Orthopedic Rehabilitation
Patients who are candidates for orthopedic rehabilitation have very different diagnoses. When we evaluate anatomically, all kinds of musculoskeletal system diseases that occur in the spine, shoulder, elbow, forearm, hand and wrist, hip, knee, foot and foot bone are the area of interest of orthopedic rehabilitation. Various diseases, traumas, congenital or acquired deformations that cause postural disorders involving these areas cause patients to see a doctor. Patients see a doctor due to pain, numbness, movement disorders, difficulty in performing daily life movements or deterioration in quality of life.
What is orthopedic rehabilitation?
Orthopedic rehabilitation is a comprehensive treatment process that helps individuals regain their physical functions after musculoskeletal injuries, surgical interventions or chronic diseases. This process aims to increase mobility, reduce pain and improve quality of life. Programs planned specifically for the individual by expert physiotherapists and rehabilitation teams allow patients to return to their daily life activities faster and safer.
How are orthopedic disorders diagnosed?
The first stage in the patient-doctor encounter is the period when the patient tells the doctor about his/her complaints. This period is called “anamnesis”. Then the patient is “examined”. The expansion of this period includes inspection-palpation-ROM examination of the joints, special diagnostic tests, neurological examinations. The diagnosis is usually made with anamnesis and examination. However, imaging and laboratory tests are often required for the diagnosis to be definitive. Biopsy, joint fluid examination, EMG and other auxiliary analyses may also be necessary for diagnosis.
What are the treatment stages in orthopedic disorders?
Then a detailed treatment plan needs to be made. Sometimes rest or manipulation, medical treatment or even alternative methods may be more prominent in the treatment. If the results are not sufficient, physical therapy and rehabilitation methods come into play. There may be cases where only cold or hot treatment will be sufficient, but there are also wide-spectrum treatment options ranging from comprehensive electrotherapy and exercise to robotic rehabilitation in some selective cases.
Orthopedic rehabilitation (OR) stages include:
- Medical treatment
- Physical therapy methods
- Exercise therapy
- Alternative methods
- Orthosis, prosthesis and other assistive devices that make life easier
What are the main units that rehabilitation clinics should have?
In order for rehabilitation practices to be carried out completely, centers must have some departments. It is essential that they are comprehensive enough to meet the demands of not only the musculoskeletal system but also all other branches of medicine. The main units that should be found in rehabilitation clinics are as follows:
- Muscle diseases unit
- Cardiopulmonary rehabilitation unit
- Vocational rehabilitation unit
- Neurosurgery unit
- Neurological rehabilitation unit
- Obstetric-uro-gynecological physiotherapy unit
- Rheumatic diseases unit
- Cerebral paralysis and neonatal physiotherapy unit
- Athlete health unit
- Orthopedic rehabilitation unit
- Orthosis and biomechanics unit
- Occupational therapy unit
What are the main procedures performed in orthopedic rehabilitation units?
Basic procedures performed in orthopedic rehabilitation units applications are as follows:
- Rehabilitation of developmental disorders and deformities of the bone, joint and muscle systems
- Rehabilitation of joint replacement and reconstruction surgeries
- Rehabilitation after ligament-tendon and nerve surgeries
- Rehabilitation of congenital and metabolic bone and joint diseases
- Rehabilitation of all pathologies of the vertebral column
- Rehabilitation after conservative or surgical treatment of all injuries and disabilities of the musculoskeletal system
Applications in orthopedic rehabilitation units:
- Diagnosis-specific assessment programs
- Heat, light and electrotherapy modalities
- Massage, manipulation and mobilization techniques
- Different exercise programs
- Neurophysiological treatment approaches
- Some special treatment protocols for orthopedic conditions
- Special exercise programs for patients with back and neck problems
- Functional activities and home exercises
- Patient education
What are the disorders treated in the orthopedic early rehabilitation unit?
Orthopedic disorders treated in the early rehabilitation period are as follows:
- Hip and knee prostheses
- Fractures
- Bone and soft tissue tumors
- Metabolic bone diseases
- Congenital deformities
- Developmental disorders
- Ligament and meniscus injuries
- Patients who have undergone surgery for general orthopedic diseases
Practices performed in the orthopedic early rehabilitation unit:
- Physiotherapy approaches that increase muscle strength and joint movement
- Practices aimed at reducing pain
- Implementation of rehabilitation protocols specific to the surgery performed
- Home program teaching
- Transfer activities teaching
What does the success of post-surgical orthopedic rehabilitation depend on?
There are many factors that affect the success of orthopedic rehabilitation. These include the timing of the surgical procedure that the patient needs to undergo. Although it is difficult to give a definitive answer to the questions of when surgery should be performed or when we can get the best results, it is very difficult for orthopedic rehabilitation to be successful in a case where the timing is wrong. Short hospital stay, correct preoperative planning, effective postoperative pain control and generally creating a special treatment scheme for each patient are simple but important elements that ensure successful results.
Some principles applied in the orthopedic surgery approach are as follows:
- Preventive treatment,
- Corrective treatment
- Preoperative planning
- Multi-level surgery in a single session
- Postoperative effective pain control
- Short hospital stay
- Personalized early rehabilitation program
The timing of orthopedic treatments is very important. Performing muscle-tendon lengthening surgeries too early may lead to recurrences in the future. This is not only valid for surgical applications. Even the timing of using botulinum toxin, one of the conservative methods, is important. Performing this procedure at an earlier age may allow the possibility of postponing tendon lengthening surgery to a later age.
In surgery, as well as timing, taking the patient to a serious preparation program before the operation will increase the success of the interventions to be performed and can significantly reduce complications. Therefore, there must be an operation preparation period and post-operative rehabilitation should be started the next day without waiting. Both active and passive neuromuscular facilitation (increasing muscle flexibility and range of motion) techniques and proprioceptive studies, balance and coordination studies can provide very useful developments. Similarly, early-starting water exercises are an important approach that strengthens the success of the operation.
In the literature, electrical stimulation, various infiltrations and manual treatment interventions stand out within the scope of rehabilitation programs after arthroplasty surgeries. Today, remote monitoring of patients even at home and early interventions can contribute to the acceleration of recovery. In this context; tele-rehab, web-rehab applications seem to make the job of rehabilitation specialists easier in the future. stem cell applications seem likely to be a new concern for rehabilitation specialists, especially in cases where surgery is not possible in the future.
What are the main goals of orthopedic rehabilitation programs?
The first goal of orthopedic rehabilitation programs is to increase quality of life. Other goals can be listed as follows:
- Preserving joint range of motion
- Improving joint area and general muscle strength
- Improving balance and coordination
- Trying to provide an optimal walking pattern
- Increasing endurance
- Improving independence inside and outside the home
- Providing professional and economic independence
- Increasing social participation
In this context, not only rehabilitation procedures performed in clinics; home programs, and all kinds of measures to regulate the general condition of the patient must be taken. If we list these measures; The first things that come to mind are helping patients lose excess weight, controlling accompanying metabolic diseases, initiating an exercise habit, monitoring the medications they use, providing professional activities and social security, arranging the environment they live in appropriate to their illness, and protecting patients from complications that may arise from the general consequences of inactivity.