Physiotherapeutic treatment methods

Role of physiotherapy in multimodal analgesia

A modern pain management standard, including for fractures, is multimodal analgesia (MMA). This strategy implies a combination of pharmacological drugs (opioids and non-opioid agents of the N02 group) with non-pharmacological interventions, which include psychotherapy and physiotherapy.

This comprehensive approach affects various levels of the nervous system and has a number of advantages:

• Ensures more effective pain relief due to the synergy of different classes of drugs and methods.
• Significantly reduces the dosages and frequency of prescription of opioid analgesics (which are recommended to be used in minimal doses and for the shortest possible course).
• Reduces the risk profile of each individual component of therapy.

In the acute period of injury, the most important physical factor for pain relief is proper immobilization of bone fragments. Before performing any manipulations, the patient must be provided with rest in the damaged area using vacuum splints, vacuum mattresses, or external fixation devices.

Physiotherapeutic treatment of facial injuries

In maxillofacial trauma, physiotherapy is prescribed differentially, depending on the phase of the wound healing process and the presence of complications:

1. Acute period: anesthetic electrophoresis, pulsed currents, ultrasonotherapy, and darsonvalization are used to relieve pain syndrome and treat the injured inferior alveolar nerve.
2. Period of subsiding inflammation: to accelerate recovery, shorten disability periods, and enhance local blood circulation, a constant electric current is applied to the fracture area or vacuum therapy is prescribed.
3. Infected open fractures: the use of an alternating magnetic field with a frequency of 50 Hz is indicated. The standard course includes 10 sessions lasting 20 minutes each. Magnetotherapy is necessarily combined with the administration of antibiotics, aprotinin, and biogenic stimulants (aloe extract, FiBS).

The magnetic field exerts a pronounced anti-inflammatory effect, reduces post-traumatic edema, restores tissue trophism, accelerates bone callus maturation, and, crucially, increases the bactericidal effect of antibacterial drugs.

Physical therapy (PT) and mechanotherapy

Rehabilitation of patients with injuries requires early initiation of motor activity. If the patient's general condition is satisfactory, early therapeutic exercise is prescribed as early as 1–2 days after the injury. Its main goals are rapid psychological adaptation, stimulation of metabolic processes, and improvement of respiratory function.

In fractures of the mandible, the physical therapy regimen is dictated by the type of immobilization:

• Osteosynthesis or smooth splint-bracket: the patient is allowed to open the mouth carefully during meals, but any chewing loads are strictly excluded.
• Maxillary fixation splints with intermaxillary hooks and rubber rings: mouth opening is allowed only after the consolidation of fragments occurs, i.e., in 3–4 weeks. In single fractures, temporary removal of rubber tractions is possible on days 9–11.

Prolonged rigid fixation of the jaws naturally leads to complications—limited mouth opening due to pathological changes in the masticatory muscles and the development of temporomandibular joint (TMJ) contracture. Local therapeutic exercise, including repeated jaw movements, is used to mobilize the joint. Special mouth gags, spacers, and rubber stoppers are used for passive (forced) movements.

Application in gynecology

Non-pharmacological methods are actively used in the complex treatment of threatened miscarriage when the patient is interested in maintaining the pregnancy.

Along with basic therapy (strict bed rest, antispasmodics, sedatives) and specific pharmacotherapy, to normalize the nervous system state and reduce uterine tone, the following are prescribed:

• Acupuncture.
• Electroanalgesia.
• Endonasal galvanization.

Class and exam questions

What else to study on this topic

• Principles of multimodal analgesia (MMA) and drug synergy.
• Pharmacotherapy of threatened and beginning abortion.
• Differential diagnosis of interrupted tubal pregnancy.
• Surgical tactics for incomplete abortion and inevitable abortion.
• Features of the use of opioid analgesics and NSAIDs in injuries.

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.