Essentials of Orthopaedics for Physiotherapists John Ebnezar
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1Essentials of ORTHOPAEDICS for PHYSIOTHERAPISTS2
3Essentials of ORTHOPAEDICS for PHYSIOTHERAPISTS
John Ebnezar MBBS D'Ortho DNB (Ortho) Former Assistant Professor of Orthopaedics Devaraj Urs Medical College Kolar, Karnataka Senior Specialist in Orthopaedics Department of Orthopaedics Victoria Hospital attached to Bangalore Medical College President The Karnataka Orthopaedic Academy (R) Chairman The Physically Handicapped and Paraplegic Charitable Trust of Karnataka (R) Director and Consulting Orthopaedist and Spine Surgeon Parimala Hospital and Research Centre Apoorva Hospital and Research Centre Bangalore Visiting Consultant Hosmat and Ramakrishna Nursing Home Bangalore
4Published by
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Essentials of Orthopaedics for Physiotherapists
© 2003, John Ebnezar
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photo copying, recording, or otherwise, without the prior written permission of the author and the publisher.
First Edition : 2003
Publishing Director: RK Yadav
9788180611148
Typeset at JPBMP typesetting unit
Printed at Gopsons Papers Ltd., A-14, Sector 60, Noida
5
To
God, who created me and the universe
my parents
and
teachers
my wife, Dr Parimala
and
my children, Rakesh and Priyanka6
7Preface
Orthopaedics and Physiotherapy are two faces of the same coin. There is a lot of orthopaedics in physiotherapy and lot of physiotherapy in orthopaedics. A good orthopaedic surgeon is one who has a sound knowledge of physiotherapy and a good physiotherapist is one who has a sound knowledge of orthopaedics. In the orthopaedic treatment methods, physiotherapy treatment begins where orthopaedic treatment ends or it can be safely said that physiotherapy treatment starts simultaneously with the orthopaedic treatment.
Instead of dealing with them as two branches separately, an amalgamation of these two principles equips with sound and wholesome knowledge of successful treatment methodology for orthopaedic disorders. I, as a medical student and later as an orthopaedic postgraduate student was seldom taught the principles of physiotherapy, only a brief mention of the physiotherapy treatment methods was made in the standard orthopaedic textbooks. When I explored further I realised to my dismay that even the physiotherapy textbooks similarly made a brief mention of orthopaedics. So the final result was that an orthopaedic surgeon on completion and starting his practice, knows very little about physiotherapy and physiotherapist starts his learning and later practices without knowing the basics orthopaedics. The sufferer is the hapless patient.
When my dear friend Mr Jitendar P Vij, suggested to write a book on essentials of orthopaedics for the physiotherapists, I decided to set this imbalance right. I made up my mind to write the book in such a way that a physiotherapy student finds enough of orthopaedic knowledge so essential to lay the foundation of a good physiotherapist. Reciprocally an orthopaedic surgeon will get to know the basics of physiotherapy that is very essential to make him a complete orthopaedic surgeon. This book tries to inculcate orthopaedic knowledge into a physiotherapist and physiotherapy knowledge into an orthopaedist. This book is thus a cocktail of sorts and that like a good cocktail will deliver the necessary punch. I am sure my effort will benefit both the sections of the students.
My Textbook of Orthopaedics is huge hit both among teachers and students. It has been well accepted across the length and breadth of this country. The encomiums and platitudes received about the distinctive style of writing overwhelmed me and it had gained a universal appeal and acceptance. I have made an effort to go one up on my previous effort on this book. Hope it whips up the same interest and passion among the students and teachers alike. I will be happy if my effort of evolving a physiotherapist within orthopaedic surgeon and an orthopaedist within a physiotherapist bears fruit. According to me the essence of a good book is that which kindles the dormant interest about a subject in a student and initiates in him an insatiable thirst to know about the subject more and more. Only time will tell whether I will be successful in this regard.
Most of the medical books due to excessive focus on the subject matter fail to evince the all important interest about the subject in a student. I have made an attempt to hit two birds with a single stone by trying to give enough of subject matter and keep the interest factor alive too. To achieve this I have trodden the following path:
  • A well thought approach has been made in each chapter. Relevant anatomy, orthopaedics and physiotherapy treatment methodologies have been kept in mind.
  • Diagrams are the soul of medical textbooks. Hence serious efforts have been made to make them more appealing.
  • 8Quick and short summaries for each chapter are included to make the students focus their attention towards the important and salient features of the topic concerned.
  • Useful mnemonics wherever feasible have been added to enable the students to remember and recall easily.
  • Good flow charts, to convey their ideas effectively.
  • Good clinical photographs, to help the students to grasp the subject better.
  • Appropriate X-rays at the relevant sections.
I hope the students and teachers will like the work. I am open for criticism and corrections. If there are any mistakes, lacunae or any other problems please feel free to write to me. Constructive criticism and suggestions will be given due regard and will be implemented in the next edition of the book.
John Ebnezar
9Acknowledgements
It is virtually impossible to write a book without the involvement of various experts and other concerned people. I am grateful to all my physiotherapist friends for their valuable inputs and advice they gave me regarding the various aspects of physiotherapy management. Without their active help and guidance, I could not have written this book. I also thank my orthopaedic colleagues who shared their knowledge with me and this enabled me to fine-tune various aspects concerning orthopaedics. I thank all my teachers right from the primary school to the recent time who have made me what I am today professionally. I thank my parents for the right upbringing.
I thank my wife Dr Parimala for the active help extended to me emotionally and physically in making this dream a reality. I also thank my son Rakesh and Priyanka who have been supportive to all my works. I also thank all the staff members of Parimala hospital who helped in compiling the data, manuscripts, typing, etc.
My sincere thanks to Mr Jitendar P Vij who was instrumental in bringing out this book. He constantly encouraged me to give my best. No amount of thanks is enough to acknowledge the role played by Mr RK Yadav and his dedicated and efficient team for giving shape to this book. The entire credit of making this book presentable goes to them.
Finally I thank God for bestowing me with knowledge and life that has enabled me to begin and complete this project successfully. I thank everyone who is involved with this work directly or indirectly. Looking at the list of people who have contributed in making this gargantuan task a reality, I feel humble.1011