ILIUM

 

The Ilium or the flank forms the upper extended plate-like part of the hip bone. It has upper and lower parts and three surfaces. The upper end is called the iliac crest which forms the two-fifths of the acetabulum and the lower end which is smaller than upper end is fused with pubis and ischium at the acetabulum. The upper part is much expanded, and has gluteal, sacropelvic and iliac (internal) surfaces. The posterolateral gluteal surface is an extensive rough area; the anteromedial iliac fossa is smooth and concave; and the sacropelvic surface is medial and posteroinferior to the fossa, from which it is separated by the medial border.

Ilium

Ilium

 

Iliac crest

The iliac crest is the superior border of the ilium. It is broad and convex upwards but sinuous from side to side, being internally concave in front and convex behind. Its ends project as anterior and posterior superior iliac spines. The anterior superior iliac spine is palpable at the lateral end of the inguinal fold; the lateral end of the inguinal ligament is attached to the anterior superior iliac spine. The posterior superior iliac spine is not palpable but is often indicated by a dimple, approximately 4 cm lateral to the second sacral spinous process, above the medial gluteal region.

The iliac crest has ventral and dorsal segments. The ventral segment occupies slightly more than the anterior two-thirds of the iliac crest. It has internal and external lips and a rough intermediate zone that is narrowest centrally. The dorsal segment, which occupies approximately the posterior 1/3^rd in humans. It has two sloping surfaces separated by a longitudinal ridge ending at the posterior superior spine. The tubercle of the iliac crest projects outwards from the outer lip approximately 5 cm posterosuperior to the anterior superior spine. The summit of the iliac crest, a little behind its midpoint, is level with the 4^th lumbar vertebral body in adults and with the 5^th lumbar vertebral body in children aged 10 years or less.

Anterior border

The anterior border descends to the acetabulum from the anterior superior spine. Superiorly it is concave forwards. Inferiorly, immediately above the acetabulum, is a rough anterior inferior iliac spine, which is divided indistinctly into an upper area for the straight head of rectus femoris and a lower area extending laterally along the upper acetabular margin to form a triangular impression for the proximal end of the iliofemoral ligament.

Posterior border

The posterior border is irregularly curved and descends from the posterior superior spine, at first forwards, with a posterior concavity forming a small notch. At the lower end of the notch is a wide, low projection known as the posterior inferior iliac spine. Here the border turns almost horizontally forwards for approximately 3 cm, then down and back to join the posterior ischial border. Together these borders form a deep notch, the greater sciatic notch, which is bounded above by the ilium and below by the ilium and ischium. The upper fibres of the sacrotuberous ligament are attached to the upper part of the posterior border. The superior rim of the notch is related to the superior gluteal vessels and nerve. The lower margin of the greater sciatic notch is covered by piriformis and is related to the sciatic nerve.

Medial border

The medial border separates the iliac fossa and the sacropelvic surface. It is indistinct near the crest, rough in its upper part, then sharp where it bounds an articular surface for the sacrum and finally rounded. The latter part is the arcuate line, which inferiorly reaches the posterior part of the iliopubic ramus, marking the union of the ilium and pubis.

• Gluteal surface

Gluteal surface is the outer surface of the ilium, which is convex in front and concave behind, like the iliac crest. It is rough and curved, convex in front, concave behind, and marked by three gluteal lines which divides into four areas. The posterior gluteal line is shortest, descending from the external lip of the crest approximately 5 cm in front of its posterior limit and ending in front of the posterior inferior iliac spine. Above, it is usually distinct, but inferiorly it is poorly defined and frequently absent. The anterior gluteal line, the longest, begins near the midpoint of the superior margin of the greater sciatic notch and ascends forwards into the outer lip of the crest, a little anterior to its tubercle. The inferior gluteal line, seldom well marked, begins posterosuperior to the anterior inferior iliac spine, curving posteroinferiorly to end near the apex of the greater sciatic notch. Between the inferior gluteal line and the acetabular margin is a rough, shallow groove. Behind the acetabulum, the lower gluteal surface is continuous with the posterior ischial surface.

The articular capsule is attached to an area adjoining the acetabular margin, most of which is covered by gluteus minimus. Posteroinferiorly, near the union of the ilium and ischium, the bone is related to piriformis.

• Iliac fossa

The iliac fossa, the internal concavity of the ilium, faces anterosuperiorly. It is limited above by the iliac crest, in front by the anterior border and behind by the medial border, separating it from the sacropelvic surface. It forms the smooth and gently concave posterolateral wall of the greater pelvis. Below it is continuous with a wide shallow groove, bounded laterally by the anterior inferior iliac spine and medially by the iliopubic ramus.

• Sacropelvic surface

The sacropelvic surface, the posteroinferior part of the medial iliac surface, is bounded posteroinferiorly by the posterior border, anterosuperiorly by the medial border, posterosuperiorly by the iliac crest and anteroinferiorly by the line of fusion of the ilium and ischium. It is divided into iliac tuberosity and auricular & pelvic surfaces. The iliac tuberosity, a large, rough area below the dorsal segment of the iliac crest, shows cranial and caudal areas separated by an oblique ridge and connected to the sacrum by the interosseous sacroiliac ligament. The sacropelvic surface gives attachment to the posterior sacroiliac ligaments and, behind the auricular surface, to the interosseous sacroiliac ligament. The iliolumbar ligament is attached to its anterior part. The auricular surface, immediately anteroinferior to the tuberosity, articulates with the lateral sacral mass. Shaped like an ear, its widest part is anterosuperior, and its ‘lobule’ posteroinferior and on the medial aspect of the posterior inferior spine. Its edges are well defined but the surface, though articular, is rough and irregular. It articulates with the sacrum and is reciprocally shaped. The anterior sacroiliac ligament is attached to its sharp anterior and inferior borders. The narrow part of the pelvic surface, between the auricular surface and the upper rim of the greater sciatic notch, often shows a rough pre-auricular sulcus (that is usually better defined in females) for the lower fibres of the anterior sacroiliac ligament. The pelvic surface is anteroinferior to the acutely curved part of the auricular surface, and contributes to the lateral wall of the lesser pelvis. Its upper part, facing down, is between the auricular surface and the upper limb of the greater sciatic notch. Its lower part faces medially and is separated from the iliac fossa by the arcuate line. Anteroinferiorly, it extends to the line of union between the ilium and ischium. Though usually obliterated, it passes from the depth of the acetabulum to approximately the middle of the inferior limb of the greater sciatic notch.

Muscle attachments

The attachment of sartorius extends down the anterior border below the anterior superior iliac spine.

The iliac crest gives attachment to the anterolateral and dorsal abdominal muscles, and to the fasciae and muscles of the lower limb.

The fascia lata and iliotibial tract are attached to the outer lip and tubercle of its ventral segment.

Tensor fasciae latae is attached anterior to the tubercle. The lower fibres of external oblique and, just behind the summit of the crest, the lowest fibres of latissimus dorsi are attached to its anterior two-thirds. A variable interval exists between the most posterior attachment of external oblique and the most anterior attachment of latissimus dorsi, and here the crest forms the base of the lumbar triangle through which herniation of abdominal contents may rarely occur.

Internal oblique is attached to the intermediate area of the crest.

Transversus abdominis is attached to the anterior two-thirds of the inner lip of the crest, and behind this to the thoracolumbar fascia and quadratus lumborum. The highest fibres of gluteus maximus are attached to the dorsal segment of the crest on its lateral slope.

Erector spinae arises from the medial slope of the dorsal segment.

The straight head of rectus femoris is attached to the upper area of the anterior inferior spine.

Some fibres of piriformis are attached in front of the posterior inferior spine on the upper border of the greater sciatic foramen.

The gluteal surface is divided by three gluteal lines into four areas. Behind the posterior line, the upper rough part gives attachment to the upper fibres of gluteus maximus and the lower, smooth region to part of the sacrotuberous ligament and iliac head of piriformis. Gluteus medius is attached between the posterior and anterior lines, below the iliac crest, and gluteus minimus is attached between the anterior and inferior lines.

The fourth area, below the inferior line, contains vascular foramina. The reflected head of rectus femoris attaches to a curved groove above the acetabulum.

Iliacus is attached to the upper two-thirds of the iliac fossa and is related to its lower one-third. The medial part of quadratus lumborum is attached to the anterior part of the sacropelvic surface, above the iliolumbar ligament.

Piriformis is sometimes partly attached lateral to the pre-auricular sulcus, and part of obturator internus is attached to the more extensive remainder of the pelvic surface.

Vascular supply Branches of the iliolumbar artery run between iliacus and the ilium; one or more enter large nutrient foramina lying posteroinferiorly in the iliac fossa. The superior gluteal, obturator and superficial circumflex iliac arteries contribute to the periosteal supply. The obturator artery may supply a nutrient branch. Vascular foramina on the ilium underlying the gluteal muscles may lead into large vascular canals in the bone. Innervation The periosteum is innervated by branches of nerves that supply muscles attached to the bone, the hip joint and the sacroiliac joint.

OSSIFICATION

Ossification is by three primary centers: one each for the ilium, ischium and pubis. The iliac centre appears above the greater sciatic notch prenatally at about the 9^th week and the pubic centre in its superior ramus between the 4^th and 5^th months. The pubis is often not recovered from prenatal remains due to its size and fragility and because it is the last of the hip bones to begin ossification (Scheuer and Black 2004). At birth the whole iliac crest, the acetabular floor and the inferior margin are cartilaginous. Gradual ossification of the three components of the acetabulum results in a triradiate cartilaginous stem extending medially to the pelvic surface as a Y-shaped epiphysial plate between the ilium, ischium and pubis, and including the anterior inferior iliac spine. Cartilage along the inferior margin also covers the ischial tuberosity, forms conjoined ischial and pubic rami and continues to the pubic symphysial surface and along the pubic crest to the pubic tubercle. The ossifying ischium and pubis fuse to form a continuous ischiopubic ramus at the 7^th or 8^th year. 

Secondary centres, other than for the acetabulum, appear at about puberty and fuse between the 15^th and 25^th years. There are usually two for the iliac crest (which fuse early), and single centres for anterior inferior iliac spine (although it may ossify from the triradiate cartilage) and symphysial surface of the pubis (the pubic tubercle and crest may have separate centres). Progression of ossification of the iliac crest in girls is an index of skeletal maturity and is useful in determining the optimal timing of surgery for spinal deformity. Between the ages of 8 and 9 years, three major centres of ossification appear in the acetabular cartilage. The largest appears in the anterior wall of the acetabulum and fuses with the pubis, the second in the iliac acetabular cartilage superiorly, fusing with the ilium, and the third in the ischial acetabular cartilage posteriorly, fusing with the ischium. At puberty, these epiphyses expand towards the periphery of the acetabulum and contribute to its depth. Fusion between the three bones within the acetabulum occurs between the sixteenth and eighteenth years. Delaere et al have suggested that ossification of the ilium is similar to that of a long bone, possessing three cartilaginous epiphyses and one cartilaginous process, although it tends to undergo osteoclastic resorption comparable with that of cranial bones. During development, the acetabulum increases in breadth at a faster rate than it does in depth. Avulsion fractures of pelvic apophyses may occur from excessive pull on tendons, usually in athletic adolescents. The most frequent examples of such injuries are those to the ischial tuberosity (hamstrings) and anterior inferior iliac spine (rectus femoris).

Complied & written by Dr. Palak Shah.

 

CARPAL BONES

 The Latin word "carpus" is derived from Greek καρπὁς meaning "wrist". The root "carp-" translates to "pluck", an action performed by the wrist.  In human anatomy, the main role of the wrist is to facilitate effective positioning of the hand and powerful use of the extensors and flexors of the forearm, and the mobility of individual carpal bones increase the freedom of movements at the wrist. 

There are 8 carpal bones, organized into two longitudinal rows, the proximal row contains Scaphoid, 

Lunate, Triquetrum and Pisiform and the distal row has Trapezium, Trapezoid, Capitate and 

Hamate.

SCAPHOID

It is a boat shaped bone and has a tubercle which is laterally, forwards and downwards.

The tubercle of the scaphoid gives attachment to flexor retinaculum and a few fibres of 

abductor pollicis brevis.

Scaphoid articulates with Radius, Lunate, Capitate, Trapezium and Trapezoid.

LUNATE

It is half-moon shaped or crescentic bone.

As it has a semi lunar surface, it articulates with the scaphoid on its lateral side. A quadrilateral 

surface for the triquetral on its medial side.

TRIQUETRAL 

It is a pyramid shaped bone.

The oval facet for the pisiform lies on the distal part of the palmar surface.

The medial and dorsal surfaces are continuous and nonarticular.

It articulates with pisiform, lunate, hamate and articular disc of the inferior radioulnar joint.

PISIFORM

It is a pea shaped bone.

The oval facet for the triquetral lies on the proximal part of the dorsal surface.

The lateral surface is grooved by the ulnar nerve.

It only articulates with Triquetral.

TRAPEZIUM

It is quadrangular in shape, has a crest and a groove anteriorly.

The palmar surface has a vertical groove for the tendon of the flexor carpi radialis.

The groove is limited literally by the crest of the trapezium.

The distal surface bears convexo-concave articular surface for the base of the 1st metacarpal bone.

It articulates with scaphoid, trapezium, capitate and 1st and 2nd metacarpal.

TRAPEZOID

It looks like a shoe of a baby.

The distal articular surface is bigger than the proximal.

The palmar nonarticular surface is prolonged laterally.

It articulates with scaphoid, trapezium, 2nd metacarpal and capitate.

CAPITATE

It is the largest bone in the carpal bones which has a rounded head.

The dorsomedial angle is the distal most projection from the body of the bone which bears a small facet for the 4th metacarpal bone.

It articulates with scaphoid, lunate, hamate, trapezoid and 2nd, 3rd & 4th metacarpals.

HAMATE

It is a wedge shaped with a hook near its base.

The hook projects from the distal parts of the palmar surface and is directed laterally.

MUSCLES AND LIGAMENTS

The intricate movements of the hand are facilitated by a delicate balance of muscular forces and a robust ligamentous network within the wrist. Two primary muscle groups contribute: extrinsic muscles, originating in the forearm, stabilize the wrist by maintaining hand position on the radius during coordinated muscle contractions. Intrinsic muscles, originating within the hand, fine-tune movements by balancing flexor and extensor forces.

The flexor carpi ulnaris, an extrinsic muscle, significantly influences wrist movement by inserting onto the hamate, pisiform, and the base of the fifth metacarpal. Intrinsic muscles demonstrate diverse origins: thenar muscles arise from the scaphoid and trapezium, the adductor pollicis originates from the capitate and second/third metacarpals, and hypothenar muscles originate from the pisiform and hamate.

A complex system of ligaments provides stability. Radiocarpal ligaments connect the radius to various carpal bones (scaphoid, lunate), while ulnocarpal ligaments connect the ulna to the lunate and capitate. Intercarpal ligaments bind the carpal bones together (e.g., lunotriquetral, scapholunate), forming a strong, interconnected structure. These ligaments, along with carpometacarpal and intermetacarpal ligaments, ensure stability during a wide range of hand movements.

BLOOD SUPPLY, LYMPHATICS AND NERVOUS SUPPLY

The radial artery, ulnar artery, and their anastomoses provide the blood supply of the wrist. The radial artery predominantly supplies the thumb and the lateral side of the index finger while the ulnar artery supplies the rest of the digits and the medial side of the index finger. In particular, vascular supply takes place via the anastomotic network consisting of three dorsal and three palmar arches, which arise from both the radial and ulnar arteries, that overlie the carpal bones. The scaphoid, capitate, and a minority of lunates (20%) all have one intraosseous vessel supply. Of note, the scaphoid has a single blood supply from the radial artery that enters from the distal portion of the bone to supply the proximal portion, thus making its proximal pole most vulnerable to avascular necrosis. The trapezoid and hamate both have two areas of blood supply without intraosseous anastomoses. The trapezium, triquetrum, pisiform, and most lunates (80%) have two areas of blood supply and consistent intraosseous anastomoses. Therefore, the rest of the carpal bones, excluding the scaphoid, capitate, and the minority of lunates, have a lower risk of developing avascular necrosis following a fracture.

Innervation of the wrist joint comes from the:

• anterior interosseous branch of the median nerve
• posterior interosseous branch of the radial nerve
• the dorsal and the deep branches of the ulnar nerve

The lateral antebrachial cutaneous nerve, the posterior interosseous nerve, the dorsal branch and the perforating branches of the ulnar nerve, and the superficial branch of the radial nerve innervate the wrist joint from the dorsum. The palmar cutaneous branch of the median nerve, the anterior interosseous nerve, and the main trunk and deep branch of the ulnar nerve innervate the wrist joint from the palmar side.

EMBRYOLOGY

Upper limb development initiates with the activation of a group of mesenchymal cells in the lateral mesoderm towards the end of the fourth week, with the limb buds becoming visible around day 26 or day 27. Each limb bud comprises a mass of mesenchyme covered by ectoderm. This mesenchyme remains undifferentiated until it is ready to develop into bone, cartilage, and blood vessels later in development. Meanwhile, at the apex of each limb bud, the ectoderm thickens to form the apical ectodermal ridge, which stimulates the growth and development of the upper limb bud in the proximal-distal axis. Other signaling centers and primary morphogens such as the zone of polarizing activity, derived from an aggregate of mesenchymal cells in the limb bud, and the Want pathway, expressed from the dorsal epidermis of the limb bud, also contribute to the development of the upper limb buds by regulating growth along the anteroposterior axis and the dorsoventral axis, respectively.

At the end of the sixth week of development, digital rays form in the hand plate. By the seventh week, the carpal chondrification process begins. The capitate and the hamate carpal bones are the first chondrogenic centers to appear as immature cartilage early in the eighth week while the pisiform is the last to appear later in the eighth week. The hamulus, otherwise known as the “hook of the hamate,” also appears as an immature cartilaginous tissue towards the end of the eighth week and does not complete its development until the thirteenth week. Last, in the fourteenth week, a vascular bud penetrates the lunate cartilage mold, an early sign of the osteogenic process that will complete during the first year of life.

Complied & Written by Dr. Palak Shah

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

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