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Recent advancement in the field of Physiotherapy

Article · February 2013

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Amrit Biswas
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 Recent advancement in the field of Physiotherapy
Submitted by: Biswas Amrit & Paul Mantu, June, 2012.

Authors information:

Biswas Amrit, Physiotherapist, BPT, MSPT; (UK); MIAP, Sr Lecturer IPTST (An undergraduate and
postgraduate Physiotherapy college under WBUHS), Consultant Vivekananda hospital (A 170 bed
multispeciality hospital, Durgapur), Consultant Apollo clinic Durgapur. amritbiswas@gmail.com

Paul Mantu, Physiotherapy undergraduate student at IPTST under WBUHS. montupaul18@yahoo.com

Abstract:

The practice of physiotherapy has changed a lot in recent past. From using the movements as
treatment means to the effect of microgravity on human body system and integration of knowledge
from development of pain science with changing facets of rehabilitation along with uses of ultra
modern technical support in motion study and electrotherapy with integration of ergonomics and
artificial limb and robotics research is rapidly changing the scope and limitations of physiotherapy
practice.

Physiotherapy has evolved a lot since its beginning era. Earlier it was a part of rehabilitation
with merely two broad sector, namely electrotherapy and exercise therapy. However, with time
there have been many other sectors of interest in the field of physiotherapy. The purpose of
this article is to sum up the diverse field of physiotherapy as a united one.

To list up the different sectors that has gained popularity with time within the field of
physiotherapy are;

1. Movement based physiotherapy also called as manual therapy. This is the most
researched field of physiotherapy (Petty N J, 2006). Movements are used as a treatment
means in this approach. There have been many schools of thought in this field since its
origin in late 1960s (Butler D S, 2001). Few very popular concepts are, Maitland concept,
McKenzie concept, Mulligan concept and neural mobilization concept (Maitland G D,
2005; Maitland G D, 2005; McKenzie R A, 1981; Mulligan B R, 1999; Butler D S, 1991). Along
with these concepts, the biggest development manual therapy has brought in the field
of physiotherapy is probably the process of clinical reasoning, which is a step for
evidence based practice and making the practice more science oriented than individual
clinical expertise and treatment by convention (Boyling JD and Palastanga N,1994; Jones M
and Rivett D, 2004). Though it must be remembered that all the treatment techniques are
rather more matter of art than science (Mulligan B R, 1999).
2. Effect of weightlessness on our body systems is a very recent field of study in the field of
physiotherapy. It has been found that loss of muscle strength and mass is more rapid if
the person spends long duration in weightlessness that is without the effect of gravity.
This ongoing field of research is concentrating on the astronauts returning from space
and on deep sea divers who spend long time in absence of or in reduced gravity
environment (Prampero di P E & Narici M V, 2003; Sawin C F et al, 2007; Goodship A E et al,
1998; Peterman et al, 2001).

3. Pain science and integration of vast emerging body of knowledge in this field had
affected the practice of physiotherapy in past couple of decades. Sometimes the
development in pain science and it’s understanding is referred as ‘the pain revolution’
(Melzack R & Wall P D, 1988). Pain has evolved from just a sensation to a perception and
experience with time. There are situations where pain is present though there is no
actual tissue damage; for example phantom limb pain (Butler D S, 2001). To explain this
scenario biopsychosocial model of pain has been developed (Zusman M, 1994). The
biochemistry of pain, pain mechamnisms and plasticity of the central nervous system
has been the most amazing development of this field in recent past (Butler D S, 2001;
Gifford LS, 1998; Gore J & Butler D, 2010).

4. Ergonomics another very exciting field in applied physiotherapy is the study of human –
machine interface. This specialized field of physiotherapy has very important role to play
in designing, architecture, human posture, their correction and to provide ergonomic
solution to industrial sector (Bridger R S, 2003).

5. Sports physiotherapy and exercise rehabilitation is another exciting field of

physiotherapy. Rehabilitation is the process of bringing back the individual towards
normal lifestyle. The facets of rehabilitation has changed dramatically in recent past and
today it do not mean just healing but accelerated healing and complete healing.
Rehabilitation not only sees locally now, but also see globally (Biswas A, 2007). Explained
in Fig 1.

6. Biomechanical study and analysis of human motion is being carried out in complicated
gait laboratory with instruments like high-speed cameras, motion sensors, force plate,
3D motion analyzers, isokinetic dynamometers, pressure sensors, ultrasonography
machine, pressure algometry to objectively measure pain, electromyography has been
set up (University of Brightn, 2007).
 7. Another emerging field of study in physiotherapy is the study of artificial limb, their
training and exploring the scope and limits of these types of limbs for functional activity
and sports. Myoelectric limbs and their uses with functional electrical stimulation and
knowledge of robotics is showing a new horizon in the field of prosthetic rehabilitation
(Lin V W, 2003).

Speed of Weight Chain of

the bearing the
movement movement

Movements Unilateral
of the low weight
back and bearing
pelvis
Joint
dysfunction
Muscle and
other soft Rehabilitation
tissue Type of
dysfunction muscle
contraction
Duration
of Role of
activity other
Nerve Role of
diet muscle
dysfunction Muscular
endurance

Fig 1, Different facets in the spectrum of rehabilitation

8. There has been integration of numerous new instruments beyond traditional

electrotherapy instruments like long wave diathermy (LWD), LASER, Shock wave therapy
and diagnostic ultrasound imaging in recent time (University of Brightn, 2007).

New developments in future will make this field of medical science more evidence based,
scientific and objective.
References:

1) Butler D S, 2001, The sensitive nervous system, NOI group publication, Adelaide.
2) Butler D S, 1991, Mobilization of the nervous system, Churchill Livingstone, London.
3) Maitland G D, 2005, Maitland’s peripheral manipulation, 4th ed., Elsevier, Edinburgh.
4) Maitland G D, 2005, Maitland’s vertebral manipulation, 7th ed., Elsevier, Edinburgh.
5) McKenzie R A, 1981, The lumber spine mechanical diagnosis and therapy, Spinal publications,
New Zealand.
6) Petty N J, 2006, Neuromusculoskeletal examination and assessment, 3rd ed, Elsevier, Edinburgh.
7) Mulligan B R, 1999, Manual therapy, NAGs, SNAGs, MWMs etc. 4th ed, Plane view
services, New Zealand.
8) Boyling JD and Palastanga N,(1994) Grieve’s Modern Manual Therapy, 2nd ed., Churchill
Livingstone, Edinburgh.
9) Gifford LS, (1998), Pain, Ch 5, 196-232; In Pitt-Brooke J, Reid H, Lockwood J and Kerr K, (1998)
Rehabilitation of movement: Theoretical Basis of Clinical Practice, WB Saunders, London.
10) Jones M and Rivett D,(2004) Clinical Reasoning for Manual Therapist, Butterwoth-Heinemann,
Edinburgh.
11) Zusman M, 1994, The meaning of mechanically produced responses, Australian journal of
physiotherapy, 40, (1), 35 – 39.
12) Gore J & Butler D, December, 2010, NOI notes, Newsletter from Noigroup, Adelaide, Australia.
13) Melzack R & Wall P D, 1988, The challenge of pain, London, Penguin books.
14) Prampero di P E & Narici, M V, 2003, Muscles in microgravity: from fibers to human motion,
Journal of biomechanics, 36, 403 – 412.
15) Sawin C F, Hayes J, Francisco D R & House N, 2007, Considerations for development of
countermeasures for physiological decrements associated with long-duration space missions,
Acta Astronautica, 60, 488 – 96.
16) Goodship A E, Cunningham J L, Oganov V, Darling J, Miles A W & Owen G W, 1998, Bone loss
during long term space flight is prevented by the application of a short term impulsive
mechanical stimulus, Acta Astronautica, 43, 3 – 6, 65 – 75.
17) Peterman M M, Hamel A J, Cavanagh P R, Piazza S J & Sharkey N A, 2001, In vitro modeling of
human tibial strains during exercise in micro-gravity, Journal of biomechanics, 34, 693 – 698.
18) Bridger R S, 2003, Introduction to ergonomics, 2nd ed., Taylor & Francis, New York.
19) Biswas A, 2007, Refelection on exercise prescription for knne joint osteoarthritis patients,
Unpublished research work, Exercise rehabilitation module, Msc Physiotherapy, University of
Brighton, UK.
 20) University of Brightn, 2007, MSc Physiotherapy , Analysis of function module study material.
21) Lin V W, 2003, Spinal cord medicine; Principles and practice, Accessed online via
http://www.ncbi.nlm.nih.gov/books/NBK8850/?depth=2, on 22/06/2012.

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