: Definition : Types of physical agents Thermotherapy Skin
structure and function
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Physiotherapy is a branch of medical science where physical
measures such as heat, light, ultrasound, water, electricity and
exercises are used in the diagnosis and treatment of orthopaedic
injuries. PHYSIOTHERAPY
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Passive Physiotherapy directed toward the alleviation of
symptoms Active Physiotherapy directed toward restoration of
function by activity
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Aims To treat disability and deformity. To correct disability
and deformity To prevent disability and deformity
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CATEGORIES Depending on severity of the ailment 1. Short term
physiotherapy 2. Long term physiotherapy
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Short Term Physiotherapy Includes patients with minor
neuromuscular-skeletal lesions like -Simple soft tissue injuries
-Simple fractures -Non traumatic lesions
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Long term physiotherapy Refers to more complicated diseases of
musculoskeletal origin Includes condition like Fractures of major
bones Spinal trauma resulting in physical disability and
complications like paraplegia, quadriplegia etc. Surgical
procedures involving major joints Chronic conditions like RA
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Modalities APTAs position statement (1995): Without
documentation which justifies the necessity of the exclusive use of
physical agents/modalities, the use of physical agents/modalities
in the absence of other skilled therapeutic or education
intervention, should not be considered physical therapy. Without
documentation which justifies the necessity of the exclusive use of
physical agents/modalities, the use of physical agents/modalities
in the absence of other skilled therapeutic or education
intervention, should not be considered physical therapy.
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Physical Agents the physical agents in use today can be
classified according to their specific effects on biological
tissues
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Classification of physical agents EffectsType of
agentModalities Thermal Conductive heating agents Heating by
radiation Hot packs, paraffin wax, cryotherapy and peloids
Infra-red Thermal and non thermal Diathermy agents producing
conversing heating and non thermal effects Shortwave diathermy,
microwave diathermy, and ultrasonic energy Stimulation of nerve
and/or muscle Low frequency currents Medium frequency currents
Faradic-type currents, long duration pulsed currents, sinusoidal
currents, direct current, interferential currents, didynamic
currents, acupuncture, and TENS
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Classification of physical agents EffectsType of
agentModalities Stimulation of circulatory mechanism Compression
units Low frequency currents Intermittent pressure cuffs with
varying pressure and cycle Faradic currents, sinusoidal currents.
Interferential currents, didynamic currents Effects on skin and
superficial tissue for infection and skin lesion Ultraviolet rays
Diathermy agents Mercury vapor lamps, fluorescent or black
lighttubeskromayer or cold quartz lamps Microwave, shortwave,
infrared radiation
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Thermotherapy Modes of use Conduction Convection Radiation
Types of Applications Whirlpools Hot tubs Jacuzzis Moist heat packs
Paraffin baths Ultrasound Phonophoresis Diathermy heat
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Transfer of Energy Energy moves from an area of HIGH
concentration to an area of LOW concentration. Radiation Conduction
Convection Conversion Evaporation
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Radiation When the surrounding environment is hotter that the
body the radiant heat is absorbed. No-contact is made. Short-wave
Diathermy Microwave Diathermy
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Conduction Direct transfer of energy between two objects in
physical contact with each other. Energy is transferred from the
area of high temp. to the area of low temp. Ice packs Moist heat
packs Paraffin
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Convection Much like conduction, but the medium moves across
the body causing variations. Fluidotherapy Whirlpools
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Conversion Changes other energy forms into Heat. Ultrasound
Microwave Liniments or Balms
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Evaporation Heat is absorbed by the liquid on the skins surface
and cools the skin as it turns into a gaseous state. Vapocoolant
sprays Alcohol
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Factors Affecting Transfer of Energy Density of Medium
Reflection Refraction Absorption Law of Grotthus-Draper
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Healing Process Three Phases: 1. Inflammatory 2.
Fibroplastic/Proliferative 3. Maturation/Remodeling
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Inflammatory Response Phase Injury Destruction of tissue
Cellular injury. Cardinal Signs of Cellular injury : redness,
edema, tenderness (pain), increased temperature. There is a
delivery of leukocytes and other phagocytes and exudate are present
at the injured tissue. Vascular Reaction involves vascular spasm,
formation of a platelet plug, coagulation & growth of fibrous
tissue
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Inflammatory Response Phase Up to day 6 Clinically should see a
decrease in edema and pain is still present. Modalities are used to
: Control pain and decrease edema. Cryotherapy is still
appropriate
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Clot formation To form a clot fibrinogen must be converted to
fibrin Clot formation begins around 12 hours following injury and
is completed by 48 hours Summary:during the inflammatory stage the
injured area is walled off, lasts 2-4 days.
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Fibroplastic repair phase Scar formation is referred to as
fibroplasia. Begins within the first few hours following injury and
may last 4-6 weeks. Breakdown of the fibrin clot allows the
development of granulation tissue. Development of a new scar
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Maturation-Remodeling Phase Can last over 1 year. Collagen
remodels or realigns in accordance with the tensile forces placed
on it
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FACTORS THAT IMPEDE HEALING Extent of injury EdemaHemorr- hage
Poor vascular supply Separation of tissue Muscle spasm
atrophyCorticoster- oids Keloids Hypertroph- ic Scars
InfectionHumidity, Climate, O2 tension Health, Age, Nutrition
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Structure of the skin The skin is one of the largest organs of
the body. It comprises about 16% of our body mass. The skin covers
the body and protects the deep tissues. Its free surface is not
smooth, but is marked by delicate groove
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Epidermis Composed of keratinized stratified squamous
epithelium, consisting of four distinct cell types and four or five
layers Cell types include keratinocytes, melanocytes, Merkel cells,
and Langerhans cells Outer portion of the skin is exposed to the
external environment and functions in protection
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Layers of the Epidermis: 1. Stratum Basale (Basal Layer)
Deepest epidermal layer firmly attached to the dermis Consists of a
single row of the youngest keratinocytes Cells undergo rapid
division, hence its alternate name, stratum germinativum
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Layers of the Epidermis: 2. Stratum Spinosum (Prickly Layer)
Cells contain a weblike system of intermediate filaments attached
to desmosomes Melanin granules and Langerhans cells are abundant in
this layer 3. Stratum Granulosum (Granular Layer) Thin; three to
five cell layers in which drastic changes in keratinocyte
appearance occurs Keratohyaline and lamellated granules accumulate
in the cells of this layer
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Layers of the Epidermis: 4. Stratum Lucidum (Clear Layer) Thin,
transparent band superficial to the stratum granulosum Consists of
a few rows of flat, dead keratinocytes Present only in thick
skin
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Layers of the Epidermis: 5. Stratum Corneum (Horny Layer)
Outermost layer of keratinized cells Accounts for three quarters of
the epidermal thickness Functions include: Waterproofing Protection
from abrasion and penetration Rendering the body relatively
insensitive to biological, chemical, and physical assaults
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Cells of the Epidermis Keratinocytes produce the fibrous
protein keratin Melanocytes produce the brown pigment melanin
Langerhans cells epidermal macrophages that help activate the
immune system Merkel cells function as touch receptors in
association with sensory nerve endings
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Dermis Second major skin region containing strong, flexible
connective tissue Cell types include fibroblasts, macrophages, and
occasionally mast cells and white blood cells Composed of two
layers papillary and reticular The Dermis helps us to control our
body temperature: N.B A. On a cold day when the body needs to
conserve heat, the Blood Vessels in the Dermis NARROW.
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Layers of the Dermis: 1. Papillary Layer Areolar connective
tissue with collagen and elastic fibers Its superior surface
contains peglike projections called dermal papillae Dermal papillae
contain capillary loops, Meissners corpuscles, and free nerve
endings
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Layers of the Dermis: 2. Reticular Layer Accounts for
approximately 80% of the thickness of the skin Collagen fibers in
this layer add strength and resiliency to the skin Elastin fibers
provide stretch-recoil properties
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DERMIS. The dermis is composed of two layers: the papillary
layer and reticular layer. The papillary layer is closest to the
epidermis. Connective tissue here is less dense than in the
reticular layer. There are numerous sections of blood vessels
(arterioles, venules, and capillaries) in the dermis.
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Hypodermis The hypodermis is the innermost and thickest layer
of the skin Subcutaneous layer deep to the skin Composed of adipose
and areolar connective tissue The hypodermis is used mainly for fat
storage. It invaginates into the dermis and is attached to the
latter, immediately above it, by collagen and elastin fibres. It is
essentially composed of a type of cells specialised in accumulating
and storing fats, known as adipocytes. These cells are grouped
together in lobules separated by connective tissue.
