What is Physical Therapy and Rehabilitation?

What is Physical Therapy and Rehabilitation?

Physical therapy and rehabilitation is a medical science that works with a multidisciplinary approach, working in collaboration with other medical branches, to improve and eliminate disabilities that affect a person’s life and quality of life, enabling the patient to effectively return to their social lives. The most appropriate treatment option is applied to each inpatient or outpatient physical therapy and rehabilitation unit, taking into account their specific circumstances. A variety of methods and technological tools are used to determine and address functional capacity that develops due to permanent and movement-limiting injuries, including thermotherapy (heat applications), cryotherapy (cold applications), hydrotherapy, electrical current therapy, phototherapy, mechanotherapy, and medication. In addition to musculoskeletal disorders, orthopedic rehabilitation is also applied after orthopedic procedures, movement disorders following stroke, facial paralysis, neurological rehabilitation following nerve injuries, and pediatric rehabilitation is applied for conditions that develop during childbirth. Rehabilitation after hand surgery for nerve injuries, fractures, and similar problems, as well as rehabilitation for movement disorders resulting from burns, are also performed by physical therapists.

Who Provides Physiotherapy?

Physiotherapy is performed by trained and specialized healthcare professionals. Physiotherapists are the primary providers. They manage the treatment process by planning physical therapy procedures based on the individual’s needs and creating personalized treatment programs. In addition to physiotherapists, other healthcare professionals may also be involved in the physical therapy process.

1. Physiotherapist:

Physiotherapists specialize in physical therapy and rehabilitation, graduating from university physiotherapy and rehabilitation departments. These programs, which typically last four years, allow physiotherapists to gain in-depth knowledge of topics such as the musculoskeletal system, neurological disorders, pain management, manual therapy, electrotherapy, and exercise therapy.

Duties of Physiotherapists:

Assessment and Diagnosis:

A physiotherapist evaluates the patient’s physical condition and develops a treatment plan appropriate for the patient.

Treatment Plan Creation:

Develops a treatment plan that includes exercise programs, manual therapy, electrotherapy, and hot and cold applications tailored to individual needs.

Applications:

Applies the prescribed treatment methods to the patient’s body type and physical condition.

Education and Counseling:

Provide education to patients on proper posture, exercises, and activities of daily living.

Follow-up:

Monitors the progress of the treatment process and makes adjustments to the treatment plan if necessary.

2. Physiotherapists (Physical Medicine and Rehabilitation Specialists)

Physical Medicine and Rehabilitation Specialists (Physical Therapy Specialists) are medical professionals who monitor patients’ treatment progress and guide physiotherapists. These specialists typically specialize in physical medicine and rehabilitation and have completed medical school training.

The Role of Physical Medicine and Rehabilitation Specialists

Diagnosis:

Provides a definitive diagnosis of the patient’s condition before receiving treatment recommendations from the physical therapist.

Determines the general approach to physical therapy methods and guides physical therapists throughout the treatment process.

Medical Management:

Complements physical therapy with medication, injections (e.g., intra-articular injections), or surgical treatment recommendations when necessary.

Tracking and Monitoring:

Monitors the physical therapy process and makes changes to treatment plans as needed.

3. Orthopedic Specialists

Orthopedic surgeons specialize in diseases of the bones, joints, muscles, and connective tissues.

Generally, orthopedists recommend physiotherapy for conditions such as fractures, dislocations, structural disorders of the musculoskeletal system, and joint problems.

The Role of Orthopedic Specialists:

Surgical Intervention and Treatment:

They perform orthopedic surgery when necessary and recommend physical therapy afterward.

Physical Therapy Referral:

They refer the patient to a physical therapist during the treatment process and monitor the treatment process.

4. Neurologists

Neurologists are specialists who specialize in diseases of the brain, spinal cord, and nervous system. Physical therapy is crucial for addressing loss of function resulting from neurological diseases or injuries. Neurologists recommend physiotherapy during the treatment process for neurological conditions such as stroke, Parkinson’s disease, and MS.

The Role of Neurologists:

Neurological Assessment:

Evaluates the patient’s neurological status and determines whether physical therapy is necessary.

Treatment Referral:

Recommends appropriate rehabilitation programs to the physical therapist.

Monitoring the Treatment Process:

Monitors neurological developments during physical therapy.

5. Rheumatology Specialists

Rheumatologists specialize in musculoskeletal and connective tissue diseases (e.g., arthritis, lupus, fibromyalgia). Rheumatic diseases can be managed with physical therapy, and rheumatologists recommend that patients begin physical therapy.

The Role of Rheumatology Specialists:

Treatment of Rheumatic Diseases:

Treat rheumatic diseases and determine physical therapy methods.

Physical Therapy Referral:

Prescribes physical therapy methods to increase joint mobility and reduce pain.

6. Sports Medicine Specialists

Sports medicine specialists specialize in musculoskeletal injuries and performance problems commonly seen in athletes. Physical therapy plays a crucial role in ensuring rapid recovery for athletes.

The Role of Sports Physicians:

Sports Injuries:

Recommends physiotherapy for the treatment of injuries involving muscles, ligaments, joints, and tendons.

Performance Enhancement:

Guides physical therapists to accelerate athletes’ physical recovery processes.

7. Family Physicians and General Practitioners

Family physicians or general practitioners are often the first physicians to initiate initial treatment for patients and refer them to specialists if necessary. When physical ailments are detected, they may refer the patient to a physiotherapist.

The Role of Family Physicians:

Initial Assessment:

Identify physical ailments at an early stage.

Referral:

Refers to a physiotherapist when physiotherapy is needed.

What are Physical Therapy and Rehabilitation Services?

As Biruni University Hospital’s Physical Therapy and Rehabilitation Unit, we offer a wide range of services to meet different needs. Our unit offers services in a wide range of areas, from orthopedic rehabilitation to electrotherapy, from post-heart attack exercises to athletic rehabilitation.

Orthopedic Rehabilitation

Working in collaboration with our hospital’s Orthopedic Department, we offer rehabilitation services for conditions such as prosthetic surgery (arthroplasty), arthroscopic procedures, fractures, hand injuries, spinal curvature (scoliosis), and kyphosis. Our goal is to prepare muscles and joints before surgery and accelerate post-surgical recovery.

Neurological Rehabilitation

We offer rehabilitation services to help restore mobility and restore functional loss resulting from neurological conditions such as stroke, brain injury, Parkinson’s disease, and multiple sclerosis (MS). We provide inpatient and outpatient services to our patients, with evaluations performed before and after neurological surgery.

Cardiac Rehabilitation

We offer exercise and training programs to improve the physical capacity and quality of life of patients following a heart attack or heart surgery. Pediatric Rehabilitation

We offer rehabilitation services for children with developmental delays, congenital anomalies, cerebral palsy, and spasticity.

Geriatric Rehabilitation

We create customized programs to maintain the mobility, independence, and overall health of our patients, particularly for conditions such as scoliosis, osteoporosis, and kyphosis, which are more common in older patients.

Athletic Rehabilitation

Sports injuries are an important area of ​​rehabilitation medicine, with both early and late-term outcomes. We help athletes return to sports quickly and safely after sports injuries such as meniscus tears and ACL injuries. Sports injuries are managed and treated in collaboration with the Department of Orthopedics and Traumatology.

Who Can Benefit from Physiotherapy?

Physiotherapy can be applied to individuals of all ages who have limited mobility, pain, or loss of function. The goal is to reduce pain, increase mobility, improve muscle strength, and enable individuals to independently perform activities of daily living.

1. Those with Musculoskeletal Problems

This group is one of the areas where physiotherapy is most frequently applied.

Who Can Benefit from Physiotherapy?

• Individuals with a herniated or cervical disc
• People dealing with muscle spasms and back pain
• Those experiencing joint pain (in the knee, shoulder, hip, etc.)
• Individuals facing limited mobility following a fracture
• Those with posture issues like scoliosis or kyphosis
• People recovering from sports-related injuries

2. Those with Neurological Disorders

Individuals who experience loss of movement and coordination due to nervous system disorders benefit greatly from physiotherapy.

Who Can Benefit from Physiotherapy?

• People who have experienced a stroke
• Individuals living with Parkinson’s disease
• Those diagnosed with multiple sclerosis (MS)
• People affected by brain or spinal cord injuries
• Children diagnosed with cerebral palsy
• Those suffering from nerve compression, such as carpal tunnel syndrome or sciatica

3. Those Who Have Had Orthopedic Surgery

Physical therapy is used to accelerate postoperative recovery and restore muscle strength and mobility.

• Individuals who have undergone hip or knee replacement surgery
• Individuals who have had surgery for a meniscus or ligament injury
• Those who have received surgical treatment on the shoulder, elbow, or ankle
• Individuals who have undergone spine surgery

4. Those with Rheumatic Diseases

Physiotherapy reduces pain and maintains joint mobility in diseases that cause joint inflammation, pain, and limited movement.

• Rheumatoid Arthritis
• Ankylosing Spondylitis
• Lupus
• Fibromyalgia
• Osteoarthritis (Arthritis)

5. Those with Respiratory System Problems

Physical therapy can be used to increase lung capacity and improve respiratory function.

• COPD (Chronic Obstructive Pulmonary Disease)
• Asthma
• Cystic fibrosis
• Those with respiratory failure
• Those who have had lung surgery

6. Those with Heart and Circulatory System Diseases

Cardiac rehabilitation after heart disease is a specialized area of ​​physiotherapy.

• Those who have had a heart attack
• Those who have had heart surgery
• Those with hypertension and vascular disease

7. Children with Developmental Disabilities

Some children may experience physical and motor skill problems, either congenitally or during development. Physiotherapy supports these skills.

• Children with cerebral palsy
• Infants with developmental delays
• Children with Down syndrome
• Children with muscle disorders (Duchenne, spina bifida, etc.)

8. Elderly Individuals (Geriatric Rehabilitation)

Decreased muscle strength, loss of balance, and walking difficulties with age can be improved with physiotherapy.

• Elderly people with balance problems
• Those with walking difficulties
• Elderly people who fall frequently
• Those with sarcopenia
• Maintaining physical activity in patients with Alzheimer’s or dementia

9. Those with Chronic Pain

Chronic, long-standing pain can be managed with physiotherapy methods.

• Those experiencing back and neck pain
• Those experiencing migraines and headaches
• Those with fibromyalgia (muscle rheumatism)
• Those experiencing long-term pain after surgery

10. Pregnancy and Postpartum

Posterior posture, back pain, and postpartum muscle laxity can be treated with physiotherapy.

Individuals dealing with back pain or discomfort during pregnancy Individuals facing postpartum abdominal muscle laxity (diastasis recti) Individuals experiencing weakness in pelvic floor muscles, such as urinary incontinence

11. Preoperative Preparation (Prehabilitation)

This treatment is used to strengthen muscles before certain surgeries and accelerate postoperative recovery.

• Patients undergoing knee or hip replacement surgery
• Before spine surgery
• Individuals preparing for major surgery

Who Should Not Use Physiotherapy?

Physiotherapy is generally a safe treatment method that can be applied to a wide range of patients. However, in some cases, physiotherapy treatments may be unsafe or require special care. In such cases, physiotherapy is not administered or is strictly limited to a doctor’s approval and specific protocols.

Situations in which Physiotherapy Should Not Be Used or Should Be Postponed:

1. Active Infections

• When there is a widespread infection in the body (e.g., flu with high fever, pneumonia, sepsis, etc.)
• When there are infected wounds or open sores on the skin

2. Febrile Illnesses and Acute Inflammatory Periods

• When the body temperature is above 38°C
• When there is a flare-up of rheumatic diseases

3. Serious Heart and Respiratory Problems

• Uncontrolled high blood pressure
• Recent heart attack
• Heart failure
• Uncontrolled arrhythmias
• Severe respiratory failure

4. Fresh Injuries or Fractures

• Recent fractures
• When stitches have not yet been removed after surgery
• When the tissue healing process is not complete

5. Cancer – Certain Conditions

• When cancer metastasizes, especially to the bones, it may be necessary to massage or apply heat to the tumor area when bone weakness occurs, i.e., osteolytic lesions occur.

6. Risk of Clot Formation (Thrombosis / Embolism)

• Diagnosed with deep vein thrombosis (DVT)
• Recent embolism (lung or brain)

7. Severe osteoporosis (osteoporosis)

• Patients with severe bone weakness

8. Risky Conditions in Pregnancy

• Pregnant women with threatened miscarriage
• Preeclampsia (high blood pressure and edema during pregnancy)
• Pregnant women at risk of premature birth

9. Skin Problems (For Some Applications)

• Open wounds, burns, eczema, etc.
• Skin problems in the area where electrotherapy devices will be applied

10. Unconscious or Uncooperative Patients

• Severely unconscious
• Uncooperative patients due to serious psychiatric disorders

11. Certain Neurological Conditions (In the Acute Phase)

• Recent epileptic seizure
• Acute head trauma

What is Physical Therapy Used For?

The goal of physiotherapy, or physical therapy, is to enable individuals to perform their vital functions in a healthy way. Physiotherapy encompasses emotional and social aspects in addition to physical therapy. A number of laboratory tests and examinations are performed before treatment.

The goals of physiotherapy can be listed as follows:

• Reducing all types of physical pain
• Relaxing tense muscles
• Positively influencing blood and lymph circulation
• Reducing inflammation
• Regaining or improving functions such as increasing movement, strengthening muscles, and maintaining balance and coordination
• Improving quality of life and comfort
• Reducing medication requirements
• Preventing and correcting posture disorders
• Accelerating the return to daily life after sports injuries and other traumas.

What Methods Are Used in Physiotherapy?

A wide variety of treatment methods are used in physiotherapy, depending on the patient’s needs and diagnosis. These methods aim to reduce pain, strengthen muscles, increase mobility, restore function, and improve quality of life.

Below, you can find a detailed description of the most commonly used methods in physiotherapy:

1. Exercise Therapy:

This is one of the cornerstones of physiotherapy. The goal is to increase muscle strength and flexibility, improve balance and coordination, and restore function.

Types of Exercise Used:

Stretching Exercises:

To relieve muscle tightness and stiffness.

Strengthening Exercises:

To alleviate muscle weakness.

Balance and Coordination Exercises

Functional Exercises:

For activities of daily living (e.g., walking, climbing stairs).

Neurological Rehabilitation Exercises:

For conditions such as stroke, Parkinson’s disease, etc.

These exercises are implemented with personalized plans for almost every patient group.

2. Manuel Therapy

This is a set of specialized techniques applied manually by a physiotherapist. It involves direct contact with the muscles, joints, and nerves.

The main manual therapy techniques are:

• Massage (relaxation, increased blood circulation)
• Mobilization (light, rhythmic movements to increase joint range of motion)
• Manipulation (sudden, rapid thrusting of the joints – only performed by experts)
• Myofascial release (releasing tension in the muscles and connective tissue).

3. Electrotherapy

These are physical therapy methods using electrical currents. They are generally used for pain management, muscle stimulation, and to support the healing process.

Commonly used types of electrotherapy:

TENS (Transcutaneous Electrical Nerve Stimulation):

Provides pain relief.

EMS (Electrical Muscle Stimulation):

To stimulate weakened muscles.

Ultrasound Therapy:

Creates deep tissue heat with high-frequency sound waves.

IF (Interferential Current):

Used for deep tissue pain.

Short Wave Diathermy:

Provides muscle relaxation and increased circulation through heat therapy.

It should be used with caution in patients with pacemakers, pregnant women, and some cancer patients.

4. Thermotherapy (Heat Applications):

Heat increases blood flow, relaxes muscles, and reduces pain.

Types of Thermotherapy:

Hot Packs:

Infrared hot packs are commonly utilized in physical therapy for their therapeutic benefits. Historically, rubber-based hot packs known as thermophores were the preferred choice for treatment. Today, these have largely been replaced by plastic or waterproof fabric bags containing silicate gel, a material that retains heat for extended durations. Similar to the effects of infrared lamps, these hot packs primarily target superficial tissues. Nevertheless, they are effective in managing pain, relaxing muscles, and offering substantial relief to patients. Their application is particularly beneficial when used as a preparatory step before specific physical therapy interventions such as traction, exercise, or massage, leading to more effective outcomes.

Areas of Use:

This procedure is no different from infrared rays, and its use and restrictions are the same.

Application Method:

The application time is between 10 and 30 minutes. The total number of sessions can be 15-20. Additionally, the pack placed on the skin is covered with a towel to ensure the heat continues for an extended period without decreasing. Unbearable heat should be avoided, as it can cause burns and interrupt the treatment.

Paraffin Bath (Especially for Hand and Wrist Problems):

Heated water cannot maintain its current temperature for very long. Therefore, we use paraffin, a substance that can maintain its heat for longer periods of time, in treatment. This or similar heated and heat-retaining substances have been used for treatment for centuries. Sometimes, the effectiveness is enhanced by adding other substances. Fango applications (artificial mud) and natural mud therapy have similar effects.

Mechanism of Action:

The therapeutic effect of paraffin heat is no different from other hot applications. It is a treatment that increases circulation at the cellular level, thereby allowing tissues to regenerate.

Application Method:

This treatment involves immersing tissues such as the hands and feet in a container filled with a substance that melts with heat. Gloves are required to retain the heat generated.

Conditions Used:

The most common treatment for paraffin is Heberdan Arthrosis (osteoarthritis) in the fingers. Paraffin therapy is also used successfully for non-inflammatory joint, muscle, and connective tissue rheumatism in the hands and feet. Paraffin applied as a spread is preferred for treatments on larger areas or to prepare the patient for subsequent physical therapy.

Areas Not Used:

Paraffin should not be used during the active stages of inflammatory joint rheumatism. Furthermore, it should not be used on open wounds, tumors, or certain vascular diseases.

Infrared Rays:

Mechanism of Action: It should be remembered that the effect of infrared rays on the body is not limited to heat alone; it also has a biological effect.

These include:

It can be summarized as dilating blood vessels in the applied area, stimulating surrounding nerve endings, eliminating accumulated toxins through sweating and the kidneys, and increasing the ability of problem tissues to repair themselves.

Treatments Used:

Infrared radiation can be applied outside the joints, except in the very painful and inflammatory early stages of non-inflammatory rheumatism. It can achieve highly effective results in painful muscle spasms after traumas such as falls, impacts, and accidents, and in the still-flare stages of arthritis. We use infrared radiation for various spinal conditions, particularly herniated discs and cervical discs, both alone and in conjunction with other treatments, and often before them. We also use infrared rays before treatments such as massage, traction, or manipulation to relax the patient’s muscles and joints and prepare them for other treatments.

Contraindications:

Should not be applied to infected or open wounds, to patients who are sensitive to heat, to those with very high blood pressure and heart disease, to cancerous areas, or to patients with local sensory deficits or vascular circulatory disorders.

Application Method:

Infrared devices should be at least 30-40 cm away from the patient during application. Feeling uncomfortable with the heat applied during treatment, excessive sweating, or even a barely perceptible amount indicates a malfunction. Ideally, patients should feel a pleasant, pleasant warmth during this time. The treatment should last 15-25 minutes. If the environment is unsuitable after the application, the patient should be covered and protected. Applications can be performed in sessions of approximately 15-20.

5. Cryotherapy (Cold Applications)

Cold is used to reduce pain and swelling.

Cold Therapy Methods:

In Which Situations Are They Used?

• Acute Injuries (Sprains, Strains)
• Muscle Tears and Sports Injuries
• Swelling After Tooth Extraction
• Inflammatory Conditions Such as Tendonitis and Bursitis
• In the First Aid of Burns

How Are They Applied?

• An ice pack or cold gel pack should be applied by wrapping it in a towel, avoiding direct contact with the skin.
• Apply for 15-20 minutes and then pause for 1-2 hours.
• If skin discoloration, numbness, or a burning sensation occurs during cold application, the treatment should be stopped.

6. Hydrotherapy (Water Therapy):

This is a treatment method that utilizes the buoyancy and resistance of water.

In Which Situations Are They Used?

1. Musculoskeletal Disorders:

Arthritis (Joint Inflammation):

Warm water relaxes joints and relieves muscle spasms.

Back, Neck, and Back Pain:

Water therapy can help relieve pain by reducing pressure.

Muscle Tears, Sprains, and Tendonitis:

Water therapy accelerates the healing process by supporting the injured area.

2. Physical Rehabilitation:

Post-Surgery Recovery:

Water therapy helps increase muscle and joint mobility, especially after joint and bone surgery.

Post-stroke and Paralysis Rehabilitation:

Because water supports a large portion of the body’s weight, it increases mobility and restores muscle strength.

3. Neurological Conditions:

Multiple Sclerosis (MS):

Water therapy reduces muscle spasms and can increase mobility.

Parkinson’s Disease:

Water therapy improves balance and coordination.

4. Respiratory Problems:

Illnesses Such as Asthma and Bronchitis:

Hot steam therapy and the breath-opening effect of water relax the respiratory tract.

Psychological and Mental Health Conditions:

Anxiety and Stress:

Hot water, with its relaxing effect, can reduce stress levels and provide mental relaxation.

Sleep Problems:

Water therapy relaxes the body and can improve sleep quality.

How is Hydrotherapy Applied?

Hydrotherapy can be applied in various ways:

Whirlpool or Jacuzzi:

This treatment uses the temperature and movement of the water to relax the body. The water temperature should be close to body temperature (usually between 37 and 39°C), which relaxes muscles, increases blood circulation, and relieves pain.

Underwater Massage (Hydromassage):

Water jets massage various parts of the body, relaxing muscles, increasing blood circulation, and helping to relieve pain.

Water Walking or Exercise Therapy:

Exercises performed in water reduce the stress on joints, improve balance, and strengthen muscles. They are widely used for physical rehabilitation and exercise.

Aquatic Therapy:

Alternating hot and cold water (cone pressure and hydrostatic pressure) provides a therapeutic effect. This promotes healing by increasing blood circulation.

Pool Therapy:

It is particularly preferred for patients undergoing rehabilitation. The buoyancy of the water allows patients to move joints or muscles more easily.

7. Traction (Mechanical Stretching)

Traction (mechanical stretching) is a stretching technique applied to muscles, joints, nerves, or the spine. This method applies a pulling force to create tension in specific areas of the body and is generally used to treat pain, inflammation, and musculoskeletal disorders. Traction must be carefully planned and applied under the right conditions to achieve a therapeutic effect.

When is it Used?

Traction is an effective treatment method, particularly for conditions related to the spine and joints.

Here are some common health conditions where traction is used:

Herniated Discs:

Spinal discs can cause pain by pressing on nerves. By lengthening the spine, traction can reduce the displacement of the discs, relieve pressure on the nerves, and reduce pain.

Spine Pain and Spinal Problems:

Traction can help relieve pain, especially for people with chronic back and neck pain. This reduces pressure on the nerve roots and relieves tension on the spine.

Joint Problems:

For joint problems such as knees, shoulders, and hips, traction can help reduce pressure on the joint space. It can particularly relieve pain related to conditions such as arthritis and osteoarthritis.

Muscle Spasms:

Excessive tension and spasms in the muscles can be relieved with traction. Traction helps reduce spasms by relaxing the muscles.

Nerve Compression (Radiculopathy):

Pressure on the spine can damage the nerves, leading to radiculopathy. Traction can help release the nerves and relieve the pain caused by the compression.

Scoliosis (Curvature of the Spine):

Traction can help align the spine in the treatment of scoliosis, but it is usually used in conjunction with surgery or other treatment methods.

Spondylolisthesis (Slippage of the Spine):

The sliding of vertebrae against each other can compress nerves and cause severe pain. Traction can alleviate the displacement of the vertebrae and provide relief to the nerves.

Physical Rehabilitation:

In physical therapy, traction is often used to treat musculoskeletal injuries. It can particularly aid in the recovery process after sprains, strains, and injuries.

How is Traction Applied?

Traction can be applied manually or with mechanical devices, and different techniques are used for different body parts.

Here’s some general information about how traction is applied:

1. Mechanical Traction

Mechanical traction is performed using specialized devices and machines. These devices apply a specific amount of force.

Cervical Traction (Neck Traction):

This is a traction application directed at the neck area. This is generally used for conditions such as neck pain, hernias, and nerve compression. The device applies a pulling force to the neck area through a support placed on the head.

Application Method:

The patient lies supine, and a special apparatus (usually a headgear) is placed over the head. The device applies a specific pulling force to the headgear. The duration and amount of force are determined by the doctor.

Lumbar Traction (Lumbar Traction):

This is a traction application applied to the lumbar region. It is particularly used for herniated discs and disc problems. Traction is applied using a belt or support placed on the lower back.

Application Method:

While the patient lies supine, a mechanical device is applied to the lumbar region. These devices are usually located on a bed or on special traction tables.

2. Manuel Traction

Manual traction is a technique physically applied by a therapist or physician. The therapist applies traction by holding the patient’s head, neck, or lower back.

Neck and Lumbar Traction:

The therapist applies stretching by carefully holding the patient’s neck or lower back. This method offers a more precise and controllable treatment, but is usually applied for short periods of time.

3. Dry Traction and Wet Traction

Dry Traction:

This is mechanical traction performed in a dry environment, without the use of water or moisture. It is more commonly used and is usually applied with devices.

Wet Traction:

A type of traction performed underwater. Water can increase the effectiveness of the traction by reducing the pressure on the body. Water exercises or traction applied in a pool are used primarily to relieve pain and relax muscles.

4. Continuous and Intermittent Traction

Continuous Traction:

In this method, a specific force is applied continuously for a period of time. It is usually performed with lighter forces and is preferred for pain relief.

Intermittent Traction:

This type of traction involves applying traction for a specific period of time followed by a period of rest. This method can be more effective for more severe pain and disc problems.

8. Kinesio Tape (Taping Techniques)

Kinesio tape therapy is the use of adhesive tape with distinctive wavy patterns for musculoskeletal conditions.

What Conditions Is Kinesio Tape Used For?

Kinesio tape can sometimes be a standalone treatment option or an adjunct treatment.

Taping therapy can be used for musculoskeletal and orthopedic conditions, as well as neurological conditions.

Taping can be used for all conditions such as:

• Mechanical problems that cause pain in the neck, back, waist, spine, and all joints,
• Soft tissue and muscle pain,
• Muscle spasms,
• Joint strains,
• Postural disorders,
• Scoliosis (curvature of the spine),
• Joint arthritis (osteoarthritis) following certain surgical procedures,
• Heel spurs,
• Muscle and tendon injuries and tendinitis,
• Muscle weakness,
• Nerve compression and nerve injuries,
• Paralysis,
• Lymphedema

Kinesio tape can be described as a physical therapy agent. It relieves pain and relieves spasms.

Kinesio tape reduces swelling by grasping and pulling the skin upwards, increasing circulation. It has a pain-relieving effect similar to TENS.

How is Kinesio Tape Applied?

Kinesio tape is applied to the area requiring taping with a certain amount of tension. The tapes allow for 60-70% stretch. However, for some conditions, they may require no tension at all.

9. Neurological Rehabilitation Techniques

Special techniques are used to retrain the nervous system in diseases such as stroke, Parkinson’s, and MS.

Methods Used:

1. Bobath Therapy

In Which Conditions Is It Used?

Bobath Therapy is used to treat motor disorders resulting primarily from damage to the central nervous system (CNS). These conditions often lead to problems with muscles and coordination.

Here are some conditions where Bobath Therapy is commonly used:

Stroke:

Individuals who have had a stroke experience loss of muscle strength, coordination, and balance due to an interruption of blood flow to a part of the brain. Bobath Therapy is used to reactivate the muscles in the paralyzed body part and restore functional movements.

Cerebral Palsy (CP):

Cerebral palsy is a congenital condition that results in weakening and impairment of muscle and motor functions due to brain damage. Bobath Therapy is widely used in children to support motor development and improve posture control and mobility.

Parkinson’s Disease:

Parkinson’s disease manifests itself with movement disorders, muscle stiffness, and balance problems. Bobath Therapy is used to regulate muscle tone, improve balance, and restore functional movement abilities in individuals with this disease.

Multiple Sclerosis (MS):

MS is a disease that affects the central nervous system, causing muscle weakness, balance loss, and coordination problems. Bobath helps reactivate muscles and improve motor functions.

Traumatic Brain Injury (TBI):

In cases of muscle and coordination loss resulting from brain trauma, Bobath Therapy can help restore the function of damaged brain areas.

Spinal Cord Injuries:

Bobhat Therapy can be used to minimize movement loss and achieve functional independence in spinal cord injuries.

Other Neurological Diseases:

Bobhat Therapy can also be used for motor control disorders such as ataxia and neurological conditions accompanied by postural problems such as low back pain.

How is Bobath Therapy Applied?

Bobath Therapy requires a treatment process tailored to each individual’s situation. Therefore, treatment is personalized and typically administered one-on-one by a physical therapist or occupational therapist. During treatment, the focus is on restoring natural movement patterns to restore motor function and perform movements correctly.

Here are some basic approaches to how Bobath Therapy is applied:

Individual Assessment:

First, the therapist evaluates the individual’s motor functions, muscle tone, range of motion, and posture. This assessment is crucial for determining the treatment plan.

Improving Postural Balance:

A key component of Bobath Therapy is improving natural postures and stances. Proper postural techniques are taught, taking into account the individual’s posture and balance problems.

By correcting posture, the body’s ability to maintain balance is enhanced. For example, a paralyzed individual can adopt correct body positions while sitting or standing.

Encouraging Movement:

Bobath Therapy activates muscle groups on the healthy side of the body, encouraging coordinated work with the other side. This helps reactivate the muscles.

Treatment begins with passive exercises and progresses to active movements.

Functional Movement Patterns (FMPs):

Functional movement patterns are used during therapy. Bobath advocates that movement should be performed as a whole body, not just a single muscle group. For example, when moving an arm upward, the shoulder, back, waist, and hip muscles are simultaneously engaged.

These movement patterns are generally diagonal, making functional movements more natural.

Reflex and Muscle Activation:

Manual techniques and proprioceptive feedback are used to ensure the proper functioning of reflexes and muscles. This allows the muscles to work more efficiently voluntarily.

For example, a visible contraction and relaxation leads to improved muscle tone.

Promoting Neuroplasticity:

Bobath Therapy utilizes the brain’s plastic properties. The brain can replace damaged areas with other areas. This therapy supports the brain’s reorganization and the formation of new connections.

Each movement supports brain remodeling and strengthens neural connections.

Daily Living Activities and Exercises:

Bobath aims to foster independence not only in therapy sessions but also in daily living activities. Therefore, the therapist also recommends exercises to help the individual make correct movements in daily activities such as eating, dressing, and cleaning.

Sensory Integration:

During treatment, sensory feedback is provided to enhance the individual’s body perception. By better utilizing the sensory information they experience during movement, the individual learns to make more accurate movements.

1. PNF (Proprioceptive Neuromuscular Facilitation)

In What Conditions Is It Used?

PNF has a wide range of uses. It is used effectively in many conditions related to both the musculoskeletal and nervous systems. 1. Neurological Diseases

PNF is used to improve movement control and muscle coordination, particularly in diseases affecting the nervous system:

• Stroke
• Cerebral Palsy (CP)
• Multiple Sclerosis (MS)
• Parkinson’s Disease
• Traumatic Brain Injury

2. Orthopedic and Sports Injuries

• Muscle strains and ligament injuries
• Large joint rehabilitation such as knees, shoulders, and hips
• Post-sport recovery and performance enhancement
• Post-surgery muscle strength recovery

3. Muscle and Joint Problems

• Muscle weakness and imbalance
• Loss of range of motion (ROM)
• Postural disorders such as scoliosis and kyphosis

4. Balance and Coordination Problems

• Conditions that put older individuals at risk for falls
• Vestibular system disorders (balance disorders)
• Gait and balance training in rehabilitation

How is PNF Applied?

PNF is based on specific movements and techniques that encourage the muscles, joints, and nerves to work together. It is usually administered one-on-one by a physical therapist.

Basic Application Principles

• Diagonal and spiral movement patterns are used. (The body moves diagonally/rotationally, not in a straight line.)
• Voluntary and reflexive muscle contractions are used together.
• Muscles are activated through techniques such as manual resistance, stretching, repetition, and sensory stimulation.
• The rhythm of the movement is adjusted according to the individual’s functional level.

In What Situations Is Balance and Gait Training Used?

Balance and gait disorders can occur as a result of many diseases and conditions.

The following are common situations where this training is used:

1. Neurological Diseases

Balance, coordination, and muscle control are impaired in nervous system diseases:

• Stroke
• Cerebral Palsy (CP)
• Parkinson’s Disease
• Multiple Sclerosis (MS)
• Traumatic Brain Injuries
• Spinal Cord Injuries

2. Orthopedic Problems

Gait training is required after hip, knee, and ankle surgeries (especially prosthetic surgeries).

Fractures and dislocations, especially those involving the lower extremities.

Musculoskeletal disorders (e.g., muscle weakness, joint stiffness).

3. Aging and Conditions with Fall Risk

In older individuals, muscle mass and balance decrease, increasing the risk of falls.

Vestibular system disorders (balance problems related to the inner ear).

Nerve conduction disorders such as polyneuropathy (loss of sensation in the hands and feet) and diabetic neuropathy.

4. After Surgery and Prolonged Bed Rest

Prolonged It is used to alleviate muscle weakness and loss of balance caused by inactivity.

Patients who remain in bed for long periods must relearn their balance when they stand up.

How is Balance and Gait Training Implemented?

The treatment plan is determined based on the individual’s age, illness, physical capacity, and goals. Training is usually conducted one-on-one under the supervision of a physiotherapist.

1. Assessment Phase

Before starting treatment, the following assessments are made:

• Muscle strength and tone
• Posture analysis
• Reflexes, proprioception (body awareness)
• Gait analysis
• Balance tests (Berg Balance Scale, TUG, Romberg, etc.)
• Need for assistive devices (walker, cane, orthoses, etc.)

2. Balance Training Applications

Purpose: To improve the body’s ability to maintain balance.

Methods Used:

Static Balance Exercises:

Standing still, standing on one foot, eye-closed balance.

Dynamic Balance Exercises:

Turning, changing direction, and walking over obstacles.

Balance with Support Surfaces:

Balance board, soft surface, therapy balls.

Vestibular Exercises:

Balance exercises with head movements.

Proprioceptive Exercises:

Activities to improve muscle-joint sensation.

Coordination Exercises:

Simultaneous use of arms and legs.

Dual-Task Exercises:

Both balance and cognitive tasks (e.g., walking while counting).

3. Gait Training Applications

Purpose: To develop safe, smooth, and functional walking skills.

Application Steps:

• Parallel bar walking training (early stage)
• Postural correction exercises (shoulder alignment, trunk control)
• Short-distance walks (especially for unilateral problems such as falling)
• Step-up and down-step exercises
• Walking on slopes and changing direction
• Walking on different surfaces (carpet, hardwood, grass)
• Training with walking aids (walker, cane, canoe)

4. Home Program and Transfer to Daily Life

• The therapist creates a personalized home exercise program.
• Balance and gait training is provided for daily activities such as toileting, bathing, and kitchen use.
• If necessary, the home environment is adjusted to prevent falls (carpet fixing, grab bars, appropriate shoe selection, etc.).

What are The Benefits of Physical Therapy and Rehabilitation?

Physical therapy and rehabilitation not only treat illnesses but also improve an individual’s quality of life, improve daily functions, and prevent future health problems.

The benefits of physical therapy include:

Increases Mobility:

Improves muscle flexibility, joint range of motion, and coordination, allowing for more comfortable movement.

Reduces Pain:

Helps manage chronic pain and minimizes the need for medication.

Increases Muscle Strength and Endurance:

Improves overall muscle function by preventing muscle weakness, allowing individuals to lead more active lives.

Corrects Postural Deformities:

Supports spinal health by correcting poor posture and movement habits that are unconsciously adopted in daily life.

Facilitates Activities of Daily Living:

Encourages independent living by supporting basic skills such as walking, sitting, standing, and climbing stairs.

Accelerates Post-Surgery Recovery:

By strengthening muscles after surgery, it accelerates the recovery process and reduces complications.

Prevents and Treats Sports Injuries:

It helps athletes maintain their performance while offering preventive exercise programs to prevent potential injuries.

Slows the Progression of Chronic Diseases:

By preventing the progression of chronic diseases such as osteoarthritis, diabetes, and hypertension, it enables individuals to live healthier lives.

Supports Psychological Well-Being:

Increasing physical activity and reducing pain improves mood and helps manage psychological disorders such as stress and depression.

Strengthens the Immune System:

Regular exercise and movement support the circulatory and metabolic systems, improving immune function.

Physical therapy is crucial for both individuals with health problems and those who are healthy. When practiced regularly, it increases body endurance, prevents mobility limitations related to aging, and improves quality of life.