Physical Medicine and Rehabilitation
He has been working as a physical medicine and rehabilitation specialist at Anadolu Medical Center since 2005.
Physical Medicine and Rehabilitation (Physical Therapy and Rehabilitation) is the medical specialty dealing with acute and chronic problems like musculoskeletal disorders, neurological diseases, chronic pain and disabilities associated with cancer using an integral approach, and focused on prevention, diagnosis, treatment and rehabilitation of medical events causing disability in all age groups.
At the Physical Medicine and Rehabilitation Department of Anadolu Medical Center, we provide services to arrange diagnosis and treatment of the diseases of the musculoskeletal system, to increase quality of life of individuals by maximizing their functional capacities and daily activity performances, and accordingly, satisfy the needs of patients who require rehabilitation with a comprehensive rehabilitation program towards all systems.
The aim in rehabilitation is to increase the individual's functional capacity, prevent and heal disability, enable the individual to function independent in daily life, and improve his/her quality of life.
A PM&R-PM&R Specialist is a medical doctor who has specialized in physical medicine and rehabilitation for four-five years after six-year medical faculty education. He/she diagnoses musculoskeletal diseases and plans the treatment program. The aim is to relieve the patient’s pain, correct functional problems (loss of muscular power, restriction of joint movements, gait disorders, balance disorders, etc.) and improve the patient’s performance, and to treat disability associated with a disease or injury.
Efforts in the area of health are classified under three categories as preventive, therapeutic (medical and surgical) and rehabilitative. All efforts aimed at preventing deterioration of health are preventive. A PM&R-PM&R specialist carries out activities to prevent development of musculoskeletal problems.
A physical therapist completes a four-year undergraduate study in a physical therapy and rehabilitation school, and works with the PM&R-PM&R specialist in the PM&RPM&R program of the patient. He/she applies the physical therapy and rehabilitation program planned by the PM&R-PM&R specialist, and helps to correct functional disabilities of the patient.
Physical therapists improve general wellbeing and prevent injury of healthy individuals who are found to be eligible for doing exercises by a doctor.
Hot packs, heating pads and paraffin can be applied as superficial heaters. Hot packs are fabric bags filled with silica gel. After silica gel attracts water and is heated up to 60-70°C, it can be wrapped with a towel and applied for 20 to 30 minutes without losing heat. Subject to the site of application, they can assure heat increases of 1.1 - 3.3°C in a tissue depth of 1-4 cm.
Hydrostatic pressure, viscosity and buoyancy of water obtained with water movement with the help of a motor are used, whereas a suitable hydrotherapy environment for exercises with the heating effect of hot water. Whirlpool baths are used for edema treatment and exercises.
Cold packs are used in cold therapy. Cold therapy reduces edema, muscle tone and muscle spasm.
This method induces heating of deep tissues (muscles, tendons, ligaments and bones) rather than the skin and subcutaneous sebaceous tissue. Ultrasound is a high frequency sound wave. Sound wave absorbed by the tissue transforms into heat energy and is used to heat deep tissues like muscles - bones.
Ultrasound has also a micromassage effect that stimulates movement of the fluid in tissues; this effect is utilized in edematous tissues, and speeds up wound healing.
In physical therapy, low-level laser therapy with no heating effects is used. It improves circulation, biological activity, regulates intercellular relationship, increases collagen synthesis and improves tissue repair. PM&R low level laser has basically two intended uses: This is a stimulation therapy that shows an acupuncture-like effect and regional irradiation used in local painful syndromes especially in tennis elbow and heel spur.
This therapy is used to pump the fluid in venous blood vessels and lymphatic vessels from the arms or legs to the heart by applying intermittent pressure. It helps regulate blood circulation. It is employed in the treatment of edemas and lymphedemas.
TENS is a pain relieving electric current applied via superficial electrodes placed on the skin. It suppresses transmission of pain at the spinal cord level via electric currents.
Uses of electric currents in the field of PM&R:
CPM device is frequently used to increase nourishment of the articular cartilage, restore joint motion and prevent effusion in the orthopedic rehabilitation program after knee surgery.
Traction is a technique that helps to extend soft tissues and separate articular surfaces and bone structures from each other with the help of a tractive force. It may be manual, mechanical, motorized or hydraulic.
Effects of traction on the spine:
Traction is used in the treatment of disk hernia. It is not employed in the presence of severe osteoporosis, multiple disc herniation due to calcification, impaired spine stability, spinal fracture, severe spinal cord compression, infection and tumor.
Appliances used to support, align the body, prevent its movement, or restore functional movements of the body are called orthoses. The orthesis team consists of a PM&R specialist, an orthesis-prosthesis technician, a physical therapist and a patient. In PM&R, cervical – waist collars, wrinkle splints and gait orthoses are frequently prescribed orthoses. The purpose of gait orthoses is to help the patient to stand and walk.
Biofeedback is gaining awareness of and controlling physiological functions of the body. It is a method that sends audio and visual signals with electronic devices and informing the person about physical functions and enabling the person to gain greater awareness of and changing functions using such information.
Biofeedback is an application in support of exercise therapy. With balance biofeedback devices used as part of the rehabilitation program, patients try to correct and improve balance and posture.
Exercises improve posture, strengthen muscles, promote flexibility and increase durability and aerobic capacity. An exercise program is prepared specially by the physical therapy specialist according to the needs and functional disorders of the patient. The physical therapist teaches the planned exercises to the patient and gets the patient to perform such exercises properly under his/her supervision. Performing the exercises properly is important in terms of both relief of pain and safety of the patient. The exercise program must be specific to the person (personal), and must be safe for the patient.
Exercise therapies can be classified under two categories including protective exercises and therapeutic exercises.
This exercise program is prepared specifically for the individual to protect the individual's physical function, prevent injuries, promote general wellbeing and fitness.
This exercise program is applied for relieving pain and treating physical functional disorders such as muscle weakness, articular movement restriction, postural disorder, balance and gait disorders.
This method is used by modification within a PM&R exercise program in the treatment of postural dysfunctions, lower back pain and fibromyalgia. It is focused on coordinating breathing and strengthening posture and the body with exercise. It strengthens muscles, provides flexibility and corrects posture. Pilates exercises include breathing exercises, abdominal muscle strengthening and stabilization exercises, back muscle strengthening exercises, mobilization and strengthening of scapular muscles, relaxing exercises and stretching exercises.
Postural dysfunctions that become a habit when sitting and standing in daily life force and impose load on the muscles, ligaments and joints around the spine, and result in pain. Pilates exercises are intended to correct postural dysfunctions. This site is stabilized by strengthening lower back and abdominal muscles.
Safety is a basic issue in the exercise program of an individual whether conducted in the presence of a physical therapist or alone.
PM&R specialist plans a safe exercise program for the patient taking all these factors into account, and while the patient is performing the exercise, the specialist checks these factors and assures patient safety. Patients should be trained on safety whether they exercise at home or in a gym.
Myofascial pain syndrome is a local pain syndrome characterized by the presence of painful and stiff strips and trigger points which are revealed when the muscle is pressed. The muscle suffers pain, tenderness, stiffness, weakness and fatigue.
Trauma, repetitive exertion and excessive use of a muscle, loss of coordination by a muscle and preserving the same position for a long time, postural dysfunction, mechanical disorders of the spine, joint disorders, psychological stress, sleep disorders, metabolic disorders (vitamin deficiency, hypothyroidism, etc.) constitute the risk factors for myofascial pain syndrome. Frequent office activities such as using a computer with shoulders down, head extended forward and the back hunched up are serious risk factors for the development of myofascial pain syndrome.
Patients complain of stinging pain caused by repetitive activity and preserving the same position for a long time, and complaints are reduced by resting and hot therapy. There are painful stiff strips and trigger points and tenderness during the examination, and when the trigger point is pressed, the patient suffers increased pain, jumps up, and also suffers from restricted movements. Diagnosis is made by history and physical examination.
Treatment methods include patient training, medical treatment. physical therapy and rehabilitation as well as local injections. It is essential that the patient is informed about the factors causing and maintaining the disease, what he/she should be careful about in daily life and how he/she can protect his/her spine, and the patient is provided with office ergonomics training and posture training, and the importance of exercise in treatment is emphasized.
The purpose of PM&R program is to reduce pain and tenderness in the muscle, to relieve muscle spasm, to correct movement restriction, to increase function and prevent reoccurrence of muscle pain. The most important treatment of myofascial pain syndrome is an exercise program. In a PM&R program, physical treatment options (hot therapy electric stimulation, ultrasound, laser, vacuum treatment) and exercise treatment should be used in combination. When the patient’s pain and muscle spasm are reduced by physical treatment, an exercise program is started. The exercises used are stretching exercises, muscle strengthening exercises, aerobic exercises and posture exercises. To treat the source of the pain and prior to stretching exercises, trigger point injections are recommended in order to support the physical treatment program.
It is a musculoskeletal disorder characterized by widespread and chronic pain. The prevalence of fibromyalgia is 1-4 percent, and 75 percent of all fibromyalgia patients are female. Viral infections, physical and emotional traumas may trigger development of fibromyalgia. Genetic factors, muscle-nervous system-psychiatric-hormonal disorders and sleep disorders cause fibromyalgia. Diagnosis is made by history and examination. Imaging and blood examinations are used to differentiate it from other diseases.
It may be accompanied by tiredness, sleep disorders, headache, irritable bowel syndrome, disturbing senses like numbness-burning-prickling, and depression and anxiety. In examination, tender points are found by palpation. The pain starts in the neck and shoulders, and then spreads to the whole body. Patients do not feel rested when they get up in the morning.
The treatment involves patient training, medicinal treatment (pain killers and antidepressants), exercise therapy, physical therapy, trigger point injections and cognitive-behavioral treatment programs. Recommended types of exercises include walking, exercises in water and swimming.
It is one of the most frequent reasons of pain around the hip.
Symptoms are pain and inflammation in the hip and outer side of the femur. Complaints increase by walking, kneeling down and climbing stairs, and are reduced by resting. Complaints aggravate when lying down on the side on the hip at night. Tenderness is seen when the bony prominence at the top of the hip-femur is pressed. Complaints increase when the hip is extended sideward. This problem may be caused by trauma, excessive sport activity, imbalances of muscles around the hip, long-term walking, excessive pressure on the waist, and obesity. This problem should be differentiated from herniated disk and hip-joint problems.
For the treatment of trochanteric bursitis, resting, reducing sport activities, especially walking, and avoiding forcing the region, non-steroidal painkillers, local injection and physical treatment are recommended. Shortness in muscles surrounding the hip should be corrected with stretching exercises and weak muscles strengthened.
Osteoarthritis is the most common rheumatic disease. Osteoarthritis of the hip joint is the most common cause of hip joint pain in adults. It is a chronic degenerative disease characterized by softening and structural deformation of the articular cartilage, bone edema and bone remodeling.
Symptoms include pain on the outside of the hips, pain extending from the thighs to the knee, stiffness after sitting or in the morning, which increases with motion, kneeling down, ascending and descending stairs, and decreases by resting. The patient faces difficulty when ascending or descending stairs, and sitting and standing. When the osteoarthritis of the hip progresses, the patient may face difficulty in daily activities such as walking or wearing socks.
The diagnosis of the disease is made by examining complaints and history of the patient, and examination findings. Hip x-ray, MRI and blood tests are examinations conducted to support examination findings. The purpose in the treatment of osteoarthritis of the hip is to control the patient's pain, to improve movement of the joints, to correct functional insufficiencies and to increase life quality.
The basic treatment methods of osteoarthritis include non-medicinal therapies including rehabilitation. The patient should be educated about the disease, treatment methods, side effects of the drug and things to avoid, and how he/she should take care of him/herself. The patient should avoid ascending-descending stairs, kneeling downs, or sitting on a low chair.
Physical treatment plays an important role in patients with functional limitations. The strength of the muscles surrounding the hip, strength and movement of the joints are improved. For supporting gait, a walking stick or a walking aid can be recommended. Arrangements in the living environment of the patient may improve the patient's functional situation (eliminating the necessity to use the stairs, etc.).
Obesity is an important risk factor in the development and progress of osteoarthritis. With loss of weight, the load imposed on the joint is reduced, and further progress of the disease is prevented, and the patient's complaints are reduced. For this reason, the patients should be guided to lose weight. Medicinal treatments and non-medicinal therapies should be used in combination in the treatment of osteoarthritis.
The purpose in the treatment of osteoarthritis of the hip is to control the patient's pain, to improve movement of the joints, to correct functional insufficiencies and to increase life quality.
This is pain in the front of the knee subject to degeneration of the cartilage on the undersurface of the kneecap.
Symptoms increase when the knee is held in bent position for a long time (theater sign). Patients find it difficult to climb or descend stairs.
An exercise program that will strength the anterior group of patellar muscles is recommended.
Bursitis is the inflammation and swelling of bursae (fluid-filled sacks) around the hip. The most important cause of the disease is prolonged pressure on the knee and repetitive micro-traumas.
Bandage, cold therapy, non-steroidal painkillers and local injections are used in treatment.
The disorder is characterized by knee pain which increases with movement and decreases with resting, stiffness, walking difficulty, swelling and deformation in the knee. Symptoms include pain which increases with movement and decreases with resting, stiffness after sitting or in the morning, and crepitation during movement. Limitation of joint movements may develop.
The purpose in the treatment of osteoarthritis of the knee is to control the patient's pain, to restore or improve movement of the joints, to correct functional insufficiencies and to increase life quality. While doing so, the patient must be protected from the side effects of the treatment to the extent possible.
Training the patient has great importance in the treatment of osteoarthritis of the knee. In addition, other treatment options are as follows:
It is the most common cause of heel pain. It occurs due to strain caused by repetitive trauma in the thick band of tissue at the bottom of the foot.
The pain increases with standing and walking, and tenderness occurs when the inner mid point of the heel is touched.
In its treatment, heel support, physical treatment and sole stretching exercises and local injections are used.
In its treatment, heel support, physical treatment and sole stretching exercises and local injections are used.
It is characterized by pain, swelling and tenderness at the back of the Achilles tendon.
It develops due to repetitive trauma, long-term walking and running. The patient hardly stands on the tip of his/her toes.
PM&R programs, non-steroid painkillers, splints, local injection and surgical treatment methods are applied.
Shoulder disorders are the most important cause of arm pain. Diseases that give rise to shoulder pain are as follows:
It is the compression of the supraspinatus muscle due to overhead activities of the arm.
Symptoms include anterior shoulder pain, increased pain due to overhead activity and limitation in shoulder movements. Edema, thickening and rupture of the tendon occur. It is the most important cause of shoulder pain in persons over 40. The patient hardly raises his hand up, and the range of motion of the shoulder becomes limited. The patient faces difficulties in daily activities such as wearing and bathing. MRI is used for the diagnosis.
Overhead activities of the shoulder are restricted, and a PM&R program is applied to strengthen the muscles that stabilize the shoulder, to extend the limitation in the shoulder, and to relieve the pain. Injection into the shoulder can be employed. Surgical treatment can be applied in patients who fail to respond to the PM&R program.
Rest: It is recommended that overhead activities, heavy carrying and pain-causing activities are limited. Also in this phase, the arm should stay below the shoulder level in daily life.
Physical treatment: In this phase, ice, electric stimulation, edema therapy, non-steroidal painkillers and shoulder injections are used in physical treatment.
Exercise therapy: Methods like pendulum stretch, finger walk and isometric strengthening exercises (muscle strengthening without movement) are used in exercise therapy.
Physical treatment: Pre-treatment hot-therapy, post-treatment cold therapy, electric stimulation, edema treatment, non-steroid painkillers and shoulder injection are methods used in physical treatment in the activity initiation phase.
Exercise therapy: In the intermediate phase, articular range of motion exercises, shoulder capsule stretching exercises and exercises for strengthening the muscles around the shoulder and the scapula are used. Towards the end of this phase, strengthening exercises are performed with theraband (exercise band) and low weight dumbbells.
In the advanced strengthening phase, exercises to strengthen shoulder muscles are increased and specific sport activities are started.
In frozen shoulder, a painful condition characterized by limited range of motion in the shoulder, shoulder motions are limited in all directions. The most important factor that causes development of this condition is long-term inactivity of the shoulder. In addition, diabetes, thyroid, lung and heart diseases may be associated with the development of frozen shoulder. A PM&R program that involves extensive stretching of the shoulder in all directions and a shoulder injection therapy are used for the treatment of this condition. Surgical treatment can be applied in patients who fail to respond to the PM&R program.
It is an injury that develops on the bony lump on the outside of the elbow which attaches the forearm muscles to the bone due to overuse of the wrist and fingers and repetitive hand movements.
There is tenderness and pain when the bony bump on the outside of the elbow is touched. Pain increases with wrist movements and heavy lifting. One of the most typical findings is pain which increases when the outer surface of the hand is pulled toward the face with the elbow in straight position. Improper techniques in tennis and other sports may give rise to this problem.
Wristbands and elbow bandages are used to restrict repetitive hand movements. Steroid injection into the painful site may be useful. A PM&R program designed to relieve pain and stretch and strengthen the muscles around the wrist is applied. Surgical treatment can be applied in patients who fail to respond to the PM&R program.
It is characterized by the entrapment of the ulnar nerve in the elbow due to repetitive elbow movements and direct pressure on the elbow in resting condition. This problem may be caused by prolonged bending of the elbow and working with elbow resting on the table.
Numbness, burning, loss of sensation and weakness of grip may be observed in the inner surfaces of the 4th and 5th fingers. Complaints increase with the bending of the elbow.
Avoid prolonged bending of the elbow and working with elbows rested on the table. A resting splint is recommended for the elbow, and a PM&R is applied. If there is severe nerve entrapment and neurological findings exist, and there is no response to PM&R, surgical treatment is employed.
This condition develops due to chronic overuse of the wrist and the thumb.
Increased pain and tenderness develop in the outside of the wrist and the base of the thumb with increased movement.
Splints designed to restrict thumb movements, local steroid injection and PM&R program are used. The purpose of PM&R program is to relieve pain and heal edema, and to strengthen muscles.
This problem which is characterized by cystic expansion of a joint or tendon sheath is one of the most common soft tissue lesions of the wrist. It occurs due to acute trauma or repetitive microtraumas of the wrist and the hand.
Methods like use of a wrist splint, non-steroidal painkillers and local injections are used in treatment. Surgery is recommended for non-responding patients.
It is the most common repetitive strain injury of the hand. It is the stenosing tenosynovitis of the thumb and other fingers. It is associated with repetitive grip. It is 2-6 times more common in women.
Pain in the inner surface of the finger particularly in the morning, and finger locked in a bent position which you are unable to straighten.
Using a finger splint and avoiding repetitive grip movement, local injection and PM&R program are recommended for treatment. Surgery is recommended for non-responding patients.
The rehabilitation program for patients with paralysis is intended to enable the patient to lead a longer, independent, safe, happy and high-quality life. Rehabilitation is a process that plays a role in improving the patient’s ability to perform his/her daily functions and to recover his/her independent function, and helps to heal the nervous system.
A patient with paralysis stays for averagely 4 weeks in the rehabilitation unit, and 54-80 percent of the patients are able to walk at the end of that period. Because arm functions are more complicated than those of the leg, rehabilitation of the arm is less successful than the leg. With the rehabilitation process, 10-15 percent recovery is achieved in arm function.
There are rehabilitation practices for physical insufficiencies subject to the effects of the tumor or cancer therapy. 54% of the patients diagnosed with cancer need a rehabilitation process.
Pain associated with cancer is seen in 70 percent of patients. Pain is primarily associated with the metastasis, and in this type of pain, a treatment that targets the tumor is effective.
In case of bone involvement, limitation of weight transfer may be necessary subject to severity of the lesion. To limit weight transfer, use of crutches – walking aids is recommended. No bed rest is recommended. Orthosis applications for bone protection, or corsets for spinal support are suitable.
Isometric muscle strengthening exercises, low-intensity aerobic exercises (walking, cycling), abdominal muscle and back muscle strengthening exercises in patients prone to spinal fracture risk, and balance exercises and environmental arrangement are recommended to prevent falling risk.
In breast cancer rehabilitation program, post-surgery shoulder joint range of motion exercises and stretching exercises are employed. After the drains are removed, active articular range of motion exercises are initiated, and exercises are gradually progressed. Lymphedema therapy is used. In lymphedema therapy, manual lymphatic drainage, compression therapy (compression bandage – compression garments), therapeutic lymphedema exercises, and skin care are employed.
In lung tumors, breathing exercises, neck and arm muscles strengthening exercises, and aerobic exercises are recommended to the patient. Patients receiving RT in the head and neck region may develop cervical restriction. Range of motion and stretching exercises for the neck joints in all directions, strengthening exercises for the posterior cervical muscles and posture training are used.
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