Friday, September 18, 2020

CARTILAGE

Cartilage is a connective tissue composed of cells and fibres embedded in a firm, gel-like matrix which is rich in a mucopolysaccharide. it is more elastic than bone.

  • Cartilage doesn't have blood supply nor it has lymphatics.it's nutrition diffuses through the matrix.
  • It doesn't have nerves hence it is insensitive.
  • Cartilage is surrounded by a fibrous membrane known as perichondrium which is similar to the periosteum in both structure and function. The articular cartilage doesn't have perichondrium so it's regeneration after injury is inadequate. 
  • When cartilage dies, it forms into a bone like tissue.

TYPES OF CARTILAGE

1. HYALINE CARTILAGE: It is the most common form of cartilage. Hyalos is the Greek word for glass which describes the appearance of the tissue which is translucent, blueish-white and shiny. The cartilage is usually only 2-4mm thick. It is the embryonic form of cartilage. It is found in ribs, joints, nose. layrnx and trachea. Hyaline cartilage collagen fibres are primarily type II, extremely thin, invisible to microscope due to similar refractory properties to the matrix itself.

2. FIBROCARTILAGE: It is found where tendons and ligaments meet the bone, at the Pubic Symphysis, the Sternoclavicular joint and Annulus Fibrosus. The fibrocartilage is a very strong and pliable connective tissue. It is reinforced with collagen fibre bundles that run parallel to each other, allowing a low level stretch. Because of the abundance of collagen fibres, fibrocartilage is white in colour. It lacks a perichondrium and is composed of type II and type I collagen fibres. 

3. ELASTIC CARTILAGE: It is found in the external ear (auricle or pinna), the Eustachian tube and Epiglottis. Elastic's cartilage main role is purely structural, offering flexibility and resilience due to mixture of elastic fibres and type II collagen fibres. It is yellow in appearance without the organized structure of fibrocartilage when viewed under microscope.


COMPOSITION OF CARTILAGE
Cartilage is made up of highly specialized cells called chondrocytes and chondroblasts (chondro refers to cartilage), and other extracellular material which forms the cartilage matrix.

All connective tissue types within the human body are derived from the embryonal mesoderm. Bone, the strongest of the connective tissues, is the last to form and can remain in cartilage form well after birth. Increased cartilage to bone ratio enables a flexible and pliable new-born to exit the birth canal. A new-born has 300 bones, as opposed to the 206 of the normal adult, and all of these originate from cartilage.

From the 7th week of embryonic life, the process of ossification or osteogenesis slowly replaces cartilage with bone. This process continues into early childhood. Cartilage grows in two ways. In interstitial growth, chondrocytes proliferate and divide, producing more matrix inside existing cartilage throughout childhood and adolescence. In appositional growth, fresh layers of matrix are added to existing matrix surface by chondroblasts in the perichondrium. The perichondrium is a dense layer of connective tissue which surrounds most cartilage sites. Its outer layer contains collagen-producing fibroblasts, while the inner layer houses large numbers of differentiated fibroblasts called chondroblasts.
Chondroblasts: As long as they are free to move, chondroblasts produce the elements of the extracellular matrix (ECM). This cell type first forms a matrix of hyaluronic acid, chondroitin sulphate, collagen fibers, and water during embryonal development. Chondroblasts eventually become immobile after becoming surrounded by the matrix, and are then referred to as chondrocytes.
Chondrocytes: They are the immobile form of chondroblasts. They are surrounded by the matrix and contained within allotted spaces called lacunae. A single lacuna can contain one or more chondrocytes. Chondrocytes have varying roles according to the type of cartilage they are found in. In articular cartilage, found in the joints, chondrocytes increase joint articulation. At growth plates, chondrocytes regulate epiphyseal plate growth. While chondroblasts are ECM manufacturers, chondrocytes maintain the existing ECM and are a less active form of the same cell.

Fibroblasts: It is found in all types of connective tissue. In cartilage, these cells produce type I collagen. In certain situations, fibroblasts transform into chondrocytes.

Extracellular Matrix: There is significantly more matrix than cells in cartilage structure, as the low oxygen environment and lack of vasculature do not allow for larger numbers. Because of this, there is little metabolic activity, and little to no new growth in cartilage tissue – one of the reasons the elderly commonly suffer from degenerative joint pain. Cartilage does continue to grow slowly, however. This can be seen in the larger ears and noses of older individuals.

The ECM of cartilage contains three characteristic elements:
  • Collagen
A protein-based collagen matrix gives form and strength to cartilage tissue through a mesh-like structure of fibrils. Although there are many different forms of collagen in the human body, the collagen found in cartilage is primarily type II, with an attached FACIT (short for fibril-associated collagen with interrupted triple helix) XIV collagen which determines the diameter of these fibers.

  • Proteoglycans
Proteoglycans are large molecules that bind with water, providing flexibility and cushioning qualities. Proteoglycan monomers bond to hyaluronic acid by way of link proteins, as is the case with the large proteoglycan Aggrecan (chondroitin sulphate proteoglycan 
  • Collagen and aggrecan in hyaline cartilage
The high numbers of negative charges such constructions provide, together with a large surface area, make it possible for proteoglycans to bind to large amounts of water. This creates high osmotic pressure, increases load-bearing, and constitutes the gel-like consistency of the ECM.

  • Noncollagenous Proteins
Noncollagenous elements of the ECM are small in number and supposed to play a role in maintenance and organization of the cartilage structure on a macromolecular level.

Complied and written by Dr. Palak Shah

Tuesday, September 8, 2020

Evolution of Physiotherapy

History

The practise of physiotherapy started in 460 BC by Hippocrates and Hector by using and studying water and massage therapy on their patients. The earliest documented origins of actual physiotherapy as a professional group date back to Per Henrik Ling “Father of Swedish Gymnastics” who founded the Royal Central Institute of Gymnastics (RCIG) in 1813 for massage, manipulation, and exercise

In 1887, PTs were given official registration by Sweden’s National Board of Health and Welfare. Other countries soon followed. In 1894 four nurses in Great Britain formed the Chartered Society of Physiotherapy. The School of Physiotherapy at the University of Otago in New Zealand in 1913, and the United States' 1914 Reed College in Portland, Oregon, which graduated "reconstruction aides."
The first physiotherapy research was published in the United States in March 1921 in The PT Review. In the same year, Mary McMillan organized the Physical Therapy Association (now called the American Physical Therapy Association (APTA). 

Introduction

Physiotherapy or Physical Therapy is a form of therapy that helps a patient to rehabilitate from illness or disabilities of different kinds. It essentially provides primary care by making use of certain movement and mechanical forces on the affected areas of the body. Physiotherapy strives to increase mobility and motor movements, reduce impairments and to improve the overall quality of life in patients. From neonatal to geriatrics, patients of all ages can make use of the healing techniques of physiotherapy.

Physiotherapy in India started back in 1952 with the outbreak of polio in Mumbai. The very next year, India’s first school and center for physiotherapy was started in Mumbai itself, with government support and support from the World Health Organization (WHO). The Indian Association of Physiotherapists (IAP) was set up in 1962.

Clinical Specialties of Physiotherapy:

  • Musculoskeletal/ Ortho
  • Neurology
  • Cardiac-Pulmonary
  • Sports
  • Pediatrics
  • Pain
  • Women Health
  • Public Health
  • Geriatrics
  • Oncology
  • Rheumatology
  • Medical Conditions

Myths & Facts about Physiotherapy

Myth: Modernized term for massage therapy

Fact: Physiotherapy and massage are two completely separate things. Physiotherapy is a practice to cure pain and disabilities while on the other hand, massage is a practice for relaxation. Besides, physiotherapy is based on comprehensive historical study, physical examination and diagnosis.

Myth: It is expensive

Fact: It is quite reasonably priced nowadays. Many hospitals and home healthcare services these days provide physiotherapy treatment at affordable prices making it attainable for all.

Myth: Physiotherapists are diploma holders

Fact: On the contrary, it is a proper course of 4 years followed by 6 months of internship. Physiotherapists are qualified to diagnose and treat acute to chronic pain

Myth: I need a doctor’s referral to see a physiotherapist.

Fact:  Imaging won’t pick up a stiff joint, tight muscles, or weak muscles. Physiotherapists are extremely thorough when screening their patients. At your first visit they take a very detailed medical history and perform specific assessments.  Patients can seek treatment from a physiotherapist without a doctor’s prior referral.

Myth: Physiotherapy is painful.

Fact: Physiotherapists seek to minimize pain and discomfort—even if it is chronic or long-term. They work within the range of your pain threshold to help you heal, and restore movement.

Myth: Physiotherapy is only for injuries and accidents.        

Fact: Physiotherapy can be used to help a diverse group of people wanting to keep active.

Myth: Surgery is the final/only option.

Fact: From treating degenerative disc disease, rotator cuff tears, forms of knee osteoarthritis to meniscal tears, physiotherapy has proven to be as effective as surgery. Therefore having surgery is not your only option. Consult a physiotherapist and you could be glad to have made that choice in the long run. In many cases, physiotherapy has been shown to be on par with surgery in treating a wide range of conditions – from rotator cuff tears and degenerative disk disease to meniscal tears and some forms of knee osteoarthritis.

Myth: Physiotherapy is an art not science

Fact: One of the most common myths around physiotherapy is that it is an art and physiotherapists are artists. In actuality, physiotherapists are qualified to assess, diagnose and treat disabilities.

Myth: Treats only muscle pain

Fact: Physiotherapists are qualified to treat wide range of diseases, and their expertise is not limited to muscle pain and ligament related issues. Conditions such as vestibular rehabilitation, paralysis, sports injuries, chronic pain, pelvic floor rehabilitation and many more can be treated by physiotherapy.

Myth: Healing takes a long time

Fact: Another common myth around it is that it takes forever to heal. Though Physiotherapy aims at complete cure and not just temporary fix, results are usually visible in few sessions. Depending on the severity of the problem, the treatment plan can vary and might be longer than others, but results are visible from the initial sessions itself

World Physiotherapy Day

In 1996, 8 September was designated as World PT Day. This is the date World Physiotherapy was founded in 1951.

The day marks the unity and solidarity of the global physiotherapy community. It is an opportunity to recognize the work that physiotherapists do for their patients and community. Using World PT Day as a focus, World Physiotherapy aims to support member organizations in their efforts to promote the profession and advance their expertise.


Complied & written by: Dr. Palak Shah