Physical Therapy & Rehabilitation

Physical Therapy & Rehabilitation

When you have an orthopedic disorder that is diagnosed by our specialists or when you are in need physiotherapy after a surgery, you are directed to physiotherapy unit. Physical therapy is needed to make a full recovery after sports related injuries. The physiotherapist will use the information provided by your doctor, along with his/her professional knowledge, experience, and evaluations, in order to implement his/her own treatment procedures. During your treatment, the rehabilitation program to be implemented and its frequency are determined in accordance with every patient’s individual needs. As we take part in the dynamic rehabilitation process through observations and attentiveness, we pay attention to protecting the repaired structures and using painless treatment methods. During this process, the most significant thing is your participation in the treatment. We will guide you through the process with continuous communication and teamwork with our staff.

GOAL

Main goals of the physiotherapy process are to make you independent in your daily life and to make you ready for social life and working life with your maximum, as soon as possible. Therefore, in this period, we follow the procedures with trying to increase awareness, strengthening your participation with continuous communication and minimizing pain.

TREATMENT PROCESS

The physiotherapists will use the information provided by your doctor, along with their professional knowledge, experience, and evaluations, in order to implement their own treatment procedures.

Some of the methods and programs included in the treatment process are below
  • Electrotherapy Devices
  • Heat Agents
  • Manual Therapy
  • Exercise Programs
  • Taping Techniques
  • Splints
  • Early Mobilization Methods (the Kleinert method for flexor tendons, early mobilization methods with dynamic splinting, etc.)
  • Specialized Profession Therapy
  • Physiotherapy in bed, respiratory treatments, and programs to help with the transition to walking are used for the patients who are considered to need them after surgery
  • For the outpatients, individual programs are prepared and splint applications are performed.

Replantation Rehabilitation

Replantation, is an important surgery that has long-term effects both on one's daily activities and professional life. Rehabilitation is extremely important in order to regain functionality. Replantation rehabilitation is a team effort and requires an experienced team. It demands attention, precision, and patience. Our goal is to protect all the repaired structures (bone, vein, tendon, nerve and skin) which are in recovery while helping the limb gain maximum functionality in terms of mobility, strength, feeling, and aesthetic.

Three Main Stages of Replantation Rehabilitation

  • Acute Stage: It is the first eight-week period. This is the stage where the healing process of the wound is at its fastest.
  • Subacute Stage:It is the period between eight weeks and four months after surgery. During this period the aim is to gain back functionality.
  • Chronic Stage:It is the period after four months. The severity of your injury determines the duration of this stage. If your injury is of the upper arm regions, this period extends. It is the period in which the functions and strength are regained in maximum and the results obtained are evaluated.

Taking into consideration these main stages, a general rehabilitation approach is developed as below.

Acute Stage

  • The first three-week period is when the circulation control is performed and the replanted limb is rested.
  • It is important for you to keep your arm at or near heart level for better circulation and for preventing fluid retention
  • Active rehabilitation begins on the third or fourth week, after circulation and bone stability are maintained.
  • Depending to the condition and form of the bone fracture, a splint that will not affect your resting position or prevent vascular circulation is prepared.
  • In order the prevent eburnation and soft tissue adhesions, mobility treatment is planned by taking into account the recovery period of each different system. Positioning the area operated on so as to prevent excessive strain on damaged tissues, active, passive and assisted exercises that will reactivate muscle strength are applied.
  • The joints on the replanted area are actively worked out.
  • Heat agents, electrotherapy applications, scar tissue massage and retrograde massage that expedite the healing of the damaged tissues and prevent fluid retention are introduced into the rehabilitation program from the fifth week onwards.
  • After all replantation operations, there will be loss of feeling in the distal of the replanted limb. At this stage, training will be provided for the loss of protective sensation
  • At the end of your treatment session, you will continue using the protective splint. Afterwards you are asked to resume your mobility training at home using our exercise program.

Subacute Stage

  • Mobility treatment resumes. According to the progress in regaining functionality during the acute phase, tendon shifting exercises, tenodesis exercises, blocking exercises are added to your general and home programs. Stretching and strength exercises are also included as the tissues’ ability to tolerate tensile stress increases. Delicate stretching is preferred.
  • The protective splint is removed at the beginning of this stage depending on the condition of the bone fracture.
  • Heat, electrotherapy and massage programs are arranged according to the progress of the tissues’ recovery whereas some of the applications are terminated.
  • The Sensation training program begins after sensation tests are performed.
  • If eburnation and soft tissue adherences are observed, new splints that are intended to repair and prevent them are prepared.
  • The use of the arm in mild daily activities is encouraged

Physiotherapy After Knee Replacements

Our aim with the physiotherapy program applied during your stay at our hospital after a knee prosthesis is to prevent the complications that might arise, provide early walking activities (going to the restroom on your own with the help of assisting equipment, going up and down the stairs), arrange and monitor your exercises, and explain your home exercise program. Upon your doctor's request, your physiotherapist will evaluate your condition from the second day onwards following your surgery. He/she will plan your treatment program that will enable you to resume independent mobility as soon as possible. In order to help you regain your mobility in the early stages, a CPM device which continuously moves the knee through a range of motions is used. The main goal of the early stage of rehabilitation after knee prosthesis is to reach a 0 to 90 degrees range of motion.

  • The socks (or elastic bandages) given to you after surgery should only be taken off while sleeping.
  • The anti-embolism socks should be put on in the morning before getting out of the bed for six weeks.
  • The home exercise program designed for and explained to you should be done regularly
  • After being discharged from the hospital, you will be able to perform your daily activities with the help of the assisting equipment (such as walker, crutches..) recommended by your physiotherapist.

Important Issues in the Physiotherapy and Rehabilitation of Hand Injuries

Physiotherapy and rehabilitation are extremely important in hand injuries for a full recovery. The patient, doctor and physiotherapist work together during the treatment process of hand injuries. The patients must follow the treatment program and do precisely whatever they are asked to for the recovery to be effective. It should be remembered that the patient is the most important part of the treatment. The rehabilitation of the hand, especially after surgical procedures, should be carried out by a physiotherapist who is specialized and has extensive experience in this field. To be able to get the best results from the treatment, these points should be taken into account:

  • The cast should not be taken off without consulting a doctor or physiotherapist, and the arm sling that was given after surgery must be used.
  • Swelling (fluid retention) on the hand are possible effects of surgery or injuries and if the necessary precautions are not taken, they will affect the treatment negatively. Thus, hand should always be kept at a high level and challenging movements that may increase the swelling should not be done.
  • The exercise (movement), massage and the splint applications recommended by the physiotherapist should be performed continuously and precisely as told. An exercise for the hand does not necessarily mean moving the fingers rapidly. Exercises should be performed knowingly as they have been shown and for as many repetitions as told; it should be kept in mind all the time that constant movement is harmful.
  • It is important to avoid movements that are challenging for the hand and may cause pain. Challenging movements and stretching harshly applied may both damage the operated area and make the joints stiffer by causing swelling in the hand.
  • Especially in the early period after an injury or surgery, the use of the hand should be avoided without consulting the medical team (doctor and physiotherapist) first.
  • Using methods advised by others (like hand grip exercises, applying hot water, applying various oils) may cause harm.
  • Every patient's injury is unique and has its own features. Suggestions, exercises, and devices given to other patients should not be used.
  • Regular follow-ups are important during the long recovery process for the hand to regain its functionality after surgery. Unless the surgeon or physiotherapist concludes the treatment, you should remain in regular contact with them.

Physical Therapy and Rehabilitation for Anterior Cruciate Ligament Injuries

After conservative (non-surgical) or surgical treatment of an Anterior Cruciate Ligament (ACL) injury, physical therapy and rehabilitation are required. Rehabilitation can vary for each patient. The type of the graft that is used and its location, patient's activity level and expectations, other accompanying injuries (like meniscal tears, other bond injuries, cartilage lesion, etc.) are the most important factors to be considered in determining the content of the rehabilitation program. The goal of this treatment is to ensure that the individuals resumes their daily routine and sports activities as soon as possible. To achieve this goal, the rehabilitation program should be planned and evaluated by a physiotherapist with expertise in this field. The rehabilitation program should aim to reduce pain and fluid retention, enable the knee to attain standard range of motion, increase the strength of the leg muscles and augment balance and coordination. For contact sports like basketball and football, a full comeback from surgery for professional athletes will take six months while for amateur athletes it may take up to one year. The success of the surgery depends on a good rehabilitation program and proper follow-ups.

Physiotherapy and Rehabilitation in Shoulder Muscle Tears

Conservative (non-surgical) Physiotherapy

  • Reducing pain and inflammation is the main goal of the treatment and to achieve this, during the first stages when pain starts and is intense, resting is recommended for the patient. The arm should not be used other than for personal care. An arm sling may be used for the first couple of days if deemed necessary.
  • The physiotherapist will prepare a special program for the patient for physiotherapy and rehabilitation. It is not safe to take into consideration suggestions from people with no experience in this field.
  • During the first stages when the pain is intense, applying a heat press should be avoided. In this stage, a cold press can be applied for a few times a day.
  • Especially in early stages, you should not lie on the injured side. Relax the arm by supporting it with a pillow if possible.
  • In the ensuing stages when the pain is relieved, hot-cold press applications, manual therapy techniques for the shoulder joints and electrical agents should be applied.
  • Exercise has great significance on the treatment of muscle tears in the shoulder. Starting from the early stages of the injury, a proper exercise program targeting the correct muscle group is planned by the physiotherapist. In general, the exercise program consists of;
    1. Lifting the arm above head level and other exercises to increase the shoulders’ range of motion.
    2. Exercises that strengthen the muscles around the shoulders.
    3. Posture and stabilization exercises.
    4. Stretching exercises for the essential muscle groups and tissues.
    5. Training on the techniques of using your upper extremity correctly
  • It is important that information about the changes to be made to prevent further shoulder problems is provided.
  • It may take about four to six months to respond to the conservative treatment. During this period, it is essential for the patient to adapt to and apply properly the rehabilitation program that has been provided.

Physiotherapy and Rehabilitation after Surgery

Rehabilitation after rotator cuff surgery is a slow process. Physiotherapy and a complete recovery period takes around four to six months. This process should be coordinated by an experienced treatment team. Helping the shoulder gain mobility and increasing its range of motion are important; however, a balanced rehabilitation program should be followed in order to protect the healing tissues. These applications become important in the treatment process;

  • Arm slings are worn to protect the shoulder after surgery. This sling is to be used for four to six weeks unless the doctor states otherwise.
  • Cold press applications and electrical agents can be used to reduce pain and swelling in the early stages after the surgery.
  • The exercise program starts when the doctor finds it appropriate. Passive exercises should be performed during the first five weeks. In the early stages, taking off the sling and moving the arm around may harm the treated area.
  • Active assisted exercises in the company of a physiotherapist will begin after five weeks and active exercises will commence afterwards.
  • Exercises to strengthen the muscles should not be performed until, at the minimum, eight weeks after surgery.
  • Active use of the arm will increase between eight to twelve weeks.
  • Full recovery may take up to 6 months.
  • Sports activities should not be performed before four to six months
  • To be able to start doing challenging activities like sports, the approval of the treatment team is necessary.

Suggestions and Exercises for a Healthy Lower Back

POSTURE

  • • It is important to have good posture during daily activities and in the work environment.
  • • Be careful to stay in an upright position while seated.
  • • Support your lower back.
  • • Avoid sitting with your legs crossed
  • • Position your hips higher than knee level (avoid being seated on lower places).
  • • Stand upright by arranging your back posture without stooping your shoulders while standing up straight or walking.
  • • Be cautious to sleeping position and do not use a soft mattress.
  • • Try to sleep lying on your side or facing upwards.
  • • Support your lower back and legs with a pillow and bend your knees slightly while lying down.

PROTECTIVE MEASURES

  • • Avoid sudden movements.
  • • Avoid gaining weight.
  • • Do not use a corset without consulting a specialist.
  • • Do not lift heavy things, stay away from activities like pushing-pulling furniture.
  • • Place one foot on a support when needing to stand up for a long time.
  • • Prefer comfortable shoes and stay away from high-heels.
  • • When lifting object from the ground, crouch by bending the knees instead of bending from the lower back.
  • • Avoid rotating (turning) movements that put strain on the lower back. When standing still, instead of rotating only the upper body to turn, think of the body as a whole and use the feet to turn.
  • • To reach high shelves, use a stool instead of reaching up.
  • • Do not hold your breath during even the smallest activity. Make a habit of performing your daily activities while continuing to breath.
  • • Try to balance the weight distribution to both hands equally.
  • • Especially if you work a desk job
  • • Get up and walk around periodically.
  • • Place the objects used most in your daily life in places that you can reach easily
  • • Arrange the distance-degree-height between the computer-table-chair-ground so that you have good eyesight while staying in the right posture without tiring the body.
  • • Support your feet by placing an object under them.

EXERCISE

  • • Strengthen your abdomen, hip and back muscles.
  • • Protect your spine flexibility and increase your muscle flexibility.
  • • Walk at a slow pace with the right outfit and proper shoes.
  • • If you have the opportunity, try to swim.
  • • Pay attention to do your exercises slowly, properly and regularly. Do not over-train.
  • • Do not push your pain limits.
  • • Continue the proper posture and the respiratory control that you have learned while performing your exercise routine.