ROLE of Orthopaedic Physical therapist

• Orthopeadics & physiotherapy are Two faces of same coin.A Good Orthopedic Surgeon is one who has a Good Physiotherapist (John Ebenezer. 2003).
• Physiotherapist blends with orthopedics and makes patient put back to normal
( Pre injury) state.
• The role of Physiotherapist doesn’t starts after the fracture is fixed or after the disease is healed but it starts from the day one of the onset of Disease or Fracture.
Causes for weakness following Immobilization
• Trauma to soft tissue
• Surgery (e.g., joint replacement)
• Joint disease (e.g., osteoarthritis)
• Prolonged immobilization
• Neuromuscular disease
Ultimate Purpose of exercise program is
· To restore function
· To restore Performance
· To restore Muscle strength
· To restore endurance – Pre trauma level
ISOMETRICS
n Maintain Muscle Strength
n Done at the early stage
n Done with POP or Plaster cast
n Done in Immobilization period
ISOTONICS
· Increase Muscle Strength
· Done at the Intermediate stage
· PRE are advised
· Dumbbells, Weight cuff, sand bags are used.
ISOKINETICS
Joint movement at a constant rate
Improves Muscle Strength
Done at the Late stage
Cyberx is used to train.
CONDITIONING EXERCISE:
Increase endurance
Cardiopulmonary fitness increases
Conditioning exercise enhance peripheral oxygen utilization & efficiency & result in Aerobic muscle metabolism.
E.g Stationary bicycle, Treadmill

Chikungunya Facts

Chikungunya [chick’-en-GUN-yah],
Also called chikungunya virus disease or Chikungunya fever,
Caused by Musquito Bite Named as Aedes aegypti is the major vector of chikungunya virus.
It is a viral illness that is spread by the bite of infected mosquitoes. The disease is characterized by severe, sometimes persistent, joint pain (arthritis), as well as fever and rash. It is rarely life-threatening.
Chikungunya occurs in Africa, India, and Southeast Asia.
1. There is no specific treatment for chikungunya.
2. Prevention centers on avoiding mosquito bites in areas where chikungunya virus may be present, and by eliminating mosquito breeding sites.
How soon after exposure do symptoms appear?
The time between the bite of a mosquito carrying chikungunya virus and the start of symptoms ranges from 1 to 12 days.

Diagnosis:
Chikungunya is diagnosed by blood tests. Since the clinical appearance of both chikungunya and dengue are similar, laboratory confirmation is important.
TREATMENT: There is no specific treatment for chikungunya., Only supportive therapy is given nonsteroidal anti-inflammatory drugs, and getting plenty of Rest.
Infected persons should be isolated from mosquitoes in as much as possible in order to avoid transmission of infection to other people.

PREVENTION
Use mosquito repellents on skin and clothing.
Use insect repellents that have been approved by the Environmental Protection Agency (EPA). They are safe and effective.
When indoors, stay in air-conditioned or well screened areas. Use bed nets if sleeping in areas that are not screened or air-conditioned. · When outdoors during times that mosquitoes are biting, wear long-sleeved shirts and long pants. Lasts through 5-6 washes.

Footwear modifications reduce load on knee.

Patients with Osteoarthritis Knee may benefit from footwear modifications that can effectively reduce knee joint moments. Foot wear design in which the Rear foot portion of the Mid sole moves independently of the rest of the shoe.
The design allows the foot to move mediolaterally as well as anteroposteriorly relative to the shoe outsole-which, the researchers found, can significantly reduce both abduction and external rotation moments at the knee.
Rigid midsoles were associated with significantly higher maximum knee abduction moments and external rotation moments than the softer midsoles.Footwear modifications that reduce knee joint moments may also be able to help patients with knee osteoarthritis
Clacaneus Valgus & Varus also contribute more stress on the knee will cause pain in Knee.
Alteration in Foot e.g. Altering foot by elevating foot wear medially at the sole cause marked reduction in stress implicated on the joint. Will make the patient feel better

Chondromalacia Patella

The term chondromalacia patella has often been used interchangeably with patellofemoral syndrome and anterior knee pain,
The term chondromalacia patella describes the softening and progressive breakdown of the articular cartilage of the patella.
It occurs secondary to an underlying condition such as malalignment or trauma (Greenfield and Scott, 1994).
Grades of the extent of cartilage damage. Eisele (1991),

1. Grade 1 - Articular cartilage only shows softening or blistering
2. Grade 2 - Fissures appear in cartilage
3. Grade 3 - Fibrillation of cartilage occurs, causing 'crabmeat' appearance Grade 4 - Full cartilage defects are present and subchondral bone is exposed

DO BONE MINERAL DENSITY IMPROVES WITH EXERCISE

Osteoporosis is a serious health problem that diminishes quality of life & Leads to decrease the person’s life.
The intense exercise training program presented here was effective in improving strength, endurance, quality of life parameters, and even BMD in women in their critical early postmenopausal years, Kemmler W, et al., 2002.
Physical activity as a way to prevent osteoporosis is based on evidence that it can regulate bone maintenance and stimulate bone formation including the accumulation of mineral,
Strengthening muscles, Improving balance, and thus reducing the overall risk of falls and fractures.
These exercise-stimulated increases in bone diameter diminish the risk of fractures by mechanically counteracting the thinning of bones and increases in bone porosity.
Seven principles of bone adaptation to mechanical stress
Principles are
(i) Be dynamic, not static;
(ii) Exceed a threshold intensity;
(iii) Exceed a threshold strain frequency;
(iv) Be relatively brief but intermittent;
(v) Impose an unusual loading pattern on the bones;
(vi) Be supported by unlimited nutrient energy; and Include adequate calcium and cholecalciferol (vitamin D3) availability. Borer KT, et al., 2005