Physical Medicine and therapy.

Means
of PT. Therapeutic exercise.
Electrotherapy.
Balneology and Climate medicine.

Department of Medical Rehabilitation, Physical

Medicine and Manual Therapy
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 Physical Medicine
• Modalities that use physical
energy for their therapeutic
effect.
• Includes: – Pressure –
Thermotherapy—Heat and cold –
Hydrotherapy – Light therapy-
ultraviolet radiation, laser –
Electrotherapy –
• These are used as adjuncts to a
therapy program including
exercise and patient education
 Classification of physical factors

Natural Artificial
• Physical exercise • Electrotherapy
• Hydrotherapy • Light therapy
• Mud therapy • Magnetic fields
• Balneology and climate • Artificial microclimate
factors
 Mechanism of action
• Mechanism of action are based on interaction of human
body and physical factors
• Effects are gained through different type of reactions
that occur namely general (reflex, humoral, immune
mediate reactions) and local (excitation of skin
receptors, ion transfers)
• the action of physical factors are based on physical
properties like temperature, pressure, intensity as well
as chemical compound of the factor
 Mechanism of action
• All modalities involve the introduction of some
physical energy into a biologic system.

• This energy brings about one or more

physiological changes, which are used for
therapeutic benefit.
KINESIOLOGY . PHYSICAL
THERAPY . THERAPEUTIC
EXERCISE.
 Physical Therapy.
Kinesiology.
• The term ‘’Kinesiology’’ – introduced in 1857 by
Dally designates the science that studies the
movements of live organisms and structures
that participate in these movements.
• Medical physical therapy – the object of study of
physical medicine
 Medical physical therapy
PT contains three components:
a) prophylaxis medical physical therapy – it occupied
with studying the movement in the salubrious trust;
b) therapeutic medical physical therapy – has methods
that focus on the therapy itself;
c) medical physical therapy in Rehabilition – has methods
that focus on the treatment of functional deficiencies in
chronic diseases.
 Physical therapy goals

• Remediate or prevent impairments

• Improve, restore or enhance physical
function
• Prevent or reduce health-related risk
factors
• Optimize overall health status
 Therapeutic exercise
• Is one of the fields of kinesiology that studies the
neuromuscular and joint mechanisms ensuring the
normal movements of people.
• It also deals with recording, analyzing and
correcting these movements when necessary.
• It is a physical activity made systematically, in order
to obtain the refinement of some abilities or skills. A
military instruction for the arms manipulation and
fight actions.
 Muscle
performance

Balance/
Cardiopulmonary/
postural equilibrum
endurance

PHYSICAL
FUNCTION

Stability Mobility/flexibility

Neuromuscular
Control/ coordination
 Therapeutic exercise
interventions
• Aerobic conditioning and reconditioning
• Muscle performance: strength, power, endurance
• Stretching techniques
• Joint mobilization techniques
• Neuromuscular control, inhibition, and
facilitation
 Therapeutic exercise
interventions
• Postural control, body mechanics, and stabilization
exercises
• Balance exercises
• Relaxation exercises
• Breathing exercises
• Task-specific functional training
 Muscles. Movements.
Agonist muscles: - are muscles directly
engaged in contraction and performing
the same action flexion, extension,
adduction, etc.
Antagonist muscles are the muscles whose
contraction counteracts the primary
intended movement.
Synergic muscles: - are those muscles
whose contractions will facilitate the
primary movement initiated by agonist
muscles
 Muscles. Movements.

• Isometric
• Isotonic
• Isokinetic
 Muscular activity – 2 types:
1. Static 2. Dynamic
- result of isometric – result of isotonic
contraction contraction
- doesn’t shorten the muscle - muscles are shortened
- body segments are moved
- doesn’t move body - constant muscular tension
segments - activates circulation and
- ensures body posture metabolic processes in
- in KT: increases muscular muscles
force - improves joint flexibility
 Isometric contraction
Advantages of isometric exercises:
• - efficiency in increasing muscular force and
hypertrophy,
• - effects are obtained after short periods of time,
• - it is a simple technique, it does not require any
equipment, it can be carried out anywhere.
 Isometric contraction
Disadvantages of isometric exercises:
• don’t improve joint flexibility,
• subjects get tired rapidly because the technique is
stressful for the nervous centers,
• muscle vessels are compressed and, therefore, blood
and lymph flow with difficulty (which stresses the
heart)
 Postures
• Represent the situation when the anatomical
elements (ligaments, synovial capsule) and the active
elements (muscles) of a joint are positioned in order
to attain relaxation and a consecutive increase in
joint amplitude (in cases of retraction).
• They aim at progressively correcting vicious
attitudes by improving the flexibility of articular and
peri-articular structures.
 Postures
- Complete relaxation of the patient
- Respect of the physiological limits of the joint
- Care and progressive action (with breaks avoiding
muscle contracture)
- Use of orthesis (immobilization, correction)
- indications: kyphosis, scoliosis, hemiplegia, rheumatoid
arthritis
- contraindications: acute inflammatory disorder
 Passive mobilization
Definition: these are motions imposed on the joints of
patients by exterior intervention without voluntarily
involving their neuromuscular system.
Indications:
- fight against joint stiffness in orthopedics, neurology,
cardiology
- fight against spasticity in neurology
Contraindications:
- very painful / inflammated joints
- intraarticular exudates, venous thromboses
 Active mobilization
Definition: represents a group of exercises carried
out by the patient himself by voluntarily using
his muscular system.
Effects:
- maintains the trophicity and muscular force
- prevents joint stiffness
- accelerates venous and lymphatic return circulation
 Active mobilization
3 degrees of progression:
1) assisted active mobilization – performed by
combining the patient’s own muscular force
with an exterior help
2) free mobilization – without exterior help /
resistance
3) active mobilization with counter resistance
 Active mobilization

• Indications:
– All types of rheumatic disorders
– Orthopedic traumatic disorders
– Cardiovasc (HBP, coronaropathy)
– Metabolic disorders (obesity, gout,
diabetes)
– Endocrine disorders
(hyperthyroidism)
• Contraindications:
– Acute diseases with fever
– Organic failures
Principles and bases of
Electrotherapy. Specific
methods used in
Electrotherapy.
 Electrotherapy.
• Electrotherapy is the use
of electrical energy as a medical
treatment.
• In medicine, the
term electrotherapy can apply to a
variety of treatments, including the
use of electrical devices.
• Additionally, the term
"electrotherapy" or "electromagnetic
therapy" has also been applied to a
range of alternative medical devices
and treatments.
 Electrotherapy.
• Modern electrotherapy practice needs to be
evidence based and used appropriately.
• The skill of the practitioner using electrotherapy is
to make the appropriate clinical decision as to which
modality to use and when, and to use the best
available evidence when making that decision.
 Galvanic current

• The electric power of zero frequency or the continuous

current is called galvanic current. Production mechanism:
through many methods, the most important are:

– chemical methods.
– mechanical methods
– thermo electrical methods

• Galvanic current properties: electrolysis, iontophoresis,

electrophoresis, electro-osmosis, tissular resistance
values alter depending on the textures nature.
 Galvanic current
• Pain-killer, arousing, stimulating, vasodilation,
trophic, resorption, SNV balancing.
• Application modalities: simple galvanization, the
partial galvanic bath, the complete galvanic bath,
galvanic ionization (iontophoresis)
 Galvanic current
• Indications: nervous system neuralgias, neuritis,
paresis, paralysis, neurovegetative unbalancing);
musculoskeletal system (myalgia, arthrosis,
periarticular rheumatism, tendonitis, bursitis,
epicondylitis, periarthritis, stabilized arthritis);
dermatology (acne, allergy,
• Contraindication: lesions of tegument continuity,
allergy, galvanic current intolerance, benign tumors,
malign, tegument infections, cutaneous TBC,
decompensated or with decompensation risk organic
diseases, patient’s bearers of the osteosynthesis
materials.
 Impulses currents
• The continuous current
interruption – with the help of a
manual switch (the first
apparatus) or by the electronic
adjustment (modern apparatus)
– gives electrical impulses
rhythmically succeeded (singular
or in series) with exciting effect.
• Characteristics: form, amplitude,
frequency currents, impulses
length (t) and break length
(tp),their modulation.
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 Impulses currents. Types:

• a. The therapy by low-frequency currents, the

stimulation of the normal innervated striated
• Indication: the treatment of the hypotonic
abdominal muscles anal and urinary
incontinence, post acute traumatism of the
musculoskeletal system conditions,
dysfunctional muscles groups from the
neighboring of the relaxing ones.
 Impulses currents. Types:

• b. The therapy of the totally relaxing muscles: the

used currents forms:- progressive currents with
impulses length between 100 -1000 ms and
frequencies between 1-10 impulses per second
• - the trapezoidal impulses currents – with
stationary intensity.
• - triangular currents with linear increasing fronts
 Impulses currents. Types II:

c. Spasmodic muscular therapy:

• Indications: spastic in paresis, paralysis of cerebral nature,
consecutive spastic of birth traumatisms, traumatic cerebral and
medullary lesions (excepting the spastic paralysis), spastic
paralysis, in multiple sclerosis, after stroke spastic hemiparesis,
Parkinson disease.
• Contraindication: lateral amyotrophic sclerosis, advanced diffuse
sclerosis
 Impulses currents. Types
II:
• d. The stimulation of the smooth muscular
contraction: is performed through the
application of exponential impulses (single
impulses or series of impulses) with long
length (hundreds of ms.), long break and rare
frequency (an impulse at 1-4 sec).
 The medium-frequency electric
current
• The mid-frequency currents present frequencies between1000 –
100.000 Hz. The mid-frequency current of NEMEC type uses two
sources of average frequency currents, unwaged by 100 Hz.
• The maxim therapeutically effects are located at crossing level of
the two mid-frequency sources , of constant amplitudes but with
different frequency – 100 Hz.
• The physiological effects of the mid-frequency currents:
excitomotor, vasodilator, trophic, resorption, muscular relaxing,
analgesic, vagothonic, sympathicolitic.
 The medium-frequency
electric current
– Therapeutical indications:
• traumatology (bruises, strains, sprains,
fractures, posttraumatic hematoma);
• rheumatology (arthritis, arthrosis,
periarticular rheumatism, tendonitis,
bursitis, enthesitis, fibromyalgia);
• neurology (neuralgia, neuritis, paresis,
paralysis);
• gynecological (salpingitis, unspecific
metrosalpingitis);
• gastro-enterology (billiar dyskinesia,
ulcer, functional enteropathies).
 The medium-frequency
electric current

– Contraindication:
• continuous dermal lesions, infections, purulent
inflammatory processes fever,metallic implants,
benign and malign tumors, tuberculosis,
applications on the precordial area.
 High-frequency electric power

• The therapeutic application of the high-

frequency electric and magnetic field and of
the electromagnetic methods (decimeter
waves of 69 cm and microwaves of 12,25 cm)
with frequencies over 300 KHz represents
the high-frequency therapy.
• The high-frequency currents are alternating
currents with a mid-frequency bigger than
500.000 oscillation / sec.
 Short waves
• The high-frequency current with wave lengths between
10 and 100 m and the frequency between 10 MHz – 100
MHz represents the short waves. They are also called
decimetrical waves.
• properties: very high frequency; produce important
capacitive and inductive phenomena;
• produce heat (used in therapy); warm up intensely the
metallic; transmit electromagnetic, waves of the same
frequency with that of the generating current.
 Short waves. Effects
• depth caloric effects without producing cutaneous lesions;
• metabolic effects: increase the need of O2 and of tissue
nourishing substrate;
• increase the catabolism; effects on the circulation: active
hyperemia, general vasodilatation, decreasing of the arterial
tension.
• SNC – sedative effect /peripheral SNF – high excitability
• muscular effects: diminish the muscular tonus on the
hypertonic muscles.
• Increase the immunology capacity of the organism.
• therapeutical effect deviated from the heat action: -
hyperemic, pain-killer, myorelaxant, antispastic, metabolism
activation.
 Ultrasound

• The swinging mechanical vibrations – representing the sound –

which exceed the limit of 20000 oscillations/sec are called
ultrasounds (estimated frequency of 50000 Hz – 3000000 Hz).
• Production mechanisms: piezo-electric procedures.
• Physiological effects : antalgic, myo-relaxant effect,
hyperemetic action, the activation of the sanguine circulation,
action on the SNV, the inhibition of the pituitary gland action,,
effects (connected by the fragmentary phenomena and the
tissue breaking), anti-inflammatory effects, vasomotor
 Ultrasound

• General indications:
degenerative rheumatism, chronic inflammatory rheumatism,
delay of the callus formation, bruises, strains, sprains,
hematoma, incorrect postures, scoliosis, leg deformation, keloid
scars, atone wounds, trophic ulcers of limbs, fibrosis, dermato-
myositis, sclerodermatitis, Dupuytren palm, aponeurosis
retraction, neuralgia and neuritis, neuralgic sequel after herpes
Zoster, amputee neuroma, muscular progressive dystrophy,
spastic and hypertonic syndromes, circulatory affections: -
obliterating arteriopathy, Raynoud disease.
 Ultrasound

• Contraindication:
General contraindication: diverse cutaneous
affections, cutaneous sensibility disorder, blood
coagulation disorders, capillary frailty, general bad
state, cachexia, all stages tumors, (before and after
surgery), active tuberculosis, fever, inflammatory
acute processes, acute joint rheumatism, cardio-
respiratory insufficiency, venous insufficiency of the
lower limbs, thrombosis, varices, progressive
calcifications of the arterial walls, atherosclerosis.
 Infrared radiations (RIR)

• Also called caloric radiations, having wave’s lengths between

760 milimicrons and 50 microns.
• Physiological effects: caloric action (the bigger is the
wavelengths, more deep is the caloric action), arterial and
capilar vasodilatation (caloric erythema), gdermal papillae
edema, leucocyte perivascular infiltrations, the increasing of
the blood flow, influences the nervous terminations with
neuralgia relief.
• Application mode: General light baths, applications in the open
air.
• Indications inflammatory edemas and superficial stasis,
different types of neuralgia, myalgia, tendinitis; post-surgery
wounds, atone wounds, eczema, peripheral circulation
disorders, spastic states of the abdominal organs; diseases
with low metabolism: obesity, hypothyroidism, degenerative
rheumatic diseases, different neuralgia, chronic intoxications
with heavy metals, chronic disorders of the respiratory system.
• Contraindications: traumatisms, recent hemorrhage, gastro-
intestinal hemorrhage risks, acute inflammations, festering,
diseases and feverish states.
 Ultraviolet radiations (RUV)

• Are radiations with wavelengths between 0,01-0,4 μm.

In therapy are used only those between 0,18-0,4 μm.
• Physiological effects: vasodilator (erythema), cutaneous
pigmentation, cutaneous exfoliation, vitamin D
production, desensitization effect, antalgic effect,
electropoesis stimulation process, bactericide effect,
viral killer, superficial edema resorption, catabolism and
perspiration stimulation.
• Application mode: general irradiations, local
irradiations.
• General indications: alopecia, psoriasis, acne, keloid scars 1-2
weeks irradiations, eczema (subacute and chronic phases),
furunculous, frostbites, herpes zoster (Zona), lupus vulgaris,
cutaneous ulcer, pyoderma, itching, skin fungus; - pediatrics:
rickets, asthma, physical debility; - rheumatology: - rheumatic
arthritis, arthrosis, arthritis, neuralgias, algo-neuro-dystrophic
syndrome, tuberculosis;- other types of affections: - neuro-
vegetative syndromes, endocrine disorders, ORL disorders,
• Contraindication: active pulmonary tuberculosis, neoplasia, any
cause cachexia, inanition, cardiac insufficiency, liver and renal
insufficiency, hemorrhagic state, hyperthyroidism, diabetes,
irritated patients, pregnancy, pigmentation disorders,
hypertension, cutaneous, solar photosensitivity
 BALNEOLOGY AND CLIMATE
THERAPY. NATURAL PHYSICAL
FACTORS
 Balneology
• Balneology is the science of the remedies of the
water and the ground.
• Medical balneology or Medical hydrology (French:
hydrologie médicale) is the science of the medical
application of the remedies of the water and the
ground.
(it is meant the place, the resort (Greek: balaneion,
Latin: balneum, English: spa) and not the bath-tub
or pool or „bathing-medicine“!)
 Balneology
• Chemical balneology is a section of the balneology
as support-science of the medical balneology to the
quality-protection and -control of the remedies of
the water and the ground.
• Hydro-geology is an autonomous science-area to
the opening and quality-protection of the mineral
resources.
 Medical climatology
• Climate:
– totality of physical and biological
factors, typical for a certain
region (t°C, humidity, nebulosity,
sun radiation, rain, atmospheric
pressure, wind)
• Bioclimate:
– Therapeutic influence of a certain
climate on the human being
 Therapeutic Waters
• Thalasso-therapy is enforced in the framework of
the health resort-medicine as complex salvation-
measure together with other fully organised
therapy-procedures with sea-waters, silt, sand and
sun as bath-cure under the influence of the climate
of the sea.
• Crenotherapy (Greek: kreno the source) is
understood as drinking therapy. The concept is also
used synonymously for Balneotherapy in some
languages.
 Hydrotherapy
• Hydrotherapy is a section of the physiotherapy. It is
used tap-water or mineral water for showers, bath
tubs, affusions (acc. Kneipp), packs or part-baths.
• Balneotherapy is enforced in the framework of the
health resort-medicine as complex salvation-measure
together with other fully organised therapy-
procedures as bath-cure, drinking-cure or inhaling-
cure under the influence of fixed-climatic factors (no
pure bath-therapy!).
 Hydrotherapy
• Hydrotherapy works on the healing properties of its thermal
and/or mechanical effects.
• Hydrotherapy makes use of the body's reaction to the
pressure exerted by the water, to hot and cold stimuli, to the
sensation of the water itself, to the protracted application of
heat.
• Stimulating the immune system, improving circulation and
digestion, influencing the production of stress hormones,
lessening the body's sensitivity to pain and encouraging the
flow of blood.
 Hydrotherapy
• treatment for relieving or reducing long-lasting or sudden pain.
• significantly increases the elimination of waste assisted by
detoxification.
• helps loosen tight, tense muscles and encourages relaxation;
hydrotherapy increases the digestion activity and metabolic rate;
hydrates the cells and improves muscle and skin tone.
• Hydrotherapy helps in boosting the immune system allowing it to
function more efficiently.
• stimulates the blood supply improving the function of the internal
organs.
• can rehabilitate injured limbs, treat burns and frostbite, lower
fevers, soothe sore or inflamed muscles and joints, soothe
headaches, clear up skin problems, ease labor pains, and promote
relaxation.
 Tallasotherapy. following factors act upon
the individual:

1. The contrast between the temperature of the air

and the sea water; this has an activator effect.
2. The movements of the waves have a stimulatory
effect
3. The salinity of the sea water
4. Low allergen, clean sea air
5. Heliotherapy
6. Marine products
7. Warm sand
8. Sulfurous mineral
 THERAPEUTIC MUDS (PELLOIDS)

Definition: Muds or pelloids are those substances

that are formed in natural conditions, under the
influence of geological processes, and that are used
in a finely divided state and mixed with water as
baths or local applications in medical practice.
 Principal biological effects

• Action on circulation → vasodilation,

oedema resorbtion
• Action on nerve endings → analgesia
• Stimulation of the ovarian function
 Application techniques
• Packing – partial or total covering of the patient with
a 2-2,5 cm layer of mud
– warm
– cold
• Mud bath – at 36-40°C
• Cataplasms – local applications (45-50°C)
• Mud unction + sunlight exposure (Egyptian method)
Questions ?