World Physiotherapy Day: Physical therapy and mental health

Physiotherapy is a complete philosophy of dealing neuromuscular, musculoskeletal and other biomechanical disorders.

In physiotherapy, one increases the function and capacity of the body to perform movements and hence can remain mobile and functional. When there is some pathology or injury in joint, muscles, tendon or ligaments, the affected part tends to be immobilised by the body to avoid pain by limiting the movement. As a result, the affected part and even surrounding safe tissues lose their strength, flexibility and extensibility that further complicates the problem. Advance medical research has shown that early ambulation and mobility improve the healing process and prevent the further complications. This early ambulation and rehabilitation is the domain of physiotherapist. Physiotherapy is the one of the oldest profession in health care practiced since 460Bc by great physicians such as Hippocrates and Galen. The events such as First World War, polio-outbreak, increasing disabilities led to rapid progression and modernisation of physiotherapy from the 18th century.

Concept behind the physiotherapy techniques is the effect produced by physical stimuli on the body. Touch, pressure, heat, cold, stretch and currents are the physical stimuli that can produce effects on the body.

A clinical physiotherapist can observe the pathology and then can find the treatment based on biomechanical principles of the body. Physiotherapists are expert and qualified professionals with a sound knowledge of body mechanics and their abnormalities.

According to World Confederation of Physical Therapy, "Physical therapy is concerned with identifying and maximising quality of life and movement potential within the spheres of pro-motion, prevention, treatment/intervention, habilitation and rehabilitation. To create awareness in general public about physiotherapy World Physical Therapy Day is celebrated all over the world on September 8. The theme of this year is "physical therapy and mental health". Physiotherapy greatly affects the mental health conditions.

Physical activity and depression: Studies show that physical activity or exercise can treat mild to moderate depression as effectively as antidepressant medication but without any side effects. In addition to relieving depression symptoms, research also shows that maintaining an exercise schedule can prevent you from relapsing. Physical activity is a powerful depression fighter for several reasons.

Most importantly, it promotes all kinds of changes in the brain, including neural growth, reduced inflammation, and new activity patterns that promote feelings of calm and wellbeing. It also releases endorphins, powerful chemicals in your brain that energise your spirits and make you feel good.

Finally, exercise can also serve as a distraction, allowing you to find some quiet time to break out of the cycle of negative thoughts that feed depression.

Physical activity and anxiety: Exercise is a natural and effective anti-anxiety treatment. It relieves tension and stress, boosts physical and mental energy, and enhances wellbeing through the release of endorphins. Anything that gets you moving can help, but you'll get a bigger benefit if you pay attention instead of zoning out.

Try to notice the sensation of your feet hitting the ground, for example, or the rhythm of your breathing, or the feeling of the wind on your skin.

By adding this mindfulness element, you'll not only improve your physical condition faster, but you may also be able to interrupt the flow of constant worries running through your mind. Physical activity and stress: Ever noticed how your body feels when you're under stress? Your muscles may be tense, especially in your face, neck, and shoulders, leaving you with back or neck pain, or painful headaches. You may feel a tightness in your chest, a pounding pulse, or muscle cramps. You may also experience problems such as insomnia, heartburn, stomachache, diarrhea, or frequent urination. The worry and discomfort of all these physical symptoms can in turn lead to even more stress, creating a vicious cycle between your mind and body.

Exercise is an effective way to break this cycle. As well as releasing endorphins in the brain, physical activity helps to relax the muscles and relieve tension in the body. Since the body and mind are so closely linked, when your body feels better so, too, will your mind.

Physical activity and ADHD (Attention deficit hyperactivity disorder): Exercising regularly is one of the easiest and most effective ways to reduce the symptoms of ADHD and improve concentration, motivation, memory, and mood. Physical activity immediately boosts the brain's dopamine, norepinephrine, and serotonin levels, all of which affect focus and attention. In this way, exercise works in much the same way as ADHD medications such as Ritalin and Adderall. Physical activity and PTSD (post traumatic stress disorder): Evidence suggests that by really focusing on your body and how it feels as you exercise, you can actually help your nervous system become "unstuck" and begin to move out of the immobilisation stress response that characterises PTSD or trauma. Instead of thinking about other things, pay close attention to the physical sensations in your joints and muscles, even your insides as your body moves. Exercises that involve cross movement and that engage both arms and legs such as walking (especially in sand), running, swimming, weight training, or dancing are some of your best choices. Outdoor activities like hiking, sailing, mountain biking, rock climbing, whitewater rafting, and skiing

(downhill and cross-country) have also been shown to reduce the symptoms of PTSD.

In spite of its recent advances and excellent results in delivering quality health care, awareness of physiotherapy remains a big question in Pakistan, not only among the general population but also other healthcare professionals, including medical professionals.

It is indeed shocking to learn that they have inadequate knowledge when most of the time they are the first point of referral for therapy. In a recent research in Peshawar it is found that the factors affecting stroke patients’ compliances with physiotherapy are poor awareness, considering physiotherapy as similar to massage therapy, misconception of routine activities as therapeutic exercises, poor communication among health care providers, and abundance of faith healers, patient's forgetfulness to exercises, poor economic status and cultural and societal barriers. It is believed that early referral and recognition by medical practitioner and awareness in general masses lead to better optimisation and deliverance of physiotherapy services which appears to be underutilised at present.

Dr Hafiz Syed Ijaz Ahmad Burq

PhD scholar,

Senior Physiotherapist, Lahore General Hospital, Lahore.