PNF

The PNF therapy method (Proprioceptive Neuromuscular Facilitation) includes the examination of the patient, the planning of individualised short and long-term therapy as well as numerous therapeutic techniques. It is one of the few methods that has its own philosophy based on scientific research and over 50 years of experience in working with patients with neurological and musculoskeletal disorders.

I consider myself incredibly fortunate to have been introduced to the PNF method during my academic studies. This approach has profoundly shaped my practice as a physiotherapist, exerting a significant influence on the way I approach rehabilitation and patient care. I was enthusiastic about its philosophy and approach to patients. The positive approach, the holistic view of the person, the mobilisation of the patient’s individual resources and the application of the principles of motor control and motor learning sounded extremely interesting. Today, several research studies have shown that this philosophy is a valuable tool in treatment. After several years of assisting and further training, I myself have achieved the status of an international PNF instructor and specialist teacher. I now train physiotherapists in the PNF method.

PNF is a globally recognised therapy method used in rehabilitation to improve movement control, strength, coordination and functional mobility in patients with neurological diseases, orthopaedic injuries and other neuro-musculoskeletal disorders. This highly specialised treatment technique is based on the neurophysiological principle of sensory stimulation and motor response and aims to optimise the interaction between muscles, nerves and the central nervous system. In other words, the therapist attempts to direct the neuroplasticity of the brain through targeted stimulation.

PNF therapy comprises a variety of movement patterns and techniques aimed at improving neuromuscular control and functional movement behaviour. These include diagonal movement patterns, stretches, resistance exercises and specific stimulation techniques that activate the proprioceptive system and optimise muscle responses. One element of PNF therapy is the use of three dimensional manual resistance by the therapist to increase muscle activity and improve neuromuscular feedback. Through targeted resistance exercises along specific movement patterns, weak muscles can be strengthened, muscle imbalances corrected and functional mobility improved. Another feature of PNF therapy is the integration of movement patterns into functional activities of daily living. By applying the movement patterns in realistic contexts, the transferability of the newly acquired skills to everyday activities such as walking, gripping, lifting, turning, etc. is promoted.

PNF has been used successfully for a variety of neurological conditions and injuries, including stroke, spinal cord injury, multiple sclerosis, Parkinson’s disease, traumatic brain injury and orthopaedic problems such as muscle injuries and post-operative rehabilitation.

You can find out more about the PNF concept at: www.ipnfa.org

Therapeutic exercises

Therapeutic exercises are a branch of physiotherapy that focuses on the implementation of targeted exercises and movement programmes. It includes exercises to improve muscle strength, mobility, endurance and coordination as well as to relieve pain and promote independence in everyday life. They can be used for a variety of conditions and injuries, including orthopaedic, neurological and pulmonary conditions.

CMD

Craniomandibular dysfunction (CMD) is a complex group of disorders that can affect the temporomandibular joint and surrounding structures. Typical symptoms include jaw pain, restricted mouth opening, grinding or cracking in the jaw joint as well as headaches and neck tension.

Physiotherapy has been shown to be an effective treatment option for people with CMD (Dwornik et al., 2002). The aetiology is multifactorial and includes: posture, orthodontic treatment, occlusion, parafunctional habits, emotional stress, trauma, disc anatomy, muscle pathophysiology, and genetic and psychosocial factors (Bagis et al., 2012).

Since posture is considered a possible cause of TMJ problems, I not only examine the jaw, but also consider the patient’s entire cervical-neck area. Treatment usually involves a combination of different techniques and exercises aimed at relaxing the muscles, improving the mobility of the jaw and correcting posture. This includes manual therapy, stretching and strengthening exercises as well as relaxation techniques.

An important aspect of physiotherapy for CMD is training the patient in self-management techniques. This can include guidance on how to perform exercises at home, ergonomics in the workplace or behavioural changes such as stress management and avoiding teeth grinding.

Discover my favourite exercises for craniomandibular dysfunction:

Respiratory therapy

Respiratory therapy is a specialised treatment method in physiotherapy that focuses on improving respiratory function and breathing efficiency. It plays a crucial role in the rehabilitation of patients with respiratory diseases, such as COPD, after pneumonia or neurological disorders, as well as in the treatment of Long Covid, a condition that can occur after a Covid-19 infection.

Respiratory therapy includes a variety of techniques and exercises aimed at strengthening the respiratory muscles, improving breathing technique and increasing breathing capacity. This also includes training the diaphragm and the targeted use of breathing exercises to mobilise secretions.

World Physiotherapy published an information brochure on the topic of long Covid / post Covid in 2021 (1). You can find more information below.

(1) World Physiotherapy. World Physiotherapy Response to COVID-19 Briefing Paper 9. Safe rehabilitation approaches for people living with Long COVID: physical activity and exercise. London, UK: World Physiotherapy; 2021. ISBN: 978-1-914952-10-4

Gait analysis

Gait analysis is an important diagnostic method in physiotherapy that makes it possible to identify functional disorders and pathological movement patterns. It plays a decisive role in the assessment of gait disorders and the development of customised therapy plans.

I base the analysis on the research of Dr Jacqueline Perry (1). Her book ‘Gait Analysis’ has had a major impact on physiotherapy and laid the foundations for the division of gait phases.

A central point of gait analysis is the identification of deviations from the normal gait pattern. These can be, for example, uneven stride lengths, disturbed “foot – rolling” behaviour or asymmetrical loading of the joints.

Gait analysis is used in the diagnosis and treatment of various diseases and injuries of the musculoskeletal system. It is often used for patients with neurological disorders such as stroke, Parkinson’s disease or multiple sclerosis, but also for orthopaedic problems such as osteoarthritis, back pain and foot malpositions.

Another important area of application for gait analysis is rehabilitation after injuries or operations. By regularly monitoring and analysing the gait pattern, progress can be documented and therapy plans adapted accordingly to ensure optimal recovery.

(1) Perry J., Burnfield J.M.: Gait Analysis: Normal and Pathological Function. SLACK, 1992 ISBN: 1556421923, 9781556421921

Neurorehabilitation

Neurorehabilitation is a specialised field of physiotherapy that focuses on the treatment of patients with neurological diseases or injuries. Its aim is to improve or restore the physical, cognitive, emotional and social functions of people with neurological impairments. This holistic approach combines medical, therapeutic and supportive measures to meet the individual needs and challenges of each patient.

Our bodies are subject to ongoing processes of plasticity, in which some connections between synapses, nerves and muscles are broken down while others are built up and strengthened.

After a traumatic injury or degenerative damage to the neural structures, neuroplasticity can be channelled through targeted stimulation. This either stimulates the nervous system to support regeneration and the restoration of everyday activities, or compensatory strategies are practised. The overarching goal is always to promote the patient’s independence in everyday life and improve their quality of life.

Neurorehabilitation is used for a variety of neurological condition, including stroke, traumatic brain injury, multiple sclerosis, Parkinson’s disease, spinal cord injury, Guillain-Barré syndrome and many others. Each of these conditions can lead to different neurological deficits, such as paralysis, coordination disorders, gait instability, speech and swallowing disorders, memory problems and emotional changes.

The process of neurorehabilitation usually begins early after the onset of the neurological disease or injury and can involve different phases, including the acute phase, the rehabilitation phase and the long-term care phase. In each phase, specific goals are set and appropriate therapies are initiated to improve function and promote the patient’s independence.

Neurorehabilitation requires interdisciplinary collaboration between various specialists, including neurologists, physiotherapists, occupational therapists, speech therapists, neuropsychologists, social workers and nursing staff. In addition, supportive measures such as orthopaedic technology and the provision of aids can also be part of neurorehabilitation. A coordinated and holistic treatment concept can achieve the best possible results for patients and sustainably improve their quality of life.