IMPORTANT ROLE OF A PHYSIOTHERAPIST IN SOCIETY

A fine morning and wonderful time to walk to school, but I sat there in the Out-Patient Department waiting for the doctor to call out my name. Let's run through the situation now, I broke my finger while playing around and I had to wear a heavy slab for 3 whole weeks which was a draining experience and I wished that I never broke it in the first place! But it was not all that bad! I did have something to feel good about. My suffering was about to end, my slab was to be removed and I could use my hands freely once again! Little did I know what was in store for me! Let’s say that my doctor, Dr. Anil Bhatt - Professor and HOD, Department of Orthopedics, Kasturba Hospital, Manipal – is one the best in the whole city! He with is ever enigmatic smile started unwrapping my cast and said, “Well Navaneeth, 90% of the work is done once this slab is off your hand.” I frowned. 90%? Well, I know 90% of everything is easy and I'm not talking about exams! It’s the remaining 10% you have to worry about! I guess he sensed my confusion because he smiled and said, “Don't worry, This is the fun part.” His eyes twinkled as he winked at me.

I smiled back. He took of the slab and I had the first sensation of numbness. A feeling that I've never felt before! It was a strange feeling. Mixed with rather a lot of emotions. Pain, joy, relief? I couldn't say! But I finally had my hand back to use as I wished – so I thought because in reality I couldn't even move my fingers. There had been skin webbing all around and that sticky material was gross! To top that I felt like my hand was not mine anymore. You don't have to be a mind reader to guess what was going on in my mind right that second! Dr. Bhatt gave me a slip and said, “Off you go then, Wash your hands and then go to the Artificial Limb Centre. Get a hand splint and then go to the Department of Physiotherapy. You'll need some patching up!” He winked yet again! Okay then. Let's go. I had a hard time finding the place as KH is a big hospital and when I say big I mean BIG and it is not easy to find the place you want without asking for directions and as it so happens I hate asking for directions! That too in my own city!

Anyway, I didn't expect to be led in as soon as I got there and so I waited in the lobby once again. Soon the lady in-charge told me to go in and talk to the professor. The Associate Professor, Prof. Kamath was given my case. I was to put my hand in a hot water bath and try to do some exercises as shown in the chart. As soon as I was about to get the hang of it, I was told to go into the rehabilitation area and that's where my knowledge about this wonderful allied health science bloomed!

Before we go all overboard about PT this and PT that let's analyze what 'therapy' actually means! Therapy according to the Oxford English Dictionary is the 'treatment intended to relieve or heal a physical disorder or illness or the treatment of mental

disorders or problems by using psychological methods'. And there are a number of therapeutic procedures and sciences dealing with different types of disorders and ailments in today's society. Stress Management, Anger Management, Physiotherapy, Occupational Therapy, Massage Therapy, Hypnotherapy, Hydrotherapy and what not! In fact just the other day I was reading about 'Equine therapy' which involves the use of domesticated horses to treat children with problems such as ADHD or physical inactivity. And among adults and teenagers it finds its use in Anger and Stress Management therapies. One could say this is just the beginning of what could be a revolution in the field of allied health sciences.

As far as that goes, let's get back to what we are presently concerned about. What is physiotherapy? What is so special about it? Why is it so essential today? What is the role of a physiotherapist in today's society? It is inevitable that at some point in our lives many of us will experience physical discomfort, muscular pain or sporting injury. This may be the result of doing too much, doing nothing or simply the demands of everyday life. Let's get back to it a bit later as this piece of writing progresses and for now let us dig into the depths of history and have a small idea about how this whole thing got initiated.

I'm pretty sure almost everyone knows what physiotherapy is.......The American Physical Therapy Association or APTA as it is popularly known, defines physiotherapy as: “clinical applications in the restoration, maintenance, and promotion of optimal physical function.” Long story short, Physiotherapy or Physical therapy concentrates on the psychological, physical and emotional well being of an individual. It involves treating a patient with disorders, diseases or disfigurations by exercise and massage and enable him to get back to his regular activities and do them as efficiently as before. Apart from curing various ailments related to joints and knees, the treatment aims to develop, restore and maintain maximum movement and functional ability. Today we see this field as a giant, standing tall – taller than all the others in this society - A highly recommended procedure by the orthopedics, sport personnel as well as other work environments demanding physical strain. But, it’s not wrong to say that, this was not always the case, because there was a time when there was no meaning for the word physiotherapy. Of course, there were always practices and procedures that are today a part of PT but as whole this form of rehabilitation did not exist. Then how did it start and how did it grow? An interesting story. This treatment was formulated a couple of centuries ago. Today it is undertaken to cure almost every ailment and injury related to bones, muscles and joints. A person undergoing PT is guaranteed to find relief over time. If we go back to history and origin of PT we see that the treatment has been in existence since the ancient times. Let us walk through some interesting lines from the history books through the lines below.

The earliest documented origins of physiotherapy as a professional group, date back to Per Henrik Ling, 'Father of Swedish Gymnastics', who founded the Royal Central Institute of Gymnastics (RCIG) in 1813 for massage, manipulation, and exercise. The ancient form of modern physiotherapy, dates back to 460 BC, when Hippocrates, Hector and later Galenus used massage and hydrotherapy to treat their patients. However, the

actual physiotherapy, which is practiced today, was formulated in 1894, when a group of four nurses in Great Britain established the Chartered Society of Physiotherapy. Formal training programs were soon started by other countries, following the treatment formulated by the Chartered Society.

The School of Physiotherapy, established by the University of Otago in New Zealand in 1913, and Reed College in Portland, founded in 1914, are the early examples of the institutions that taught physiotherapy. From 1917 to 1918, the therapy was performed widely, to cure people injured in the World War I. The treatment was considered as 'rehabilitation therapy' during that time. The people who were employed to provide aid to the injured patients were named 'reconstruction aides'. They were trained nurses who had the knowledge of physical education and massage therapy. The year 1921 holds significance in the history of physiotherapy. A research paper on the therapy was published in the PT Review, March 1921, in the United States. It was during this time that Mary McMillan, the first physiotherapy aide, established the American Women's Physical Therapeutic Association. The organization's name was later on changed to the American Physical Therapy Association or APTA. Due to her significant contribution in the reconstruction aide services, Mary McMillan came to be known as the 'Mother of Physical Therapy'. More and more research papers were published about physiotherapy in the following years. The treatment was further promoted by the Georgia Warm Springs Foundation. The foundation, in the year 1924, proposed the therapy as a treatment for polio. Massage, exercise and traction were the common practices carried on in physiotherapy in the 1940s. In the following decade, the British Commonwealth countries started the practice of undertaking manipulative therapy for spine and joint pains. Until the early 1950s, physical therapy was performed only in hospitals. It was only in the late 1950s that physical therapists started treating the patients beyond hospitals. Public schools, universities, skilled nursing facilities, medical centers and rehabilitation centers were chosen by the physiotherapists to treat their patients. In 1974, many doctors in the United States specialized in physiotherapy. A separate division - the Orthopedic Section - was formed in the APTA, for the physiotherapists who had specialized in Orthopedics. The manual therapy was popularized worldwide in 1974, when the International Federation of Orthopedic Manipulative Therapy was established. Further development in the field of physiotherapy was recorded in the 1980s, when the use of computers became prevalent in Medical Science. Various devices, such as electrical stimulators, were introduced for practicing physiotherapy, which increased the effectiveness of the treatment. In the present time, the therapy is practiced for curing a number of disorders and injuries, ranging from the most common back pain to musculoskeletal and sports injuries.

With that being said let's get back to my experiences in the PT department. As already stated mine was a minor injury – A hairline fracture, but unfortunately the crack was so

close to the joints of my finger that I could not even bend it let alone use it normally. Actually, the catch lies there. Because we aren't able to use our fingers properly we normally tend to use the other hand for our daily chores which drastically hinders the proper functioning of the damaged hand even after complete healing. The goal for me was to be able to roll a ball-point pen refill through my palm and to the underneath of my finger. Well, okay then. And so started my exercise sessions when and where I had the opportunity to interact with a lot of patients with other problems and discuss them with the PTsts in the department.

One such case that I observed was quite interesting. Owing to an unfortunate kitchen mishap Gangubai from Sidhapur had suffered severe burns on her hand – right hand and was now unable to do her daily chores. I noticed that she was in so much pain that she couldn't even rotate her wrist freely. Her neurotransmitters in that area were badly damaged. What was she going to do? She could not stay in bed for the rest of her life. Neither would she – anyone for that matter – want to do stuff only with their left hands. She wouldn't want her right hand to be hanging around like some dead weight, would she? That's exactly where Physiotherapy comes in. The PTsts works with the concerned doctors through her treatment to help her regain mobility and overcome the pain that was bothering her thus enabling her to do her daily chores with near perfection if not complete. She was given a strap with a spoon fitted onto it to help her eat without external or the other hand's help. “She will soon be mixing food with her fingers once she gets accustomed to it”, said the professor. Wow! I was really psyched. Such mishaps and accidents happen to everyone of us every now and then. Be it on the road or at home. Sometimes in the playground and sometimes even in the bathroom and all might not have healed the way we wanted them to. After all what God creates for us is perfect in every respect and once we attempt to recreate what he has done, we fail to attain perfection though we might come seemingly close. Again, we can settle for the next best thing. Something very close to absolute perfection. Ability to return to the things we used to do as though nothing has happened. I mean, fractures, burns, concussions, strokes – they happen to everyone but just because of these few incidents we cannot let our life's dream, our life's goal, the way we want to live our lives - in extension our lives as a whole go to waste. we don't want people shunning us and our work just because of one single incident that might not have been our fault at all!

That can be prevented by doing our work with perfection. This can be achieved by getting ourselves, our working capabilities to the way they were before the incident. No one needs to know about the disability we once had as no sign of it is left now. The Physiotherapist can help you do this.

Let's talk about Gangubai for instance. She is what they call a 'burns survivor'. Let us go into the theoretical understanding of what a burn really is – A burn is a type of injury usually caused by heat such as in case of fire or chemicals like acids and cleaning fluids or sometimes electricity. Burns can be extremely painful and can result in disfiguration and disability of a victim. Scarring, amputation of affected parts or even death in severe

cases is not unheard of. Burns can be classified into first, second and third degree burns depending upon the skin involvement and total body surface area affected.

In India alone more than 7 lakh people with burn injuries are admitted to the hospital every year. These injuries are a major cause of death and disability. While most are accidental, others are suicidal or homicidal. Burns survivors depending on the nature and degree of their burns may find it difficult to get back there and regain their daily roles in the society. Of course when your hand is charred for life with the permanent marks of an unwanted unfortunate mishap you will definitely feel an upheaval in your life but that should not be the end in any case. There are innumerable examples of people who undertook therapy and today happily travelling in their chosen paths to success as though nothing had ever happened! A Physiotherapist helps you find your way back to the road you fell off from when the incident happened. A Physiotherapist puts you back on track and readies you to face your challenges that arose due to your physical impairment. A Physiotherapist is there for you untill you finish what you started, overcoming the handicap of any acquired physical disability. A Physiotherapist will be able to help you on your way to success here.

Among the many straps and assistive devices that I noticed in the workplace, a few interesting ones caught my eye. There was this big bracelet kind of thing filled with a pencil holder for those who have lost mobility of their wrist. The guy in-charge told me that it could double up as a pen and a compass so that the patient will not have any problem writing one he got used to the device. And I was pretty sure that required a long time to get used to. Keeping those factors aside, it is really a wonderful utility. One more was fitted with a spoon, fork and a knife – kind of like the Swiss Army knife – only that it was for patients with injuries which could be used in the kitchen and while doing chores. Yet another was to bend your hand into a cup holding position. A motor neuron intensifier or something. Pressure garments, exercise utilities and many more. Applying pressure to a burn is thought to reduce scarring by hastening scar maturation and encouraging reorientation of collagen fibres into uniform, parallel patterns as opposed to the whorled pattern seen in untreated scars. It’s obviously hard for me to describe what they do because I haven't used them, but nevertheless it was fruitful experience and a meticulous procedure.

Along with this a work or school environment analysis may also be needed so as to assess not only the physical surroundings but also to address the needs of the people involved. The therapist may then modify the environment to suit these needs and help the client return to work or develop work skills to fit into an entirely new line of work.

“You can see the impact and influence that PT has upon the daily walks of life and the need for more professionals in the sports fields, fitness training institutes as well as other rehabilitation centres that deal with musculoskeletal problems”, added Prof. Kamath. Wait, musculoskeletal problems? Well I guessed it dealt with the muscular and

skeletal systems from the name but what is it really about? Why does PT play such a major role in it? Because among the others when you say PT the first thing you think about are fractures and sprains. All these started whirring in my mind.

A musculoskeletal condition pertains to problems related to the skeletal and muscular systems, as the name suggests. Therefore any birth related problems, injury or disease that hampers the bony or soft tissue – muscles, tendons, skin, fascias, ligaments, peripheral nerves etc. - structure and function primarily falls under the ambit of musculoskeletal conditions.

Conditions ranging from fractures, burns, arthritis, spinal cord injury, congenital anamolities of bones and muscles to amputations, polio, leprosy, peripheral nerve injuries, birth defects, overuse syndromes, hand injuries and the list continues.

These conditions rather than treatment involve active work towards minimizing the debilitating effects of the secondary complications that are usually permanent to near permanent in nature, left behind by the injury or the disease process that affects the life role of the individuals

The common physical complications expected are oedema at the distal part, pain at the injured site or on moving the joints, contractures of muscles and tendons, muscular or generalized weakness, low generalized endurance of specific muscles, stiff joints, sensory loss, instability of joint, inability to balance, problems related to wounds, scars, abnormal sensations among others. Most of these complications are very dynamic in nature and they can either improve if facilitated or will deteriorate if ignored. The changes are slow and gradual and their management is a time consuming process. The fixing of a definitive time frame for a desirable outcome is difficult. A PTst plays a critical role during this phase.

As the individual with limitations starts to interact with the physical environment, he starts facing difficulty or rather inability to carry out tasks. These tasks are primarily categorized as activities of daily living, competitive jobs and leisure activities. For instance, difficulty in eating, putting on a dress, bathing, brushing, using a telephone, inability to sit through the long office hours, difficulty in typing on a keyboard due to the lack of co-ordinate movements or weakness, inability to count currency, difficulty in reaching out to the upper shelves to fetch the item in a departmental store, operating machinery, assuming certain typical working postures, inability to participate in any kind of indoor or outdoor group activities, social activities.

A PTst uses several standard and non-standard assessment techniques to identify the basic components of both physical and functional problems. A PT administers standard tests to check dexterity, strength, sensation, oedema, vocational aptitude, joint analysis along with work-site analysis and others. “With all these, there are other complications”, the professor said. “Other complications....? As in post-therapy conditions?”, I asked. “Oh no! Not those kind of

complications!”, she laughed, “By complications I meant misconceptions.” There is a common misconception about PT among medical personnel as well as the family of people with conditions that once the physical complications are dealt with the individual will automatically be able to do all tasks. But the issue is not as simple as it seems. There is a paradox that exists, the physical complications would have been taken care of but he still may not be able to perform the desired task and the converse is also true. Therefore it becomes imperative for all team members to ask the individual whether he has resumed a life close to the pre-morbid style. If not, then physiotherapy has a role to play.

I gulped. Of course I loved all this and I was absolutely sure that I would overcome the pain and do the things normally as I used to but will the deformity in my finger remain as it is? I hesitantly asked this question. And I was disappointed with the answer. “Sadly yes”, said Prof. Kamath. “That finger of yours was perfect. Now it is deformed. But you don't have to live with that. After your sessions are over you can use your finger with just the ability and skill as you used to before.” I smiled. So I would always remain the 'guy with one and a half hands.' I resolved to improve. That was the day I took the initiative towards putting my heart into a speedy recovery. Today, though I still feel a lump in my hand when I make a fist, but that lump does not hinder me from my daily activities writing, typing, climbing trees or anything of that sort. As I mentioned before, perfection though unattainable, near perfection is always within grasp.

Another major cause of disability today would be Arthritis. About one percent of the world population suffer from Rheumatoid Arthritis – RA. Anyone can have RA at any age but it most often appears between ages of 25 and 50. Another staggering fact is that RA affects women three times more often than men.

What is this Rheumatoid Arthritis? The word 'arthritis' literally means inflammation of the joint. It is derived from the Greek words 'arthos' meaning joints and 'itis' meaning inflammation. Rheumatoid Arthritis is an inflammatory disease of an unknown cause that affects peripheral joints in a symmetric pattern. The US National library of medicine defines it as: 'a chronic and painful clinical condition that leads to progressive joint damage, disability, deterioration in quality of life, and shortened life expectancy.' RA may also affect lungs, heart, blood vessels and eyes. RA usually has a slow onset with progressive joint involvement, but maybe abrupt with simultaneous inflammation of multiple joints. Even mild inflammation may result in irreversible damage and permanent disability. The aim of RA management is to achieve pain relief and prevent joint damage and functional loss. Physiotherapy and rehabilitation applications significantly augment medical therapy by improving the management of RA and reducing handicaps in daily living for patients with RA.

“Nothing Cures me better and faster than when I am part of the treatment.”- This is exactly what is done during the treatment of the patient. The therapist together with the patient and his family plan the treatment according to his needs.

PTsts ensure that the patient moves his joints through the possible range of movement. This is usually done 3-4 times daily preferably after the pain and morning stiffness has subsided. The therapist can also help to move the joints and apply moist heat after the inflammatory phase. Different customized splints are provided by the PTsts to reduce inflammation, pain, prevent and correct joint deformities.

Individuals with RA are educated on the principles of joint protections like for example using the larger wrist joints than smaller finger joints for carrying heavy objects. This promotes energy conservation to minimize pain, prevent deformities and maximize functions.

The functions of patients with RA are enhanced through the use of assistive aids, modification of the environment, compensatory methods, energy conservation, work simplification and joint protection techniques.

PTsts teach patients proper planning and structuring of their daily activities, to make use of their optimal strength, eliminate unnecessary steps and take frequent intermittent rest periods in between activities to prevent fatigue.

Fatigue reminds me of yet another condition wherein you need therapy. Now in today's society working is every man's key to survival and overworking is his worst enemy. Overworking and overexerting yourself can lead to many physical and psychological conditions one such being Hemiplegia. Now this is not the only reason for Hemiplegia but certainly one of the major ones. What is Hemiplegia exactly? Hemiplegia is a condition in which a part of your body including the face and the limbs is completely paralyzed. Any disease - congenital or acquired that affects the motor centres of the brain or its pathways can cause Hemiplegia. The examples include stroke, head injury, meningitis, encephalitis, cerebral palsy, brain abscess and tumour Lesions of the right cerebral hemisphere can cause left hemiplegia and vice-versa.

Physiotherapy for Hemiplegia is a patient centred program that is designed to enhance participation in meaningful roles, tasks and activities and the overall quality of life. The PTst evaluates the patient for specific limitations, remediates these deficits and maximizes existing abilities to facilitate functional and neurological recovery. Intervention involves integration of preventive, remedial and rehabilitative strategies.

PT intervention is associated majorly with preventing secondary complications. These usually become major problems if allowed to grow unchecked. For example, falls, shoulder subluxation and pain, fixation of trunk and limbs in a typical posture or pattern etc. Intervention includes positioning programs, splints, protective slings for shoulder subluxation, activities and exercises to maintain joint range, teaching safe transfer and others.

PT also takes on balance and mobility training such as teaching correct patterns of rolling in bed, coming to sit, stand and walk. PTsts encourage bilateral hand use. This is very essential to prevent disuse of the affected limb and promote motor recovery. There are specialized therapeutic techniques to improve hand functions under hand

rehabilitation about which we shall be discussing later on. Because the recovery of hand functions is slow the intervention involves facilitating release, different grasps, dexterity and functional hand use through activities.

Unlike the commercially available splints, customized splints provide better fit and comfort that facilitates compliance and improve treatment outcome. PTsts also design and fabricate customized splints to fit the needs of its user. Along with this, the PTst monitors environmental modifications to decrease architectural barriers and improve safety. For example, addition of a ramp for people with wheelchairs, construction of custom made arm rests or supports to help in movement and so on.

Okay, well all this – fine. Relating the bones, muscles and all of that. But what about nerves? What neurological conditions can benefit from PT and how? This question was bugging me and as always I got an appropriate answer from the professor.

Many infections, tumors, degenerative diseases and disorders of the circulatory system are commonly associated with the nervous system. Some examples of such diagnoses include brain injury, meningitis, encephalitis, stroke, brain of spinal cord tumors, multiple sclerosis, motor neuron diseases, spinal cord injury, Parkinson's disease and other movement disorders.

Clients and professionals alike are often surprised to discover the unique roles and skills that neurological physiotherapists offer. PT neurological rehabilitation is a therapeutic program designed to improve function, reduce limitations and improve the overall well-being of the patients who have experienced disease, traumatic injury or nervous disorders.

In common with all kinds of, neurological physiotherapy is vitally concerned with movement, but one possible difference compared with more traditional physiotherapy 'treatment' is that a neurological physiotherapist's intervention may be predominantly in the area of teaching and training the client in gaining or regaining function. As such, neurological physiotherapists develop expertise in analysing abnormal movement, hypothesising reasons that the movement is occurring and developing a regime that assists the client to relearn lost or impaired skills.

The PTst will do the initial assessment to determine baseline function. Intervention may focus either on the impairments or on the functional problems or on the both. The therapist encourages the patient to participate in meaningful activities to facilitate restitution of motor, sensory cognitive and perpetual functions. In case of severe deficits, therapy is directed towards promoting compensatory strategies to attain maximum possible functional independence.

Let's get back to what happened to me. Mine was a simple case where I accidentally kicked my ring finger and broke it. It was a hairline fracture that almost touched the joint and therefore I would have some swelling even after the crack completely healed.

A hand is anatomically defined as a prehensile, multifingered extremity located at the end of an arm or forelimb of primates such as humans, apes and monkeys. Hands are chief organs for physically manipulating the environment used for both gross motor skills such as grasping a large object as well as fine motor skills such as picking up a small pebble. The fingertips are the richest source of tactile feedback and hence the greatest positioning capability of the body – thus associating the sense of touch intimately with hands. The function of hands can get impaired due to several conditions involving the hand: Arthritis, joint deterioration, amputation, sports injury, crash injury leading to fractures and tissue loss, burns nerve injuries and so on.

“Hand rehabilitation has a broader scope than hand surgery. IT takes into account all factors that are important to the patient as well as those local factors that are amenable to the surgeon's knife and the therapist's skill” - Dr. Paul W. Brand

What is hand rehabilitation......? Hand rehabilitation is an extremely dynamic intervention which takes into account all relevant problems posing a threat to successful return to work. It is a strategic, systematic, rationale method of intervention that is dedicated for early recovery and functional restoration of problems related to hand, be it acquired or present by birth.

Assessments of the patients hand and a knowledge about the patients lifestyle is a priority during this procedure. For example, the amount of effort which goes into treating a corporate's hand and a carpenter's hand is different. Clinical examination of the hand is a basic skill that the therapist has to master.

The touch of a therapist's hand plays a critical role. Manually handling the dysfunctional hand, the therapist reads through several vital parameters of the affected hand in terms of pain, warmth spasm, severity of contractures. That becomes the essence of manual therapy. Apart from these medical fields PT as popularly known, finds extensive use in other walks of life. In today's competitive world, stress is every man's friend. You can say work and stress go hand in hand. And this stress along with overwork leads to several conditions that need to be fixed. Physiotherapy can help here. We watch numerous sports - cricket, badminton, tennis, boxing, to name a few, and we see many champions rising to fame and glory. But what we don't see is the people behind them, supporting them in every one of their endeavors, always there to help them up when they fall down – in their tough times. And no, I'm not talking about the fan clubs but about the trainers, doctors and PTsts in the field.

Sports Physiotherapy is a specialized practice that focuses on prevention, evaluation, treatment, rehabilitation, and performance enhancement of the physically-active individual.

Now, let's analyze what I have stated - The practice of sports physical therapy includes those interventions that assist the athletically-active individual in preventing injuries and then, if an injury occurs, continuing their pursuits with minimal disruptions. Areas of this practice include pre-participation screening, equipment recommendations, and cardiovascular fitness programs designed to assist in a safe and unremarkable return to activity.

Sports PTsts are highly skilled in evaluation of active and chronic injuries. A hallmark of this practice is the assessment of surgical and non-surgical neuromusculoskeletal injuries. Included in this is the functional assessment of the individual post-injury to assist in a safe return to activity. Treatment and rehabilitation of neuromusculoskeletal injuries is at the centre of sports PT practice. In a team approach with the doctors, the sports PTst designs and implements programs for the management of these disorders in clients of all ages and physical abilities, including those with physical disabilities as well as elite athletes.

Sports physical therapists assist athletically-active individuals to improve their performance in a variety of ways. The foundation of performance enhancement is provided by a thorough evaluation of the neuromusculoskeletal and the cardiovascular-pulmonary systems. The results of this evaluation are compiled to outline strengths and weaknesses in an individual's physical profile. This profile can then be matched to the individual's specific athletic activity. Areas of deficiency in flexibility, muscular strength and endurance, and in the aerobic/anaerobic systems can be outlined in a specific training regime. Follow-up evaluations can determine further training program changes.

Treatment and rehabilitation are constantly changing in response to our interpretation of the basic and clinical sciences. The sports PTsts is a part of a team that is researching and implementing research findings to assist the athletically active individual in his or her pursuits. Education of athletes and their parents and coaches about the various preventative and management techniques previously discussed is a service that sports PTsts provide. Sports PTsts are also involved in educating other therapists therapists, other allied health professionals, and physicians in these important areas.

Today's children are tomorrow's citizens. And nothing comes without effort. We have to put in a little effort to groom them into what they need to be. There are hurdles at every step and health related problems are among many others that hinder the success. Pediatric Physiotherapists do their bit in this. Pediatric PT assists in early detection of health problems and uses a wide variety of techniques to treat disorders in the pediatric population. These therapists are specialized in the diagnosis, treatment, and management of infants, children, and adolescents with a variety of congenital, developmental, neuromuscular, skeletal, or acquired disorders/diseases. Not only this but you can find the applications in various other fields that I can go on and on about. The useful activities this allied health science has exercised is innumerous and so I would like to conclude after a short discussion on PT today.

Imagine a society without physiotherapists. And by the word I refer to all professionals who work within or in the vicinity of the field such as Massage therapists, Stress management therapists, Physical trainers, Occupational therapists and others. Imagine an everyday situation that occurs – in that society. You hurt yourself. You go to the doctor. He puts a plaster on you. Removes it after a couple of weeks and then lets you on your own. Imagine a condition where there is no one – not a single soul to guide you, console and encourage; to tell your family what to do. Let us take an example here. Take a heavyweight boxer for instance. A real champion. A person on whom the company depends. A person who the people love. He hurts himself badly and is hospitalized. His injuries heal but the scar in his mind still remains. He is crushed – literally. He does not have the confidence nor the willpower to stand up and face his opponents once again. His family is too concerned about his well being to care for his career and his professional life bites the dust. His fans are disappointed and his managers discard him. One single unfortunate incident mars his life, his career, his dreams forever! But just add one single person in there. A person who is able to talk to him and help him regain his self-confidence as well as self-reliance. A person who can build up his physical as well as mental strengths by helping him regain his functional abilities and maximize physical capabilities. A person who can communicate with his family and prepare them for the changes. A person together with the near and dear ones can play a major role in encouraging and amplifying him. A person who can talk to the managers and let them know what and when he would be able to do. A person who is there every single step the injured takes towards regaining his best days – his days of glory. One single person has made ALL of this possible. That man or woman, that person – is a Physiotherapist. He is a friend, a professional, and a person who the society JUST CANNOT live without! I had the opportunity to talk to a couple of foreign exchange students during my time in the Department. Samuel and Patrick from New Zealand. They were really enjoying themselves, besides the food and the beauty of Manipal. Now one of the founding fathers of PT, that country along with many many others is fathering numerous therapists that are changing lives world wide. PT is a field of study and profession that is in demand everywhere in the current society. There is nothing or no one who shuns the need for physiotherapy. A career that is interesting and creative, challenging yet satisfying, In demand but different. That right there, is Physiotherapy.

So, in conclusion Physiotherapy among many others is one such inseparable entity of human society today that covers almost all the problems faced by today's workaholic adults and students alike. So important is the role of a Physiotherapist today is that his non-existence can cause damage to millions around the globe. I humbly congratulate every selfless person who makes his profession out of helping people. A person who dreams of fulfilling others dreams. A person who is the essence of rehabilitation and rejuvenation mind, body and soul alike. The 10% that is instrumental in shaping our lives. Hats off to such individuals. We need people like you in our society.

Jai Hind