One may feel fatigued and sore after cardiac surgery; it is only natural.  On the other hand, it seems altogether strange to think of embarking on a course of physiotherapy afterwards instead of just resting.  Yet, that is just what is recommended.

Types of cardiac surgery include bypass surgeries, angioplasty, stents, heart valve replacements, and even heart transplants.  Patients having all of these surgeries can benefit from physiotherapy.  Patients who have other cardiac problems can use the help too; they include victims of heart attacks, heart failure, peripheral artery disease, chest pain, and cardiomyopathy.

Physiotherapy will usually begin within a couple of weeks of cardiac surgery, if not sooner.  The first step is for nurses or doctors to administer a stress test to determine how much exercise one can handle.  This involves walking on a treadmill or riding on a stationary bike while having one’s vital signs monitored.

When the data is gathered and analyzed, a program of physical therapy will be put into place.  For safety’s sake, it is often the routine to bring cardiac surgery patients into the hospital or an outpatient clinic for their exercise at first.

Under the watchful eyes of nurses and physiotherapy personnel, cardiac surgery patients will be looked after as they perform their exercises.  This way the professionals will be alerted if the cardiac surgery patient is having troublesome symptoms.  The exercises done are cardiovascular exercises like walking on a treadmill or riding a stationary bike.

After the initial period of the monitored physiotherapy has passed, cardiac surgery patients will be sent to do their exercising at home.  Before they go, though, they will have been taught warm-up and stretching exercises, and when to stop.  Generally, they should exercise three to five times a week unless they are having problems.

Swimming is another form of exercise that is especially good for cardiac surgery patients.  It is a cardiovascular exercise that is not hard on the joints, so it will often be kept up longer.  The only thing to remember is that all wounds must be completely healed first.

Physiotherapy for cardiac surgery patients is often not carried out by physiotherapy staff.  Nurses in hospitals and clinics who are trained to deal with these areas of rehabilitation for cardiac surgery will do the work.  However, physiotherapists sometimes help, and the principles are the same.

The physiotherapist will instruct the patient about what activities are acceptable in the weeks and months after surgery.  During the first six weeks, there will only be a few activities allowed, such as light housekeeping or going to movies, for example.  From then until the third month, more activities will be added.  You may be able to return to work, at least part-time, you may be able to drive.  After this time, your physiotherapist will work with you to ease you back into all your old activities.

If a patient has cardiac surgery and then does nothing to regain strength, that patient will soon weaken.  Physiotherapy offers a means to stay in shape, or get into shape.  It lends more purpose to the cardiac surgery by making the patient much healthier than before the surgery ever took place.

No related posts were found, so here's a consolation prize: How to Judge Your Physical Therapist.

Health is the most important asset for leading a hurdle- free life. As usually said, health is wealth; good health is the reason behind a great life. People without any health problems are very happy and usually in a pleasant mood. Mental and physical stress are very much interconnected, so a person who is physically fit, generally has a smooth and calm life overall. Doctors or other professions related to medicine are very famous among the students and most of the medical students aim to become a doctor due to the respect this profession gets.

With the masses getting aware of the side effects of alternative medicines, people are getting more cautious about the methods or the treatments, one undertake to cure a particular disease. Also, with the advancements in technology and the changing work and general lifestyles, discovery of new diseases is also becoming a regular phenomenon. Due to all this, people prefer taking precautions towards the use and practice of their daily habits, to have minimum encounter to the medicinal institutes.

Alternative medicine is a term which is working as a relief factor for the people to give away the side effects of alternative medicine. Keeping in mind the increasing popularity of the alternative medicines, many medical students are also opting for subjects like, naturopathy, acupressure, acupuncture, homeopathy, physiotherapy, etc. Physiotherapy is the medicinal profession which is purely free from any kind of medicines, it is the therapy used for curing disability, dysfunction of a human body part, by the use of physical exercises.

The students with the science background in class 12th can apply in physiotherapy colleges, providing degrees related to the same. A student aiming to pursue his career in physiotherapy can opt for any of the following specialized fields in the subject:

• Back Care
• Orthopedics
• Pediatrics
• Occupational Health
• Leisure Activities
• Rehabilitation
• Neurology

Physiotherapy has helped in curing various diseases related to bone fractures or dysfunction of a body part. Physiotherapy is generally prescribed after a patient has undergone some operation, or has some back or orthopedics related problem. These problems are cured with the help of some machines and exercises, which helps in correcting the body posture of the patient and helps him fighting back the use of his body parts. The students taking physiotherapy as their career are entitled for the following responsibilities:

• To keep a check and help patients achieve their normal routine and daily practices, after they have undergone any operation or surgery.
• To help patients fight with their postures or back ache problems, which mostly occurs due to the changing lifestyles.
• To asses or evaluate patients suffering from injury and check their level of problem.
• To ensure that patients, who have been operated achieve their full independence of the body parts affected.
• To educate and promote the importance of regular exercise among its patients, as a step of precaution from diseases like, survical, backache, muscular pains, or problems related to nerves.

1. Career in PHYSIOTHERAPY
2. Are You Thinking of Beginning a Physiotherapy Career
3. Physiotherapy – Good Or Bad Career Choice?

It is a sad day when one has to deal with pediatric disorders in the family.  Most people believe that children should never suffer from physical problems.  Yet, the reality must be faced that pediatric disorders can happen.  The good news is that physiotherapy offers some help for them.

Unfortunately, there are numerous pediatric disorders.  To name a few, there are: scoliosis, torticollis, Osgood-Schlatter, sports and traumatic injuries, reluctant walkers, developmental disorders, cerebral palsy, and genetic disorders.

Physiotherapy for scoliosis – a curvature of the spine – consists of exercises to strengthen the back.  Electrical stimulation is used for this type of pediatric disorders.  The stimulation goes directly to the skeletal muscles.  Chiropractic is also used in an effort to straighten the spine.

Torticollis is a type of pediatric disorders of the neck.  There is a problem with one of the muscles of the neck so that the child is not able to hold his head up straight.  The head will be tilted to one side.  This chin will jut out on the opposite side of the neck.  Physiotherapy can stretch this muscle so that the child can hold his head more normally.

Spinal cord injuries as pediatric disorders are difficult to treat.  Children often do not want to do the work that is required to stay ahead of the deterioration that can be caused by this condition.  Physiotherapy personnel are challenged to keep the child’s spirits up as they teach them how to exercise with and without special equipment.

Brain injuries, including cerebral palsy and strokes are pediatric disorders that must be managed delicately.  The neurological system is often not as sturdy as the skeletal or muscular systems.  However, brain injuries also involve these other systems as well.

A new treatment for these pediatric disorders like brain injuries is using hyperbaric oxygen therapy.  This type of physiotherapy is based on the idea that, in these conditions, there are often parts of the brain that are not working but can be revived.  The HBOT can sometimes revive them.

Pediatric disorders such as sports injuries and traumatic injuries require different types of physiotherapy based upon the location and severity of the injury.  If a child has repeatedly sprained the same ankle, therapy will necessarily focus on that ankle, as well as any body part that supports or counterbalances that ankle.  Overall strength is important.

Traumatic injuries require a certain amount of psychological training, as the subject of the accident or other ordeal may bring on such distress that the child does not want to work.  A good physiotherapist will be able to work with such a child.  Traumatic injuries can also be severe enough that the physiotherapist plans a lengthy course of therapy to overcome them.  Pediatric disorders like this require patience from everyone involved.

The list of pediatric disorders is long and varied.  Not all of them can be helped by physiotherapy at this time.  Right now, physiotherapy can be used in many cases to relieve symptoms or even to reverse damage.  Physiotherapy performs a valuable function in helping children live more normal lives.

No related posts were found, so here's a consolation prize: Physiotherapy to Help Pain Management.

The rotator cuff is a musculotendinous cuff which surrounds the humeral head and through which the shoulder stabilising and movement muscles exert their forces onto the shoulder. The cuff enables us to put our shoulder through a very large range of motion, the greatest range of any joint in the body, for the purpose of putting our hands in functional positions. The shoulder’s function is to allow our hands to be put in useful positions within our visual field so we can perform the intricate activities that define being human to a degree.

As the muscles approach their insertions on the humeral head they become more and more fibrous until they become wholly tendinous. Many bodily tendons are cylindrical and long but the shoulder tendons are flatter structures which coalesce over the top of the humeral head. The rotator cuff has a relatively poor blood supply and little or no ability to heal and with time and physical stresses tears appear which are often painful but not always so. Rotator cuff tears are a major part of a shoulder surgeon’s work and rotator cuff surgery is common, complex and demands detailed physiotherapy follow up for successful outcomes.

Many causes of rotator cuff tears have been postulated by there is no agreed single cause, with competing ideas which favour external factors to the tendon and its rival which favours internal degeneration of the tendon itself. The leading shoulder surgeon Neer named impingement syndrome as a condition where the shoulder tendons are repeatedly stressed against the anatomical structures which overlie them. These structures include the acromio-clavicular joint and the front of the acromion, the outside end of the shoulder blade. The supraspinatus tendon can be compressed regularly as the shoulder goes into repetitive flexion and medial rotation,

The natural anatomical shape of our acromion plays a role in the likelihood of us having impingement type problems and therefore the tendency to get cuff tears. X-ray studies have shown that a hooked acromion is strongly related to the development of cuff tears although a proven causal link is not yet clear. The acromioclavicular joint develops degenerative outgrowths on its underside and the underlying cuff tendons are pressed against this area on repetitive movement. Repeated overhead work in younger people can cause bleeding and oedema in the tendon, with inflammation and scarring of the tendon after many such small injuries. With time in patients older than forty years complete or partial tears and bony spurs can develop.

A third impingement type can occur in throwing as the arm is cocked back for the throw and the edge of the glenoid socket can be forced repeatedly against the lower surface of the supraspinatus tendon. Minor trauma is produced each time this occurs, gradually developing into small tears particularly in athletes who throw a lot. The biceps and supraspinatus tendons and the lesser tuberosity impinge against the coracoid process. Most rotator cuff tears are probably contributed to by these three impingement process.

The intrinsic view holds that the external factors may be contributory but that the fundamental underlying process is age-related degeneration inside the tendons themselves. This helps explain why young people rarely suffer cuff tears and that tears increase strongly with age, for example after fifty years old. Under the supraspinatus tendon near to its insertion onto the greater tuberosity is an area which has been called the critical zone and postulated to have a poor vascular supply. This could increase the risk of injury and poor healing in this area but further studies have not confirmed this idea so degenerative changes in the tendons may still be important.

It is likely that the cause of rotator cuff degeneration is a combination of both extrinsic and intrinsic causes, with the tendon tending to fail first in the areas of greatest load, leading to rupture of small tendon fibres. This causes increased forces being loaded onto close fibres, detachment of some fibres from bone, reduction in cuff power and compromised blood supply due to kinked fibres. Wound healing could be reduced and this would impair the possibility of repair.

1. Physiotherapy of Your Shoulder
2. Physiotherapy – Pain Syndromes
3. Physiotherapy and Stretching
4. Physiotherapy and Back Exercises
5. Physiotherapy and Gait Analysis
6. Ankylosing Spondylitis and Physiotherapy
7. Try Physiotherapy for Golfer’s Elbow
8. Physiotherapy Can Help Cervical Nerve Root Neck Pain
9. Treating Lumbar Spinal Pain by Physiotherapy

Sprained ankles are very common and repeated sprains can lead to a swollen, painful ankle, problems walking on rough ground and the risk of re-injury. The physiotherapist begins with asking: How did the injury occur? Was there a high level of force involved? What happened afterwards – could the patient walk or did they go to hospital? Was there an x-ray?

The amount of pain the patient suffered after the injury is extremely important and if the level of pain is very high or if it doesn’t settle, there might be a fracture. Pain should settle with time and if not the physio will refer the patient back to the orthopaedic doctor. The areas of pain should match the mechanism of injury, indicate which structures might be injured and should be tested by the physiotherapist later.

Special questions are asked about the past medical history and previous injuries, any drugs the patient is taking, their appetite level, whether they are losing weight, their sleep quality and pain in the morning, their bladder and bowel normality and any relevant family history. This is to clear the patient of any serious underlying condition so that treatment can be safely performed.

How Physiotherapists examine a sprained ankle

The physiotherapist will note any oedema, change of colour or abnormality of circulation. Ankle movements when not weight bearing are assessed by the physio, dorsiflexion is pulling the ankle upwards, plantarflexion involves pushing the foot down, eversion is turning the foot outwards and inversion turning the sole of the foot inwards. The physiotherapist assesses movement of the ankle as pain can limit movement and the readiness of the patient to engage in rehabilitation.

Depending on pain the physio may manually test the strength of the ankle muscles. This can occur on the plinth or up on their feet if the injury permits it. Once the active movements have been recorded, the physiotherapist performs passive movemenst of the joint, pushing carefully with their hands to explore stretch of the joint structures in each direction. The physio may manually palpate the area to test which structure is at fault, noting swelling or tenderness

Treatment protocols for Physiotherapy

Physiotherapy treatment starts with PRICE, which stands for protection, rest, ice, compression and elevation. Protection involves using a brace to prevent abnormal movement of the joint and further damage. Rest is important for damaged structures and allows the part to settle without stress. Cryotherapy or cold/ice treatment is useful to reduce pain and swelling.

A compression dressing such as a joint sleeve reduces or prevent swelling or effusion occurring as swelling can interfere with normal joint movement, and the joint is kept up to prevent swelling due to gravity. A walking aid such as a stick or elbow crutches may be useful if pain is severe and normal weight bearing gait is not possible. The physio’s hands can test for stiffness or pain in the ankle and allow improvement of the joint gliding movements to normalize joint mechanics. Reducing stiffness of the joint loosens it and eases pain which allows exercises to start in weight bearing. Less dynamic exercises are used initially, progressing to active exercises without support.

In proprioception or the sense of joint position the brain monitors the position of the ankle, quickly coordinating the muscle response to prevent risky positions. Rehab involves balance work by standing on one leg and progressing to working with balance on a wobble board. Balance and coordination are retrained until the joint can perform well on rough ground and in running and jumping. Good movements, little pain, good strength, normal balance and walking mean that the ankle has recovered.

About the Author
Jonathan Blood Smyth is a Superintendent Physiotherapist at an NHS Hospital in the South-West of the UK. With over 15 years experience of managing orthopaedic conditions and looking after joint replacements, he specializes in managing chronic pain. Visit his site if you are looking for Physiotherapists in London or throughout the UK.

1. Physiotherapy and Gait Analysis
2. Treating Lumbar Spinal Pain by Physiotherapy
3. Physiotherapy and Stretching
4. Physiotherapy and Back Exercises

Physiotherapy is a therapeutic treatment concerned with prevention, treatment and management of movement disorders arising from conditions and diseases occurring throughout the lifespan. Physical therapy is performed by either a physical therapist (PT) or a physical therapist assistant (PTA) acting under the direction of a PT.

However, various non-PT health professionals  employ the use of some physical therapeutic modalities in practice. A program of physical therapy will typically also involve a patient’s caregivers. Physiotherapy is the system of treatment of disease and disability using physical exercises. It is a vital rehabilitative service needed in a community and a therapeutic supplement of the medical profession, integral to the treatment of most patients.

Physiotherapy  seeks to improve movement dysfunction, promote optimal health and functions of the human body. It helps in optimal functioning of the body and involves the assessment, maintenance, restoration of the physical function and performance. It is  recommended for people with degenerative disorders, the physically challenged, sportspeople and those suffering from arthritis and neurological disorders etc;

Physiotherapists  have a thorough knowledge of the human anatomy and the way the bones, muscles and nerves move. Physiotherapists  specialization is possible in areas such as pediatrics, geriatrics, orthopedics, sports physical therapy, neurology etc;

Eligibility : Students with a science can  become a practicing physiotherapist or be employed as a professional in a hospital or clinic, but should have a B.Sc. degree or a diploma in physiotherapy.

Career Options & Job Prospects : Employment opportunities in the rehabilitation departments, municipal corporations and private bodies.

For best guidance and information contact your Employment Department and there Vocational Guidance Officer

About the Author
B.Sc.(Med.), B.Ed., M.A.(Edu.), M.Litt.(Edu.), Ph.D.(Edu.Psy.)PGDCA. Served as Science Master, Employment Department as Vocational Guidance Officer. Retired from Employment Department, Punjab India as Dy. Director (Off.) Serving now Arihant Computer Center and Many Medical Hospitals such as Sadbhavna Medical & Heart Institute.

1. Physiotherapy- A Lucrative Career Option In The Field Of Medicine
2. Are You Thinking of Beginning a Physiotherapy Career
3. Physiotherapy – Good Or Bad Career Choice?

Unless you’re an athlete or are close to someone who is, you may not be all that familiar with sports physiotherapy. It isn’t an occupation with which most people have a great deal of personal experience, after all. This article will provide an overview of his very interesting and wide-reaching career field and will outline some of the many things sports physiotherapists actually do.

The Collins English Dictionary (Second Edition) defines physiotherapy as “the treatment of disease or injury by physical means, such as massage or exercises, rather than by drugs [physio- (prefix) physical + therapy]. Thus, sports physiotherapy refers to the treatment of sports injuries by physical means.

That’s a good working definition, but it really only scratches the surface of what sports physiotherapy is really all about. It is true that athletes will consult with physiotherapists about injuries and that they may receive treatment as directed by the physiotherapist as part of their rehabilitation.

Rehabbing sports injuries, though, doesn’t represent the whole of the practice. Many in the field focus their interests on the development of equipment to protect injured athletes from aggravating the circumstances and on the creation of equipment designed to actually improve the rehabilitation process. Sports physiotherapists aren’t just doling out massages to uncomfortable athletes in the locker room, they’re often on the cutting edge of medical improvement.

Working on the development of equipment designed to assist the injured in their recovery isn’t the only non-therapeutic role performed by professionals in the field of sports physiotherapy. Some practitioners focus their attention on creating equipment and protective gear designed to ward off injuries in the first place. You can find physiotherapists involved in the design and testing of new helmets, guards and braces designed to protect athletes from injury.

As you can tell, the field really is wider than the strict dictionary definition would suggest. While treatment of injuries remains at the core of sports physiotherapy, the subject area also encompasses the research and development of equipment used in injury rehabilitation and the of the gear intended to reduce injuries in the first place. This completes the physiotherapy circle, making physiotherapists involved in the prevention, treatment and rehabilitation of sports-related problems.

This is an area of study and a profession worthy of serious consideration for those with a strong academic interest in biology and related sciences. Sports physiotherapists are in high demand as more and more people make athletics and exercise a regular part of their lives. With the aging baby boomer population remaining more active than previous groups of senior citizens, the likelihood of continued high demand for subject area experts should remain quite high for some time to come. Sports physiotherapy appears to be a wise vocational choice for those with a strong interest in sports and/or medicine.

Here is some more information on physiotherapy and all you need to know on health insurance.

1. Physiotherapy to Treat Sports Injuries

I’ve been a physiotherapist for 6 years in Australia. In Australia, physiotherapy is very difficult to get into through a university. For instance, the TER score (score after you finish your high school certificate) was 93 in 2000. That was the third highest score to apply for through university. Now, you may think that the higher the difficulty to apply, the higher the prestige, income and satisfaction the job will be. You think so right? Wrong!

Let me tell you, physiotherapy or physical therapist as a career choice is not what you think. I came to think when doing the course I expect a high income and high levels of satisfaction, but from my experience and others this is totally wrong. I have friends who have been doing physiotherapy for more than 5 years who have changed careers because they thought physiotherapy will get them nowhere. I’ve been told by one of the board members of the physiotherapy association that there is no physiotherapist working full time in a private practice above 45. So it seems many physiotherapists are not satisfied with their career.

So why is it that many physiotherapists aren’t satisfied with their careers? I can give you three good reasons.

First is the income. Our income is around $60-70k year on average, but the ceiling for physiotherapist to get is around $100-110k a year (which is rare) if working for someone or in the public sector. Now in the private sector (working in your own practice) you can make considerably more, about $100k or greater. But setting up and working in the private sector cost money and it is very expensive. You have to pay rent, equipment, labor and many other expenses. So in the end, you might not make much because of all the expenses.

Second is the level of satisfaction. You may think helping people get better makes you happier, it does. But there are many more people who don’t get better. Also, the job that you do in physiotherapy is very monotonous it’s either doing assessment, electrotherapy, exercises or hands on work (which I basically call massage). People who work as a physiotherapist will most likely have hand, wrist or back pain because the job requires you to do repetitive movements or awkward postures most of the time. For instance bending down to treat a patient on a bed,

Third is security. If you do extra courses or have masters degree to specialize in physiotherapy, most likely that won’t guarantee you extra income or status. There is a lack of differentiation between an experienced physiotherapist or an inexperienced physiotherapist in terms of pay. Also, the future of physiotherapy as a profession is overtaken by other health professionals such as chiropractors and even nurses.

This is due to incompetence of the physiotherapy board and association of pushing our status in government and general public opinion into insignificance. It seems that the physiotherapy association has no lobbyist in the government or insurance industry thereby cutting our status as a health professional. For instance, insurances are cutting physiotherapist rates and services (for example HBA in the UK) as they see physiotherapy as not important. In the long term, physiotherapy as a profession will die out and overtaken by other health professionals.

So is physiotherapy a good or bad career choice? I say most definitely not a good career choice. But this is my opinion. If you want to get another person’s opinion, see your physiotherapist or a person who is working in your career.

Tito King is an Author living in Sydney, Australia. He is interested in reading and creating websites. His latest website is about furniture sets and finding the best furniture dining sets on the web

1. Are You Thinking of Beginning a Physiotherapy Career
2. Career in PHYSIOTHERAPY
3. Physiotherapy- A Lucrative Career Option In The Field Of Medicine

Documentation is very important in physiotherapy. A thing or a case is documented especially when that case has something that can help the present patient and even future patients for that matter. Different kinds of case studies are undertaken (e.g., types of support chairs that cater to back ailments, inventions that can aid a person recover from an ailment, a certain drug?s effects and side effects, etc.). Journals concerning therapy and medicine often include various accounts regarding physiotherapy. These documentations help physicians and other health care professionals by informing them about the latest methods, concepts, and works that have been successful and those that fell short.

More and more areas regarding physiotherapy cases are being covered in various studies. These cases are assessed then documented so that specialist as well as people in the community will learn about the findings of such cases. Documentations in physiotherapy are essential legal texts and should not be taken for granted especially by experts and professionals in health care.

In general, documentation papers and forms often contain introduction the physical issue or to physiotherapy, background of the study, past methods used to treat the case, attempted methods, procedure created and guidelines followed, discussion of the case, and other things that the author things are relevant to the case or study.

Most physiotherapy documentations are relevant to elderly patients. That is because many studies documented in physiotherapy concerns elderly patients. A good number of documentations confirm that physiotherapy is advantageous to aged patients, although some cases or studies appear to be unaltered between those having therapy and those who are not having any, or they remain to be inconclusive.

At present, there is a need to extend documentation in physiotherapy in the realm of children?s wellbeing, especially regarding various disorders and illnesses that struck children. Studies and documentations concerning speech and language disorders, Cystic Fibrosis, Multiple Sclerosis, Cerebral Palsy, development and so on.

Documentation in physiotherapy is a very broad term; however, some may not know that this term also embraces strategies focusing on hospital policies, information on guidelines and physical therapy. These policies and guidelines may be utilized in hospitals, clinics and other institutions.

No related posts were found, so here's a consolation prize: Physiotherapy Importance – Great Solution For Quick Recovery From Pain.

Travelling short or medium distances for us is easily accomplished by walking, which is convenient and easy but needs our muscles and joints to be in good condition and to be pain free. Having enough muscle power and sufficient joint range of movement in the legs is necessary for efficient walking. As walking progresses one leg gives the body support while the other swings through to be placed forward and in its turn to take weight. The swing and stance phases are the easiest way of understanding where either leg is at a particular point.

Achieving all the phases of gait so that you get back onto the same foot you started on is referred to as the gait cycle. The duration of both feet remaining on the ground at the same time is about 10 percent and one leg is standing on the ground for about 40 percent of the time. The rest consists of the swing part of the cycle as the non-weightbearing leg is taken through to a position where it can again bear weight. As our walking speeds increase the duration of the gait cycle phases  reduces until there is no double support phase where both feet are weight bearing at the same time, a condition known as running.

The leg joints follow a specific and repeatable series of actions during the swing and stance phases with stance made up of five sections in the order of initial contact, loading response, mid stance, terminal stance and preswing. Heel strike is the common name given to initial contact but some people do not heel strike at all or transfer weight to the heel later in the phase. Heel strike allows the leg which is about to weight bear to take the weight but not compromise speed, stability or shock protection.

While the one leg is supporting the weight of the body the other leg is in swing phase. The first part of the single leg support phase is called mid stance and it is during this phase that the bodyweight moves the centre of gravity and support over the foot. The cycle continues into terminal stance where the supporting foot rises at the heel and then stops when the opposite foot makes contact. The last phase, which is preswing, is preparatory for the swing phase, starting with the last part of both leg support and ending when the heel comes up on one side. The swing phases (initial, mid and terminal) manage clearance of the foot above the ground and the bringing forward of the trailing limb to move to the front.

Efficient gait includes aspects of shock absorption and energy conservation and alterations of joint movement or absence of muscle power may increase the joint contact forces which can lead to pathological changes in the structures abnormally loaded. Almost 60% of the body weight is transferred to the early stance leg in very short period, under 20 milliseconds.

The leg joints absorb and control these forces as they act as shock absorbers and dampers. When the leg is placed initially on the ground the forward forces involved tend to make the knee bend so we resist this by making the knee straighter even though this increases the forces through the joints. Loading forces are minimised by eccentric muscle action by the hip adductors and quadriceps.

Locomotion demands that we expend energy but for most of us the level is low if we are healthy, going at our normal speed and walking on level ground. We minimise the amount of energy we use in walking by choosing a preferred speed which is most efficient. Musculoskeletal or neurological conditions always slow down the walking speed but do not have to increase the energy load per unit time because patients usually slow their cycle down. However, the energy needed to cover an identified distance can increase greatly with more than three times the normal expenditure in the case of stroke.

Wheelchair use allows locomotion speed to be maintained and can cut energy expenditure per unit of distance by fifty percent. Patients tend to choose a wheelchair to get about when the amount of energy necessary exceeds a particular level, especially when it goes beyond three times the normal amount of energy required.

About the Author
Jonathan Blood Smyth is a Superintendent of Physiotherapy at an NHS hospital in the South-West of the UK. He specialises in orthopaedic conditions and looking after joint replacements as well as managing chronic pain. Visit the website he edits if you are looking for physiotherapists in Manchester.

1. Physiotherapy and Stretching
2. Shoulder Rotator Cuff Disease
3. Physiotherapy and Back Exercises
4. Physiotherapy of Your Shoulder
5. Physiotherapy – Pain Syndromes
6. Try Physiotherapy for Golfer’s Elbow
7. Ankylosing Spondylitis and Physiotherapy
8. Ankle Sprain Physiotherapy Treatment
9. Physiotherapy Can Help Cervical Nerve Root Neck Pain
10. Treating Lumbar Spinal Pain by Physiotherapy