You’ve been dealing with chronic pain for months, and have talked to your doctor about surgery. It’s been scheduled and now you’re anxious about getting through the day. Many patients mind so much about the hours spent at the hospital that they don’t consider the importance of physical therapy as part of the rehabilitation process after the operation.

Health experts define physiotherapy, also known as physical therapy, as a healthcare branch that assesses, diagnoses, treats and works to prevent disease and disability through physical means.

Anita Nkusi, a physiotherapist at King Faisal Hospital, Kigali, explains that physiotherapy plays a very vital role in the prevention of injury and maintenance of health and wellbeing.

Physiotherapists treat many different conditions and systems in the body with some areas of specialty, including areas of neurology, pediatrics, orthopedics, neuromuscular skeletal and sports therapy and cardiopulmonary. They provide preventive measures, treatment and palliative care as well.

How it works

Physiotherapy treatment may include massage, electoral modalities, therapeutic exercise programs and functional training. Exercise programs strengthen, mobilize, stretch, and build exercise endurance and tolerance. Dysfunctional unit patterns and incorrect postures are assessed and treated, according to Nkusi.

Nkusi says in addition to "hands-on” care, physiotherapists also educate patients to take care of themselves and to perform certain exercises on their own.

"We do this by educating patients about the structure and functions of the systems that they are concerned about, and teach them what they can do to prevent it, reduce the risk of damage and ‘the correct self’ including posture correction, work postures, work station set ups, sporting technique, breathing exercises, and cardiovascular training to name a few.”

"When there is a disease or injury, we spend time assessing the problem and then treat it with various techniques, modalities and exercise. We also spend a considerable amount of time explaining to the patient why they have the problem and medically based ways to alleviate, eliminate or manage it,” she says.

Jean Damascene Gasherebuka, the chairperson of Rwanda Allied Health Professions (RAHP), explains that treatments are largely evidence-based, which means that medical research proves that it works and is beneficial to the patient. Treatments ensure optimal function and the best outcome following surgery or injury. The length of rehabilitation, he says, also depends on the condition or surgery that was performed, and it may take a few weeks or months.

"Since we do a very thorough assessment, we usually do get a lot of details concerning the diagnosis that we can then explain to the patient. We have more time than the doctors do, to sit and explain to the patient what the problem is. Some problems are not going to go away so we teach the patient how to deal with it.Patients can seek advice or go for assessment depending on specialty,” Gasheberuka notes.

Preventive physical therapy

Gasheberuka says physiotherapists also help evaluate how one does an activity and make suggestions for doing the activity in a way that is less likely to result in an injury.

"Examples include geriatric physiotherapy that helps older adults to improve mobility and balance, build strength, boost confidence in their physical abilities, and remain active over years. Prenatal physical therapy help pregnant mothers shorten the labor period and make it less painful at the time of delivery and postnatal physical therapy to help the mother prevent the postnatal effects such as obesity.

"In cases of chronic or ongoing health conditions such as spinal stenosis, arthritis, and Parkinson’s disease, a physical therapist will work with you to establish your goals and help one live more easily with the health condition,” he explains.

Palliative care

By providing pain relief and management of distressing and debilitating symptoms, palliative care improves quality of life for patients with a life-limiting illness, and their families. Physical therapy aims to maximize movement and function, where threatened by ageing, injury or disease, it is essential for optimal wellbeing of the patient.

"For illnesses that we cannot cure, the physiotherapy team helps the patient to improve or maintain their physical functioning and independence and gain relief from distressing symptoms,” Gasheberuka says.

A must-have

Nkusi notes that it is therefore not optional but a very essential treatment and if omitted, full recovery will be compromised, as the treatment goals are usually to achieve maximum functional capacity and participation at home, work and in society.

"Patients should take it seriously because if they don’t seek treatment and commit to it. They will have to put up with pain with some level of continuing dysfunction or disability.Physical therapy is successful when the patient and the therapist work together on creating a treatment plan in order to meet the patient’s goals.

"The problem may become chronic or long standing, or recur frequently. The patient will then need to seek treatment on a regular basis. Physical injuries and pain impacts on a person’s overall wellbeing and productivity. They will not be able to do what they want to an optimal level,” she says.

Gashebaruka also explains that the condition can restrict the patient from engaging in their work, sport, leisure and personal activities completely to a certain extent.

"Sometimes a problem can seem small but if neglected, it may lead to residual pain and weakness. The body has a natural capacity to heal and the pain may go away but the affected structures may remain vulnerable and not function normally putting other unaffected structures at risk. Also if patients are not exposed to accurate information from a medically trained person, then they compound the condition making it more difficult to treat,” he adds.

Gasheberuka says by observing some of your basic movements we can determine what exercises you need to do to become better at your sport, reduce injury and even recommend activities you can begin if you’d like to become more active and find your stride in a regular activity or sport. We can help speed up recovery and minimise long-term complications.

You do not require a referral from your doctor to receive physiotherapy treatment, Nkusi explains, noting that physiotherapists can help assess any kind of health problem and recommend treatment or preventive measures like exercise.Patients need to be aware of the various therapies available and may require to consult with anyone of these therapists.

According to Gasheberuka, gyms, massage parlors and health care centers all need to have physiotherapists.

"Sometimes chronic pain, overuse and repetitive strain injuries can be caused by poor postural alignment. Physiotherapists are however able to offer a comprehensive physical therapy and massage service. A diagnostic assessment can often reveal these at an early stage thus permitting a preventative treatment plan to be initiated.

"Massage is just one way of doing treatment because we can give advice. We give advice according to the level of injury or preventive measures. Massaging without assessment can result in long term damage,” Gasherebuka notes.

Gerald Luzindana, the director of Amazon Nutrition and Reflexology Therapy, Kigali, advises that, it is important for all centres that deal with healthcare to have physical therapy before any kind of treatment is given to the client.

"Some patients come with a desire for massage, but it might end up in disaster as some of them might end up fracturing the muscles, nerves or bones if proper assessment is not done. It is essential for all massage centres to have physiotherapists to assess the patients and know what the actual problem is. They prevent further injuries by assessing whether it is the bone, nerve or muscles that need to be treated, as sometimes massage may further damage the affected area.

"It is the reason we first do consultation to assess the real problem of the patient and which areas need more pressure, and which areas need to be massaged gently.It is important for the massage therapists to do their work under the direction and supervision of qualified physical therapists,” he says.

Gasheberuka, however, cautions patients to ensure that the physiotherapists are licensed for proper treatment and care.