Most people associate physical therapy with only those exercises necessary after muscle injuries, surgery or recommended for elderly people.
Those who like or follow sports should also remember a player who was away due to injuries and who started physiotherapy.
But, in fact, the area is much wider and capable of attending to different conditions, whether to treat specific or persistent physical conditions, such as an ankle sprain or postural malformation.
In order to preserve, develop, rehabilitate and maintain the proper functioning of internal or external systems, physiotherapy meets the patient’s health in his various needs, but is not always recognized or valued.
To understand the importance of this area of study and care, learn more about the role of the physiotherapist, the therapeutic application and the mechanisms of action.
Physiotherapy is a science focused on the study, diagnosis, prevention and rehabilitation of patients who have a movement disorder or functioning (functional kinetic) of the body organs or systems, according to the definition of Crefito 9, which is the Federal Council of Physiotherapy and Therapy Occupational.
Diseases caused by genetic alterations, traumas or acquired diseases can be treated by qualified professionals, aiming to maintain or recover the patient’s health, preserving the integrity of organs, systems and functions, without disregarding the psychological and social aspects.
In order to carry out a functional kinetic diagnosis – that is, to give an opinion on the quality of the movements and functioning of the body systems -, the professional physiotherapist needs to integrate multiple knowledge, involving:
- Morphological : it comprises the parts and microstructures of the body, making the study of the organic form;
- Physiological : understanding of the functioning of the organism from the integration of parts (cells, organs and systems);
- Pathological : understanding of diseases that affect or compromise the patient’s integrity;
- Biochemicals : study of the processes that occur in cells, their functioning and actions in metabolism;
- Biophysicists : integration of the notions and theories of physics to understand the systems of the organism;
- Biomechanics : understanding the functioning of internal and external forces that act on the organism and what are the biological effects;
- Kinesics : understanding of body movements in their multiple actions (what are the possible causes that prevent or enable movement);
- Synergistic functional and pathological : understanding and evaluation of the actions, movements, reactions or stimuli of the organism, whether they are normal or the result of pathologies.
That is, it is necessary to know the micro actions of the body to understand the correct organic functioning, assessing and considering the patient in full.
But it is not just that, as the physiotherapist still needs a psychosocial understanding that is capable of meeting the reality and needs of each individual.
As it is a wide area, the specialties are diverse, although the importance of a qualified professional to perform the activity is not always recognized. Many people undergo treatments that are done by people without training, sometimes due to lack of information, sometimes because they think there are no risks.
The fields of expertise and expertise recognized by COFFITO – Federal Council of Physiotherapy and Occupational Therapy, are:
- Physiotherapy in Acupuncture;
- Aquatic Physiotherapy;
- Cardiovascular Physiotherapy;
- Dermatofunctional Physiotherapy;
- Sports Physiotherapy;
- Geriatric Physiotherapy;
- Occupational Physiotherapy;
- Neurofunctional Physiotherapy;
- Physiotherapy in Oncology;
- Respiratory fisioterapy;
- Traumato-Orthopedic Physiotherapy;
- Physiotherapy in Osteopathy;
- Chiropractic Physiotherapy;
- Physiotherapy in Women’s Health;
- Physiotherapy in Intensive Care.
For physiotherapist Carlos Henrique Canedo, physiotherapy has a fundamental role in promoting health and quality of life. Returning autonomy and independence to the patient is one of the main points of the professional’s performance, but the prevention of pathologies and maintenance of well-being have been a field of intervention in evidence.
We do not always know what physical therapy is for, as many people think it is only indicated for injuries or after surgery.
Although the most recurrent visits to clinics, they are usually due to injuries, fractures and changes that restrict the patient’s mobility, but it is not only in rehabilitation that physical therapy is applied.
Although the scenario is changing, the profession is still often characterized as a secondary or codependent treatment of other medical procedures and the struggle of the category aims to disassociate the intervention from secondary or optional assistance.
Physiotherapists have conquered their autonomous space in the intervention and prevention of health and well-being in the various active areas.
That is, having physiotherapy sessions should not be a measure of last resort or delimited by other treatments.
Several studies point out the significant improvements in the quality of personal, social, physical and mental life when there is the performance of the physiotherapist, either as a therapeutic, palliative or preventive mode.
For Dr. Carlos Henrique Canedo, physiotherapy acts, therefore, to “restore the best possible physical condition of the patient, acting in the control of initial pains and, later, rehabilitating them to return to their daily activities”.
There are several possibilities for the professional to perform the intervention, which will be determined according to the patient’s condition. Factors such as the routine, the size of the pain, the resources available for treatment, as well as the time of treatment are considered.
It is difficult to determine how a session takes place, as this will depend on the patient’s condition. However, if we consider clinical physiotherapy, most patients undergo an evaluation in which pain, complaints and limitations are checked.
After identifying the main objective of therapy – reducing pain, recovering muscle, correcting posture – low-impact physical exercises are recommended to improve movement and amplitude.
After the exercises, it is possible that waves of electrostimulation are applied to stimulate and strengthen the muscles.
All exercises are taught and monitored by the professional and will depend on each case, but some basic exercises from physiotherapy sessions can be:
Lying on your stomach, with your legs and spine aligned, you should place your hands at chest level. Raising the shoulders and gradually removing the trunk from the ground, but keeping the pelvis region on the ground.
To do this, use the strength of the arms, extending them almost completely (be careful not to force the elbow joint), so keep your arm slightly flexed.
Lying with your back on the floor, with your knees bent and your hands parallel to your body (extended to the side, with your palm on the floor), you should raise your hips, keeping your spine aligned.
With your back flat on the floor and your legs flexed, you should keep your knees together. Swing your legs on your hip axis, throwing your knees to the sides, avoiding moving your shoulders and neck.
Sit on the floor with your legs extended and slightly apart. Keep your spine aligned and gradually try to reach the balls of your feet until you feel that the thigh muscle (flexors) is stretching.
Elongation of the inner thigh
Sitting, with your spine aligned, bend your legs and bring your feet together, making the butterfly position. Keep the soles of your feet together and gradually separate your knees.
Stretching for the neck
Standing, keep your spine well aligned and your feet parallel and slightly apart. Place your hands behind your head and tilt it slightly, looking down.
To stretch the side muscle of the neck, place your left hand behind your head and pull it to your left side, looking down as well. Repeat the movement on the right side with your right arm.
Stretching the arm
Standing, with your spine erect and well aligned, and your feet parallel and slightly apart, lift one arm and place it behind your head.
Bend your elbow, as if your right hand is trying to reach your left shoulder. Repeat the process with the other arm.
Although the training is initially one, there are several types of physiotherapy. After graduation, the physiotherapist has the capacity to act in several areas that include the care, assistance, prevention and rehabilitation of the patient or client.
In addition to general care, such as clinics or hospitals, which can serve the most diverse staff, the professional can opt for a specialization, dedicating himself to a segment.
Crefito recognizes as a postgraduate specialist any professional duly trained by higher education institutions approved by the MEC, and who undertake a postgraduate course with a minimum workload of 750 hours.
Specialization courses must provide theoretical bases and training activities, under supervision, for professional practice restricted to areas of specialty. In other words, the student finishes the postgraduate course with practical knowledge of his area of expertise.
Below you will find some specialties that the professional can practice, remembering that there are specific actions of the physiotherapist and others that can also be performed by professionals from other areas.
Acupuncture consists of therapeutic practices based on Eastern medical traditions that stimulate points on the body in order to reduce pain, treat dysfunction, prevent disease and promote more well-being.
For the World Health Organization (WHO), the practice is considered a complement to modern medicine and, in Brazil, it is recognized as a medical specialty by the Federal Council of Medicine.
According to the resolutions of Coffito 60/85, 97/88, 201/99 and 219/00, the duly registered physiotherapist is qualified to exercise acupuncture.
In addition to traditional acupuncture, the application of electroacupuncture has been of great interest to professionals and patients. The procedure aims to enhance the effects of the traditional technique with the use of small pulse chains in the body’s tissues.
Studies on the practice point to more immediate and wider effects. While acupuncture promotes and highlights pain relief, electroacupuncture can reduce muscle spasms more efficiently , by increasing local blood circulation, in addition to stimulating the tissue recovery process.
The small needles cause very moderate pain, well supported by most people, and patients report that the difference between the methods is small. Basically, the holes are accompanied by a slight tingling or tickling sensation due to the electric current.
Dermatological interventions can be recommended for patients who have pathological conditions or want to improve aesthetic aspects. According to the resolution of Coffito 362/09, the physiotherapist is able to assist, treat and recover the skin’s functionalities.
Diseases such as ulcers, scars, wounds, cancer , skin aging, stretch marks , acne , localized fat, pre and postoperative are some of the conditions that can refer the patient to dermatofunctional physiotherapy.
Attention to the worker’s health is also the role of the physical therapist. According to Resolution Coffito 351/08, it is up to the professional to contribute to actions of prevention, promotion and restoration of the worker’s health, in the collective or individual sphere.
Therefore, the physiotherapist can be integrated into the companies’ routine or act in a timely manner in assessing the quality of the environment.
That is, to observe if there are risks to the integrity of workers, systems that are harmful to physical and functional health, in addition to assisting in the planning and implementation of educational actions on occupational accidents, functional and occupational diseases.
Thus, it may be that a physiotherapist starts to monitor your work habits or, in a few days during the month, go to visit the company. But it is only to guarantee better environmental conditions.
For Dr. Carlos Henrique Canedo, physical therapy contributes by providing health and well-being assistance, reducing the risks of dysfunctions or future problems. For the professional, “we can see that the concern with prevention has increased a lot, in the past, people only thought about physiotherapy when they were already in a pathological condition”.
Dysfunctions or occupational problems cause many workers to withdraw from their jobs. In addition to causing damage to the employee’s personal life, the withdrawal triggers other consequences, such as impacts on health investments and changes in business productivity.
If more people get hurt, the greater the amount of money invested in these therapies, which is often withdrawn from other areas of health. Therefore, prevention is always ideal and welcome.
However, occupational problems are not always perceived or treated with due attention in the business sphere. Thus, occupational physiotherapy observes, prevents and optimizes work processes and environments.
If the need to get away from sports or physical activities already generates immense disorders for those who practice just for pleasure, imagine when it comes to professional players or sportsmen.
Since players’ high salaries are clearly maintained when they are injured and need to stay out of games, the damage to the teams is immense.
To get a sense of the impact that a fall or muscle break can cause, British insurer Jardine Lloyd Thompson (JTL) has estimated the expenses of clubs competing in the Premier League.
The 20 English teams considered in the assessment spent, in just 6 months, about R $ 606 million in salaries for players on leave due to injuries. Not to mention the treatments.
In order to prevent, minimize the risks or – when it has already occurred – treat the injury, a properly trained professional is needed for the patient to return to activities. And it is not just the players and sportspeople, as practitioners of any physical activity and even weekend athletes need to be referred for rehabilitation.
Resolution Coffito 337/07 establishes that the practice and promotion of sports physiotherapy is exclusive to the qualified physical therapist.
It is up to him to develop and intervene in the sphere of health, sport and leisure, preventing, treating and recovering injuries, injuries or functionalities of the body systems.
The accompaniment of physiotherapists in sports centers or high-intensity training is essential, as the neglect of injuries or the poor execution of exercises can cause severe damage to the life of the athlete or patient.
The physiotherapist can act in the treatment of diseases or neurological dysfunctions already installed that cause physical or neuromotor limitations to the patient.
The purpose of follow-up should be the rehabilitation of the patient, aiming to return or guarantee their independence and autonomy, which can be restricted by neurological and degenerative diseases and their consequent complications.
With regard to children, the physiotherapist can act to offer better conditions for the development and growth of the patient, considering their neurological, psychological and motor skills.
Resolution Coffito 207/00 determines that the denomination of specialist in neurology or specialist in neurofunctional care is only granted to the physiotherapist who performs a postgraduate course with residency assignments, with in-service training, and is recognized by the agency.
The conditions treated and alleviated by neurofunctional physiotherapy are diverse and the importance and effectiveness of the professional’s performance in accompanying the patient is increasingly recognized.
The faster the intervention starts, the better the results and the progression of the clinical picture. Among the conditions assisted by physiotherapists are:
- Multiple sclerosis;
- Duchenne Muscular Dystrophy;
- Alzheimer’s disease;
- Parkinson’s disease;
- Cerebral Palsy (CP);
- Facial paralysis;
- Down syndrome;
- Cranial Injuries (TBI);
- Traumas Raquimedulares (TRM);
- Guillain-Barré syndrome.
In these cases, the professional will stimulate and enable the patient (be it an adult, child or elderly person) to maintain their daily activities, avoid social isolation, optimize their daily actions by reducing pain and discomfort, improving posture and muscle tone, preventing and treating deformities (congenital or acquired), adapting to the use of orthoses and prostheses if necessary and preventing aggravation of diseases.
Oncological treatments can affect the kinetic-functional capacities and the integrity of the patient, with the role of oncological physiotherapists acting in rehabilitation, prevention or maintenance of quality of life.
The interventions are different and depend on the patient’s condition. Cancer treatments involving radiotherapy, chemotherapy or surgical intervention, can involve and cause impacts on motor or functional independence.
The physiotherapist can act both pre and postoperatively, playing an important role in cases of breast , head, neck, bone tumors, spine, uro and gynecological cancers, for example.
Even in non-surgical treatments for cancer, the patient may experience pain, fibrosis, reduced movement, muscle shortening, difficulty in motor control and muscle weakness.
These conditions are minimized or resolved with physical therapy.
Resolution Coffito 220/01 determines that the physiotherapist is responsible for the professional practice of osteopathy.
Created by the American doctor Andrew Taylor Still during the American Civil War, at the end of the 19th century, the practice is considered an intervention of alternative medicine or non-conventional therapy that uses musculoskeletal manipulation (muscles, bones and joints) to treat diseases and relieve symptoms.
Osteopathy can be separated into:
- Structural – focusing on the functioning of bone, muscle, neural, fascial and ligament tissues;
- Postural – aiming at maintaining, obtaining or recovering the proper posture;
- Visceral – intends to reduce the organic disturbances caused by the imbalance between the structures of the organism.
Therefore, it is through mobilization and manipulation techniques that the physiotherapist promotes pain relief, corrects postural dysfunctions, restores balance and muscle strength, in addition to reducing other disorders that may affect the patient’s routine.
Respiratory physiotherapy (Pneumofunctional)
The physiotherapist focused on the pneumofunctional area acts in the prevention, recovery and maintenance of the health of the respiratory system.
Respiratory diseases can affect patients and cause dysfunctions in the skeletal muscle (diaphragm), muscle metabolism and blood oxygenation.
Usually, the professional specialist in pneumo-functionality works in hospitals, outpatient clinics and intensive care centers (ICU). But it is possible that the clinical action also requires physical therapy intervention focused on the respiratory tract.
Especially with the arrival of winter, breathing difficulties may become more evident in the elderly, children and debilitated patients. Some diseases are widely benefited by physical therapy, such as cystic fibrosis , chronic obstructive pulmonary disease ( COPD ), pulmonary fibrosis, bronchiectasis, pneumonia and respiratory failure.
According to Resolution Coffito 399/2011, the professional physiotherapist specialized in chiropractic works to prevent diseases or worsening of pathologies, in addition to physically rehabilitating the patient for routine activities.
For the World Health Organization, chiropractic works in the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system. That is, the integration of the nervous, muscular and bone systems.
It is through the application of massages and physical manipulations (muscular and articular), especially of the spine, that the specialty acts.
Chiropractic care should be a complementary and associated treatment, when there is a need to use medications, for example.
However, the therapeutic purpose is to reduce or dispense with the use of medicines or surgeries for pain, especially those in the pelvis, sciatica, shoulders, back, hips, head and limbs.
Women’s health and urogyneco-functional
For Coffito, in Resolution 372/09, it is up to the physiotherapist to act in physical therapy care in women’s health.
Initially, the specialty was called urogineco-functional and was intended solely or mostly for dysfunctions or changes in the woman’s genital and urinary systems.
However, in order to amplify assistance to female integrity, the specialty came to be called physiotherapy for women’s health, comprising the specificities of the female body, as well as psychological and social aspects.
The specialty understands that the organisms of women and men are different and, therefore, it is necessary that different interventions are made, respecting biological and social particularities.
You may have heard of pompoarism, the Indian practice that strengthens the musculature of the vagina.
Intimate gymnastics is recommended by health professionals because it helps to reduce colic and the menstrual period, can decrease the symptoms of menopause , prepares the pregnant woman for the moment of delivery and recovery, helps to prevent and treat urinary incontinence.
According to Crefito 10, pompoirism is one of the traditional practices that is currently supported by physiotherapy.
Women’s health specialists can draw on the knowledge brought by tradition, adapting it to the knowledge and goals of pelvic physiotherapy.
Physiotherapeutic performance in pregnancy
Obstetric physiotherapy works before, during and after the pregnancy period, working on the body systems to bring more quality, comfort and well-being to the pregnant woman. It is mainly through stretching, breathing, relaxation and muscle strengthening exercises that the professional acts.
The physiotherapy indication is very relevant even in women who are physically active and with healthy routines, because during pregnancy there is an overload of specific muscles of the pelvic floor.
With a qualified professional, the pains and complaints that are common and recurrent during and after pregnancy can be minimized and even avoided.
In addition, the moment of delivery demands a very high body action and needs psychophysical preparation and monitoring.
If the woman feels that her body is conditioned and prepared to give birth, surely the anxiety will be lessened and the whole process of childbirth will be smoother.
Cardiology and respiratory physiotherapy in Intensive Care (ICU)
You have probably noticed that the ICU, or intensive care units, is always aimed at patients in an aggravated state.
The environment is, in fact, aimed at patients with clinical complications and who need continuous monitoring, with controlled conditions (such as oxygen supply and cardiac monitoring).
Therefore, the physiotherapist who works in the ICU provides multidisciplinary care (that is, acting with other specialists is essential), mainly in maintaining vital functions, such as breathing and heartbeat, preventing complications and improving circulatory actions. that the physiotherapist is dedicated to.
The methods and interventions applied will vary according to the needs and possibilities of the patient, but respiratory and musculoskeletal exercises can be applied.
An article published in 2009, in the Revista de Terapia Intensiva, points out that it is already recognized that the early action and mobilization of patients in the ICU brings more stability and progress in the quality of life of patients.
The activities and interventions of the physiotherapist are quite comprehensive and, among the interventions, are:
- Motor exercises in bed;
- Bedside sedation (position the patient in a sitting position);
- Orthostatism (positioning the patient in a standing position);
- Walking (short or short walks);
- Correction of the patient’s position on the bed for correct breathing;
- Exercises with the assistance or intervention of the physiotherapist (active-assisted and resisted) for the joint and muscles.
In addition, Coffito recognizes, under Resolution 402/11, that the professional physiotherapist is able to work in neonatal, child and adult intensive care.
Diagnostic trauma-orthopedic physiotherapy monitors, prevents and treats musculoskeletal disorders, which can be caused by injuries, trauma or orthopedic diseases.
In general, that muscle rupture or dislocation due to physical exercises are treated by this specialty, but not only that. Because patients who present changes in posture due to spinal deviations or who have undergone surgery and amputations can also turn to the professional.
In order to reduce or resolve pain and quality of movement, the physiotherapist promotes:
- Improved muscle strength;
- Aid in stretching and muscle length;
- More flexibility;
- Better joint movement and amplitude.
These actions and interventions result in more quality in daily and specific activities (such as climbing stairs and playing sports).
For the action of aquatic physiotherapy, the physical properties and principles of water and the effects on body systems are considered.
You may have heard about the benefits of hydrotherapy or swimming for those who want to lose weight or need to recover from injuries. This is because water generates greater resistance to body movement, while reducing impacts.
That is, it is necessary to apply more strength to complete the movements, but your joints suffer less and, consequently, the risks of injury during exercise are lower.
Pain relief, reduction of muscle spasms, rehabilitation of joint amplitude, muscle and postural strengthening, as well as respiratory recovery are some of the works developed in aquatic physiotherapy.
According to Coffito Resolution 443/14, the specialty encompasses the use of water in different environments or contexts for the performance of physiotherapists within the scope of:
- Hydrotherapy: different uses of water for therapeutic purposes;
- Hydrokinesiotherapy: exercises and therapy performed in water, with immersion of the patient, in order to treat various pathologies;
- Balneotherapy: treatment and alleviation of symptoms through baths (therapy is widely applied in patients with burns);
- Crenotherapy: set of actions and interventions that uses baths or the ingestion of natural mineral waters with therapeutic agents to treat and prevent various pathologies;
- Thermalism: treatment done directly in natural thermal environments that may involve, in addition to baths, the use of natural products taken from the spring, such as vapors, gases and sludge;
- Showers: are applied in a localized manner, helping in muscle relaxation and relief of contractions;
- Compresses: hot or cold compresses are applied according to the patient’s condition, helping with muscle recovery, circulation or pain relief;
- Vaporization / inhalation: indicated mainly in the treatment and improvement of breathing;
- Cryotherapy: cold therapy acts to reduce pain, decrease inflammatory processes, decrease muscle spasms and cell metabolism, by reducing blood flow at the application site;
- Thalassotherapy: uses sea water in a therapeutic and controlled way, as well as naturally marine products (such as algae and sludge) for physiotherapy treatment.
Specialized care for the elderly
In 2014, the process started for the segment to be recognized by Coffito as a specialty, but only in December 2016 did gerontology be assigned as a branch of physiotherapy as well.
Geriatric care and attention is aimed at caring for the elderly, with an emphasis on healthy aging, as quality of life, independent mobility and well-being can be affected throughout life, causing the elderly to have specific needs.
Age does not always cause disease or dependency, but there are conditions that are favored with aging, such as a drop in immunity, muscle weakness and difficulty in walking. In addition, there are diseases associated with age, such as Alzheimer’s and Parkinson’s disease.
Even if the patient does not present severe weaknesses or functional difficulties, the physiotherapist, in addition to rehabilitation, acts in the prevention or optimization of the physical and psychomotor mechanisms, as there are a series of physical, organic and psychosocial changes that can compromise the health of the elderly.
By increasing and maintaining muscle strength, flexibility, balance and motor coordination, there is a reduction in the risk of injuries and fractures due to falls.
The respiratory and cardiovascular systems are also worked on, monitored and benefited from physiotherapy, increasing the quality of life and favoring the patient’s longevity.
The electrotherapy technique consists of applying low intensity electric currents directly to the affected region or under treatment. The procedure is widely used in patients with muscle injuries, in post-surgery or in the treatment and monitoring of some pathologies.
The use of electrostimulation techniques aims to optimize therapy, combining resources in search of improving the person’s condition. In general, currents act by stimulating more intense or accelerated responses.
Among the indications and applications of electrophysiotherapy are:
- Control and reduction of pain, improving the patient’s movement;
- Aid in reducing the accumulation of fluids and swelling (edema);
- Muscle relaxation;
- Decrease in muscle contractures;
- Aid in soft tissue regeneration: acts in stimulating collagen tissues and fibers;
- Stimulation of bone healing in fractures;
- Improves muscle performance.
Know some of the electric currents applied by physiotherapists:
Transcutaneous electrical nerve stimulation therapy (TENS)
TENS is indicated for the treatment and relief of pain, usually associated with the practice of physical exercises.
With electrostimulation, the stimulus, excitation and depolarization of nerve fibers are favored, causing the perception of pain to be controlled.
Electrodes are placed in the sensitive area and adjustable electric currents are applied, which may vary according to the sensitivity of each patient.
Research published in the American Journal of Nursing shows that patients experience relief of up to 60% in pain caused by peripheral neuropathy, peripheral nerve damage, radiculopathy and musculoskeletal pain after just 5 sessions.
Another study pointed out that 12 days of treatment with electrostimulation provided improvements in 69% of patients with back pain and 40% with headache.
The Russian chain was created in order to stimulate and tone the muscles. Currently, the current is applied at an average frequency of 2,000 Hz to 10,000 Hz, with a pulse that can vary from 50 to 250 microseconds.
The application is varied and, according to a study published in the Brazilian Archives of Digestive Surgery, in 2012, the technique can be indicated to improve muscle tone, reduce flaccidity, stimulate blood circulation, in addition to improving cellular oxygenation.
There are aesthetic applications including to reduce cellulite , sagging and promote the reduction of localized fat.
The current has a low frequency and acts to decrease pain and improve muscle performance. The therapy offers few adverse effects and accelerates the patient’s recovery and rehabilitation.
In the application, its alternating electrical currents are used with medium frequency, resulting in a low frequency therapeutic current indicated for chronic or acute pain.
Applications and indications for treating interferential current include low back pain , neck pain, myofascial pain, knee pain (including those caused by the postoperative period), psoriatic arthritis, intestinal constipation and pain caused by excessive exercise or muscle injuries.
The electromagnetic action reaches the deepest soft tissues, acting on the increase and stimulation of collagen, pain relief and decrease of spasms. Providing a rapid vibration in the tissues, the procedure causes them to be heated and the vessels to dilate, providing pain relief.
Bruises, muscle hypotrophies, muscle stiffness and immobility, arthritis, periarthritis, bursitis , myalgia, low back pain and fibrosis are some of the conditions that can be treated with short waves.
Ultrasound is capable of emitting waves that produce vibration movements, resulting in an increase in local metabolism. That is, the blood is stimulated to circulate more in the region.
With high blood flow, there is more nutrition, oxygenation and tissue regeneration. Cases of tendonitis , myalgia, contractures and muscle tension, and scarring can be favored with the procedure.
Through the phototherapy process, the laser relieves pain, acts as an anti-inflammatory and stimulates tissue cells, accelerating regeneration and healing.
Inflammatory processes and soft tissue injuries (such as tendons, muscles and ligaments), edema, nerve damage and open wounds that take time to heal can be treated with the laser.
According to the physiotherapist Carlos Henrique Canedo, the professional physiotherapist should always be sought when the person is in any condition of physical weakness, with difficulty to perform routine activities at home or at work.
These restrictions can be caused by pain or physical limitations, compromising the patient’s routine and quality of life.
It is also important to resort to physical therapy in cases of constant pain, be it in any intensity.
In addition, according to the professional, physiotherapy acts to prevent these problems. So don’t wait for pain, injury or pathology to show up to see a specialist.
There are 4 or 5 years of studies and dedication to understanding the organic functioning to train physiotherapists. The bachelor’s degree course is composed of multidisciplinary approaches, ranging from the biochemical studies of the organism, to the stages of application and practice of learning.
The idea that physical therapy only works with rehabilitation is still very much present. An example of this is Loyhrana Pilato, a graduate student in physiotherapy, who reports “before studying, I believed that it was a course that was very much geared towards rehabilitation and that physiotherapists only worked in clinics, nor did I imagine that there would be several areas of activity, I ended up being surprised” .
If the area initially seemed to be focused on treating injuries and injuries, mainly being restricted to clinics, it was enough to witness a little bit of the professionals’ routine for the professional interest to be aroused.
After monitoring the mother’s treatment, who needed to be referred to some physiotherapy sessions, Loyhrana discovered many more possibilities for action and intervention by the physiotherapist.
After completing graduation, the professional acquires general training and is able to take care of the health and well-being of the elderly, the child, the woman, the worker, the family, the pregnant woman, the sportsman and the community, for example.
The physiotherapist deals directly with the patient, accompanying him in his treatment and evolution, so there is a need to understand him in addition to dysfunctions or pain. For this, the social and psychological aspects addressed during graduation are essential.
As well as professional training at a higher level, the course offers extensive training, presenting the possibilities to the student. After experimenting with the different areas of physiotherapy, the skills and interests become evident and assist in professional guidance.
After completing the training, it is necessary to register professionally with the Regional Council of Physiotherapy and Occupational Therapy, enabling the newly graduated to exercise the profession legally.
Those who want to improve or continue their studies, focusing on the area of interest, find specializations in clinical, cardiopulmonary aesthetics, functional dermato, neurofunctional, pediatric and neonatal, respiratory, orthopedic trauma, sports and making orthoses, for example.
Until 2017, according to a survey by the Federal Council of Physiotherapy and Occupational Therapy (COFFITO), Brazil has 243,644 registered physiotherapists.
A census conducted by Crefito-3 raised data on 24,822 trained professionals and found that about 32% do not have paid activities in the area and 18% work without ties to institutions or clinics.
Where to work: what areas can a physiotherapist work in?
Anyone who thinks that a physiotherapist works only in clinics or hospitals is well mistaken. It is enough to know the performance routine better to see that the professional can work in different places and segments, allowing different interventions. Between them:
According to the Brazilian Physiotherapy Society (SBF), clinical physiotherapy is dedicated to diagnosing, preventing and treating patients in an articulated way, aiming to train or rehabilitate them to daily and specific activities (such as walking or playing sports).
For this, the attention to the patient or client must be aimed at solving the problem or difficulty with the greatest effectiveness and in the shortest possible time.
Among the possible places where the clinical physiotherapist works are outpatient centers, private offices, multidisciplinary clinics (where there are other specialties working together), rehabilitation centers and hospitals.
In the routine of physiotherapist Carlos Henrqiue Canedo, who attends especially traumatic-orthopedic and sports and postural cases, it is the patients with spine, knee and shoulder injuries, including the postoperative cases, are the most frequent.
The professional highlights the importance of prioritizing individualized care, identifying the needs and characteristics of each case. Thus, after the kinetic-functional evaluation, it is possible to refer the patient to specific treatments and, consequently, more effective.
Collective Public Health
The physiotherapist is able to act in the prevention and attainment of health in the community, advising on monitored physical activities, the practice of healthy habits and quality of life.
Together with the families, the physiotherapist can act in an interdisciplinary manner, promoting assistance to relatives, informing and conducting a complete recovery of the patient. In addition, family care optimizes the social integration of the different groups served.
For this, the professional can participate in basic health actions, institutional programs and even physical therapy at work.
The professional physiotherapist can also work in educational and training centers, in the areas of research and extension, teaching, course coordination, service centers and hospitals, in addition to technical and administrative supervision.
In general, the fields most attributed to the area of education are colleges and postgraduate courses, in which the physiotherapist acts as a teacher, coordinator or researcher, however, it is necessary that hospitals and clinics have trained professionals for the supervision and administration of the place .
The physiotherapist who works in the home care modality can work privately or in association with clinics and hospitals that offer the service.
Through extra-institutional care (outside clinics and hospitals), the professional performs interventions mainly at the patient’s or client’s residence, maintaining the therapeutic principles of clinical care: making the diagnosis, treatment, prevention and rehabilitation encompassing the physical, social aspects and psychological aspects of the patient.
Home care is ideal in cases where the patient is weak or unable to move.
But there are advantages of the modality even for people who do not have severe motor impairment, as performing care at home can reduce risks of infection, reduce stressful processes (especially in elderly patients or with social phobia ), integration of the family in therapy, improves the understanding of the routine and setting by the professional.
Gyms and clubs
The integration of professional physiotherapists in gyms and sports centers has increased in recent years due to the understanding of the importance of multidisciplinary care.
Together, physiotherapists and physical educators accompany students and athletes more effectively, reducing the risk of injury and improving quality and physical capacity.
Industry and Commerce
In addition to working in direct care to the patient or client, the physiotherapist still finds a professional space in industry and commerce, as the demand for prostheses and orthoses requires the correct monitoring, production and commercialization.
Pilates works on aspects of breathing, concentration, balance, spatial orientation, coordination, stretching, mobility and flexibility. The strength and endurance of the entire body are required, working specific muscles in an integrated manner.
The practice is offered in private studios, gyms and sports centers. But after all, who can teach pilates classes?
The professional qualified and qualified to offer a pilates class is, according to the legislation, the physiotherapist and the physical educator.
And no matter the location of the class – at the gym, pilates centers or clinics – to be properly trained, in addition to training in physiotherapy or physical education, you need to take the pilates training course.
Research demonstrates the effectiveness of the activity’s action on the patient’s health and well-being. An article published in the journal of the Salus Institute, points out that pilates can be performed with several objectives, such as:
- Obtaining and maintaining quality of life;
- Rehabilitation for patients with some neurological disorder, chronic pain, orthopedic problems and spinal disorders, for example;
- One-off treatments for postural or trauma-related pain.
Physiotherapy and Occupational Therapy (TO) share the same Council – COFFITO – and together they seek to maintain and recover the integrity of the patient or client.
Although, in some cases, activities come together – working on rehabilitation through physical activities, for example -, they have different lines of action and are not substitutable. That is, many times those who do physical therapy may also need occupational therapy.
The modalities must go together and, as Nachaly Neves, occupational therapist points out, are complementary.
While OT works mainly with daily activities (called activities of daily living – ADL) and uses them as a resource to achieve therapeutic goals, physiotherapy stimulates, recovers, rehabilitates and maintains muscle tone and movement through exercises and appliances.
In general, according to the occupational therapist, patients who are referred to OT have some dysfunction in the areas of occupation, activities of daily living (ADL), instrumental activities of daily living (IADL), education, work, leisure, sleep and rest, social participation and, in the case of children, playing.
It is necessary to consider joint therapy to optimize the recovery process, if necessary. But the correct indication for each specialty must start from the assessment and diagnosis of trained professionals.
The appreciation and recognition of the professional physiotherapist is, still, a constant battle. As physiotherapist Carlos Herique Canedo points out, even though the medical profession and society in general have valued physiotherapy more, the area still needs to establish its autonomy and importance.
“There is a lot of interference in the autonomy of the physical therapist. We know that there is total autonomy and capacity for the evaluation and development of the treatment plan from the beginning to the moment of discharge, but this often does not happen. ”
It is up to the physiotherapist to indicate and monitor exercises according to the patient’s condition, as well as, it is essential that the interruption of activities is done after the professional’s evaluation.
In addition to the need to present its functionality and importance in the social sphere (showing the importance of people only doing physiotherapy treatments with qualified and certified professionals), physiotherapy also finds it difficult to situate its importance among health professionals as well.
If, before, it was treated as an assistant medicine practice, currently professionals still find it difficult to position themselves as an autonomous area of health.
The initiatives that encourage patients and clients to seek health, aesthetic and functional treatments only with qualified professionals, help to avoid consequences such as poor resolution of the problem or, even worse, the worsening of the condition.
Factors such as remuneration, working conditions and the awareness of responsible companies (which offer services only with qualified professionals) are still constant struggles in the specialty, as explained by Dr. Canedo:
“I believe that people do not appreciate what the physiotherapist’s job really is. We have a huge gap in the values practiced due to the difficulty of patients’ acceptance. ”
The professional adds that the companies involved in the provision of health plans generate difficulties in salary negotiation, making the physiotherapist’s remuneration, in general, far removed from that deserved.
Although the records of therapies through body movements are old, the recognition of the professional status of physiotherapy is quite recent, making it considered a relatively new area in the sphere of health.
Ancient people resorted to natural elements, such as sun, water, heat and their own body movements to relieve pain and treat diseases. Even Hippocrates (460a.C to 377a.C) described that fractures and dislocations were treated using traction devices, approaching or referring to current therapeutic tactics.
According to researchers who trace the trajectory and precursor events of physiotherapy, it was in the period of the renaissance that the knowledge of body movement began to be used for aesthetic, therapeutic and health purposes.
At the time, the concern with beauty and symmetry resulted in greater attention to body functioning. It was in the 1770s that activities close to what we know as kinesiotherapy started to be employed – that is, using body movements to treat pain and dysfunction.
But not only from the attention to the physical and functional aspect was physiotherapy born. Researchers point out the importance of psychoanalysis and psychological therapies in the design of the profession.
At the time when psychoanalysis began to be studied, professionals – among them Freud – began to observe and draw a parallel between mental states and the organism’s responses.
Through therapies focused on the state of emotions, the aim was to alleviate physical symptoms, such as pain, infections, discomfort and organic changes.
The understanding of the impact of feelings on biological health remains present in the approach and principles of physiotherapy. In addition, the context – or social context – is also linked to current practice, since the environment we are in is responsible for our mental health .
As a profession, physiotherapy was born in the twentieth century, in the period of wars. As there were a large number of soldiers wounded, debilitated, amputated and, therefore, prevented from continuing with their activities – from working, bathing or eating – the need for therapeutic intervention was seen.
In the beginning, the approach was carried out without many clinical or medical parameters, promoted by volunteers on the battlefield. With the return of soldiers to their common activities, voluntary assistance gained a fundamental character and began to develop.
Through intense changes in the approaches, techniques and understanding of professional action, therapy – which was beginning to take the molds of current physiotherapy – followed and traced an important path of the 20th century in the understanding of health, rehabilitation and well-being.
In Brazil, physiotherapy started at Santa Casa de Misericórdia de São Paulo, in 1929. Although the performance started early, it was only in 1951 that the first professional training course in physiotherapy was planned and created by Dr. Rolim.
Still with a technical education title and degree, the course lasted about 1 year and trained medical assistants. Therefore, the struggle for the recognition of therapeutic importance is old and slow.
In 1959, the activities of the Brazilian Association of Physiotherapists (ABF) began, which, by joining the World Physiotherapy Confederation (WCPT), intensified the search for scientific, technical and social attribution for the profession.
Under Decree-Law No. 938/69, validated on October 13, 1969, physiotherapy started to be recognized and titled as a higher education. Until 1979, the course had a duration of 3 years and, from 1980, the training was 4 years.
Even with the increase in workload, between 1953 and 1983, the curriculum remained unchanged. In other words, the subjects were not very specific and did not pay attention to essential aspects of the physiotherapist’s performance. Only after 1983 was the curriculum reformulated.
In 1975, from Decree Law 6,316 of December 17, 1975, the National Congress decreed the creation of the Federal Council of Physiotherapy and Occupational Therapy (COFFITO) and the Regional Councils of Physiotherapy and Occupational Therapy (CREFITO).
Some people may even think that the decision to unite the physical and occupational therapy categories is due to the proximity of their work.
However, researchers in the historical process point out that, at the beginning, the number of professionals in these two areas was quite small, not reaching the amount needed to create a Council.
Therefore, the union of professionals was essential to forward the approval.
The Federal and Regional Councils of Physiotherapy and Occupational Therapy aim to standardize, monitor and ensure the proper ethical, scientific and social activities of physiotherapy and occupational therapy activities.
This means that the bodies exist to protect the professional’s work, ensuring that professional guidelines are respected.
Just as it is necessary for physiotherapists to be properly recognized and remunerated according to their functions, it is essential that there is regulation on who exercises and applies physiotherapeutic treatments.
For this reason, the aim of any professional Council is to ensure and protect the professional and the patients.
While COFFITO is the Federal Council, acting and determining the instances of physiotherapy at the national level, Crefitos are the Regional Councils that exist to represent the localities, making the closest mediation between the national sphere and the society served (be it the professional physiotherapist or the patient).
Several curiosities are part of the world of physiotherapy. From trends in the profession to the meaning of the physiotherapist symbol. Learn more about them:
The professional market is always constant and changing. As people change their habits and lifestyle, health specialties need to meet new demands.
However, congresses and physiotherapy specialists have pointed to 3 axes in the growth of the profession, which are sports, aesthetics and virtual reality or gametherapy. Know a little more about each one:
Of the recent market trends, this is the best known by the public and professionals. The action of the physiotherapist in sports clubs is already known, but there is a growth in the market also in gyms and sports centers.
Aesthetics has been an area of specialization for physiotherapists. The treatments employed require functional knowledge of the body’s systems and integrate equipment, such as electrostimulators.
Aesthetic centers offer services ranging from more superficial treatments (such as cellulite reduction), to post-operative ones that include improving the appearance of the skin and preventing sagging, accelerating healing.
Virtual reality and gametherapy
This is probably one of the most recent – and even curious – segments of the physiotherapist. The practice consists of using games and virtual reality to stimulate the patient’s action and interaction.
The movements tend to be better executed, as soon as the sound and visual stimuli are present. In addition, the sessions are more fun and less tiring, causing the patient not to abandon treatment so easily.
Physiotherapy symbol: what does it mean?
According to COFFITO, the official representation of physiotherapy is formed by 2 green snakes intertwining a golden ray, inserted in a cameo, which is an ancient and valuable stone.
Snakes signify strength, renewal, rejuvenation and goodness combined with wisdom and are represented in some other symbols related to health, such as nursing, medicine and pharmacy.
In addition, snakes can mean knowledge and knowledge, with green symbolizing health. The intertwining of animals refers to the union of fundamental and complementary activities and knowledge of the professional, as well as the link between the social, human and professional relationship.
The ray refers to light or illumination, used to indicate the transmission of values and knowledge. It also represents the union between personal, professional and social aspects, linking the measures used in therapy and individual knowledge.
The cameo is a valuable stone that, in addition to the aspects that can link it to preciousness, is folklore related to the attraction of health and good luck.
Cristiano Ronaldo’s physiotherapist is among the 3 best in the world
The professional physical therapist is not always in evidence in the world of sports. In games and competitions, the field or court is always occupied by coaches, technical staff and assistants, in addition – of course – to the players. But it is enough for an athlete to be injured for the physiotherapist to start being mentioned.
However, the professional’s work is continuous and has been carried out for some time before the player enters the field, trying to avoid the need to intervene and remove him due to injuries or muscle pain.
Football is one of the most talked about and followed sports in the world. The high investments in games and world championships makes the physiotherapist more and more recognized in the preparation and physical conditioning of the athlete.
Among one of the many players with high visibility is Cristiano Ronaldo, who, in 2018, boasted the highest salary from Real Madrid, the club he served in.
According to data from the sports press, the player accumulates around £ 40.50 per minute and in one month, his salary is £ 1,750 million. In Brazilian currency, this amounts to approximately R $ 95 million per year.
Such an esteemed (and expensive) player needs strong preventive physical support. Imagine the damage that an injury leave can cause?
Behind the strength and physical performance of Cristiano, there is the work of Joaquín Juan, a Spanish physiotherapist who accompanies several high-value athletes and sportsmen. The performance of the physiotherapist is so valued that Joaquim is considered one of the three best in the world.
The best physiotherapy course in the world
In 2017, QS University Rankings – which measures the quality and position of institutions around the world – reported that the University of Sydney was considered the best in the world in the category covering physiotherapy, sports therapy and rehabilitation.
To measure the quality of the course, the satisfaction of teachers and students is evaluated, as well as academic productivity and results for the community.
Physiotherapist is a doctor?
It is necessary to make a distinction between the terms “doctor” and “doctor”. While the medical professional is one who has a degree or a degree in medicine, a doctor is employed by several professionals, such as doctors, lawyers, psychologists, physiotherapists and people with a stricto sensu title at the doctoral level.
According to Resolution No. 23/2000 of Crefito 8, it is recommended that professionals adopt the use of a Doctor in the performance of their professional activities as treatment and recognition of their knowledge and training.
Therefore, a physiotherapist is not a doctor, but a doctor.
How much does a physiotherapist earn?
The physiotherapy wage floor is defined by the unions and regional councils, so it is necessary to consult Crefito to see the updated values.
Average estimates of how much each professional category earns in Brazil indicates that the average salary of the physiotherapist, considering the national territory, is 2300 reais.
But it is necessary to consider that there are several specialties and, therefore, the average salary may be influenced.
According to COFFITO guidelines, the remuneration of the self-employed professional can be accounted for in accordance with the table provided by the Board.
In summary, the physiotherapist should preferably consider a minimum value of 52 cents for each CHF (Coefficient of Physiotherapeutic Fees). The booklet presents the CHF suggested for each type of service, which must be multiplied by the amount stipulated by the professional.
It is worth mentioning that the parameter of 52 cents is an initial general value, and it is up to the professional to determine and evaluate the way in which the fees will be stipulated.
From this, one should consider, for example:
- Physiotherapeutic consultations and functional exams: between 20CHF and 2500CHF;
- Assistance in dysfunctions of the nervous system: between 100CHF and 180CHF;
- Assistance in the dysfunctions of the locomotor or musculoskeletal system: between 100CHF and 150CHF;
- Respiratory dysfunction care: between 80CHF and 150CHF;
- Home care: between 210CHF and 252CHF;
- Consultancy to physiotherapy at work: between 75CHF and 220CHF.
Physiotherapy has been increasingly recognized, but the fight for professional valorization is constant.
The development of the profession caused significant changes in the physiotherapist’s mode of action, making intervention tactics increasingly effective and focused on solving the problem.
Remember that every procedure must be accompanied by a qualified professional so that your health and well-being are preserved and improved.
Always consult a specialist and learn more about quality of life at Hickey solution.