Fysiotikka projects - 1st week

Introduction

My beginning in Fysiotikka was very busy and quiet different from Voimala. My staying in Fysiotikka is only 2 weeks. In this place, where coming most of all people with specific problems on their body, so we were based on the diagnosis of their disabilities, and on their rehabilitation. In this project, i was with other 6 physiotherapy students, who did also their traineeship there. Each of them, had their own week schedule and arrangements with their own clients. I did not have this schedule, but I was cooporated with each of the groups, so I was going to any client they told me to go. Of course, i would like to have my own schedule to know everyday which clients i have, but i got used to this!

Well, i worked with a lot of clients with multiple problems. The physiotherapy treatments were different on each of the customers.

Physiotherapy treatment of rapture of supraspinatus

I began with a young client, that was diagnosed after MRI with rapture in her right supraspinatus, after a sudden movement in voleyball playing. We did the accessment to her, to be sure about her problem.  She was feeling pain while the abduction of her shoulder. Then, we went in the Gym, and did some exercises to her shoulder with the theraband. Our main purpose, was to do scapular control and focus the glunehumeral head.

Τhe exercises that she did, were the following:

• Stabilazation exercises with horizontal abduction.
• Rowing with the resistance band, to adduct her scapulas.
• Abduction of her shoulders with the resistance band.
• Flexion of the shoulder with the resistance band.
• Internal and external rotation with the risistance band.

rowing

abduction 1

abduction 2

horizontal abduction

shoulder flexion

external shoulder rotation

internal shoulder rotation

After the Gym exercises, we went back to the previous room, and did static passive stretching to the muscles of the rotator cuff, in both sides. Except of her supraspinatus rapture, she also had her levator scapulae tight, so we did massage in that area to relax and relieve from the pain. At the end, we put tape on the area of her right shoulder and scapula, to reduce the front position the movement of her shoulder and also to stabilize it.

tape for rotator cuff injuries

Physiotherapy treatment on group of 2 elderly women

The treatment was in the Gym of the University. I was with another physiotherapy student in this group. I started with the warm up and then continued with muscle exercises. Each of the clients, had their own fitness program, so they knew from the beginning what exercises to do. Both of them, did the same exercises, but sometimes with different difficulties. I was only helping and correcting the way of exercising.

Each of them, were very healthy and quit strong. The exercises that they did, were the following:

1st client:

1. Leg abductions: 20kg of 2x15 times
2. Diceps with weight: 2kg of 2x15 times
3. Rowing with theraband on the yoga ball : 2x20 times
4. Star Excursion Balance exercise on unstable surfaces: 2x10 times of each leg
5. Leg press: 34kg of 3x12 times
6. Bag extension: 2x15 times
7. Trunk rotation: 2kg of 3x15 times
8. Squats with kettlebell: 6kg of 2x15 times

2nd client:

1. Leg abductions: 28kg of 2x20 times
2. Diceps with weight: 2kg of 1x20 times and 3kg of 1x15 times
3. Rowing with theraband on the yoga ball: 2x20 times
4. Star Excursion Balance exercise on unstable surfaces: 2x20 times of each legs
5. Leg press: 34kg of 1x12 times and 43kg of 2x12 times
6. Bag extension: 2x20 times
7. Trunk rotation: 5kg of 2x20 times
8. Squats with kettlebell: 14kg of 2x20

Star Excursion Balance exercise

Physiotherapy treatment of client with health and weight problems

A different kind of problems had this client, than the previous ones. This woman came to Fysiotikka to lose some kg. She had multiple health problems, like diabetes, cholesterol and problems with arterial and blood pressure. 

First, we did some questions associated with her health. Then, we measured her pulmonary pressure with the Peak-flow meter (Spira) and her arterial pressure and heart rate while doing the exercises on the ergo-metric bicycle (ergoline-fysioline). The ergoline was connected with a special software, that showed her pulses, the levels of difficulty and the time of the exercise. It also calculated her maximum heart beat that was 181bpm. So, our purpose was to reach till the 153bpm of her heart rate (the 80% of the maximum heart rate)

The levels of the ergoline were from 1-20. The client rised the levels, depending on her feelings, like fatigue. If the level was under 17, she could continue the exercise. After 20 minutes, she stopped doing the ergoline and we measured again her arterial pressure and also her pulmonary pressure with the peak-flow meter.

This method of losing kg was very interesting for me and very useful.

Home visit - Physiotherapy treatment of an elderly man

This man was living alone at his house and didn't move a lot. He had problems with his wight, blood pressure problems and the main problem was osteorthritis on his right hip, so that was the main reason that he could't walk, because he was feeling pain.

When we entered into his house, we found him sitting on his chair. After a while, he started doing exercises. He already knew what to do, so we were just helping him improve the movements.

Sitting position:

He started with the core stretching in front and with rotation. Then, he did strengthening on adduction muscles with the small pilates ball, and hip flexion without the ball. He continued with flexion/extension of his knees, by dragging the calcaneus on the floor.

adduction muscles strengthening

Supine position:

On supine position, he did bridge exercises on the bed. At the end, we put the TENS on his right hip for 25 minutes, to relieve him from the pain because of the osteoarthritis.

bridge exercise

TENS

Physiotherapy treatment on stroke

An elderly man with stroke and left hemiplegia came into Fysiotikka to have some treatment. He also had inability to conceive and handle.

First of all, he started with the Hp Cosmos Valjaat, which is a special machine for people that are not able to walk without a support. He walked 4 meters to the one side and 4 to the other side, 5 times.

Hp Cosmos Valjaat

NOTE!!! I noticed, that everytime the client was starting the walking, he always started with his normal leg (right) and not with the hemiplegic leg.

After the walking, we gave him exercises for his hand, to motivate his hand muscles. He began with his right hand, trying to catch some things from the table, and put them in a box, extending his core and rotating his trunk at the same time. This hand, was quiet good, and the client catched all the things. Then, he did the same with the hemiplegic hand. It was very difficult for him to open the fingers and catch the things, the more so his hand was shaking and has much spasitity. Although, he didn't give up, and continued the exercise with our help.

Physicaltherapy treatment in the Gym with elderly people

7 elderly people (6 men and 1 woman), came into the Fysiottika's Gym, to have some muscle strengthening and endurance. They did circuit training. First, they did warm up with some dynamic and static exercises and stretching, and then everyone did their own program. The gym program included exercises for:

• trunk rotation 
• leg press
• abdominals 
• abduction and adduction
• rowing
• back exercises
• chest 
• diceps
• shoulder
• quadriceps and hamstrings

At the end of this program, they did cool down and some stretching to all the body muscles.

All of the clients, were very strong and healthy, and especially three of the elderly men, were very active!

Physicaltherapy treatment on neck pain

A young client, about 30 years old, had pain on his neck because of his bad ergonomic posture on the computer. I checked his posture, and his neck and head were in front and he had also kyphosis.

The exercises that we did, were:

1. Strengthening for the deep muscles of cervical flexors.
2. Abduction and flexion of the shoulders with theraband and with nodding of his head at the same time.
3. Adduction of his scapulas with the theraband.
4. Stretching to his cervical muscles.
5. Rotation of the neck, with the elbows on the wall for stability.

Finally, we gave him a guidance, about the right posture of his whole body while sitting, standing and doing all the exercises. He was very patient and did exactly what we recommend and advised him.

Physicaltherapy treatment of diabetic elderly man

An elderly man, around 65 years old, came to Fysiottika's Gym, to burn fat and to increase his physical condition. This man, did the High Intensity Interval Training (HIIT), which is an exercise method that consists of short bouts of exercise that are performed close to an individual’s maximum effort with brief rest periods (less than 30 seconds) between exercises.  HIIT programs have many benefits.  They can provide variation in resistance and aerobic activities.  The increase in variety may make your exercise more engaging and even reduce your exercise time.  Research has shown that HIIT programs can improve blood sugar profiles in diabetics and even depression symptoms in older adults.

So, he did

1. Static Bicycle from 2-4-7 level for 20 minutes. After some minutes, he increased the speed and the difficulty (7 level) for 15 seconds, and then he relaxed for 45 seconds. He did this for many times.
2. After the static bicycle, he did Leg Press: First with 20kg 1x20 repeats, then with 34kg with 1x20 repeats and at the end with 43 repeats with 2x15 repeats. 
3. Then, he did Trunk Rotation to both sides, with 4kg and 2x15 repeats.
4. At the end, we went to another room to do the Power Plate. First, he stand on the power plate with flexed knees for 30 seconds. Secondly, he stand on one leg for 15 seconds. Each of the exercises, he did 3 times.

NOTE!!! The client's left leg was more weak than the right leg.

Physicaltherapy treatment of the shoulder

A middle aged woman came with shoulder problems, after a falling on her right shoulder. We were not sure enough about her problem, because she also felt pain on her humerus.

We evaluated her shoulder, and estimated that she had rapture on the rotator cuff muscles. After the evaluation, she did some exercises to her shoulder.

First, she did flexion of her shoulder with a rope assisted from the other hand, so that the movement could be better and without much pain. Then, she did rowing with the theraband and openning of her hands behind the head.

After that, we tested her labrum by compressing technique. Then, we did passive internal rotation of her shoulder on the bed and then, she did the same by herself, helping with the other hand, doing the stretching of the external rotators. 

At the end, she stabilized the shoulder holding the theraband with flexion of her elbow and adduction of the shoulder, doing side steps the same time. 

Finally, we gave to her shoulder exercises for home, so she could do them alone and improving her condition.

Physicaltherapy treatment of low back pain

A young 19 years old girl, came to have some treatment to relieve from the pain of her low back. We evaluated her anatomical posture and estimated that her spinal cord was very straight, her pelvis had an anterior tilt, her gluteous muscles were very weak, her right hip was more with external rotation, her knees were overextended and her right patella was displaced to the left side.

Then, we asked from her do do squats with one and two legs, to see the way she was doing them. Her joints were not stable and her knees were going in front. I tryed to fix her posture, so that she could to the squats in the correct way. To help the right way of doing the squats, i taped her right knee from the internal side, in order to protect and to stabilize the joint.

Afterwards, we told to her to flex and extend her back. She was feeling pain while she was extending her back. I thought to do the McKenzie technique, to centralize the pain. So, the first thing that I asked from the client, was to lie down on the bed in a prone position, so that i could fix her posture. After this, i told her to extend her back. She felt pain on her back with that movement. Then, she lied down on supine position and I did to her passive flexion of the legs up to her chest, and finally the same, but with rotation to the right and to the left.

The McKenzie Method was developed in the 1960s by Robin McKenzie, a physical therapist in New Zealand. In his practice, he noted that extending the spine could provide significant pain relief to certain patients and allow them to return to their normal daily activities.

With the McKenzie approach, physical therapy and exercise used to extend the spine can help "centralize" the patient's pain by moving it away from the extremities (leg or arm) to the back. Back pain is usually better tolerated than leg pain or arm pain, and the theory of the approach is that centralizing the pain allows the source of the pain to be treated rather than the symptoms.

ΝΟΤΕ!!! The client felt pain while exdenting her back, but felt releive while I did flexion of the legs to her chest. I think that in the first test, she was afraid because of the pain, but it is very important for her to understand that the mind leads the body, and if her phsychology allows to do the test, she will releive her back from the pain.

Back extension

Flexion of back

centralization of the symptoms

Extension and Flexion Progressions

Physicaltherapy assessment on the lower limbs of an elderly woman

An elderly woman, who was my client in Voimala, came to measure and analyze her balance and the way of her walking. Her balance was measured with two legs on the Metitur Balance and her Walking was measured on the GAITRite Electronic Walkway.

Metitur Balance

GAITRite Electronic Walkway

             GAITRite Electronic Walkway 

The main problem of this woman, was that her right leg, after the hip replacement surgery, had low movement and her joints were totally fake, as she couldn't flex her leg and begin the walking. Moreover, her right leg was 3cm taller than the left leg, so that was an important factor for her disability.

After the measurements, we figured out that she uses her left leg more than the right, because she trusts it more than the right. So, the purpose was to rehabilitate all the joints and the movement of the client's right leg.

Physicaltherapy treatment on Madelung deformity on wrist

 

The client with Madelung deformity on the wrist was a young girl 18 years old.

Madelung's deformity is a rare congenital condition in which the wrist grows abnormally. Part of radius, one of the bones of the forearm, stops growing early. The other forearm bone, the ulna, keeps growing and can dislocate, forming a bump. Other bones can be affected as well, and the hand ends up rotated and lower than the forearm. Movement of the hand and elbow are not affected.

Signs and symptoms can range from a just a slight protrusion of the lower end of the ulna to a complete dislocation of the wrist. Other indications can include:

   •    Limits to wrist range of motion (ROM)—can range from minor to major
   •    Pain—chronic or following activity involving the wrist joint
   •    Visible difference in the wrist

The physicaltherapy treatment that we did to this girl, were:

• Pintch Pressure 

  

• 9-Hole Peg Test which is a brief, standardized, quantitative test of upper extremity function. It is the second component of the MSFC to be administered at each visit. Both the dominant and non-dominant hands are tested twice. The patient is seated at a table with a small, shallow container holding nine pegs and a wood or plastic block containing nine empty holes. On a start command when a stopwatch is started, the patient picks up the nine pegs one at a time as quickly as possible, puts them in the nine holes, and, once they are in the holes, removes them again as quickly as possible one at a time, replacing them into the shallow container. The total time to complete the task is recorded. Two consecutive trials with the dominant hand are immediately followed by two consecutive trials with the non-dominant hand.

9-Hole Peg Test

• Grip tennis ball in purpose to strengthen the muscles of her hand. Squeezing a tennis ball can be an effective way to increase hand and grip strength.

https://www.youtube.com/watch?v=dLYvbc73sXA : How to grip the tennis ball

NOTE!!! In this exercise, the girl didn't feel much pain, but more weakness.

• Adduction of fingers with the theraband in order to strengthen the muscles. 

NOTE!!! This exercise was very painfull for the client.

At the end of the treatment, we showed to the client the right posture of the whole body while sitting on the chair (lower limbs, upper limbs, core end head).

Physicaltherapy treatment and workout exercises

This kind of treatment, was more workout exercises to a middle aged man, who had had osteoarthritis on his left leg, and just wanted to improve his muscular strengthen, endurance and balance.
First, he started with the Cross-Trainer for 6 minutes in the Gym. Then, we went to a room with the Power Plate. He did all the exercises on the Power Plate. The exercises included:

1. Static squats 
2. Rising one leg (in this exercise, the client stands with the one leg on the power plate, and with the other on the floor. The purpose is to do squats with the leg on the power plate and flexion of hip-knee by rising the leg that is on the floor)
3. Bridge exercises with the legs on the power plate
4. Plank exercises with the noses of the feet on the power plate
5. Rising on the noses of the feet on the power plate

NOTE!!! The middle aged man was really strong and with endourance. He did successfully all the exercises without problems (only on his left knee he felt a little pain while doing the squats, because of the osteoarthritis).

Conclusion

This weekend went good. I did a lot of treatment with different kind of clients. It was really busy and enjoyable at the same time. All the clients were cooperated with every kind of physicaltherapy treatment. That is very good, because they really care about their health and the necessity to be able of doing independent things!