Orthopaedics relates to the branch of medicine concerned with the diseases, conditions and injuries of the musculoskeletal system, namely bones, joints, soft tissues (muscles, tendon, ligaments) and neural tissue. A major aspect of the role of physiotherapy in this area is to rehabilitate after trauma, most commonly bone fractures and joint dislocations. Depending on the nature and extent of the damage sustained, some patients will have undergone surgery followed by a period of immobilisation in a cast or splint, whilst others are treated by immobilisation only. This provides a stable environment for optimal healing to occur. However, once healing is complete and the referral to physiotherapy has been made, the challenging process of rehabilitation has to commence! This includes the regaining of normal joint movement, full strength, co-ordination, balance and function. Our role is also to provide advice and guidance regarding the return to work, driving, sport and leisure activities.
Elective orthopaedic surgery also often necessitates a physiotherapeutic approach. Many of these are detailed under ‘Post Surgical Rehabilitation’ and can range from an arthroscopy to a complete joint replacement. For the majority of elective orthopaedic surgical procedures, specific post–operative rehabilitation protocols have been developed by the surgeons and these in turn are implemented under the professional supervision of physiotherapists. In many cases, hands-on treatment is required to ensure that progress keeps pace with the prescribed protocol and that complications are avoided to produce the best outcome possible.
The most common orthopaedic conditions that many patients present to our clinic with include osteopenia, osteoporosis and osteoarthritis. Osteopenia is a condition characterised by less than normal bone density and can increase an individual’s risk of developing osteoporosis. Osteoporosis is a systemic skeletal disease that is associated with low bone mass, deterioration of bone tissue and compromised bone strength. As a consequence, this leads to an increase in bone fragility and susceptibility to fracture, particularly of the wrist, hip and spine. Whilst the role of the physiotherapist in dealing with the consequences of osteoporosis, in terms of the rehabilitation after an osteoporotic fracture may be obvious, our preventative or prophylactic role is of equal if not more importance. It is widely accepted that participation in suitable weight-bearing exercise can reduce the risk of development of osteoporosis, although other factors including normal hormone levels and sufficient calorific intake (especially protein) and adequate levels of calcium and vitamin D are required to achieve adequate peak bone mass. Physiotherapists are therefore expertly positioned to give advice and education regarding the most appropriate form of weight-bearing exercise to be undertaken for an individual with osteoporosis, taking age, gender, cardiovascular fitness and general physical condition into account. Other important aspects of physiotherapy intervention in osteoporosis can include pain management if this is a feature and the prevention of falls by implementing balance re-education and strengthening programmes.
Osteoarthritis (OA) or mechanical arthritis is another common orthopaedic condition. It is characterised by the degeneration of joints due to the breakdown of joint cartilage. OA is also featured in the ‘Joint Pain and Dysfunction/Arthritic Problems’ section in more detail. When the boney surfaces of a joint become less well protected by cartilage as a result of degeneration, the underlying bone may become exposed and damaged. These degenerative changes usually result in bone and joint inflammation and the development of pain, swelling, stiffness, locking and clicking with in the affected joint. In the acute phase, physiotherapy treatment is primarily aimed at symptom resolution and minimisation and to restore normal movement, strength and function. The emphasis then switches towards facilitating self-directed management by dispensing practical advice and prescribing appropriate individual home exercise programmes to keep exacerbations of the underlying condition to an absolute minimum.