What is Physiotherapy?

Physiotherapy targets impairment to restore an individual’s physical function and enable them to return to their social role. Physiotherapists serve anyone from infants to seniors. They may be sited in intensive care units, hospital wards, clinics or at home. Heart-lung issues, neurological conditions like stroke, musculoskeletal problems like neck or back pain, and even cancer rehabilitation are among the typical conditions for which people need physiotherapy. (mosAIC, Nov 2019)
Commonly misinterpreted as a quick-fix for pain or disability, physiotherapy can do way more for people than most are aware of.
There are 3 main types of physiotherapy:

  • Musculoskeletal physiotherapy
  • Cardiopulmonary physiotherapyNeurological physiotherapy
  • Physiotherapists serve all ages of patients. We categorize the different age groups as:
  • Paediatric (under 12 years of age)AdultsGeriatric (above 65 years of age, depending on societal demographics)
A family taking care of Dog f- physiotherapy

We will now expand on the descriptions of each category of physiotherapy to help you understand our work better.

Musculoskeletal physiotherapy

is the most common type of physiotherapy known to the public. Areas of specialization within this category include: sports physiotherapy, orthopaedic/post-surgical physiotherapy, chronic pain management, spine and peripheral physiotherapy, women’s and men’s health physiotherapy, pre/post-natal physiotherapy, etc. Musculoskeletal physiotherapists use a myriad of tools to help their clients overcome pain and disability. Some of these tools include soft tissue manipulation techniques involving manual skills, machines or instruments, exercise prescription for movement re-education or strengthening or mobility, sports taping, joint manipulation, nerve stimulation and more.

While this category of physiotherapy is more often glorified in the sporting scene, it can also do magic for the geriatric and paediatric population. Conditions that are commonly treated by physiotherapists in this category include: joint and nerve injuries (e.g. osteoarthritis, slipped disc, sciatica, shoulder impingement, neck pain, shoulder dislocations, ankle sprains, etc), falls prevention in the elderly, muscle strains/tears (e.g. hamstring pulls, groin strains, incomplete bicep tears), frailty (e.g. cancer rehabilitation, sarcopenia). The list goes on…

Skeleton of a leg

Cardiopulmonary physiotherapy

is most commonly seen in the hospital setting where physiotherapists are involved in returning function to a patient who has been bed-bound and gravely ill. These physiotherapists work hard and meticulously in the intesive care unit, general ward and outpatient setting until a patient is stabilized and can return to a ‘normal’ life of independence. Common conditions that require cardiopulmonary physiotherapy include: heart disease, lung disease, kidney impairment, post-surgery involving vital organs (e.g. post organ transplant or gastrectomy) and more.

Cardiopulmonary physiotherapists also work in the community setting. Most of them are present in community hospitals where step-down care is needed before the patient is able to be independent again. The use of gym equipment is common with important close monitoring of vital signs (heart rate, blood pressure, etc) while the physiotherapist facilitates the patient back into a state of strength and endurance. As pushing a patient too hard or too little while training can result in detrimental effects, these ‘gym training’ sessions are definitely not as simple as they look!

Every cardiopulmonary physiotherapist has to be well-versed in the different types of cardiopulmonary illnesses that humans can present with and understand how that can affect their strength, mobility and endurance – eventually affecting their lives. In spite of this, these physiotherapists are able to help their clients achieve the best possible quality of life through exercise, chest physiotherapy and sustainable lifestyle modifications.

Neurological physiotherapy

involves rehabilitation for those who have disability arising from nerve and brain-related disease. Neurological physiotherapists commonly work in the outpatient and community setting in a long-term manner with their clients as most of these conditions that afflict their clients do not resolve as fast as other conditions. Conditions that fall under the neurological category include: stroke, Parkinsonism, dementia, cerebral palsy, diabetic neuropathy, Down’s syndrome, motor neuron disease, etc.

Some of these conditions result in permanent disability. Neurological physiotherapists are trained to maximise the quality of life and fitness levels of their clients in spite of the terminal and progressive nature of certain diseases that their clients present with. These physiotherapists use a unique set of skills to help their clients regain movement, strength and balance – eventually leading them to achieve the best possible version of themselves.

Besides working with clients, physiotherapists commonly work with caregivers and even employers. This can come in the form of caregiver training for clients who need long-term assistance or workplace ergonomic advise. As long as there are humans, there is a need for physiotherapists!

In a world where many suffer and fear disease and disability, physiotherapists will always see the light and be that beacon of hope for all their clients, regardless of what kind of injury or disease you have.

women doing exercise

We are here to help, always!

With WhatsDoc services, you can have all your queries about physio answered with our expert panel physiotherapist. Feel free to contact us. We offer round-the-clock telemedicine attention at your fingertips.

Written by: Beatrice Choong, Founder of Physiotherabeat, and Hydrotherapy Singapore.

Sports Injury in Teenagers

Sports Activities: The Physical Injuries That Haunt

As parents, we encourage our children to be active in sports for their wellbeing, as well as to increase their outdoor activity for the betterment of their health. Especially for growing children and teens, the following benefits of sports and exercise are expected: 

  • Energy levels are increased 
  • Improved mental well-being
  • Better focus and dexterity
  • Training in leadership and team-building skills

In Singapore, participation in competitive youth sports is on the rise in relation to the traditional philosophy of “catch them young”. While this philosophy is observed according to a few sources like the KK Women’s and Children’s Hospital, the Department of Family Medicine, SingHealth Polyclinics, and the Duke-NUS Medical School upon their research, it is believed the aim of the philosophy is to maximise the physical, social, emotional and psychological benefits associated with an active lifestyle. 

Nevertheless, there are also times where children and teenagers tend to get hurt in the process. Though expected, it is good to pay close attention to those injuries and ensure immediate treatment is given to lessen future repercussions.  

Common Facts for Sports Injuries 

According to Mount Elizabeth Hospitals, here are some sports injuries by the numbers:

  • 65% of sports injury cases involve people aged 5 – 24
  • 39% of sports injury patients are female and 61% are male
  • 28% of sports injury cases resulted from falls

Sports and activities that cause the most injuries:

  • 16.3%: general exercise (running, etc.)
  • 9.9%: basketball
  • 8.3%: football
  • 7.2%: cycling
  • 6.3%: soccer
  • 52%: others

Common Sports Injuries

There are a number of sports injuries that can occur, but the most common sports injuries include: 

  • 41.4%: strains & sprains
  • 20%: fractures
  • 19%: cuts & bruises

Figures by Mount Elizabeth Hospitals

  1. Strains & Sprains: A strain is an injury to a muscle or a tendon caused by overuse, force, or sudden stretching. A sprain on the other hand is a torn muscle or ligament which can caused by a collision or fall that will lead to inflammation or spasms. 
  2. Knee injuries: There are different types of knee injuries, which are dependent on the circumstances. Knee injuries can be caused by a traumatic sports injury, a repetitive overuse injury or other traumatic and sudden stop movements to halt a momentum like landing awkwardly from a jump. 

The types of sports that may be at a high risk of experiencing knee injuries include football and gymnastics. Wearing footwear that does not fit well for physical activities can also be a risk factor. 

  1. Stress Fractures: These are the tiny cracks found in the bone. They are also caused by overuse or overstrain, such as jumping repeatedly or running long distances. Symptoms of fractures are pain and swelling, while the types of sports that may be of risk to fractures include soccer, track and field, and gymnastics.
  1. Dislocations: Can occur in both muscle or joints, and bones. This injury occurs when the ends of the bones are forced from their normal positions.  

Sports that may have the risk of dislocations include gymnastics, wrestling, as well as basketball and football. The latter two sports have additional risk to suffer dislocation in their hands or fingers.

  1. Muscle Tears: Can be a partial or complete tear. A partial tear is a damage to the tendon but does not completely sever it. A complete tear refers to the tear causing a hole in the tendon, and the tendon is separated from the bone.
  2. Rotator Cuff: A rotator cuff is a group of muscles and tendons that surround the shoulder joint. They act as a stabiliser for the shoulder and allows its extensive movement and overhead motions for their daily life.

An injury to the rotator cuff can be caused by repetitive lifting or overhead activities. Symptoms include such as feeling weak when lifting or rotating the arm, or suffering from pain when lifting or lowering the arm, or with other specific movements. Usually tennis players, baseball pitchers and weightlifters can relate to this injury, 

Sports Injuries in Teenagers

Physiotherapists in Singapore have seen an increase in children and teenagers seeking treatment for sports-related injuries in the last 10 years to manage the persistent pains. While some may think the pain will go away after some rest, most will continue experiencing pain which can affect their daily routine and other activities.

The young, including the teenagers who are actively participating in sports might tend to brush away the minor inconvenience caused by any slight pain due to passion and love for the sport. Unfortunately, this is slowly becoming an epidemic of overuse injuries. 

While some teenagers tend to heed their doctors’ advice to take a break from sports to ensure complete healing, the soonest that they are permitted to resume training, it is undeniable that they will jump right into it – totally forgetting about their initial injury until it resurfaces and continue to overburden their growing bodies. 

We have to remember that old injuries can linger around and further increasing the chances of getting injured again in the same place.

Prevention of Sports Injuries

Sports injuries though sometimes can be inevitable due to strenuous activity and practice, it can still be avoided by taking precautionary measures. Here are a few suggestions:

  • Do Warm-Ups & Cool-Downs: Warming up and cooling down are important exercises but are often not taken seriously, and are also often skipped, or not doing it for a sufficient period of time or not properly stretching every part of your body. 

Warm up exercises help to prepare the body and mind while gradually increasing your heart rate to bring blood flow to your muscles, tendons, ligaments and flexible joints.  

In general, warm-ups help improve your mobility that will decrease the risk of sustaining injuries. 

Cool-downs on the other hand are advised to be done twice as long as your duration for warm-ups, lasting approximately 10 minutes which will allow your heart rate to return to normal. 

  • Learn Proper Techniques: Always check that you have proper technique and form when you start or try out a new form of exercise routine for the first time. A proper technique reduces the risk of injuring yourself, or sustaining an overuse injury.

Amyotrophic Lateral Sclerosis

Amyotrophic Lateral Sclerosis (ALS): What to be Expected?

Looking at the name of this disease, it is a mouthful, no? Well, if you have no idea what this would be related to, read further as this disease can be considered quite common.

It was once commonly known as Lou Gehrig’s disease, following the retirement of the famous ballplayer in the 1940s due to the disease.

In Singapore, an estimated 300 to 400 people suffer from ALS. 

What is Amyotrophic Lateral Sclerosis (ALS)?

ALS, or amyotrophic lateral sclerosis, is a progressive neurodegenerative disease, or also known as a rare neurological disease. It belongs to a wider group of disorders known as motor neuron diseases, which are caused by gradual deterioration (degeneration) and death of motor neurons. Eventually, the brain loses its ability to initiate and control voluntary movements.

ALS primarily affects the nerve cells (neurons) in the brain and the spinal cord that are responsible for controlling voluntary muscle movement.

So, voluntary muscles are the muscles we choose to move, which usually includes movements like chewing, walking, and talking. The disease is progressive, meaning the symptoms get worse over time. 

Individuals with ALS will slowly lose their strength and the ability to speak, eat, move, and even breathe. Most people with ALS die from respiratory failure, usually within 3 to 5 years from when the symptoms first appear. 

Currently, there is no cure for this fatal disease and no effective treatment to halt or reverse the progression of the disease. Nevertheless, about 10% of people with ALS survive for 10 or more years and with a median survival of 3 years, treatment can extend the length and meaningful quality of life for patients.

Symptoms of Amyotrophic lateral sclerosis (ALS)

Amyotrophic lateral sclerosis (ALS) can be differentiated from stroke or trauma due to the subacute or chronic progression of symptoms.

Some early symptoms of ALS usually include muscle weakness or stiffness. They might seem subtle, but if overlooked, these weakness and stiffness will gradually affect all voluntary muscles and develop into more obvious weakness or atrophy. 

Symptoms include:

  • Difficulty in chewing or swallowing; tend to lose weight rapidly and can become malnourished
  • Impairment in the use of arms and legs
  • Muscle cramps
  • Muscle twitches in arms, legs, shoulders, or tongue
  • Muscle weakness affecting an arm, a leg, the neck, or diaphragm
  • Slow or slurred speech, difficulty in projecting voice
  • Tight and stiff muscles (spasticity)

The first sign of ALS usually appears in the hand or arm and can cause difficulty in simple tasks such as buttoning a shirt, turning a key in the lock or writing. In other cases, symptoms initially will affect a leg. People will experience awkwardness when walking or running, or they might trip or stumble more often. 

When symptoms begin in the arms or legs, it is called “limb onset” ALS;

If it presents as speech or swallowing problems, it is called “bulbar onset” ALS.

Besides muscle cramps that may cause discomfort, some individuals with ALS may develop painful neuropathy (nerve disease or damage).

Individuals with ALS eventually lose the ability to breathe on their own and must depend on a ventilator. Affected individuals also face an increased risk of pneumonia during later stages of the disease. Progressive symptoms will include:

  • Problems with moving, swallowing, speaking/ forming words, breathing (sequence will vary with different individuals)
  • Advanced stages: Shortness of breath and difficulty in breathing and swallowing – eventually leading to death

People with ALS are able to perform higher mental processes such as problem-solving, reasoning, remembering, and understanding. Therefore, they are very aware of their progressive loss of function and may become anxious and depressed. 

A small percentage of individuals may experience problems with language or decision-making, and there is growing evidence that some may even develop a form of dementia over time.

Risk Factors of Amyotrophic lateral sclerosis (ALS)

ALS is a common neuromuscular disease that affects people of all races and ethnic backgrounds, worldwide.

  • Age: Although the disease can strike at any age, symptoms most commonly develop amongst people aged between 55 to 75. It is also commonly believed to affect older people, but young people in their 20s can also get it,
  • Gender: Men are slightly more likely to develop ALS compared to women. However, in terms of age, the difference between men and women disappears.

Types of Amyotrophic lateral sclerosis (ALS)

ALS can be classified into two different categories:

  1. Sporadic ALS

Nearly all cases of ALS are considered sporadic, which means the disease seems to occur randomly to some individuals that have no clear associated risk factors and no family history of the disease. 

Although family members of people with sporadic ALS are mostly at an increased risk for the disease, the overall risk is very low and most will not develop ALS.

  1. Familial (Genetic) ALS

About 5% to 10% of all ALS cases are based on familial/ genetics, which means that an individual inherits the disease from a parent or within the family. 

The familial form of ALS usually only requires one parent to carry the disease-causing gene. Mutations in more than a dozen genes have been found to cause familial ALS.

Causes of Amyotrophic lateral sclerosis (ALS)

Exact causes of the ALS disease are not known, and it has not been identified the reason why it only strikes some individuals. However, there is evidence that both genetics and environmental factors play some role in motor neuron degeneration and the development of ALS.

The reasoning for genetics revolves around associated gene mutations that may lead to ALS-related motor neuron degeneration. It is also likely that specific gene mutations and/ or heredity modifies the disease and the likelihood of developing it.

As for environmental factors, it revolves more on the following:

  • exposure to toxic or infectious agents, 
  • physical trauma, 
  • diet, 
  • viruses, 
  • other behavioural and occupational factors that may be responsible for the disease:
  • Accumulation of protein aggregates (clumps)
  • Autoimmune and inflammatory mechanisms
  • Cytoskeletal protein defects
  • Defective glutamate metabolism
  • Free radical injury
  • Gene defects
  • Mitochondrial dysfunction
  • Programmed cell death or apoptosis
  • Viral infections

Treatment for ALS

Currently, there is no known possible cure or treatment that halts or reverses the progression of ALS. However, there are some medications that are prescribed to modestly slow the progression of ALS. 

While the search for an effective treatment and cure continues, global multidisciplinary teams are assisting ASL patients and their families to adjust to the many challenges of living with the disease. 

Specialists and healthcare professionals use various devices and therapies to help patients manage their ALS symptoms, while allowing those with the disease to maintain their independence as well as their quality of life. The approach has also been shown to prolong survival of people who have ALS. 

Various treatments and interventions may include:

  • braces and splints for arms and legs 
  • breathing-support devices
  • customised wheelchairs
  • diaphragm pacers
  • easier-to-swallow foods and liquids
  • exercise regimens – physical and occupational therapy
  • feeding tubes
  • home assessments to assist movement around the house
  • proper body positioning
  • support from a nutritionist
  • technological devices to assist communications
  • walking support devices

Always Make Those with ALS More Comfortable

Patients with ALS will have a mental and emotional impact to those around them, especially loved ones and family members due to their health deterioration. Nevertheless, with quick action, it could at least make the patient feel much more comfortable than they already are, while taking their minds off the depreciating conditions.

Always pay attention to the early symptoms and check with a healthcare professional on your health updates for early preparation. 


Neurologists and Physiotherapists at WhatsDoc are available for your constant enquiries, for you to have a peace of mind.

References:

https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Amyotrophic-Lateral-Sclerosis-ALS-Fact-Sheet

https://www.als.org/understanding-als/what-is-als

https://emedicine.medscape.com/article/1170097-overview

https://www.hss.edu/condition-list_amyotrophic-lateral-sclerosis.asp

https://www.mda.org/disease/amyotrophic-lateral-sclerosis

https://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/als/conditions/als_amyotrophic_lateral_sclerosis.html

https://medlineplus.gov/genetics/condition/amyotrophic-lateral-sclerosis/

https://www.medicalnewstoday.com/articles/281472

https://www.medscape.com/answers/791154-194098/how-is-amyotrophic-lateral-sclerosis-als-differentiated-from-stroke-or-trauma#:~:text=ALS%20can%20be%20differentiated%20from,of%20pain%20or%20sensory%20symptoms.

https://www.healthxchange.sg/head-neck/brain-nervous-system/motor-neuron-disease-symptoms-weakening-grip-speech-loss