Ramakrishna Mission Vivekananda Educational and Research Institute

RAMAKRISHNA MISSION
VIVEKANANDA EDUCATIONAL AND
RESEARCH INSTITUTE
(RKMVERI)

Faculty of General and Adapted Physical Education & Yoga

Coimbatore Campus

Compiled by
Dr. A. Sathiya Moorthy
Assistant professor cum Sports Physiotherapist

Sports Medicine, Physiotherapy and

Rehabilitation

B.P.Ed.,
Bachelor of Physical Education
(Study Material – Student Copy)

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Sports Medicine, Physiotherapy and Rehabilitation

UNIT – I SPORTS MEDICINE

Sports Medicine: (Definitions)

―Sports medicine is an area of medical
practice concerned with the treatment of injuries
resulting from athletic activities. A physician
practicing sports medicine focuses on sports-
related medical services.‖
―A field of medicine that relates to the
prevention and treatment of injuries and other
health problems that affects people who play
sport.‖
―A field of medicine concerned with the
prevention and treatment of injuries and disorders
that are related to participation in sports.‖

Meaning and Sports Medicine Team:

Sports Medicine is a special division of Health Care Sector, which takes care of physical fitness and
injuries associated with sports & exercise. Sports Medicine Companies provide effective treatments against the
musculoskeletal issues. The concept of Sports Medicine is not very old. It began in the late 20s. However,
Sports Medicine has become an important sector itself. Sports Medicine comprises several forms of non-
surgical orthopedic treatments.

Sports Medicine Professionals have specialization in Exercise and Sports Science. The professionals in
the field of Sports Medicine are designated as following:
 Medical Doctors
 Physical Therapists
 Physical Therapists Assistants
 Athletic Trainers
 Massage Therapists

Aim and Objectives:

 Sporting performance enhancement including nutrition, equipment and training
 Medical syndromes associated with sport and exercise
 Injury prevention and treatment
 Exercise for rehabilitation and health
 The application of physiological and biomechanical principles to specific sporting codes

Concept and Importance:

 Sports medicine specializes in preventing, diagnosing and treating injuries related to participation in
sports and/or exercise, specifically the rotation or deformation of joints or muscles caused by engaging
in physical activities.

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 Sports medicine has always been difficult to define because it is not a single specialty, but an area that
involves health care professionals, researchers and educators from a wide variety of disciplines.
 Its function is not only curative and rehabilitative, but especially preventive.
 The sports medicine "team" includes specialty physicians and surgeons, athletic trainers, physical
therapists, coaches, and other personnel, as well as the athlete himself/herself.
 Because of the competitive nature of sports, a primary focus of sports medicine is the rapid recovery of
patients, which drives many innovations in the field.
 Despite this wide scope, there has been a tendency for many to assume that sport-related problems are
by default musculoskeletal and that sports medicine is an orthopaedic specialty.
 There is much more in sports medicine than just musculoskeletal diagnosis and treatment.
 Illness or injury in sport can be caused by many factors – from environmental to physiological or
psychological.

Role and Contribution of Physical Education Teachers:

Being an active member of the school wellness committee;
 Helping in the evaluation and planning process for the school
 Actively learning about and promoting opportunities for physical activity in the community
Serving as a resource person for classroom teachers;
 Informing classroom teachers about the need for and benefits of adding small bouts of physical activity
to the school day
 Providing resources and training to the classroom teachers
 Aiding teachers in understanding and implementing appropriate practices for physical activity
 Providing opportunities for the teachers to engage in physical activity before or after school
Organizing school-wide physical activity experiences;
 Planning school-wide activities such as field day, fun runs, a walking program, and morning exercise
breaks
 Encouraging fund-raisers that promote physical activity
 Planning before- and after-school clubs for activities such as jump rope, walking, dance, gymnastics,
and intramural sports

Role and Contribution of Coaches:

The coaches are likely to be involved in each portion of the athletic health care relay—prevention,
recognition and first aid care, assessment and treatment, and rehabilitation.
Coaches’ roles are defined by:
 certain rules of the legal system and rules of your school administration,
 expectations of parents, and
 interactions with other athletic health care team members
 Properly planning the activity
 Provide proper instruction
 Warn of inherent risks
 Provide a safe physical environment
 Provide adequate and proper equipment
 Match your athletes appropriately
 Evaluate athletes for injury or incapacity

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 Supervise the activity closely
 Provide appropriate emergency assistance

Need and importance of Sports injuries in the field of Physical Education:

 Identification of proper sports talent with the help of medical tests
 Selection and rejection of team members on the basis of sports medical problems
 Helping in the preparation of training schedule
 Prescribing the balance and special diet for people and sports men
 Suggesting coaches and trainers for modifying their training programme
 Educating the athlete regarding first aid of some common sports medical problems
 Educating the athlete regarding use and abuse of drugs and other medicines

UNIT – II INJURIES MANAGEMENT

Prevention of Sports Injuries:

 Wear protective gear, such as helmets, protective pads, and other gear.
 Warm up and cool down.
 Know the rules of the game.
 Watch out for others.
 Don't play when you're injured.

Common Sports Injuries:

a) Sprain – traumatic twist in a joint affecting the joint structures. It is classified into three grades
b) Strain – tear in the muscle fibre. It is classified into three grades.
c) Fracture – anatomical discontinuity in the bone
d) Dislocation – complete misposition of the joint from its articulating surfaces
e) Subluxation – partial misposition of the joint from its articulating surfaces
f) Muscle spasm – adaptive shortening of the muscle due to pain
g) Muscle pull – sustained contraction of the muscle fibres
h) Contusion – accumulation of ICF in the injured area
i) Oedema – generalized swelling
j) Haematoma – accumulation of blood in the injured site
k) Blister – accumulation of PUS or ICF just beneath the epidermis of the skin
l) Abrasion wound – injury to the epidermis of the skin
m) Laceration wound – injury to the epidermis, dermis and exposure of underlying tissues
n) Puncture wound – sharp objects piercing the skin and entering the inner structures
o) Avulsion wound – the structure peeling-off from its anatomical position
p) Incision wound – sharp cut in the skin and underlying structures

Diagnosis: (related to sports medicine)

a) ECG machine
b) Glucometer
c) thermometer
d) Blood glucose test strips

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e) X- ray machine
f) Ultrasound Scan machine
g) Defibrillator
h) Computer tomography (CT Scan) scan machine
i) Magnetic Resonance Imaging (MRI Scan) machine
j) Haematology analyzers
k) Endoscope
l) Color Doppler Ultrasound Scan
m) Oxygen therapy equipment
n) Fat analyzer
o) Pulmonary function test machine
p) Biopsy

First Aid:
Definition: It is defined as the emergency procedure performed at the injured site to the injured person with
the help of available medical and non-medical substances in order to treat or prevent the injury
from getting worsened. If needed shift the injured person to the nearest hospital as soon as
possible.

First Aid Treatment: (General)

RICER – Closed Injuries PRICER – Open Injuries

R – Rest – do not move the injured site unnecessarily

I – Icing – apply ice to the injured site – “033 Principle”
0 – from the time of injury (0 hours)
3 – every three hours thereafter apply ice only (direct or indirect)
3 – for the first three days (72 hours)
C – Compression – apply pressure at the injured site either with the hands or with the elastic bandage
E – Elevation – raise the injured site to the level of the heart
R – rehabilitation – follow the rehabilitation procedures after adequate rest and healing period for optimal
recovery and normality

P – Protection – protect the open wound from infection

Wound Cleaning and Dressing has to be carried out
Care to be taken in wound cleaning procedures and in selecting dressing type
R – Rest – do not move the injured site unnecessarily
I – Icing – apply ice to the injured site – “033 Principle”
0 – from the time of injury (0 hours)
3 – every three hours thereafter apply ice only (direct or indirect)
3 – for the first three days (72 hours)
C – Compression – apply pressure at the injured site either with the hands or with the elastic bandage
E – Elevation – raise the injured site to the level of the heart
R – rehabilitation – follow the rehabilitation procedures after adequate rest and healing period for optimal
recovery and normality

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First Aid for Sprain and Strain:

Rest: Rest the injured part until it's less painful.
Ice: Wrap an icepack or cold compress in a towel and place over
the injured part immediately. Continue for 10 - 15 minutes at a
time, every three hourly (033 principle).
Compression: Support the injured part with an elastic compression
bandage for at least 2 days.
Elevation: Raise the injured part above heart level to decrease
swelling.

Emergency situations to hospital

 severe pain when the injured part is touched
or moved
 continued trouble bearing weight
 increased bruising
 numbness or a feeling of "pins and needles"
in the injured area
 a limb that looks "bent" or misshapen
 signs of infection (increased warmth, redness, streaks, swelling, and pain)
 a strain or sprain that doesn't seem to be improving after 5 to 7 day

First Aid for Fracture:

Signs and Symptoms:
 intense pain in the injured area that gets worse when you move it
 numbness in the injured area
 bluish color, swelling, or visible deformity in the injured area
 bone protruding through the skin
 heavy bleeding at the injury site

First Aid:

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 Stop any bleeding: If they’re bleeding, elevate and apply pressure
to the wound using a sterile bandage, a clean cloth, or a clean
piece of clothing.
 Immobilize the injured area: If you suspect they’ve broken a bone
in their neck or back, help them stay as still as possible. If you
suspect they’ve broken a bone in one of their limbs, immobilize
the area using a splint or sling.
 Apply cold to the area: Wrap an ice pack or bag of ice cubes in a
piece of cloth and apply it to the injured area for up to 10 minutes at a time.
 Treat them for shock: Help them get into a comfortable position, encourage them to rest, and
reassure them. Cover them with a blanket or clothing to keep them warm.
 Get professional help: call emergency 108 or to nearest hospital as soon as possible

First Aid for Dislocation and Subluxation:

Signs and Symptoms:
 swollen
 bruised or red
 painful
 difficult to move
 out of place

First Aid:
 Leave the joint alone. Attempting to move or jam a
dislocated bone back in can damage blood vessels,
muscles, ligaments, and nerves.
 Apply an ice pack. Ice can ease swelling and pain in and
around the joint.
 Use ibuprofen for pain.
 Use slings or bandages for (during) transfer.
 Get professional help: call emergency 108 or to nearest hospital as soon as possible
 Use splints and braces.

First Aid for Contusion (Bruise):

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First Aid:
 Elevate the injured area.
 Apply an ice pack wrapped in a towel or a cloth dampened with cold water. Do this for about 10
minutes. Repeat several times a day for a day or two after the injury as needed.
 Rest the bruised area, if possible.
 Consider acetaminophen (Tylenol, others) for pain relief, or ibuprofen (Advil, Motrin IB, others)
for pain relief and to reduce swelling.

Emergency situations to hospital

 Notice very painful swelling in the bruised area
 Still experiencing pain three days after a seemingly minor injury
 Have frequent, large or painful bruises, particularly if your bruises appear on your trunk, back or
face, or seem to develop for no known reasons
 Have easy bruising and a history of significant bleeding, such as during a surgical procedure
 Notice a lump (hematoma) form over the bruise
 Experiencing abnormal bleeding elsewhere, such as from your nose or gums or in urine or stool
 Suddenly begin bruising, but have no history of bruising
 Have a family history of easy bruising or bleeding

First Aid for Blister:

―If a blister isn't too painful, try to keep it intact. Unbroken skin over a blister
may provide a natural barrier to bacteria and decreases the risk of infection.
Cover it with an adhesive bandage.‖

Draining a blister:
 Wash your hands and the blister with soap and warm water.
 Swab the blister with iodine.
 Sterilize a clean, sharp needle by wiping it with rubbing alcohol.
 Use the needle to puncture the blister. Aim for several spots near the blister's edge. Let the fluid
drain, but leave the overlying skin in place.
 Apply an ointment (Vaseline, Plastibase) to the blister and cover it with a nonstick gauze
bandage. If a rash appears, stop using the ointment.
 Change the dressing every day. Apply more ointment and a bandage.

First aid for laceration:

 Stop the Bleeding. Apply direct pressure on the area.
 Clean and Protect. Clean the area with warm water and gentle soap.
 Cleaning – use Betadine solution, hydrogen peroxide (if needed)
 Dressing – soft or hard dressing according to the injury
 Follow Up. For a minor cut or laceration, remove bandage after a couple of days to promote healing.

Bandage:

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Definition: A strip of woven material used to bind up a wound or to protect an injured part of the body.

Types of Bandages:
 Adhesive bandage - bandage consisting of a medical dressing of plain absorbent gauze held in place by
a plastic or fabric tape coated with adhesive
 Capeline bandage - bandage that covers the head or an amputation stump like a cap plaster bandage,
plaster cast, cast - bandage consisting of a firm covering (often made of plaster of Paris) that
immobilizes broken bones while they heal
 Compression bandage, tourniquet - bandage that stops the flow of blood from an artery by applying
pressure medical dressing, dressing - a cloth covering for a wound or sore
 Elastic bandage - a bandage containing stretchable material that can apply local pressure
 Four-tailed bandage - a bandage consisting of a strip of cloth split in two on both ends; the central part
is placed under the chin to restrict motion of the mandible and the tails are tied over the top of the head
 Gauze, gauze bandage - (medicine) bleached cotton cloth of plain weave used for bandages and
dressings
 Immovable bandage - a bandage of cloth impregnated with a substance (e.g., plaster of Paris) that
hardens soon after it is applied
 Oblique bandage - a bandage in which successive turns proceed obliquely up or down a limb
 Roller bandage - bandage consisting of a strip of sterile fabric (of variable width) rolled into a cylinder
to facilitate application
 Scarf bandage, triangular bandage, sling - bandage to support an injured forearm; consisting of a wide
triangular piece of cloth hanging from around the neck
 Suspensory, suspensory bandage - a bandage of elastic fabric applied to uplift a dependent part (as the
scrotum or a pendulous breast)
 Swathe, wrapping - an enveloping bandage
 Truss - (medicine) a bandage consisting of a pad and belt; worn to hold a hernia in place by pressure

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UNIT – III PHYSIOTHERAPY

Physiotherapy:

Definition: The treatment of disease, injury, or

deformity by physical methods such as
massage, heat treatment, and exercise
rather than by drugs or surgery.

Importance of Physiotherapy:
 Assessment and Treatment of acute and
chronic injuries on rest days.
 Stretching before training or matches.
 Muscle activation before training and matches.
 Pre match strapping / treatments.
 Medical cover at training sessions and
matches.
 Medical screening and injury prevention.
 Liaising with management regarding the
severity of injuries and the conditioning of the
team.
 Referral for Scans / Surgery.
 Rehabilitation of the injured player.
 Recovery sport massages, hydrotherapy pool
sessions and recovery ice-baths or contrast
baths after matches.
 Psychological support during tournaments and

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matches.
 Physical therapeutics.
 Manipulation and mobilization
 Strapping and taping
 Massage

Guiding principles of physiotherapy:

Indications and contra-indications:

Electrotherapy:
Indications:
 Relaxing muscles spasms
 Preventing or slowing tissue atrophy due to disuse
 Increasing blood circulation
 Re-educating muscles, such as in situations where a muscle injury limited its use
 Maintaining or increasing range of motion
 Treatment of symptomatic, chronic, intractable pain
 Acute pain related to trauma
 Acute pain related to surgery

Contra-indications:
 It should not be used to treat symptomatic local pain unless the cause of the pain has been clearly
diagnosed.

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 Electrotherapy should not be used in areas of the body where cancerous lesions exist.
 The treatment should not be applied in areas of the skin that are swollen, infected, or inflamed (e.g.
varicose veins)
 Women who are pregnant should avoid electrotherapy treatment, as safe use has not been
established for pregnancy.
 Patients with cardiac demand pacemakers should not be treated using powered muscle stimulators
and TENS waveforms.

Infrared therapy:
Indications:
 Increasing circulation
 Reducing pain
 Reducing stiffness
 Reducing muscle spasm

Contra- indications:
 Pregnant or lactating
 Dehydration
 Recent (acute, within 48 hours) joint injury, chronically hot and swollen joints, enclosed infections
(either dental, in joints or any other tissue).
 Multiple sclerosis
 Heat illness (heat cramp/exhaustion/stroke)
 Medication with a narrow therapeutic index, out of which is life threatening
 Unstable hypertension
 Severe hypotension
 Hemophilia and/or a predisposition to hemorrhage
 Superficial metallic implants (ie. metal pins, rods, artificial joints or any other surgical implant due
to the reflection of infrared rays by these articles.

Ultrasound Therapy:
Indications:
 Ligament injury (sprain)
 Strain
 Point tenderness
 Muscle spasm
 Tendinitis
 Myositis

Contra-indications:
 Avoid exposure to the developing foetus
 Malignancy
 Vascular abnormalities including DVT and severe atherosclerosis
 Pacemakers - in the region of the implant and its associated electronics
 Haemophiliacs not covered by replacement factor

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 Application over :
 Specialised tissue e.g. eye and testes
 The stellate ganglion
 The cardiac area in advanced heart disease
 The cranium
 Active epiphyseal regions in children

Wax Therapy:
Indications:
 Joint stiffness
 Arthritis
 Osteoarthritis
 Aarticular and peri-articular diseases

Contra-indications:
 Impaired circulation
 Areas of recent bleeding or haemorrhage
 Lack of thermal sensation
 Devitalised tissue (e.g. after Deep X Ray therapy)
 Open wounds
 Infection
 Malignancy
 Acute inflammation
 Skin conditions (e.g. acute dermatitis, eczema)
 Unstable, fragile or early stage skin grafts

Transcutaneous Electrical Neural Stimulation: (TENs)

Indications:
 Musculoskeletal pain
 Chronic low back pain
 Painful diabetic neuropathy
 Neuropathic pain
 Visceral pain and dysmenorrhea

Contra-indications:
 Patients who do not comprehend the
physiotherapist’s instructions or who are unable to
cooperate
 Avoid the application of the electrodes over the
trunk abdomen or pelvis during pregnancy with the
exception of the use of TENS for labour pain
 Pacemaker
 Patients who have an allergic response to the electrodes, gel or tape
 Dermatological conditions e.g. dermatitis, eczema

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Electrical Muscular Stimulation: (EMS)
Indications:
 Relaxation of muscle spasm
 Prevention or retardation of disuse atrophy
 Increasing local blood circulation
 Muscle re-education
 Immediate post-surgical stimulation of calf muscles to prevent venous thrombosis
 Maintaining or increasing range of motion
Contra-indications:
 Patients who do not comprehend the physiotherapist’s instructions, or who do not
cooperate should not be treated
 Patients with pacemakers
 Patients who have an allergic response to the electrode / tape / gel
 Patients with skin conditions (e.g. eczema, dermatitis)
 Patients with current or recent bleeding / haemorrhage
 Patients with open wounds
 Patients with compromised circulation

Traction Unit:
Indications:
 nerve impingement
 herniated or protruding disc
 sub-acute joint inflammation
 joint hypomobility
 paraspinal muscle spasm

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Contra-indications:
 when motion is contraindicated
 joint instability
 tumor
 pregnancy
 acute inflammatory response
 acute pain
 osteoporosis
 fracture

UNIT – IV: MODES AND APPLICATIONS OF VARIOUS THERAPIES

Hydrotherapy:
Hydrotherapy, formerly called hydropathy, is a part of medicine, in particular of naturopathy,
occupational therapy and physiotherapy, that involves the use of water for pain relief and treatment.

Benefits of hydrotherapy:
 Production of a relaxed, calm effect.
 Stimulates nerve endings to create an invigorated feeling.
 Exfoliates and cleanses skin.
 Improves skin tone.
 Enhances skin circulation.

Contraindications of hydrotherapy:
 Open or draining wounds.
 Topical infections.
 Skin rashes.
 Freshly shaved skin (salt glow).

Cryotherapy:
Another popular water therapy modality is cryotherapy, which is the application of cold. Ice therapy is
safe, inexpensive, and can be used in the home or in the therapist’s establishment.
The physiologic effects of ice vary according to the length of time ice is applied to the skin. During the
initial time from nine to sixteen minutes, the area experiences vasoconstriction or reduced blood flow. The skin
appears pale, local edema is reduced, and hematoma formation is controlled.
If the ice application continues another four to six minutes, vasodilation occurs.
After a few minutes, vasoconstriction will occur again. The entire cycle will take fifteen to thirty
minutes. This cycle of vasoconstriction – vasodilation – vasoconstriction is referred to as the hunting response.
The alternating response brings blood into and out of the area where the ice is applied, causing tissue
debris to be flushed out and oxygen to be brought into the area.
The subject feel a variety of sensations, coldness, burning, stinging, and numbness. Leave the ice on the
body until numbness occurs (approximately five to twenty minutes). As soon as numbness occurs, remove the
ice.

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Benefits of Cryotherapy
 Reduced edema
 Decreased tissue damage
 Reduced pain
 Hypoxia (temporary decrease in local oxygen supply)
 Reduced muscle spasm
 Stimulated vasodilation
 Reduced inflammation
 If ice is applied to an area for longer than twenty minutes, tissue damage or frostbite may occur.

Contraindications of Cryotherapy
 Asthma
 Raynaud’s Disease
 Open wounds
 CVA (cerebrovascular accident)
 Allergies to cold or plastic
 Skin rash or skin disease of any kind
 Rheumatoid arthritis
 Sensory impairment
 Aversion to cold

Treatment Techniques:
Ice Massage
 Take the pieces of ice cube
 Rub the skin in circular or to-and-fro movements,
 Apply treatment for approximately three to ten minutes and repeat a number of times per day.

Immersion - Select desired water temperature

 Tap water-12.8° C (53°F)
 Water with ice slush - approximately 0° C to 4°C02oF to 39.2°F)

Icepacks
 Use crashed ice, as these contours more easily to the body part - Place in a double layered disposable
plastic bag.
 Apply treatment approximately twenty minutes per hour and repeat a number of times per day.
 Re-freezable commercial Packs

Ice Sprays
 Evaporate coding - ethyl chloride or Flouri-methane spray. These sprays cool by the heat exchange
effect of rapid evaporation and result in reflex muscle relaxation. For those individuals who have never
experienced cryotherapy treatment, or for those who do not seem to tolerate ice massage or ice
immersion, begin the treatment with sprays.

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Thermotherapy:
The external application of heat is thermotherapy. Heat can be transferred into the body by conduction,
convection, and radiation. Conduction is the exchange of thermal energy, while the body’s surface is in contact
with the thermal agent, such as hot packs. Convection is a faster process and involves contacting the body’s
surface with heat energy through a fluid or gaseous method; such as a whirlpool bath or a steam bath. Radiation
is the transfer of heat energy in electromagnetic rays through a conducting medium, such as infrared lamps.
Moist heat is transferred by conduction and convection. Dry heat is transferred by radiation. Moist heat
is the best form of heat for enhancing general relaxation.

Physiologic responses to heat:

 Sweating is stimulated and evaporation cools the body.
 Blood vessels near the skin surface begin to dilate and excess heat is lost through the skin. This flushes
the skin.
 Our behavior will be altered. Feeling hot makes us uncomfortable and we make environmental
adjustments; such as turning on the air conditioner or turning down the thermostat.

Benefits of Thermotherapy:
 Alleviates pain by reducing endorphins when applied.
 Increases white blood cells, stimulating an immune system response.
 Soothes, comforts, and sedates as long as inflammation is not present.
 Reduces muscle spasms.
 Increases blood volume, oxygenation, and nutrition.
 Distends and softens superficial fascia.

Contraindications of Thermotherapy:
 Tumor or malignancy
 Recent injury
 Recent contusion
 Phlebitis
 Diabetes
 Hypertension
 Cardiac impairment
 Recent burn or sunburn
 Edema
 Directly over eyes or external genitalia
 Cerebrovascular accident
 Fever

Contrast Bath:
(Heat-102º-105º F, Cold-50º-60ºF)
Contrast baths involve alternating between placing the injured area in hot and cold tanks or a whirlpool
bath. The hot water should be about 102 to 105 degrees Fahrenheit, and the cold water should be between 50

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and 60 degrees Fahrenheit. Begin with hot water first for 5 to10 minutes, then the cold water for 1 to 2 minutes,
for a hot to cold ratio of 3:1 or 4:1.
Contrast baths stimulate circulation by alternating between vasoconstriction (cold) and vasodilatation
(heat) of the superficial blood vessels. This maximizes blood flow to the painful area. The entire treatment lasts
30 minutes and is always concluded with the cold bath in order to reduce swelling. Improved circulation
promotes healing and may reduce pain over time, although it provides little immediate pain relief.

Whirlpool Bath:
(105º– 110º Fahrenheit)
Definition: A quickly rotating mass of water in a river or sea into which objects may be drawn, typically
caused by the meeting of conflicting currents.
The whirlpool is a large tub that is filled with water. The body part that is to be treated is then placed in
the tub of water, and a small motor agitates the water. While in the water, you can move your body part to help
improve the motion around the injured area.
The temperature of the water in the whirlpool can be warm or cold, depending on the desired goal.
Warm whirlpools can increase circulation, as the heat helps to open up small arteries in the body. Increased
circulation can bring fresh blood, oxygen, and cells to the injured area, which can promote healing.
A typical whirlpool treatment lasts for 10 to 15 minutes.

Goals of Whirlpool Therapy

 Decrease swelling
 Control inflammation
 Promote wound healing
 Improve motion

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 Decrease pain
 Decrease muscle spasm

Indications for whirlpool bath

 Ankle fracture
 Plantar fasciitis
 Lisfranc dislocation
 Colles' and Smith's fractures
 Ankle sprain
 Tennis elbow
 Achilles tendon rupture and tendinitis

Steam Bath:
Definition: A room that is filled with hot steam for the purpose of cleaning and refreshing the body and for
relaxation.

Advantages of steam Bath:

 The most common benefit of steam bath is relaxation. It gives a soothing effect to your body and mind,
thereby reducing stress levels and tension.
 It also provides your muscle the best form of relief especially near the joints. When joints and muscles
are relaxed, you have fewer chances of encountering conditions like arthritis and other joint pains.
 You surely must have experienced sweating while taking this bath. The cumulative effect of sweating
results in 30% reduction of toxins in your body. It is an effortless and a practical way to detox, and with
a greater degree of effectiveness. Not even detoxifying foods can rival the benefit of this bath in this
regard.
 This increases the temperature of your body temporarily. This phenomenon is known as hyperthermia.
 In a controlled setting, this favors you by killing harmful micro-organisms that might have invaded your
body when you go out or perform routine activities. If not killed, organisms will at least be weakened,
making them available to your immune system to fight them. Thus, it helps your immunity.
 This regulates and stimulates the flow of blood and boosts your metabolism. Thus, it also aids in steam
bath weight loss.
 It helps you generate heat from your body. This in turn increases the blood circulation to your skin and
thereby helps in skin nourishment.
 The heat thus also generated helps you to get rid of the fat deposited under the skin. For people with
oily skin, it is an added benefit, because it reduces the chances of developing acne that is caused due to
fat in the sebaceous glands.
Steam bath benefits for skin: Post having this bath; the skin looks significantly radiant and healthier. The skin
gets sufficiently hydrated which improves its elasticity and gives a youthful look. Detoxification also helps in
making the skin glow.

Disadvantages of Steam Bath:

 If the water is too hard, certain impurities, such as chlorine, and other chemicals if any, may be absorbed
by the skin that may not be healthy to the body.
 Improper installation and portable steam bath may sometimes cause headache to the user.

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 The heat emitted from the steam room may not be suitable for those who have asthma and heart
problems.
 Installing this is a little expensive affair.

Sauna Bath:
Definition: A small room or building designed as a place to experience dry or wet heat sessions, or an
establishment with one or more of these facilities.

Types:
Saunas can be divided into two basic types:
 Conventional saunas that warm the air
 Infrared saunas that warm objects.

Treatment mode types:

 Smoke sauna
 Heat storage-sauna
 Continuous fire sauna
 Electric stove sauna

Hot water fomentation:

In this technique the patient uses the towel and immerses in the hot water and wraps it around the
injured area (closed injury). This treatment should be done for 15 mins and the towel wrapping shoulb be
repeated for 5 to 10 times. After completion of the treatment the skin should be kept dry and if required powder
can be applied.

Massage:
Definition: Massage involves working and acting on the body with pressure – structured, unstructured,
stationary, or moving – tension, motion, or vibration, done manually or with mechanical aids.

Massage can be applied with the hands, fingers, elbows, knees, forearm, feet, or a massage device.
Depending on the application and technique used, massage is used to promote relaxation and well-being, and is
beneficial in treating sports injuries and other problems affecting the musculature of the body such as postural
misalignment and many painful conditions.

History of Massage:
Archaeological evidence of massage has been found in many ancient civilizations including China,
India, Japan, Korea, Egypt, Rome, Greece, and Mesopotamia.
BC 2330: The Tomb of Akmanthor (also known as "The Tomb of the Physician") in Saqqara, Egypt
depicts two men having work done on their feet and hands, presumably massage.
Massage in sports, business and organizations: Massage developed alongside athletics in both Ancient
China and Ancient Greece. Taoist priests developed massage in concert with their Kung Fu gymnastic
movements, while Ancient Greek Olympians used a specific type of trainer ("aleiptes") who would rub their
muscles with oil. Pehr Ling's introduction to massage also came about directly as a result of his study of
gymnastic movements.

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The 1984 Summer Olympics in Los Angeles was the first time that massage therapy was televised as it
was being performed on the athletes. And then, during the 1996 Summer Olympics in Atlanta massage therapy
was finally offered as a core medical service. Notable athletes such as Michael Jordan and LeBron James have
personal massage therapists that at times even travel with them.

Swedish Type:
Swedish massage techniques are different from other massage techniques in that they are quite specific
in the order in which the massage is done. These techniques apply deeper pressure than other kind of massages
and they are also known to increase oxygenation of blood and release metabolic waste such as lactic and uric
acids from the tissues of the muscles.

Effleurage: These are the sliding or gliding Swedish massage techniques that cover different areas of the
body. They are long sweeping strokes that alternate between firm and light pressure and with can
be performed using the palm of the hand or the fingertips. The knots and tension in the muscles
tend to get broken with this massage technique.
Petrissage: This is the technique of kneading the muscles of the body to attain deeper massage
penetration. The thumbs and the knuckles of the fingers are used to knead the muscles of the body
and to squeeze them to prepare them for the other Swedish massage techniques that follow.
Tapotment or Rhythmic Tapping: This technique of Swedish massage, as the name suggests consists of
rhythmic tapping that uses the fists of the cupped hands. This helps to loosen and relax the muscles
being manipulated and also helps to energize them. The sides of the hands are used in this massage
technique.
Friction: This move seeks to create heat to bring about relaxation of the muscles. The palms of the hand
are rubbed together vigorously with each other, or they are rubbed onto the skin of the person
being massaged in order to produce heat by friction. This technique can be used as a warm up for
the muscles of the body to be treated for deeper massage.
Vibration or Shaking: This is the one among Swedish massage techniques that helps to loosen up the
muscles by using a back and forth action of the fingertips or the heel of the hand over the skin. The
muscles of the body are literally shaken up to loosen and relax the muscles. The sides of the hand,
and any part of the hand such as the tips or heel can be used by the masseuse to shake up the
muscles of the person.

Benefits and effects of Massage:

Physical effects of massage:
Pumping - The stroking movements in massage suck fluid through blood vessels and lymph vessels. By
increasing the pressure in front of the stroke, a vacuum is created behind. This is especially
important in tight or damaged muscle tissue as a tight muscle will squeeze blood out like a
sponge, depriving the tissues of vital nutrients and energy to repair.
Increased tissue permeability - Deep massage causes the pores in tissue membranes to open, enabling
fluids and nutrients to pass through. This helps remove waste products such as lactic acid
and encourage the muscles to take up oxygen and nutrients which help them recover quicker.
Stretching - Massage can stretch tissues that could not be stretched in the usual methods. Bundles of
muscle fibres are stretched lengthwise as well as sideways. Massage can also stretch the
sheath or fascia that surrounds the muscle, so releasing any tension or pressure build up.

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Break down scar tissue - Scar tissue is the result of previous injuries or trauma and can effect muscle,
tendons and ligaments. This can lead to inflexible tissues that are prone to injury and pain.
Improve tissue elasticity - Hard training can make tissues hard and inelastic. This is one reason why
hard training may not result in improvements. Massage helps reverse this by stretching the
tissues.
Opens micro-circulation - Massage does increase blood flow to tissues, but so does exercise. What
massage also does is open or dilate the blood vessels and by stretching them this enables
nutrients to pass through more easily.

Physiological effects of massage:

Pain reduction - Tension and waste products in muscles can often cause pain. Massage helps reduce this
in many ways including releasing the bodies endorphins.
Relaxation - Muscles relax through heat generated, circulation and stretching. Mechanoreceptors which
sense touch, pressure, tissue length and warmth are stimulated causing a reflex relaxation.

Psychological effects of massage:

Anxiety reduction - through the effects mentioned above relaxation is induced and so reduces anxiety
levels.
Invigorating - if massage is done with brisk movements such as what would be done before an event
then this can produces an invigorating feeling

UNIT – V: THERAPEUTIC EXERCISE

Definition: 1. Therapeutic exercise is the systematic and planned performance of body movements or
exercises which aims to improve and restore physical function.
2. Therapeutic exercise is performance of physical exertion for improvement of health or
correction of physical deformity.
3. Therapeutic exercise is a physical therapy intervention encompassing a broad range of
activities designed to restore or improve musculoskeletal, cardiopulmonary and/or
neurologic function.

Scope of therapeutic exercise:

 Prevent or rehabilitate disabilities
 Improve or restore physical function so that ADL’s Functional fitness and
are no longer a challenge rehabilitation
 Improve overall health and fitness
 Reduce risk factors
 To try whenever possible to restore full function
and achieve an optimal level of physical fitness.
 Achieve this by setting shared realistic goals and Early to middle
identifying how fit the client needs to be. management
 Motivation
 Adherence, compliance and concordance

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Principles of therapeutic exercise:
 Readiness
 Overload
 Specificity
 Motivation
 Learning
 Reversibility
 Diminishing returns

Classification of therapeutic exercise:

 Stretching
 Range of movement exercises
 Strengthening exercises (resistance exercises)
 Co-ordination exercises
 Endurance exercises
 Proprioceptive or balance training or exercises
 Cardio-vascular training or exercises
 Corrective exercises

Effects and uses of therapeutic exercises:

 Increases size and strength in musculotendinous tissue and tensile strength
 Improves coordination and timing of muscular groups
 Reduces atrophy
 Improves reaction, recruitment and endurance
 Improve cardiovascular fitness
 Reduces edema
 Improves connective tissue strength and integrity
 Promotes circulation to enhance soft tissue healing/metabolism
 Increases bone density
 Increases endurance, reduces fatigue
 Improve range of motion of the spine and extremities
 Improves postural balance
 Improves joint function

Active movements:
Definition: Active movement is defined as a movement of the body or the extremity or the treatment area by
the patient or the person himself without any aid.

Concentric movements or contraction:

A concentric muscle contraction is a type of muscle activation that increases tension on a muscle as it
shortens. Concentric contractions are the most common types of muscle activation athletes perform in a gym
when lifting weights.

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For example, a concentric contraction of the bicep occurs when the arm holding a weight is lifted from
the full-extended (downward) position by the leg, up to the shoulder area.

Eccentric movement or contraction:

During eccentric muscle contractions, the muscle fibers are stretched out. Eccentric contraction is the
motion of an active muscle while it is lengthening under load. The muscle returns to the starting position of the
exercise during eccentric contractions, such as a fully-extended arm.

For example, in a biceps curl the action of lowering the dumbbell back down from the lift is the
eccentric phase of that exercise — as long as the dumbbell is lowered slowly rather than letting it drop.

Isometric movement or contraction:

Isometric contractions do not cause any joint movement. An example is pushing against a wall. In such a
situation, there is no lengthening or contraction of muscles. For this reason, isometric exercises are typically
utilized in rehab programs, as the tension applied to the muscle remains consistent throughout the exercises,
which can help a muscle to develop.

Passive movements:
Definition: Passive movement is defined as a movement of the body or of the extremities of a patient
performed by another person without voluntary motion on the part of the patient.

Types:
 Relaxed Passive Movements, including accessory movements.
 Forced Passive movement.
 Continuous Passive movement.

Relaxed Passive Movements, including accessory movements:

These are movements performed accurately, rhythmical and smoothly by the physiotherapist through
available range of motion (according to anatomy of joints) . The movements are performed in the same range
and direction as active movements. The joint is moved through the free range and within the limits of pain.

Forced Passive movement:

An exercise performed on a subject by a partner who exerts an external force not only to produce a
passive movement, but also to increase the range of movement of a joint. The partner presses the joint into its
end-position (i.e. end of range), while the subject's muscles that normally carry out the movements are
completely relaxed. There is a danger of overextension beyond the range of movement and damage to the joint
if the exercise is not carried out carefully.

Continuous Passive movement:

A continuous passive motion device maintains movement of a joint after limb sparing surgery. This
device is usually called a CPM. Continuous movement limits stiffness and pain. It is very important to keep
joints moving following surgery so that motion will not become limited. The CPM will move the involved leg
through its full range of motion. It is only used in bed, but can be used while relaxing, eating, or sleeping.

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Stretching:
Definition: Stretching is a form of physical exercise in which a specific muscle or tendon (or muscle group)
is deliberately flexed or stretched in order to improve the muscle's felt elasticity and achieve
comfortable muscle tone. The result is a feeling of increased muscle control, flexibility, and
range of motion.

Therapeutic stretching:
 Therapeutic Stretching focuses on the use of both active and passive stretching as part of the
rehabilitation of common musculoskeletal conditions and injuries. Covering all forms of
stretches for the able-bodied, injured, and selected special populations. Therapeutic Stretching is
a comprehensive resource for practitioners and students working in massage therapy, osteopathy,
physical therapy, occupational therapy, rehabilitation, and personal and athletic training.
 With both active and passive stretches outlined for a range of musculoskeletal conditions and
injuries, Therapeutic Stretching offers a range of rehabilitative stretches for the foot and ankle,
knee and leg, hip and thigh, upper limb, shoulder, elbow, wrist, hand and fingers, and back and
neck.
 Therapeutic Stretching includes a visual guide to stretching routines that could be performed in
the prone, supine, and seated positions.
 Therapeutic Stretching offers a range of stretches to assist both current and future practitioners in
safely treating clients rehabilitating from musculoskeletal conditions and injuries. Delivering the
most up-to-date stretching techniques.

Application of therapeutic exercises:

SHOULDER:

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ELBOW:

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WRIST AND FINGER:

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HIP:

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KNEE

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ANKLE and FOOT

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HEAD and NECK

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