🏃♂️🦴 PHYSIOTHERAPY & REHABILITATION IN ORTHOPAEDICS
Physiotherapy and rehabilitation are essential components of orthopaedic care, focusing on restoring mobility, strength, function, and quality of life after injury, surgery, or chronic musculoskeletal conditions.
🔹 Goals of Physiotherapy & Rehabilitation
✅ Relieve pain
✅ Improve joint mobility and flexibility
✅ Restore muscle strength and balance
✅ Prevent stiffness and contractures
✅ Enhance functional independence
✅ Prevent complications (e.g. DVT, pressure sores)
✅ Promote return to work/sports
🔹 Phases of Orthopaedic Rehabilitation
| Phase | Focus |
|---|---|
| 1. Acute Phase (0–5 days) | Pain control, swelling reduction, immobilization (if needed), basic movement |
| 2. Subacute Phase (1–6 weeks) | Start ROM exercises, begin strengthening, proprioception |
| 3. Functional Phase (6–12 weeks) | Advanced strengthening, endurance, gait training |
| 4. Return to Activity (12+ weeks) | Sport/work-specific training, high-level functional tasks |
🔹 Common Physiotherapy Modalities
🟢 Manual Therapy
Joint mobilization and manipulation
Soft tissue massage
Myofascial release
🟢 Therapeutic Exercises
Range of Motion (ROM) exercises (passive, active)
Isometric and isotonic strengthening
Core and postural training
Balance and proprioception exercises
🟢 Electrotherapy
TENS (Transcutaneous Electrical Nerve Stimulation)
IFT (Interferential Therapy)
Ultrasound therapy
NMES (Neuromuscular Electrical Stimulation)
Laser therapy
🟢 Cryotherapy & Heat Therapy
Ice packs (acute phase, pain/swelling)
Hot packs or infrared (chronic pain, stiffness)
🔹 Rehabilitation by Condition
1. Post-Fracture Rehabilitation
After immobilization (cast or surgery)
Focus: joint mobility, muscle strength, gait re-training
Monitor for complications (e.g. joint stiffness, CRPS)
2. Post-Joint Replacement Rehab
Knee Replacement: early ROM (especially extension), quadriceps strengthening
Hip Replacement: hip abduction/adduction strength, gait with walker/crutches
Focus: regain independence in ADLs (activities of daily living)
3. Spine Surgery Rehab
Gradual return to movement with bracing (if required)
Core strengthening, posture correction
Ergonomic education and lifting mechanics
4. Sports Injury Rehab
Tailored to sport-specific demands
Plyometrics, agility, proprioception
Gradual return-to-play protocol
5. Arthritis Management
Joint protection techniques
Low-impact aerobic exercises (e.g. cycling, swimming)
Strengthening surrounding muscles to unload joints
🔹 Assistive Devices & Support
Orthotics: braces, splints, insoles
Mobility aids: walkers, crutches, canes
Taping techniques: Kinesio taping, athletic taping
Hydrotherapy: water-based rehab, useful for low-impact recovery
🔹 Psychological Aspects of Rehab
Patient motivation and compliance are key
Address fear-avoidance behavior (especially in chronic pain)
May involve cognitive behavioral therapy (CBT) in chronic conditions
🔹 Outcome Measures Used in Rehab
| Tool | Use |
|---|---|
| VAS (Visual Analog Scale) | Pain assessment |
| ROM measurements | Goniometer-based mobility tracking |
| MMT (Manual Muscle Testing) | Strength grading |
| Functional scores | e.g. WOMAC (knee OA), DASH (upper limb), Oswestry (back pain) |
🔹 Summary Chart: Rehab by Condition
| Condition | Focused Therapy |
|---|---|
| ACL reconstruction | ROM + hamstring/quadriceps strengthening |
| Total Knee Replacement | Full knee extension, gait training |
| Shoulder surgery | Pendulum exercises → progressive ROM |
| Spine surgery | Core strengthening, posture correction |
| Ankle sprain | Proprioception, inversion control |
