Physical medicine and rehabilitation are equipped with modern and state-of-the-art equipment, and the team consists of physiatrists, orthopedists, neurosurgeons and physiotherapists with European certificates for the implementation of specialized physiotherapeutic methods. The approach of the physical medicine and rehabilitation includes an individual and holistic approach to each patient in the treatment of diseases and injuries of the locomotor system. Our rehabilitation center offers complete rehabilitation of acute and chronic painful conditions of the spine and joints, sports injuries and overexertion syndrome, as well as preoperative and postoperative rehabilitation. We are particularly proud of our experience in working with painful conditions of the spine of various etiologies, as well as postoperative rehabilitation after spine surgery.
ELECTROTHERAPY
Electrotherapy includes a range of treatments that utilize electricity to reduce pain, improve circulation, repair tissues, strengthen muscles and promote bone growth, leading to an improved physical functioning. At our Clinic, we use various methods of electrotherapy as an aid in rehabilitation. These include therapeutic currents, ultrasound and laser.
TENS (Transcutaneous Electrical Nerve Stimulation) is based on electroanalgesia. Stimulation of A-nerve fibers inhibits the C-fibers responsible for transmitting pain to higher levels of the nervous system. TENS is applied using small single-channel or dual-channel devices. When using TENS, patients may feel tingling, but motor stimulation must be avoided.
Indications: acute and chronic painful conditions.
Contraindications: pacemaker, epilepsy, decompensated heart failure.
Electrostimulation is a procedure of applying electrical impulses for the purpose of inducing muscle contraction, thus trying to prevent muscle atrophy. Electrostimulation is performed using modern Compex devices which provide various stimulation options, exercises for improvement of muscle trophism, relaxation and analgesia.
DDCs (Diadynamic Currents) are low-frequency half-wave or full-wave rectified sinusoidal currents, of frequencies between 50 and 100 Hz. Their main effect is pain relief and active hyperemia. By combining different frequencies and adding low-strength current, more modulation of diadynamic currents is achieved.
Indications: vertebral and vertebrogenic syndromes of the spine, neuralgia, radiculopathy, extra-articular rheumatism, contractures, distortions, subluxations.
Contraindications: acute inflammation, febrile state, malignant tumors, skin defects at the site of electrode application, pacemaker, pregnancy.
IFC (Interferential Currents) are medium-frequency currents which form as a result of the crossing of two sinusoidal currents that overlap in intensity, phase and frequency. The interference occurs deep in the tissue. The currents cause active hyperemia in tissues and have an analgesic and a trophic effect.
Indications: degenerative diseases of the joints and spine, neuralgia, inflammatory diseases in remission, post-traumatic conditions, delayed callus formation, circulatory disorders and vascular diseases.
Contraindications: acute and subacute thrombophlebitis, thrombosis, Parkinson’s disease, spasticity, malignant tumors, febrile state. Metal bodies are not a contraindication to the use of IFC.
FirstTx is a device intended for the treatment of acute and chronic pain. It utilizes computer-modulated, therapeutic neurostimulation and thus stimulates the natural mechanisms of tissue healing and regeneration.
PHYSIOTHERAPY ASSESSMENT
Physiotherapy assessment is the first contact with the patient and an indispensable part of the physiotherapy treatment. A physiotherapist’s examination includes a detailed analysis and assessment of the general condition, as well as the assessment of the posture and active and passive mobility. The assessment also includes all the necessary neurological, orthopedic and functional tests, all for the purpose of discovering the exact cause of the problem.
LASER
The source of laser light is a stimulated electron emission which uses monochrome, polarized, coherent low energy light (100 – 200 mW) for short periods of time (s). The laser has a biophotostimulating effect, it accelerates collagen synthesis and the formation of granulation tissue, and has an analgesic and antiedematous effect.
Indications: acute and chronic pain, inflammatory and degenerative rheumatic diseases, injuries of soft tissues, tendons, ligaments and open wounds.
Contraindications: pain of unknown cause, acute thrombophlebitis, first trimester of pregnancy and malignant tumors.
Due to the potential risk of eye damage, protective eyewear should be worn when using the laser.
MANUAL THERAPY
Manual therapy prevents, detects and eliminates disturbances in the interrelationships of structures and functions of the locomotor system by methods of mobilization, manipulation and massage. At our Clinic, we use various manual techniques and concepts of exercise in the prevention, treatment and rehabilitation of various painful conditions of the locomotor system. We most often use the Maitland manual technique, MFR (Myofascial Release), Stecco (fascial manipulation method), Trigger Point Therapy, NDS (Neurodynamic Solutions), DNS (Dynamic Neuromuscular Stabilization), PNF (Proprioceptive Neuromuscular Facilitation), CLT (Coordinative Locomotor Training) and the Bobath concept. We put emphasis on the postural reeducation and change of bad movement patterns which can lead (or have already led) to problems in the locomotor system.
The Maitland concept is a manual therapy method characterized by an individual approach from targeted examination to mobilization and manipulation of the spine or extremities. It uses neurodynamic techniques, muscle stretching and specific adaptation techniques that the patient can apply at home. The Maitland manual therapy particularly helps with acute painful conditions, postoperative conditions and various sports injuries that require proper diagnosis and treatment.
Stecco (fascial manipulation method) is a science-based method that involves manual therapy of the muscles and fascia. It is used to reduce pain and stiffness, as well as to restore muscle balance and control movement.
MFR (myofascial release) is a technique of working on the fascia that treats deep and superficial fascia as well as organ fascia. It is a relaxing and painless technique in which the therapist by stretching and pulling the skin communicates with the tissue below, but also with the whole body, finds blockages of the fascia and relaxes them.
Trigger Point Therapy – Trigger points represent sensitive places in the muscle, tendon, ligaments, the joint capsule or skin. They are characterized by local and irradiating pain on pressure, depending on the type. Trigger point therapy is performed by stretching the affected tissue and directly relaxing the tense tissue through fine palpation and adequate short-term pressure, which reduces the pain and tension of the trigger point and improves the blood flow and metabolism.
NDS (Neurodynamic Solutions, neurodynamic of the nerves) is a diagnostic and therapeutic method by which we detect whether the pain is caused by pressure on the nerve, and if so, we distinguish whether the pressure is in the spine or somewhere peripheral. Once we have identified the problem, we start with nerve therapy, i.e. specific opening, sliding and closing exercises. This way, the possibility of releasing the nerve structure from pressure is obtained and the nerve slides freely, a better blood supply is established and the pain and tingling disappear.
DNS (Dynamic Neuromuscular Stabilization) is a technique used in a number of problems of the locomotor system, as well as in the prevention of pain and injury. It is a method of deep stabilization of the locomotor system, and is based on the developmental kinesiology of a child in the first year of life. Due to its exceptional effectiveness in rehabilitation, but also in prevention of injuries and improvement of sports performance, this method rapidly became popular in top rehabilitation and sports facilities around the world. The key assumption of the DNS method is that the position of each joint depends on the stabilizing function of muscles and coordination of local and global muscles, for the purpose of ensuring a neutral and centered position of the joints in the kinetic chain. Regulation of an ideal intra-abdominal pressure optimizes movement efficiency and prevents joint overload. The final goal is to “train the brain” in order to maintain the central control, joint stability and ideal movement quality. With time, through the repetition of exercises, an automatism that becomes an integral part of everyday movement and skills occurs.
PNF (Proprioceptive Neuromuscular Facilitation) is a manual technique used to assess and treat neuromuscular dysfunctions. The therapist analyzes the patient’s movement and facilitates a more economical, purposeful and functional movement. It is most often used in people with neurological impairment, but it is also an excellent tool in the rehabilitation of disorders of the locomotor system.
CLT (Coordinative Locomotor Training) is a concept of exercises based on the foundations of the PNF. It is about simultaneous activation of muscle synergies and motor control of the whole body, which leads to fast and quality results. The application of the CLT concept leads to the establishment of muscle balance in the whole body, with an emphasis on the part that is out of normal function, which improves joint stability, mobility, strength and movement coordination.
The Bobath concept is a therapeutic approach based on re-learning normal movement and posture, and is aimed at solving problems for people who have difficulties with function, posture or movement. Every person has the potential to improve movement by choosing positions, activities and techniques that best suit him/her and his/her motor skills.
THERAPEUTIC ULTRASOUND
The action of therapeutic ultrasound is mechanical, biochemical, physicochemical and thermal. The therapeutic effect is achieved by increasing the temperature of the tissue in the applied area, increased circulation and metabolism, and increased tissue elasticity. By heating the structures near bones (tendon insertions, tendon sheaths, bursae, ligament insertions, joint capsules), we can influence the regenerative processes in chronic, degenerative and inflammatory conditions.
Indications: chronic degenerative diseases and diseases from the group of extra-articular rheumatism: enthesitis, bursitis, injuries of ligaments and joint capsules.
Contraindications: acute inflammation and fresh injuries, pacemaker, pregnancy, foreign bodies in tissue, malignant tumors, hemophilia, active pulmonary tuberculosis.
