Basic physiotherapeutic procedures

Physiotherapy – is a part of clinical medicine that studies the healing properties of natural and artificially created physical factors; it also develops the ways in which these factors can be practically used in treatment and prophylaxis of diseases as well as medical rehabilitation.

The impact of physical factors (cold, heat, mechanical irritation) on skin coats of the body – the so-called reflexosegmentalcounter-attracting therapy – produces particular functional reaction of the appropriate organs and systems: increase or decrease of nonstriated muscle tone, vasospasm or vasodilatation, metabolism stimulation. Apart from that physiotherapeutic procedures have general health-improving effect, normalize sleep, help the person be in high spirits.

Among the “temperature” methods of physiotreatment are compress, hot-water bottle, ice bag – i.e. all the activities that use heat or cold to provide vasoconstriction or vasodilatation, speeding-up or slowing-down of blood flow, change of respiratory organs functions, cardio-vascular system, metabolism intensity, etc. Mustard plasters and cupping glasses, apart from warming-up, provide irritative effect with the help of mustard essence and cupping glasses also create local negative pressure on the body. Treatment with leeches, referred to here as physiotherapeutic method, is in fact medicamentous procedure, because its effect is provided with the excreted by the leeches special substance – hirudin.

Applyingcold

The principle of action of cold procedures (compress, ice bag) is local cooling-down of a body part which causes constriction of blood vessels of skin and inner organs. During its contact with cold organism has three major stages of reaction:

v Reflex dermovascular constriction: paleness of skin, decrease of skin temperature, decrease of heat emission; there is a redistribution of blood to inner organs.

v Reflex dermovascular dilatation: the skin gets pinkish red, warm.

v Capillaries and venules are dilated, arterioles – constricted; blood flow speed is decreased; the skin turns crimson red, cold. The vasoconstriction leads to regional decrease of blood flow, slowing-down of metabolism and decrease in oxygen consumption.

Aims of cold procedure:

· Isolate inflammation

· Decrease (isolate) traumatic edema

· Stop (slow down) bleeding

· Painkilling effect (because of the decrease of nerve fibers sensitivity)

Compress

· Compress – medical multi-layer bandage made of gauze or other fabric, usually united with cotton wool, wax paper or water-resistant film.

· Prescribed: the first hours after injury or trauma, nasal and hemorrhoid bleeding, second stage of fever.

· Contra-indications: crampy abdominal pains, collapse, shock.

· Necessary equipment: cold water with ice, gauze that was folded several times.

· The procedure:

o Wet the gauze in cold water, squeeze it a little.

o Place the compress on the place of application.

· The gauze needs to be changed every 2-3 minutes as it warms up.

Ice bag

Ice bag is used for a prolonged local cooling. It is a flat rubber bag with a wide opening and a cap, which is filled with ice before use.

Prescribed: first hours after the trauma, internal bleedings, the second stage of fever, the initial stage of some acute abdominal diseases, bruises.

Contra-indication: crampy abdominal pains, collapse, shock.

Necessary equipment: ice, ice bag, towel (sterile rubber sheet/oilcloth).

The procedure:

o Fill the two thirds of the bag with ice and close it tightly.

o Hang the bag over the part of the body (head, stomach, etc) 5-7 cm from the surface or the bag can be put directly on the treated body part if it was wrapped in a towel.

o In cases when the procedure takes a long time we need to make 10 minutes breaks every 30 minutes.

Applying heat

The principle of action (compress, hot-water bottle, poultice) is local heating of a body part, which causes prolonged vasodilatation in skin and inner organs, increase of blood circulation in tissues.

Aims:

· Stimulation of inflammatory process resolution;

· Decreasing pain (removal of viscera muscles spasm).

Hot compress

Hot compresses are used to treat local infiltrates, muscles and joints. Types:

· Dry compress

· Wet compress

· Wet hot compress

Dry compress is applied for heating and protection of some body parts (neck, ear, etc.) from cold. To achieve this we use bulky dressing. Compress for heating procedure includes:

· First layer (surface) – cotton wool (battin, flannel).

· Second layer (middle) – rubber sheet, polyethylene film or wax paper; this layer must be 2-3 cm shorter than the first one.

· Third layer (inner, placed on the skin) – wet napkin (soft fabric); it must be 2 cm smaller than the previous layer.

Wet compress

Prescribed: local inflammatory processes in skin and hypodermic tissue, infiltrates, arthritis, traumas.

Contra-indications: skin diseases (dermatitis, empyesis, allergic rash), high fever, malignant neoplasms.

Required equipment:

· Room-temperature water;

· Weak solution of vinegar or alcohol (ethyl or camphor, alcohol solution of salicylic acid);

· Soft napkin (gauze), cotton wool (flannel), rubber sheet (wax paper), bandage, towel.

The procedure:

· Prepare the solution (warm water, weak solution of vinegar (1 teaspoon 9% solution of vinegar to 0,5 l of water) or vodka, perfume or 96% alcohol diluted in water in 1:2 proportion).

· Use of undiluted alcohol or perfume can cause burns.

· Wet the napkin in the solution, squeeze it.

· Place the wet napkin on the body part and press it tightly.

· On top of it put the other two layers: wax paper, then cotton wool.

· Fix the compress with the bandage.

· After 8-10 hours remove the compress, wipe the skin with water (alcohol), then with a dry towel.

Wet hot compress

It is used sometimes for local painkilling effect. In this case the napkin is dipped into hot water (50-60⁰C), squeezed and applied for 5-10 minutes covered with rubber sheet or wool fabrics.

Poultice

It is a medical procedure that involves heating of a body part with the help of hot loose or semi-liquid substance that is placed into a special linen bag. Poultice is used for treatment of infiltrates, old hematomas, radiculitis. There can dry poultice (using hot sand, oats, linseed) and wet (bran and oats, linseed, Iceland moss, etc. that are mixed with boiling water until porridge-like state). Dry poultice is put on the body part, covered with rubber sheet, fixed, and on top of it covered with a blanket.

Hot-water bottles can be 1 to 3 l. There are several avriants.

Contraindications: abdominal pains of unknown origin, malignant tumours, the first day after the trauma, external and internal bleeding, skin sensitivity disorder, unconscious condition of the person.

Hot-water bottle

It refers to dry heating procedures; it provides local heating effect. Hot-water bottle is used as painkilling or spasmolytic procedure. In cases of frequent and prolonged use to prevent burns and hyperpigmentation the skin is covered with vaseline.

Prescribed: inflammatory infiltrates, neuritis, neuralgia.

Contra-indications: acute abdominal pains of unknown origin, acute abscess in abdominal cavity (appendicitis, pancreatitis, cholecystitis, etc.), malignant neoplasms, the first day after the trauma, bleeding, infected wound, unconsciousness.

Hot-water bottle can be from 1 to 3 litres. There are several variants of action:

· Rubber hot-water bottle (uses water)

· Electric heating pad (uses electricity)

· Chemical heating pad (uses chemical reaction)

In case when there is no hot-water bottle at hand it can be replaced by any usual bottle filled with hot water (do-it-yourself variant).

Equipment: Rubber hot-water bottle, hot water 50⁰C, towel, vaselin.

The procedure:

· Put vaseline on the place of application (to prevent burns or hyperpigmentation).

· Fill 2/3 of the hot-water bottle with water.

· Remove air fromhot-water bottle by pressing its neck.

· Close it tightly.

· Turn it upside down to check for possible leaks.

· Wrap it in a towel and put on the appropriate part of the body.

Cupping glasses

Cupping glasses (cups) – glass vessels in the shape of pots with thick rounded edges and half-round bottom, volume 30-70 ml. Cups produce a strong vasodilating and anti-inflammatory effect; they are frequently used in cases of bronchitis, pneumonia, neuralgia, neuritis, myositis.

Principle of action

The flame causes rarefaction inside the cup. Because of the created negative pressureinside the cup (vacuum), it sticks to the skin and to even deeper located tissues; this leads to the rush of blood and lymph and as a result influences the inner organs vessels: blood and lymph circulation increases, trophism of tissues improves, and all this forwards the resolution of inflammatory foci.

The mechanism of cupping has one more component. Skin capillaries, being filled with blood, burst and in that places there are small intracutaneous bleedings (bruises), that is why skin turns bright-red or crimson. In the places of bleeding the products of blood disintegration and autolysis (self-digestion); these products, being biologically active substances, are carried across the organism and produce beneficial (stimulating) effect on different tissues and organs.

So cupping can be viewed as a variant ofautohemotherapy. Autohemotherapy (Greek autos – self, haima – blood, therapeia - treatment) – intramuscular or subcutaneous injection of the patient’s own venous blood in order to stimulate the protective and metabolic functions of the organism; this method is used for treatment of slow inflammatory processes and other diseases (e.g., furunculosis).