavy work such as climbing stairs or a hill to fine work such as sewing or typing on a keyboard. While losing feeling in a part of the body can be more disabling, losing muscle power always has consequences for our function and our independence, especially as we get much older when our power levels decline anyhow. We may lose muscle power for a wide variety of reasons: disuse; pain; injury; disease or neurological illness. Physiotherapists are skilled at the assessment of muscle power and in progressive strengthening techniques to restore power within the patient's capacity.

The Oxford Scale is the rating system used by physiotherapists for the assessment and recording of muscle power when required. Knowledge of muscle anatomy is vital so that the joint can be positioned correctly and the tendon and muscle palpated so whether there is any muscle action can be judged. The muscle is rated on the Oxford Scale from one to five and written down as 2/5 or 4/5, at times with a plus or minus sign to show the muscle has more or less strength but not enough to go down or up the scale. The physiotherapist ensures the joint is in the optimal position to enable the muscle to function easily and for easy visualisation of the tendon and muscle.

The physiotherapist will ensure the joint is positioned best for good visibility of the muscle, easy manual palpation of the tendon and muscle belly and the correct alignment for the expected strength of the muscle. Palpating the tendon and muscle, the physiotherapist will ask the patient to perform the muscle action desired, feeling for any contraction or movement. If there is none then the score is 0/5 and 1/5 if there is a just discernable contraction or a twitch, without apparent joint movement. If the joint can be moved through its whole motion but only without gravity resisting then the grade is 2/5, for which the joint needs careful positioning. 3/5 grade would be recorded when the joint can be moved through its range against gravity, an example being straightening the knee from bent in sitting.

To be rated as 4/5 on the Oxford Scale a muscle must be able to move its joint through full range against resistance and gravity. The physiotherapist will decide what degree of resistance is reasonable for this test, bearing in mind the characteristics of the patient such as age, sex, activity levels and medical status. The normal rating of 5/5 is given only when the muscle can move the joint painlessly to the extent that the tester feels is entirely adequate, given the personal status of the patient. Full power for a younger, strong man will be very different for a child or old person.

Grade three out of five for the shoulder muscles might be the ability to lift the arm above the head, but if this cannot be easily done or to full range then the muscle can be graded as three minus to indicate its inability to be fully grade three. If the physiotherapist can resist the muscle firmly but it still doesn't seem to be strong enough for a five, then the rating can be four plus. Physiotherapists go through all the muscles to be tested and rate them all on a muscle testing chart as a record of the muscle strength, which can be retested over time to chart recovery.

Physiotherapists begin muscle strengthening techniques in a position where gravity is eliminated, allowing a weak muscle to be repetitively exercised. As the patient's ability increases they can perform more functional activities of daily life which strengthens the muscles in a co-ordinated way which reflects normality. Next, resistance against muscle action is increased as muscle strength improves in response to the level of intensity of resistance and not just repetition. High intensity causes muscle fibre breakdown which repairs with increased size and power until the next intensity workout repeats the process. Progression is then moved to functional exercise with bodyweight resistance as dynamic movement is more useful.

Ankylosing spondylitis belongs to a group of disorders called the spondyloarthropathies, a group which also includes psoriatic arthritis, reactive arthritis and arthritis related to inflammatory bowel disease. All these conditions are linked by the genetics of a gene on white blood cells called HLA B27 and by the presence of enthesitis, inflammation at the points where ligaments and tendons insert into bone. This can lead to fibrosis at these sites and then bone formation, causing joint fusion (ankylosis) in some cases.

The commonest spondyloarthropathy is Ankylosing spondylitis, which occurs as a reflection of the occurrence of the HLA B27 gene in the population. The gene occurs much less commonly near the equator and much more commonly in northern latitudes, and this is also the pattern with the development of AS. White race people are more commonly affected with around 0.1 to 1.0 percent overall, varying with latitude. Only 1 or 2 people of a hundred with the HLA B27 gene actually develop AS, but if they have a close relative who has the condition the likelihood rises to 15 to 20%.

Three males to every one female is the ratio of patients with Ankylosing spondylitis, as female patients may have much less obvious symptoms and so be missed from the diagnosis. Young men are the commonest presenting group with most consulting a doctor before they are 40 and up to 20% before they are sixteen years old. 25 years is the average age that someone goes down with the symptoms and is uncommon to find a diagnosis of AS in a person over fifty. It is easily overlooked as it can look like mechanical back pain if care is not taken. On questioning how they are in the morning, a typical answer is very stiff.

Low back pain is the major diagnostic alternative but AS patients are generally younger and the inflammatory process leads to different symptoms:

Morning back stiffness lasting half an hour and often longer Back pain improved with exercise Back pain worsened with rest Night pain later on in the night Other joints may be affected Fatigue is common Active inflammatory disease can cause systemic affects such as unwellness, weight loss or fever

On examination the physiotherapist can find a stiff lumbar spine with reduced movements from normal, postural abnormality such as a flat lumbar spine and an increased thoracic kyphosis. In later stages neck movements may also be involved and chest expansion will be reduced from normal. In the third of patients who get peripheral involvement, enthesitis develops in areas subject to mechanical stresses, the most common being the insertion of the plantar ligament in the foot and the insertion of the tendo Achilles to the heel. These areas will be palpated by the physio to help confirm the spread of the disease, helping to focus the treatment plan later on.

The physiotherapist initially notes the postural changes which have occurred in an AS patient such as any spinal deformities, round shoulders, bent knees or an increased cervico-thoracic curve and poking chin posture. The physio will record ranges of movement of the spine and include the neck, thorax and lumbar ranges, also assessing any peripheral joints which may be affected. Any entheses which are reported as painful are palpated to confirm the presence of an inflammatory process, and if the AS is very active then the physiotherapist might also find effusions in the joints, perhaps with a feeling of unwellness, night sweats and poor rest.

Physiotherapists will concentrate on treating the inflamed areas first such as the areas where the ligaments insert into the bone, using insoles, cold, ultrasound and stretching techniques. Routine spinal range of motion exercises are taught to patients with an emphasis on getting to end ranges, concentrating initially on the anti-gravity muscles such as thoracic and lumbar extensors. Neck rotation and retractions and thoracic rotations are also important functional movements not to lose. Patients should rest themselves in good postures such as prone or supine with only one pillow, to avoid accentuating the typical spinal deformities. Treatment for AS in a hydrotherapy pool is beneficial and soothing and patient education important so they keep up their programme.