Physiotherapists are highly qualified health care professionals who work in collaboration with both human and animal patients to improve health and function, ultimately guiding individuals to get back on track in life following an injury or illness. Physiotherapists work in a huge variety of settings, from occupational health setting to private practice, from the emergency department to the intensive care unit. Physiotherapists specialise in a wide variety of areas, including animal, paediatrics, women’s health, sports, cardiorespiratory, neurology, musculoskeletal, rehabilitation, continence and aged care physiotherapy. Physiotherapists have a wide variety of techniques and modalities in their ‘toolbox’ to draw upon when formulating a treatment plan for their patient. The choice of technique will depend on patient preference, evidence based practice (what does the research tell us to do?) as well as post graduate training and continual professional development that the physiotherapist has engaged in. Some of the more commonly used treatment modalities are described below.
Manual therapy / joint mobilisation
Joint mobilisation refers to a variety of ‘hands on’ techniques, designed to mobilise joints in specific directions and at different speeds, in order to restore joint movement. Techniques range from passive mobilisation, where small to larger movements of a joint are produced, with the aim of reducing pain and improving joint range and quality of movement. In addition, joint mobilisation can affect the soft tissue surrounding the joint in question, soothing spasm and pain in affected muscles. In contrast, manipulation (in Musculoskeletal Physiotherapy terms) is a short, high velocity movement of a joint often associated with a ‘click’ or a ‘pop’ sensation.
Massage has been used as a therapeutic modality since 2700 BC, referred to as “the art of rubbing” by Hippocrates. A more modern definition is described by Standley as “a mechanical manipulation of body tissue with rhythmical pressure and stroking for the purpose of promoting health and well-being”. Many different massage techniques can be used, depending on the aim of the treatment. Techniques include effleurage, petrissage, tapotement and frictions. The effects of massage will depend on the specific technique used, but include increase of blood flow, improved muscle compliance, increased range of motion, reduced stiffness, neuromuscular excitability, pain and stress hormones as well as reducing anxiety and increasing relaxation. Both humans and animals generally respond very well to massage – dogs, cats and horses are all known to routinely scratch, lick and groom themselves as well as their companions, which facilitates the formation of social bonds between individuals.
Dry needling is a treatment technique used in the management of muscular or myofascial pain and dysfunction. In simple terms, the treatment involves using needling of trigger points in a muscle, with the aim of reducing muscle tension and alleviating the pain experienced from trigger points. Trigger points are an area of hypersensitivity in muscle, often felt as a taut, tender band or knot in the muscle belly. Although the same needles are used in both dry needling and acupuncture, this approach should not be confused with acupuncture. Acupuncture is based on Traditional Chinese Medicine, whereas dry needling is based on Western anatomical and neurophysiological principles.
Strapping and Taping
There is a variety of tape available on the market. Your physiotherapist will select the type of tape based on what the aims of treatment are. Rigid taping is used to either immobilise a joint, encourage a joint to move in particular manner or improve posture. Kinesiology taping is a more flexible and forgiving material, often used to either facilitate or inhibit specific muscle activity.
Many different types of electrotherapy modalities are available. Neuromuscular Electrical Stimulation (NMES) uses electrical stimulation to elicit muscle contraction by stimulating muscle fiber activity. NMES is useful in stimulating weak and atrophied muscle post-surgery or in the management of neurological cases. Transcutaneous Electrical Stimulation (TENS) works to reduce both acute and chronic pain. How TENS works will depend on the specific settings chosen by the physiotherapist.
Exercise Based Therapy
Movement based rehabilitation is one of the most important tools in the physiotherapy toolbox. No matter what an individual’s ability is, everyone benefits from exercise. Your physiotherapist will create an individualised home exercise program, with choice of exercise, equipment used and level of intensity, frequency as well as duration of exercise depending on injury or illness type as well as stage of healing. Exercise techniques used include postural and movement retraining, pilates, active assisted and passive range of motion exercises, strengthening and stretching exercises, balance, proprioception and coordination exercises. If improving a particular function is one of your goals, then your physiotherapist will likely choose functional based exercises for you to work on.
Your physiotherapist will educate you, the patient or guardian of the patient, on how to manage whilst rehabilitating following injury or illness. This may range from assessing your home and providing advice regarding home modifications, to advice regarding orthotics, equipment and wheeled carts for your small pet. In addition, physiotherapists are well placed to guide you through the process of returning to sport or work post injury.