Physiotherapy is an ancient science,
which involves physical treatment techniques, such as massage, and the use of electrotherapeutic
and mechanical agents – rather than drug therapy – for the management of a
condition.
Physiotherapists play an important
role in helping people to overcome disability and pain related to orthopedic, musculoskeletal,
neurological and rheumatologic illnesses.
Any person with diabetes whose
aching legs have experienced relief after a massage, or whose painful feet have
been relaxed after a soak in cool water will testify to the importance of
physiotherapy in relieving their symptoms.
Preventing
diabetes-
The Diabetes Prevention Project
demonstrated that lifestyle modification, including intensive exercise, is more
effective in preventing diabetes than pharmacological therapy, and highlighted
the role of trained professionals in motivating people to follow lifestyle
interventions. Similar results have been reported by the Malmö Study, the Da Qing
Study, the Finnish Diabetes Prevention Study and the Wenying Study.
Physiotherapists are able to help people, to plan an individualized exercise
programme in order to maintain good blood glucose control and achieve optimal weight.
Furthermore, physiotherapy leads to metabolic improvements even in the absence
of weight loss, reducing the frequency of cardiovascular events and improving
life expectancy. Effective exercise counseling ensures both cardio respiratory and
musculoskeletal fitness. This helps people with diabetes improve their quality
of life, and contributes to overall control of blood glucose. The use of
alternative therapies, such as yoga, can contribute to the achievement of
optimal cardio-respiratory health.
Physiotherapists can help people to
maintain good blood glucose control and achieve optimal weight. Physiotherapists,
with their knowledge of physiology and anatomy, can suggest specific exercises
for people with coexisting complications, cautioning against certain movements
that might be detrimental to their health. For example, an isotonic exercise
like jogging will benefit a person with high blood pressure and diabetes, but
the repeated foot trauma associated with jogging may harm someone with
peripheral sensory neuropathy or Charcot foot.
Beyond
exercise counseling-
Most people with diabetes suffer
from musculoskeletal complications, which might include frozen shoulder, back pain
or osteoarthritis. Many people with poorly managed type 1 diabetes develop a
syndrome of limited joint mobility. Diabetic amyotrophy is a type of neuropathy
that involves muscle wasting and weakening, especially in the thighs. Carpal
tunnel syndrome and sciatica are other neurological conditions that are
commonly suffered by people with diabetes. In all these conditions,
physiotherapy plays a pivotal role in returning people to normal levels of
health and wellbeing. The physiotherapist uses a combination of active and
passive exercises, and mechanical and electrical aids to
improve musculoskeletal and
neurological functions.
Pain
relief-
Physiotherapy offers various
effective non-pharmacological approaches for pain relief. Transcutaneous
electrical nerve stimulation (TENS) involves electrical nerve stimulation
through the skin, sending a painless current to specific nerves. The mild
electrical current generates heat that serves to relieve stiffness, improve
mobility, and relieve pain.
Interferential therapy (IFT) uses
the strong physiological effects of low frequency electrical stimulation of
nerves.
TENS and IFT are considered
gold-standard therapies for the relief of neuropathic pain, and have proven
benefits in the management of painful diabetic neuropathy, edema (build-up of
fluid in tissue) and resistant foot ulcers. TENS has been shown to be most
effective against burning and stabbing pain, but comparatively less efficient
for the relief of painfully sensitive skin and restless legs syndrome. Other
modalities, such as ultrasonic therapy and hot wax, are useful for specific
conditions in both people with diabetes and people without the condition. In
spite of the benefits – safety, lack of drug interactions, efficacy, cost –
associated with these methods, few centers’ have adopted TENS/IFT as primary
treatments for painful neuropathy. Perhaps this underscores the need to create
specialized diabetes physiotherapy units, staffed by qualified physiotherapists
specializing in the care of
people with diabetes.
Physiotherapy can play an important
role in preventing and managing foot problems.
Improving feet-
Physiotherapy centers’ can play an
important role in preventing and managing foot problems. Teaching the importance
of correct gait and posture, along with the basic principles of off-loading
when required, can prevent or stabilize a number of foot complications. In
people with tropic ulcers, for example, which are typical in people with diabetes-related
foot problems, the effective use of crutches or foot splints can ensure
off-loading and early healing. In people who are unfortunate enough to undergo
an amputation, the physiotherapist helps with post-operative pain relief,
rehabilitation, limitation of disability, and the optimum use of prostheses.
Similar rehabilitative measures, exercises and therapeutic aids are available
for people who are recovering from heart attack, stroke, peripheral
vascular surgery, or other traumas
or surgical interventions.
Wider benefits-
Physiotherapeutic interventions,
usually delivered on a one-to-one basis are patient-centered, in line with the contemporary
approach that all providers of chronic medical care, including
endocrinologists, try to provide to people in their care. The time spent with
the physiotherapist during the course of treatment can strengthen patient provider
bonding and enhance communication.
As the number of people with
diabetes continues to rise, and as the existing diabetes population ages, the
need for efficient physiotherapy services will continue to grow. Including
specialized physiotherapists as equal members of the diabetes care team will
help us to utilize their services effectively in order to improve the health
and well-being of all people with diabetes.
