Recovery after surgery or joint or spine injury mostly depends on good rehabilitation. For the recovery to be as quick and painless as possible, kinesiotherapy needs to be timely, focused, personalized for every patient depending on the surgery characteristics and personal patient goals. We use passive methods of physical therapy (electrotherapy, thermal therapy, magnetotherapy, shockwave therapy, laser and others) and various methods of kinesiotherapy which are combined with every patient depending on the difficulties and phase of rehabilitation. The details of these methods which are physiotherapists use in everyday practice are explained below.
The Mulligan concept is a manual technique which improves the radius of movement and reduces pain of a certain segment by combining passive mobilization and active movement. It was invented by Brian Mulligan, physiotherapist and manual therapist from New Zealand. The concept is based on the Kaltenborn method of regaining physiological movement in the joint. It is effectively used on the spine and joints. The basic rule is that the treatment has to be painless. The patient performs active movements while the physiotherapist does the sliding and/or rotation of the certain segment. This is called MWM - mobilizations with movement. Mulligan thinks that injuries and strains can be a result of a small change of joint position, which as such, can cause reduced movement of the joint. Mobilization with active movement is just one of the components of the Mulligan concept. With spine mobilization, assisted mobilization with active movement called SNAG’s (sustained natural apophyseal) and passive oscillation mobilization is applied. It is also called NAG’s (natural apophyseal glides). It is very important to activate the patient in the recovery and teach him or her the correct exercise execution. Without cooperation, the results will not be there.
PNF – Proprioceptive neuromuscular facilitation
Proprioceptive neuromuscular facilitation is a treatment concept based on the ability of every person, even the ones with a disability, has unused psychophysical possibilities. PNF was developed in the late 40s, and its pioneers were Dr. Herman Kabat in cooperation with Margaret Knott and Dorothy Voss. Proprioceptive – stimulation of proprioceptors (sensory cells in the joint, tendons, ligaments, muscles) and exteroceptors (sensory cells which communicate with the environment, for touch, temperature, vision, hearing). Neuromuscular – signifies work and the improvement of the connection between muscles and nerves. Facilitation – movement relief, the ability to begin and lead movement. With this technique, the therapist uses the healthy part of the body, tries not to cause pain and that way influences the ill area. The therapist is in contact with the patient giving him or her three-dimensional resistance with the arm or environment on the muscle groups, depending on the desired movement. The amount of resistance depends on what the physiotherapist wants to achieve – contraction, stability or muscle relaxation. The physiotherapist's approach stimulates sensory cells in the skin, pressure receptors which stimulates muscles to move or contract. PNF concept is applied in all muscular skeletal injuries, i.e. in orthopedic and neurological disorders, for improving vital functions (such as breathing swallowing etc.), face movement and other.
PIR – postisomeric relaxation
Postisomeric relaxation is a technique which is used in manual medicine and has the aim of relaxing muscles and preparing them for mobilization-manipulation. It is done with control of the patient's breathing and mild manual resistance from the physiotherapist. The procedure is repeated 3 to 5 times. The length of the muscle which is achieved after every stretching has to be held and there is no going back in the next phase. With good relaxation, the physiotherapist feels that the stiffness and shortening of the muscle slackens and, in that case, a bigger number of repetitions does not help to achieve a better result. PIR is a therapeutic method which is performed by a physiotherapist, but the patient can learn how to perform it himself or herself.
A trigger point is a hard spot in the muscle fascia where local circulation is reduced, thus the cells lack proper oxygen saturation. The muscle becomes spastic, painful and very sensitive to the touch. The pain can radiate around the trigger point or can expand to distant places through an irritated nerve. By place of localization, trigger points can be the cause of headaches, vertigo, pain in the neck and lower back. The method of muscle relaxation and pain reduction is done with deep massage directly on the trigger points. Treatment is done by a series of repeated pressures where compression of trigger points is done and therefore stimulation of blood and lymph circulation is achieved. The blood and lymph contain waste products from continuous muscle fiber contraction. Besides, it helps in the return of searchability of muscle fibers in which trigger points are located. The massage of every trigger point takes 3 to 5 minutes depending on its condition (inflamed or not). With examination of other muscles which are located in the pain area, whole tension reduces, and normal cell metabolism is restored.
They are sticky elastic and non-elastic tapes which are put on the skin above a certain part of the body with the aim of stabilizing joints, reducing edema after injury and prevention of injury. Bandages are used in specific indications as well, for correcting various orthopedic or traumatic deformities. We divide them on the basis of time of application, type of injury and technique of application.
They reduce stress factors on the locomotor system, protect the joint from traumatic changes and wasting during activity, and reduce the potential for injury.
They serve as support for the weaker points of the kinetic chain, limit the full range of movement or enable a certain range of movement of that segment or function of the joint.
They are closely related to functional bandages but are usually used after trauma and in different phases of tissue healing. They also speed up the recovery process and return to full activity.