'PHYSIOTHERAPISTS make all the right moves,' is the message the Bermuda Physiotherapy Association - along with other physiotherapists on the island - will be trying to pass on to the population this month. As part of Physiotherapy Month, health care professionals are hoping to educate members of the public on the importance of proper movement to prevent injury, and the impact that rehabilitation can have in restoring function to those in recovery.

PHYSIOTHERAPY - whatever you imagined it to involve, chances are it won't cover the full spectrum of services offered by health care professionals in the field. For those who believed the role of the physiotherapist to be limited to rehabilitation, it may come as some surprise to find them involved in other areas.

"We work in a variety of different areas within the community," explained Sandra Thornhill, chairman of the Bermuda Physiotherapy Association and co-ordinator of Government's Community Physiotherapy Services programme.

"Some of us work in the hospital; some of us work in private practice; some of us work in mental health. I'm involved with community health; some work with women's health. And there are others.

"Yes, we restore function; that's exactly what we do and we do it best. Those who come to see us have probably had an injury. It might be a sports injury, it might be a debilitating injury where they've fallen and broken their hip, or they may have had a stroke. But in public health, what we also look at in the community is prevention. We want to help people know what they should be doing to prevent injury in the first place."

As a profession, physiotherapy is centred around movement - and its importance to the health and well-being of individuals in society. It falls upon the physiotherapist to identify and maximise movement potential through such means as health promotion, preventive healthcare, treatment and rehabilitation. Fundamental to that approach is an appreciation of the psychological, cultural and social factors that influence their clients, and the patients own active role in helping themselves.

"Others may look at easing the pain or muscle relaxation or movement but ours is the only profession that looks at rehabilitating clients back to full function," Ms Thornhill said. "I can say that our training is very extensive and, because it is so extensive, we actually know the body - how it moves and how it functions.

"In order to know which treatment to use, we analyse (the movement of the problematic area) to the fullest extent. We recommend treatment to back up what we're doing, based on years of research. Our clients aren't simply doing something because we say they have to do it but because it's what the research says. But the crucial part is the work put in by the patient. If they're not willing to do their end then no amount of physio will help."

Living proof of the success that can be met when clients follow their therapist's direction is James Hannam. Mr. Hannam was sent to physiotherapist Jill Bewsher in anticipation of hip replacement surgery. Additional therapy was required after the former rugby player fell, dislocating his shoulder and rupturing three-and-a-half of the four rotating cuff muscles that help hold it in place.

"My specialty is orthopaedics," explained Ms Bewsher. "I work mainly with some of the orthopaedic surgeons who do their surgery in the hospital. And some of those patients then come to me for treatment after. Mr. Hannam had a hip replacement and needed rehab following that, but what I had been doing pre-op, was a mobilisation of his hip to try to relieve some of his pain, some of his stiffness, so he could put off the length of time when he needed the hip replacement. Because hip replacements now have a finite life span, you don't want to put them in somebody (too soon) because they'll wear them out.

"Mr. Hannam, however, also fell, and dislocated his shoulder. As a general ageing process, you lose quite a lot of elasticity that the shoulder uses and (because of his injury) he had to have a fairly major reconstruction of his shoulder. Because the tissues that we were dealing with were generous enough to have ruptured badly, his rehab was very specific in order to get range of movement back again.

"We would monitor (his progress) here and change (the exercises) as he improved. The bulk of it, we rely on the patient to do what we've suggested in order to make sure that we have success. He was an excellent patient, in that he listened to everything that was said and so his recovery and range of movement he got back, was fantastic. But, in terms of the shoulder, it took him ten months to obtain it."

Everything about the process impressed him, said Mr. Hannam, from Ms Bewsher's interaction with his surgeon, to her complete understanding of his injury and what needed to be done in order for him to recover movement.

"From a patient's point of view, (with the state my shoulder was in) you can't really do anything but preserve. Rehab lasted for a year. Exercising every day, that's the important part. You've got to have a regime. In my rugby-playing days, about 50 years ago, if you got an injury on the field, (you received) literally a bucket of muddy water and a sponge.

"That's probably the last time I had physiotherapy until I had my two operations and it's light years away. I managed to get back into a functioning human being again. Jill analysed everything I'd done. She was in communication with the surgeon who did the shoulder operation at Johns Hopkins. I was most impressed. I was especially impressed with her knowledge. She was so thorough."

According to Sue Astwood, a physiotherapist at St. Brendan's Hospital, it's through constant communication with other medical professionals that the physiotherapist is able to achieve great results.

"We work very much in teams - with nurses, doctors and surgeons; there's an awful lot of networking so that the patient does get the full package," she explained. "I think all physios try and tailor what they do, to meet the needs of their client. We try and actually treat the whole person, rather than just the condition.

"It surprises most people that physios work in mental health at all. But there is actually a huge amount of work that can be done. Not only the usual sort of things - people in mental health suffer from pain as everybody else does - but I have amputees. I do a great deal with people with learning disabilities, everything from eating to posture management and people with mental illness as well as physical illness, require education.

"There is also quite a lot done on body awareness, body image, touch, reducing barriers with people. It's well known now that exercise actually increases endorphins and the feel-good factor too, and a lot of that works for them."

Many of the clients seen by physiotherapists are stroke victims, most often elderly. As the area of the brain affected by a stroke loses function, victims may have difficulty controlling movement on one side of the body. Speech, vision, swallowing, bowel and bladder can also be affected. The person's emotions, ability to concentrate and memory may also change.

Treatment may include guided movements of limbs, and relearning how to sit, stand, walk, and other everyday activities. In such cases the therapist takes on an additional role - educating the caregiver.

"Very often with the elderly we're dealing with people who've had strokes," Ms Astwood said. "And what we often do is educate (their) carers on how to manage them, to reduce risks both to carers and to the clients themselves. It's part of what we do generally, teach people how to manage their injury and how to improve their lifestyle."

Teaching proper breathing technique to post-operative patients and asthma sufferers is another physiotherapist specialty.

"For many people, they're feeling quite knocked out and tired after having had an operation anyway," added Ms Astwood. "One of the things physios will do is monitor that person's chest, to make sure they're doing breathing exercises on a twice-daily basis and that they're using as much of their lung capacity as they can to make sure that they're not getting blocked or getting congested.

"In the old days, there were lots of people who would die in hospital, not from anything to do with the (injury), but from pneumonia. Twenty years later, things have moved on and there's so much focus on the chest that people are getting out of bed sooner."

Outside of injury caused by accident, one of the most common reasons the average person will turn to physiotherapy is because of stresses brought on by their work setting, added Ms Thornhill.

Called Repetitive Stress Injury (RSI), such problems are caused by repetitive movement leading to muscular pains or problems with nerves, ligaments and joints to the upper limbs. Usually work related, its incidence has risen dramatically with the increased use of computers and automated equipment which need only a limited range of movement.

"Today, many of us are, for the most part, sedentary," said Ms Thornhill. "We sit at the desk and stay there. With computers, people are sitting longer and what we see are (incidents of) RSI in people who are office workers or people doing the same movement over and over again.

"If you're always sitting, you should be looking at the ergonomic situation of your desk. Is it at the right height? Where is your computer screen? Are you getting up and moving frequently?"

Added Carol Cam, rehab co-ordinator at King Edward VII Memorial Hospital (KEMH): "At the hospital, actually, we're looking at nurses who are spending more and more time now working with computers, and seeing the effect that has on them. What we recommend, is that people get up and move away from their desks about every 20 minutes."

Rehabilitation can run anywhere from a matter of minutes to a full year, depending on the injury involved.

"Physiotherapy is very important for getting people back on their feet after they've had surgery of any kind and can last anywhere from ten minutes to a year or more," said Mrs. Cam.

"Even if somebody comes in suffering from severe pain (brought on by RSI)," said Ms Bewsher, "if you're actually able to correct the way they're sitting and gotten them to move in a normal, physiological way, they can go out moving better straight off.

"And all you've really done at that stage is correct their movement. You haven't really needed to treat the part. From an orthopaedic point of view, most people will (leave our office) having changed positively in some way and so you see very very quick improvement. In different conditions, that can take a bit slower. Something say, for example, neurological might be a bit of a slower process."

Added Ms Thornhill: "If you're dealing with someone with mental challenges, it can take longer and also if you're working with a senior client. But it depends on the senior, how vital they are, how agile they are and the (state of) health they're in."

A number of events are planned to create awareness during Physiotherapy Month. An in-house ergonomic assessment of backs will be offered to the public during the first two weeks of May at KEMH. During the End to End charity walk, staff from various areas of physio on the island will be in the medical tent for anyone who wants or needs attention - not massage - for any physical injuries.

Physiotherapists will appear as guest speakers on radio talk shows and Nick Jones' television sports show and the group also intends to offer posture and falls screening for individuals 50 years and over, to identify those who might be at risk.

For more information on planned events, interested people may contact either Ms Thornhill at 239-3528 or Mrs. Cam at KEMH.