Physical Therapy and Rehabilitation

Physical Therapy and Rehabilitation is a field of medicine that contains all treatments for improving the quality of patient’s life by focusing on structural problems, congenital as well as acquired, and the treatment of diseases in musculoskeletal system.

Diagnosis and treatment of all spine diseases, rehabilitation after all sports injuries and orthopedic surgery, rehabilitation of neurological diseases, follow-up and treatment of lymphedema, diagnosis and treatment of all metabolic bone diseases and rheumatic diseases, especially osteoporosis, are performed in the Physical Therapy and Rehabilitation Center of our hospital.

The program established within Group Florence Nightingale Hospitals Physical Therapy and Rehabilitation Center is a treatment program used in all cases where the biomechanics of the body is disrupted due to any orthopedic, neurological, and even metabolic reason and musculoskeletal pain, limitation of movement, shape and posture disorders occur related to these, muscle strength and endurance are reduced.

The basic philosophy here is to evaluate the body as a functioning biomechanical system and to ensure all structures building up the musculoskeletal system to operate compatible with each other and smooth, like in a well-functioning machine.

Changes in the modern people’s life cause the formation of functional impairment in the musculoskeletal system, although not structural, starting from a very young age. These cases, which we call posture disorders, actually bring a combination of a much deeper problem. Because not only neck, back and hip pain begin in the process that began with posture deterioration, but also a dysfunction process related to whole body begins. If we consider the body as a building, the spine is the load-bearing column of this building.

So all disorders in this column will affect the durability of the entire building and will lead to more vulnerable to vibration and shock. All the structures that build up the musculoskeletal system interact with each other. Injuries related to all structures in the arms and legs are occurring more often in a person with spinal disorder due to these physical interaction mechanisms, which we call kinetic chains.

It may be said by this biomechanical standpoint that human health depends on a healthy spine.

Especially deep muscle structures of the spine in the lumbar and back region from an internal corset system for the body to be able to perform healthy and safe movements during our actions in daily life. If we strengthen this internal corset system, we will have a healthy load-bearing column, in other words spine. The prevention of the injuries is possible because not only neck, back and hip pain will be controlled as well as the loads to shoulder, hip, knee and ankle will be controlled.

We may have a much more fluent and energetic, less tired musculoskeletal system by strengthening internal corset system. This control and fluency in movements will result in being a painless, happy individual, with a correct posture, low risk of injury and high body perception in our daily lives.

This program implemented in our hospitals covers an average of 10 weeks period, which is implemented in periods of 5 weeks. First, starts with the evaluation of the person by a specialist physician of physical therapy and rehabilitation. This evaluation involves the evaluation of the human musculoskeletal system as a mobile system and mainly includes posture, gait, muscle strength, and neurological examination.

After determining treatment goals depending on the patient’s biomechanical characteristics and disease, one-to-one exercise applications are started by an experienced medical exercise instructor in this system. The exercise system used in the program is whole body electro muscle stimulation or with the original name EMS (Electromyostimulation). (MIHA is a brand name in this system). In this system providing electrical stimulation to the major body muscles, the patient is always performing active medical exercise.

The application is 30 min and performed up to 2 times per week. The patient, who worked 10 sessions in 5 weeks, will be taken under control evaluation by a physician at the end of this period. As a result of this evaluation it is decided for the next step. Generally, an average of 20 sessions, in other words 10-week period is required to provide a good posture correction and strengthening internal corset system.

The most important feature of the system is to avoid large and strenuous exercises causing strain on the joints by means of electrical stimulation during performing active exercise. So by performing small, but correct and safe exercises it may be able to achieve great results. Another important feature of this program is the ability to strengthen the interior corset muscles in the deep located around the spine and in charge of protecting it, which we cannot work with conventional exercise programs actually.

The groups of patients, who benefit most from the posture rehabilitation program with whole body electro muscle stimulation, are especially the people who could not return to daily life after the diseases and surgery related to the back and lumbar region. Painful muscle spasms, hernia, osteoporosis together or without fracture, posture disorders and neck, back and hip pain related to this, hip problems and shoulder problems can be included in these. Diseases such as diabetes and obesity due to metabolic diseases, especially with improper fat distribution and posture disorder, are also held within this program.

Elimination of pain and loss of function is primarily aimed in the process of the treatment of traumatic, mechanical or surgical problems in the musculoskeletal system, especially involving the spine. The target in the stage, in which the pain of the person is taken under control with physical therapy and rehabilitation methods, is not to face limitations in daily living activities and to improve quality of life. But most of the time, difficulties are experienced during returning to daily living habits, occupations, hobbies and sports; and many patients can hurt the injured area of the body again during these activities.

To exercise with the EMS system creates a great option at this stage. In this system, while electrical muscle stimulation is performed via body-worn vest and electrodes on it, on the one hand, exercise is performed actively accompanied by a qualified instructor at the same time. There is no risk of injury because exercise is performed by considering all anatomic and mechanical features of a person and thanks to electrical stimulation is very efficient. In other words, sufficient reinforcement of whole body and particularly spine can be provided by performing this exercise system performed in one session of totally 25 minutes 2 times per week.

In fact, to activate a muscle with electrical stimulation is a method used in physical therapy and rehabilitation for many years. In cases which muscle is not stimulated due to nerve damage, or in cases which muscle’s mass has been decreased and its strength has been lost these externally applied electrical currents prevent myolysis.

Providing all fibers contained to be contracted in every aspect by electrically stimulation while a muscle is moving, is a method that started to be used in recent years. This application, which can be especially applied in the arms and legs with satisfactory results, has gained a new dimension via whole body EMS. Because the interior bracing (core) muscles, which are responsible for keeping body muscles especially the spine straight, can be worked in this system.

By way of an example, deep and superficial muscle groups surrounding the trunk should be worked in order to reduce the load on the spine in a patient who is treated due to back and low back pain. However, an important part of the movements that will provide the strengthening of these muscles can cause the person’s pain triggered. Thus, spine rehabilitation is realized in a very slow speed and long time. Most of the time, treatment is terminated at the stage where the pain passes. However, rehabilitation of the spine, correction of mechanical disorders without being permanent and prevent the next attacks is the actual need in the next process. Many patients admitted with a new attack when returned to his/her life after insufficient rehabilitation.

EMS, carries out the process of return to normal life completely and very quickly after painful period by especially providing strengthening of deep trunk muscles quickly.

‘Correct posture, healthy living’ program applied in our centers is a unique strengthening program that has been created using these features of EMS(MIHA)

The anti-gravity treadmill, which was developed by using NASA patented ‘ lifting system via air pressure ‘ in 2005, is the latest technology that has been reached in physical medicine and rehabilitation.

Anti-gravity treadmill is a very safe system, which shortens the recovery time after waist, hip, knee and ankle traumas and surgeries very much, and provides rapid development of walking in some neurological diseases.

The goal here is to keep the person mobile. Thanks to this system the patient can achieve the targeted goals; whether the mobility target of the patient is to run the marathon or to go from one room to another at home.

The anti-gravity treadmill located in the Istanbul Florence Nightingale Hospital Physical Therapy and Rehabilitation Clinic, is the only solution for re-mobilizing of the patients who can not walk due to diseases in the body weight-bearing joints, and putting on weight and cannot avoid damaging of his/her joints upon being in a vicious cycle, for patients experiencing condition disorders related complications.

Underwater walking system is a treadmill placed into a tank full of water. The tank is entered after wearing appropriate clothing and filling of desired level of water is provided by the system controlled by the therapist after the door is closed. A very safe exercise becomes applied via treadmill, which may be monitored by the patient. Treadmill speed, water temperature, water level, jet streams are kept under control by the therapist.

• Decreases heart rate and blood pressure by supporting circulation.
• Reduces peripheral edema.
• Increases the metabolic rate and calorie loss.
• Supports muscle groups.

• Relaxes muscles.
• Reduces pain.
• Accelerates circulation.
• Buoyancy force of water reduces the burden of painful joints.
• Flexibility increases.
• Increases ‘Core’ stabilization.

• Supports weak muscles.
• Increases the intensity of the exercise.
• Accelerates circulation.
• Supports movement.
• Surface tension of the water supports the balance of the patient.

These physical properties of water, which are used for centuries, is in a very htygienic, safe and convenient state in this system.

It is a personal pool and it is drained of water before each patient goes out and refilled with water for the new patient.

The system that is especially used at the period, when the patient started to add load after waist, hip, knee, ankle and foot injuries and surgeries, shortens the recovery time very much.