Physical methods of treatment are widely used in the system of modern medical rehabilitation of the sick and injured and represent its basic and most important tool. Physical therapy is a part of physical medicine that deals with the use of physical agents for the purpose of:
- metaphylaxis (prevention of exacerbation and recurrence of the disease) and
- medical rehabilitation.
Physical therapy today means the therapeutic action of various physical agents, which are applied through certain physiological structures, primarily through the skin. Applied within an adequate dose, which does not disturb the integrity of the tissue, these agents act in the form of physiological stimuli on extero and proprioceptors and lead to local and other reactions of the organism, which should range within physiological variations.
Physical therapy can be considered a method of treatment primarily based on the action of a stimulus and the body's response to that stimulus (action-reaction).
The tasks of physical therapy are, among others, the following:
- pain reduction or relief;
- improving local circulation;
- reduction of edema through resorption and prevention of extravasation;
- anti-inflammatory action in acute inflammation;
- local increase in metabolism;
- improving trophism, tissue repair and regeneration processes;
- increase in soft tissue elasticity;
- establishing the function of deprived nerves;
- preventing the formation of dense connective tissue and scars;
- prevention and elimination of muscle contractions and contractures;
- motor reeducation of certain parts of the locomotor system after deprivation or prolonged inactivity;
- improving movement coordination;
- establishing automation and movement stereotypes.
Physical therapy is an integral part of medical rehabilitation, without which one cannot imagine the functional training of physically disabled persons for daily activities, and also possibly for return to work. The best results in the functional training of these persons are achieved by the combined application of procedures in various areas of physical therapy.
According to the type of physical agent used, physical therapy is divided into the following areas:
- ELECTROTETAPY which deals with the application of various types of electric current (electricity in the form of constant direct - galvanic, low frequency, high frequency current) for the purpose of treatment.
- PHOTOTHERAPY that uses artificially obtained light (light energy) in the form of ultraviolet (chemical energy), infrared (thermal energy) and laser light (biostimulating effects).
- SONOTHERAPY which implies therapeutic application of silent ultrasonic waves of high frequency (870 kHz to 3 MHz), where sound energy (mechanical, thermal) acts on the skin and subcutaneous tissues.
- THERMOTHERAPY which deals with the therapeutic application of heat (thermal energy) in the form of: heating the body, bringing heat (thermotherapy in the narrow sense), when thermotherapeutic procedures are applied whose temperature is higher than body temperature or cooling the body, taking away heat, so called. cryotherapy, when thermotherapeutic procedures are applied whose temperature is lower than body temperature.
- KINESITHERAPY which deals with the application of therapeutic exercises (kinetic energy created by muscle contraction) in order to preserve, establish, develop and replace the functions of the locomotor system.
- HYDROTHERAPY which implies external application of water (thermal and mechanical energy) in all aggregate states (ice, water, steam) for the purpose of treatment.
- MANUAL MASSAGE where passive mechanical energy is used for healing purposes.
- MAGNETOTHERAPY which deals with the application of pulsating magnetic and electromagnetic fields of low and high frequency (electromagnetic energy) in the treatment of the injured and sick.
METHOD OF PHYSICAL THERAPY
Within physical therapy, various physical agents act on the skin, and through the skin on other tissue structures and organs. Agents achieve their effect by acting on stimuli on numerous receptors:
Mechanoreceptors (react to pressure and deformation of the skin) are affected by mechanical stimuli within hydrotherapy (hydrokinetic procedures), massage, manual therapy and sonotherapy.
Thermoreceptors (react to hot and cold) are affected by thermal stimuli within thermotherapy, hydrotherapy, phototherapy, electrotherapy and sonotherapy.
Nociceptors (react to chemical substances released under the action of intense mechanical, thermal, chemical or electrical stimuli) are stimulated by mechanotherapy, electrotherapy, thermotherapy, phototherapy.
On neuromuscular spindles in skeletomotor muscles (react to stretching of extrafusal or contraction of intrafusal muscle fibers), tendon bodies - Golgi (react to increase of tension in muscles during contraction) and free nerve endings in joint capsule and ligaments - so-called. proprioceptors, therapeutic exercises, ie kinetic stimuli within kinesitherapy, hydrotherapy, occupational therapy, therapeutic sports and recreation.
The biological reaction that occurs under the action of various physical agents is mostly of a non-specific character and is manifested by local changes in the skin and other tissues and general reactions of the organism.
Local skin reaction
- reflex vasomotor reaction in the form of vasodilation, type of active hyperemia;
- intra and extracellular changes in ion concentration;
- membrane polarity changes;
- bioelectrical effects of changes in membrane potential (depolarization and formation of action potential in the neuromuscular system);
- biosynthesis processes, etc.
Local reaction of locomotor apparatus segments
The local skin reaction can, in the form of a consensual reaction, be extended by humoral and reflexive means to larger areas of the skin, other tissues and organs. During the procedures of kinesitherapy, hydrotherapy and electrotherapy, as well as during the massage, the following occurs:
- local changes in muscles, tendons, ligaments and joint capsules, in terms of better blood circulation and trophism,
- with improved muscle tone and
- increased soft tissue elasticity.
Action on internal organs
Through cutaneous visceral reflexes, physical agents can also act on internal organs (heart, lungs, gastrointestinal tract, urinary system, genital organs, etc.)
Action on the brain stem
If the intensity of the irritation, the duration of action and the surface of the skin on which the irritation acts are great, the irritation reaches the elongated spinal cord, mesencephalon or diencephalon. At the same time, regulation reactions of various types occur:
- mesencephalon, which controls posture and movement;
- diencephalon, which controls the vasomotor system, body temperature, metabolism, appetite, thirst, hematopoietic organs, etc.
Action on the subcortical part of the brain
As a reflection of the action of physical agents at the subcortical reactive level, regulatory reactions may be present, which include: skin turgor, muscle tone, pulse, blood pressure, heart rate, peripheral resistance; blood morphology and blood chemistry; respiration rate and depth; heat maintenance; electrolyte and water metabolism; metabolism of proteins, carbohydrates and fats; incretion and excretion, etc.
Action on the cortical part of the brain
Of particular importance is the effect on the limbic system, which is responsible for emotional reactions.
Physical agents can effectively contribute to the elimination or mitigation of:
- primarily caused by skin pain, especially with the application of thermotherapy procedures, galvanic or low-frequency current, therapeutic exercises and massage.
- secondary, reflexively occurring skin pain.
- as well as pain in the internal organs, because there is a possibility of a favorable reflex effect in the opposite direction, from the skin to the visceral organs (angular visceral reflex), resulting in improved function of the corresponding organ.
Effect on connective tissue
Within the reaction of the organism to the action of physical agents, the ubiquitous connective tissue - mesenchyme - is included, in which a non-inflammatory mesenchymal reaction occurs. Stimuli of a certain intensity lead to:
- acceleration of connective tissue metabolism and
- enhanced production of connective tissue components.