EL Physiotherapy – A new approach to physiotherapy (practical solutions)Presenter

Margarita Gurevich

EL Physiotherapy – a new approach to physiotherapy in Australia

Implemented modern physiotherapy techniques new to Australian practice

Extensive use of electrotherapy techniques with proven capabilities for efficient disease prophylaxis and treatment as demonstrated in Europe and the USA

Combination of electrotherapy and Clinical Pilates

Practice principles

Use of the established in accordance with the Clinical Practice Guidelines computerised patient data management system which permits: Accurate and detailed patient record including a wide range of diagnostic and treatment

parameters Effective monitoring of the treatment progress based on regular clinical reassessments Traceability at all stages (patient history, diagnostic results, treatment plan and protocols,

clinical notes, records of adjustments to the treatment procedures, and treatment effect) Regular data back up

Privacy Policy assuring the confidentiality of health records

Documented diagnostic and treatment procedures

Regular staff training and maintaining appropriate training records

Continuous search and implementation of new proven diagnostic and treatment approaches

Main diagnostic techniques

General clinical examination

Imaging techniques e.g. ultrasound, MRI, CT, etc.

Special physiotherapy techniques: FBA MMT using the designed at the Centre

adjustable fixation device Real Time ultrasound

FBA (full body assessment)

Special physiotherapy diagnostic approach allowing detailed clinical examination of the musculoskeletal system of a patient to identify potential pathological conditions

Performed for 1 hour during the initial session

Comprises over 200 different diagnostic parameters

Example of clinical examination of neck pathology as part of the FBANeck - ROM LEFT RIGHTFlexion (90 degrees) and repeat flexion Flexion after repeat retraction Extension (110) and repeat extension Extension after repeat retraction Rotation (190) LF (190) Retraction (110) Protraction (110) Passive physiological movement Neurological ULTT - 1 (elbow extension <10) ULTT - ulnar nerve (shoulder abduction) ULTT - radial nerve (shoulder extension) Palpation - neck Significant findings Cx disc bulge Disfunction Facet pain Cx instability - flexion Cx instability - extension Other

Treatment techniques

Electrotherapy: Electrostimulation Interferential Ultrasound Magnetotherapy Pharmacological phoresis SCENAR Combination therapyClinical PilatesGeneral physiotherapy: Mobilisation Traction Exercise programs etc.

Electrotherapy

Performed using the Chattanooga Intellect Advanced Therapy System and other modern devices

Parameters of the Chattanooga electrotherapy system The features of the electrotherapy system include: More than 25 clinical waveforms 2 independent electrotherapy channels Various ultrasound frequencies Pulsed and continuous mode Variable duty cycles Over 200 clinical protocols available Over 100 user-defined protocol capacity Graphic anatomical and pathological clinical library Documentation of treatment outcomes with patient

data cards system

Pharmacological phoresis

Types of pharmacological phoresis: Iontophoresis

Drug delivery system using galvanic current Phonophoresis

Drug delivery system using ultrasound Magnetophoresis

Drug delivery system using magnetic flux

Drugs administered as single preparations or in combinations from the following groups:

NSAID Corticosteroids Local analgesics Vasodilators

SCENAR therapy

Standard use for treatment of musculoskeletal, cardiovascular, gynecological, neurological, dermatological, gastroenterological, respiratory and other diseases

Special dental probe for treatment of oral pathology such as gingivitis, parodontosis etc.

SCENAR blanket for enhancing the therapeutic effect

of the treatment

Combination therapy

Usually two treatment modalities on the same/different area

Iontophoresis and ultrasound

Interferential and phonophoresis

Iontophoresis and magnetotherapy

SCENAR and magnetotherapy

Clinical Pilates – diagnostic assessmentDetailed diagnostic assessment

FBA using special modern diagnostic techniques:

MMT with the adjustable fixation device ROM

Aquilla real-time ultrasound

Haematological and biochemical analyses if required

Clinical Pilates - treatment

Use of modern treatment equipment: Allegro reformers DMA trapeze tables

Individual and group treatment sessions conducted by physiotherapists

Sessions also include hands-on work if required

Principles of treatment sessions

Individual exercise treatment programs for specific pathologies based on outcome of FBA

Performance control

Regular reassessments after 7 weeks and comparison with the previous results

Program adjustments following reassessments

Detailed record of results at each session

Individual sessions initially, then potential for group sessions

Group treatment sessions

Groups composed of patients with similar level of physical strength and Pilates skills

Group structures

2:1 (2 patients, 1 physiotherapist)

3:1 (3 patients, 1 physiotherapist)

Progressive transfer of patients to the next level based on the reassessment results

General physiotherapy

Mobilisations

Traction

Therapeutic weights

Exercise programs

Thermal therapy

Prenatal, antenatal and postnatal therapy

Incontinence therapy

19 year old male Intersection syndrome of the right wrist (1 week

history) Main issues:

Pain (6/10 on VAS) aggravated by lifting and carrying objects heavier than 500g

Treatment method: combination of 2-pole interferential therapy and phonophoresis with diclofenac 1% (w/w)

Number of sessions: 8 Reassessment results:

pain reduced by 70% Increased wrist ROM and strength

71 year old female Irritation of cervical (C5-7) and lumbar (L3-5) facet

joints Main issues:

Cervical pain (7/10 on VAS) aggaravated by lying down Lumbar pain (7/10 on VAS) aggravated by prolonged

standing Treatment method: combination of SCENAR and

magnetotherapy Number of sessions: 9 Reassessment results:

Both cervical and lumbar pain reduced to 3/10 on VAS Increased cervical and lumbar ROM

68 year old female R knee fat pad impingement and patello-femoral

joint pain Main issues:

Unable to walk more than 5 mins without knee pain Treatment method: combination of 2-pole

interferential and phonophoresis with diclofenac 1% (w/w)

Number of sessions: 3 Reassessment results:

Pain completely disappeared

21 year old male C5/6 disc bulge with extension instability Main issues:

Acute cervical pain (1 week history) reaching 9/10 on VAS

Treatment method: SCENAR therapy Number of sessions: 5 Reassessment results:

Cervical pain settled almost completely

61 year old female C5/6 disc bulge Grade 2 right subacromial joint impingement Main issues:

Longstanding history of right shoulder and neck pain Had 2 cortisone injections into right shoulder

Treatment method: SCENAR therapy Number of sessions: 8 Reassessment results:

Right shoulder pain and neck pain settled almost completely

Increased cervical and right shoulder ROM

47 year old female Left heel spur Main issues:

6 month history of L heel pain (5/10 on VAS) Difficulty getting out of bed, walking

Treatment method: phonophoresis with diclofenac 1% (w/w)

Number of sessions: 8 Reassessment results:

L heel improved by at least 50%, getting out of bed and walking became easier

62 year old male Left L2/3 posterolateral disc prolapse Main issues:

Longstanding history, 1 month flare-up Taking oxycontin, voltaren (25mg),

panadol/panadeine (2 tablets, 3-4 times/day) Treatment method: Clinical Pilates Results: stopped taking analgesics after 5

sessions; able to increase exercise intensity after 7th session

50 year old male R tennis elbow Main issues:

Longstanding history aggravated by playing tennis, work Treatment method: combination of SCENAR and

Clinical Pilates Number of sessions: 3 sessions of SCENAR only,

then combination for further 5 sessions Reassessment results:

After 3 sessions pain ceased; able to work for 1-2 hours without pain

Trial tennis session after 7 sessions, no pain

72 year old female Tx osteochondrosis, R shoulder grade 2

supraspinatus impingement Main issues:

6 month history of thoracic and R shoulder pain aggravated by ADL’s

Treatment method: combination SCENAR therapy Number of sessions: 6 Reassessment results:

After 1 session pain reduced; able to do shopping without pain after 3 sessions; ceased completely after 6 sessions

50 year old female Plantar fasciatis Main issues:

4 year history aggravated by getting out of bed in the morning and walking

Treatment method: combination of SCENAR and phonophoresis with diclofenac1% (w/w)

Number of sessions: 10 Reassessment results:

Getting out of bed got easier after the first session; significantly better 4 sessions; overall improvement at least 60%

53 year old female Longstanding history of LBP: Lx facet joints

irritation, L3/4, L4/5 ext instability, bilateral anterior SIJ instability

Treatment method: Clinical Pilates Reassessment results:

Started feeling significantly better after 7 sessions Still gets occasional flare-ups, but significantly

reduced in frequency and intensity; much better body awareness, posture and core stability

41 year old female 4 week history of cervical pain with

numbness in the R middle finger Main issues: C5/6 disc bulge Treatment method: Clinical Pilates Reassessment results:

Pain started to decrease after the first session

34 year old female Longstanding history of LBP aggravated

during pregnancy (had a baby 6 months ago) Main issues: L4/5 disc bulge with extension

instability Treatment method: Clinical Pilates Reassessment results: noticed an

improvement after the first session, pain disappeared completely after 5 sessions

54 year old male Grade 2 subacromial impingement of the

supraspinatus tendon Main issues:

1 month history of L shoulder pain aggravated by heavy lifting and lying on his left side

Treatment: 2 sessions of SCENAR therapy – moderate reduction in

pain which returned after patient went back 3 sessions of iontophoresis with dexamethosone sodium

phosphate (8mg/2mL) – good results, pain disappearing almost completely for 1-2 days after each treatment, returning with reduced intensity

53 year old female Functional dyspepsia Main issues:

7 month history of almost constant nausea, reduced appetite, decreased energy

Has been taking motilium, lexapro, stemitil/maxalon Treatment method: SCENAR therapy in combination

with SCENAR blanket Reassessment results:

Improved appetite and increased energy after 4 sessions Nausea started to decrease after 7 sessions, disappeared

completely after 12 sessions

49 year old female Paradontosis Main issues:

Pain and swelling of the lower gum (L side>R) Visual swelling, redness and dropping of the lower gum;

difficulty eating coarse food Treatment method: SCENAR Number of sessions: 10 Reassessment results:

After 5 sessions redness and swelling decreased, lower gum lifting up

Patient able to eat coarse food (apples) after 9 sessions