This branch of physical therapy focuses on the problems from the muscular skeletal system (muscles, bones, ligaments or tendons). Physical therapy in this area deals with diagnosing, managing and treating injuries and problems from the muscular and skeletal methods and rehabilitating right after orthopedic operations, as well. Orthopedic therapy workers function particularly in treating postoperative joints, acute injuries due to sporting activities, arthritis and amputations. Some from the techniques and approaches involved in orthopedic physical therapy to make recovery faster are strength training, hot/cold packs, joint mobilizations and electrical stimulation. An additional procedure recently utilized is sonogram, particularly in remedies like muscle retraining.
Orthopedic physical therapy is truly essential to restore the patients’ activity, strength and motion right after injuries or surgery. Its importance is two folded. 1 the 1 hand, orthopedic patients typically have deficiencies and weaknesses which could be eliminated or at least alleviated via particular targeted workouts and only a specialized physical therapist can show the patient and teach him/her the appropriate workouts designed to restore and enhance functions or, at least minimize the problems.
Below are essential things therapists can do in orthopedic physical therapy and there are lots of rehabilitation tools that they have on hand. Among these we ought to mention: stretching, strengthening (closed chain, proprioceptive, etc), ice and heat therapy, ultrasound, etc. Stretching is critical if a patient has stiff joint, which can affect normal activities severely. Proper stretching exercise can assist preserve such functions. To aid a patient in improving the function of his/her muscles, increasing endurance and maintaining or improving the range of motions strengthening workouts are utilized. Closed chain workouts are meant to assist balance the strength of muscles whereas proprioceptive workouts assist patients who lost the sense of knowing where a body part is in space due to a sprain for example, learn again how to control the position from the respective injured joint.
The ice and heat therapy warm up and cool off muscles and contribute to the stimulation of blood circulation and assist decrease swellings, as well. By utilizing an ultrasound probe, deep tissues are stimulated and warmed while the blood flow will improve. Even though you can find numerous orthopedic problems that could be solved without physical therapy, yet quite frequently really easy workouts might assist expedite the healing procedure, not to mention the complicated situations in which a physical therapist particularly trained for, is really a must.

Common Conditions

Ankle
One of the commonest injuries at the ankle is a sprain of the ligament (running from bone to bone) on the outer aspect, from the base of the fibula to the calcaneus. Easily done, by missing your footing, or slipping, the foot turns in and the lower leg doesn’t. The fibres of the ligament are over-stretched to varying degrees depending on the force involved. There will be an inflammatory response at the time of injury. Inflammation is the body’s defense response to injury, what you see is redness and swelling, what you feel is tenderness to the touch and pain on movement. A normal healthy inflammatory response is, if anything, rather overdone, so it is important to reduce swelling which in turn reduces pain and support the injured tissues, enough to make movement more comfortable and allow the ligament to repair (the inflammatory exudate contains fibroblasts, cells responsible for tissue repair). As the ligament heals it is important to keep the fibers approximated so that the ligament heals at the the appropriate length – not too long or the ankle will be unstable after repair, not too short or the ankle will lack its normal flexibility. The ankle ligament contains loads of proprioceptors: nerve endings sensitive to position which feed up to the brain and inform balance reactions in the leg muscles. It is important to retrain these balance reactions after ankle injury, otherwise the ankle performs poorly on uneven ground or in complex rapid movements and the ligament will be vulnerable to reinjury.

Spinal problems

Low back pain is a big problem in the western world in
terms of loss of working days and health service bills. If you have back pain, however severe it may be, other people can’t see it. Time and again patients with back pain will say to me: “I had no idea it could be this bad.” If you’ve had a severe bout of back pain, you will know only too well how disabling it feels, as if even the slightest movement is going to make it so much worse. Your body seems to be telling you to stay absolutely still. Yet we know from many research papers that the sooner you get moving the better it will be for your back.
Of course it is important to get your back thoroughly examined and in a tiny percentage of cases surgery will be required but the vast majority of patients with back pain will benefit from appropriate manipulation and exercise.

Elbow

Tennis elbow is a common injury. It tends to be precipitated by a period of repetitive use.lots of people get tennis elbow without ever having played tennis! It has become a common term for elbow pains associated with difficulty in gripping.

Pain can arise from irritation of a number of structures around the elbow joint : inflammation can occur around the tendon(s) at the point of attachment to the bone, or at the junction between tendon and muscle fibre; the mobility of the elbow joint can deteriorate, particularly the articulation between the head of the radius and the humerus. There can be restriction of the passage of nerve fibres, particularly the radial nerve, through the soft tissues around the elbow.
Research has shown that in the majority of cases there will be some degree of dysfunction in the neck, contributing to elbow pain, particularly if the condition has been persistent.
All of these structures need to be accurately examined and treated to resolve tennis elbow. If you have had tennis elbow for any length of time you will probably hear about all sorts of different treatment approaches which may or may not have worked; this is because it is a condition which can have a number of differing underlying causes.

Headaches

Tension headaches, as they are called, can arise from irritation of the structures between the base of the skull, and the top two vertebrae: the atlas and the axis.

Hip

Hip pain often arises from reduced mobility in the hip joint. This joint is extremely mobile but sedentary western living makes hardly any use of the available range. The ball and socket mechanism of the hip joint needs to be lubricated across the entire surface to ensure nutrition of the cartilage. Otherwise the cartilage surface tends to deteriorate. Without use the muscles, ligaments and tendons around the hip become distorted and weak. It’s a good example of the “use it or lose it” adage.
Where the hip is the primary source of pain, restoration of movement and muscle power is essential to reduce pain and improve function. Not all hip pain comes from the hip though ! Sometimes there will be pain around the hip, even including tenderness in the muscles, yet it is the lower back ( lumbar spine) that is at fault, giving rise to “referred” pain into the hip.

Knee & Kneecaps

The knee can be described as a hinge joint, its main movements being flexion and extension (i.e bending and straightening). It is vulnerable to torsion which can damage a) the ligaments (running from bone to bone) either on the inner or outer aspect of the knee b) the cartilages (washer type structures inside the knee) c) the cruciate ligaments inside the knee – these are designed to hold the knee steady from front to back – so they are more likely to become injured when the knee is “sheared”.
Some sports are particularly tough on knees, football for instance. Knees that have taken a lot of trauma over the years will tend to get arthritic. This means that the actual cartilage surface on the femur and the tibia gets ragged and irregular. Normal cartilage surfaces slide on each other incredibly smoothly, like ice on ice. When this surface deteriorates, movement of the knees can be more restricted, certainly more noisy, but not necessarily painful. The mechanism of injury often suggests the structures most likely to be damaged. The physiotherapist can then confirm the problem by careful (and gentle) testing in the clinic. It is common practice to use expensive scanning procedures for many injuries these days, but a good physiotherapist can often identify the injury in the clinic by examination.

Kneecaps

A common cause of pain around the knee, not only for sporty types, is retro patellar pain, (pain behind the kneecap). The kneecap is actually enclosed within the tendon of the quadriceps muscle (four muscles on the front of the thigh) The balance between the muscles needs to be just right so that the knee cap sits centrally over the knee. If the balance goes off then the muscles tend to pull the kneecap sideways (usually towards the outer aspect) on the knee. This causes friction between the back of the kneecap and the front of the femur, leading to inflammation.
Alternatively the knee can hyper extend (when standing with the knees locked straight, they don’t just straighten, they go past straight and bow backwards) this can cause the kneecap to rub excessively against the knee joint, setting up a low grade inflammation which will become painful.
Typically the pain is more noticeable when sitting for a long time, (for instance, in the car or at the cinema), or when the knee works under load – e.g down or upstairs. For some, kneeling is impossible. Physiotherapy assessment will include muscle testing, measuring the “lie” of the patella, working out how to correct the position and retrain the muscles to restore balance.

Shoulder

The shoulder or gleno humeral joint is an intricate arrangement – loads of movement is available in just about every direction, but stability is limited, so this has to be provided by the muscles and ligaments surrounding it. The head of the humerus (the long bone of the upper arm ) moves on the glenoid, a slightly convex surface on the outer aspect of the shoulder blade. The collar bone also connects up with a part of the shoulder blade called the acromion. The muscles surrounding the joint, running between the humerus and shoulder blade are known as the rotator cuff.
Shoulders dislocate relatively easily, once the dislocation is treated it is important to get all the muscles back in good working order. Shoulders can become painful and restricted seemingly out of the blue, and the term frozen shoulder is quite often used.
Shoulder problems need really careful examination, they can be very difficult to diagnose because the whole mechanism is so intricate. Not only that, a significant number of pain patterns will appear to be arising from the shoulder when in fact the problem lies in the neck and the pain is actually referred to the shoulder, shoulder blade or down the arm.

Wrist & Hand

Common problems around the wrist and hand can arise from repetitive activities such as using a keyboard. Factors which can contribute include unusually prolonged periods of time using the keyboard, or using the keyboard in an awkward position ( too high, too low, at an awkward angle etc) or switching from one type of use to another – (keyboard to mouse, scrolling etc)
Pain can arise from local inflammation in the tendons and / or small joints of the hands and wrist. There may also be irritation of the nerves supplying the hands/ wrist/ forearms.
Careful examination will identify the source of symptoms. Treatment can include improving the mobility of the soft tissues: muscles, tendons, ligaments; the joints of the hand and wrist. The use of low dose pulsed ultrasound will reduce inflammation. Clearly it is often worth reviewing the working environment to prevent recurrence of this sort of problem.