Back in Shape


Physical therapy and allied treatments of Rehabilitation Medicine can help restore one’s functional capacity and productivity. Beneficiaries include those recuperating from strokes, prolonged debility, sports injuries, automobile and motorcycle accidents, amputees, and many other with joint disease and reduced mobility

By Henrylito D. Tacio

Hollywood actress Patricia Neal suffered a series of near-fatal strokes in 1965. Though pregnant at the time of the first stroke, she bore a normal child. She resumed her acting career in 1968 and received an Academy Award nomination for a leading role for her tour de force performance in The Subject Was Roses.

American president Dwight David Eisenhower made a quick and complete recovery from stroke in 1955. The following year, he was reelected a second presidential term. In retirement, he remained active in politics and wrote three books. An avid golfer, he scored his only hole in one in 1968, 13 years after his stroke and a year before his death.

George Frederick Handel, a German-British composer, suffered a stroke in 1737, at age 52. Five years later, he composed The Messiah and continued to compose until his death in 1759.

What do the three people had one thing in common – aside from stroke? They all underwent rehabilitation services.

“The need for rehabilitation crosses all age groups, although the type, level, and goals of rehabilitation often differ,” explains The Merck Manual of Medical Information. “People with chronic impairments, often older people, have different goals, require less intensive rehabilitation or a longer period of rehabilitation, and need different types of therapy than do younger people.” Occupational therapy, the treatment of any pain and inflammation and physical therapy are the focus of rehabilitation.

Occupational therapy

Occupational therapy is intended to enhance a person’s ability to perform basic self-care activities, useful work and leisure activities. Techniques used to treat pain and inflammation includes heat therapy, cold therapy, electrical stimulation, traction, massage, and acupuncture.

Physical therapy (PT), also known as physiotherapy, is needed as rehab after a stroke, accident, injury, or surgery. “Your doctor might suggest this type of treatment if you’ve had an injury or illness that makes it hard to do daily tasks,” says the website,

PT may also be needed in the following instances: relieve pain, improve movement or ability, prevent or recover from a sports injury, prevent disability or surgery, work on balance to prevent a slip or fall, manage a chronic illness (like diabetes, heart disease, or arthritis), recover after giving birth, control the bowels or bladder, adapt to an artificial limb, learn to use assistive devices like a walker or cane, and get a splint or brace.

PT is one of the allied health professions that remediates impairments and promotes mobility and function. Physical therapy is used to improve a patient’s quality of life through examination, diagnosis, prognosis and physical intervention. It is performed by physical therapists (known as physiotherapists in many countries).

“Physicians like Hippocrates and later Galen are believed to have been the first practitioners of physical therapy, advocating massage, manual therapy techniques and hydrotherapy to treat people in 460 BC,” Wikipedia, the free encyclopedia, points out. “After the development of orthopedics in the eighteenth century, machines were developed to treat gout and similar diseases by systematic exercise of the joints, similar to later developments in physical therapy.”

Goniometer, an instrument used to evaluate the range of
joint motion

However, the earliest documented origins of actual physical therapy as a professional group date back to Per Henrik Ling, “Father of Swedish Gymnastics,” who founded the Royal Central Institute of Gymnastics in 1813 for manipulation and exercise. Other countries soon followed.

Modern physical therapy was established towards the end of the 19th century due to events that had an effect on a global scale, which called for rapid advances in physical therapy.

“Physical therapy involves exercising and manipulating the body,” the Merck manual states. Techniques include range-of-motion exercises, muscle-strengthening exercises, coordination exercises, ambulation (walking) exercises, general conditioning exercises, transfer training, and use of a tilt table.

Now, that’s too many kinds of exercises. How are these being accomplished? How do they differ from each other? The Merck manual gives some details:

Range-of-motion exercises: Range of motion commonly becomes restricted after a stroke or prolonged rest. Restricted range of motion can cause pain, reduce a person’s functional level, and predispose a person to bedsores.

Range of motion is evaluated with an instrument, called goniometer, that measures angles of joint motion. Range of motion typically declines with age; even so, the decrease in range of motion does not usually prevent healthy older people from being able to perform self-care activities.

Before beginning the therapy, the physical therapist first determined if restricted motion is the result of light ligaments and tendons or of tight muscles. If tight muscles are the cause, a joint may be stretched more vigorously. If tight ligaments or tendons are the cause, gentle stretching is attempted, but surgery is sometimes needed before progress can be made with range-of-motion exercises.

Royal Central Institute of Gymnastics in 1813

An affected joint is moved beyond the point of pain, but the movement should not cause residual pain (pain that continues once the movement is stopped). Sustained moderate stretching is more effective than momentary forceful stretching. For sustained stretching, weights with pulleys are applied for about 20 minutes per day.

Muscle-strengthening exercises: Many forms of exercise increase muscle strength, all involve progressively increased resistance. When a muscle is very weak, gravity alone is sufficient. As muscle strength increases, resistance is gradually increased, either with stretchy bands or weight training. In this way, muscle mass and strength are increased, and endurance improves.

Coordination exercises: These task oriented exercises are for people who have problems with coordination and balance, usually as a result of a stroke or brain injury. The exercises involve repeating a meaningful movement that works more than one joint and muscle, such as picking up an object or touching a body part.

Ambulation exercises: The purpose is to improve a person’s ability to walk independently or to walk with assistance. Before starting ambulation exercises, some people need to improve a joint’s range of motion of muscle strength. Some people need an orthotic device such as a brace. Training may begin on parallel bars, especially if the person’s balance is impaired, and progress to walking with mechanical aids, such as a walker, crutches, or a cane. Some people must wear an assistive belt to prevent the person from failing.

As soon as the person can walk safely on a level surface, training to step over curbs or to climb stairs may be initiated. A person being taught to climb up stairs is instructed to step up with the uninjured leg first. To climb down stairs, the person is instructed to step down with the injured leg first. These instructions can be memorized with the phrase, “Good is up, bad is down.”

General conditioning exercises: A combination of range-of-motion, musclestrengthening, and ambulation exercises is used to counter the effects of prolonged bed rest or immobilization. General condition exercises help restore proper blood flow and increase heart and lung function.

Transfer training: This is often a critical goal of rehabilitation because people who cannot transfer safely and independently from bed to chair, chair to toilet, or chair to a standing position generally require 24-hour assistance. The techniques used depend on whether the person can bear weight on one or both legs, has sound balance, or is paralyzed on one side of the body.

Assistive devices can sometimes help. For example, people who have difficulty standing from a seated position may benefit from a self-lifting chair, a chair with a raised seat, or another assistive device.

Tilt table: For people who have low blood pressure and who get dizzy when they stand up, a tilt table may help. The person lies faceup on a paddled table with a footboard and is held in place with a safety belt. The table is tilted so that the angle is very slowly increased until the person is nearly upright. By slowly increasing the angle, the person’s blood vessels regain the ability to constrict. How long the position is maintained depends on the person’s tolerance, but it should not exceed 45 minutes. This procedure is performed once or twice a day; its effectivity varies depending on the person’s disability.

“Before beginning the therapy, the physical therapist first determined if restricted motion is the result of light ligaments and tendons or of tight muscles”

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