With greater research-backed insights, the field of medicine is gradually adopting a multidisciplinary approach to treating various ailments.

 

 

 

Extensive research and enhanced insights have emphasized exclusively disease-focused treatment regimens.However, it is gradually evolving that there is a need for a shift of approach; from an exclusively disease-centred framework to a broader patient-centred focus. Because irrespective of aetiology, chronic pain has profound and prolonged consequences for patients and their families. It affects all aspects of the patient’s lives, causing major disruptions to their normal activities and relationships.

An interdisciplinary approach involving physiotherapists can be immensely impactful. As the saying goes-- ‘Survival is not enough, we must strive to improve the quality of life’; excluding or ignoring the benefits of physiotherapy from the overall treatment regimen of patients suffering from pain, neuromuscular ailments, patients admitted in ICU for respiratory symptoms, or elderly population suffering from imbalance hampers the quality of their lives.

 

Physiotherapy is underprescribed

Physiotherapy, especially in India, is often neglected and many-a-times not considered as helpful part of the treatment regimen, when in fact, a well-prepared and implemented  physiotherapy (PT) intervention consisting of exercise and manual therapy appear beneficial in several areas as an adjunct therapy in conditions such as chronic arthritis, stroke, joint replacements, and even in congenital disabilities such as cerebral palsy.Physiotherapy can also have a positive effect on patients with HIV.Studies have indicated that well-planned physiotherapy interventions including manual therapy with aerobic and resistive exercise have a positive effect on several categories of impairment in patients with HIV. 

In some cases, studies have indicated that physiotherapy regimen is superior to corticosteroid injections.(Vasseljen O, AJP, 2007,53 vol).

For healthcare professionals, it is important to understand that simply prescribing exercise, in a generic sense, to a patient is not only insufficient guidance but it is also unlikely to achieve the desired outcomes.Factors that contribute to underprescription of exercise interventions may include a lack of awareness among many clinicians and patients about the effectiveness of exercise interventions.

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Physiotherapists can treat patients using well-planned and well-executed exercise therapy, manual therapy, and electrotherapy plans tailored to fit every patient’s needs. In fact, rather than superficially advising back pain patients to ‘do asanas everyday’, which also carries the added danger that patients may go wrong with form and end up hurting their spines, it is always best to take a physiotherapist’s advice to ensure medications and exercise are suited to a patient’s requirements.

Moreover, the doctors can be rest assured that it is safe, as physiotherapists never resort to prescribing supplements, herbal remedies, fad diets, or expensive ‘wellness-programs to their patients.’ Instead, they rather rely on evidence-based strengthening, stretching, sport or activity-specific rehabilitation regimes.

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Here we explore few ailments/conditions where physiotherapy acts as a critical treatment regimen.To help clinicians prescribe evidence-based exercise interventions, we provide practical details for some conditions

Mechanical neck & upper or lower back pain

Certain types of spinal conditions, mainly those caused by muscle strain, partial ligament sprain, wrong posture, or osteopenia/osteoporosis need intervention by a trained physiotherapist. In a study conducted by Harvard University’s school of medicine and published in the Annals of Internal Medicine, the pain and physical function among people who received intensive physiotherapy and those who underwent surgery to treat lumbar spinal stenosis were similar after nearly two years of treatment.

In such cases, the HMS study and its authors advised that the surgeon, physiotherapist, and the patient should come together to determine the best mode of treatment for the patient. In some cases, surgical intervention can be prolonged for a long time with physiotherapeutic treatment, and sometimes, surgery can be avoided altogether. However, the caveat is that the team (mentioned above) should take a call on a case-by-case basis.

Antenatal and post-natal condition

When preparing for childbirth and parenthood, doctors should advise consultations with physiotherapists. Physiotherapists have the expertise to teach skills such as positioning, rhythmic movement, relaxation techniques, and breathing techniques along with very essential, ‘Kegel exercises’ which help strengthen core muscles as well as pelvic floor muscles during pregnancy. Doctors should advise physiotherapy and should counsel patients regarding certain conditions that can manifest during pregnancy, like

• back and neck pain
• abdominal muscle weakness
• breast problems
• incontinence and prolapse

The physiotherapist may also advise pelvic floor and gentle deep tummy muscle exercise so that the muscle groups which have been damaged and strained after childbirth regain their usual shape and function as soon as possible. With expert assessment, treatment and instruction in self-help techniques, physiotherapists can help women prevent or reduce those problems.

Postnatal recovery

After childbirth, gynaecologists should actively encourage patients to seek treatment from a physiotherapist, since it is important to follow a series of exercises to strengthen the muscles which have been stretched out during pregnancy and birth.

Phsyiotherapists can also work along with lactation specialists to teach mothers the correct posture for breastfeeding which can reduce strain on the mother’s back. Posture correction will help prevent a backache and help regain muscle strength more quickly. Circulation also improves due to such exercises.

Needless to say, pregnancy is a complicated and systematic process, and appropriate muscle and tissue repair is essential for women to regain their health after delivery. Reputed medical institutions such as the National health services of the UK and the Australian Physiotherapy association recommend including a physiotherapy regimen in the antenatal and postnatal care regimens of mothers. Although some major hospitals do emphasize this aspect, the message needs to reach far beyond plush urban hospitals.

Cerebral palsy

The condition requires a multi-pronged approach for management. Moreover, CP requires a well-planned pharmacological, physiotherapeutic, and even psychological component. Physiotherapists can help on many counts, including helping in muscle training. Specific exercises can help children with CP gain strength, flexibility, balance, motor development, and mobility. For the first 1 to 2 years after birth, both physical and occupational therapists provide support with issues such as head and trunk control, rolling, and grasping. Later, both types of therapists are involved in wheelchair assessments.

Paediatric physios are trained in designing exercises through various plays and activities using different colours, toys, and equipment, specifically designed for treating patients with neurological difficulties. It is always best to include physiotherapists in the team when treating children with CP as only medications and multiple surgeries to reduce muscle tightness may not help overcome activity limitations.

Stroke

Modern advances in medicine have made tremendous progress in minimizing the damage caused by strokes. If treated in time, doctors not only save lives but also minimize the damage and sharply reduce the painful and debilitating after-effects of a stroke. However, once the acute pharmacological or surgical treatment is over, physiotherapists can play a major role in helping patients regain the use of their body, especially their limbs and in performing complex motor tasks to the greatest extent possible.

Physiotherapists across the world undergo rigorous training and can be an extremely effective in drastically improving clinical outcomes. Working with quality physiotherapists, seeking their expertise and opinion in diagnosis, treatment protocols, and rehabilitation can help doctors become more effective caregivers and facilitate recovery. In many specialities such as orthopaedics, neurology, cardiology, and many others, diseases often affect large parts of the body and in such cases, a synchronized treatment plan which includes physiotherapy along with pharmacotherapy and surgical interventions can be far more effective than an isolated approach.