In ancient times, for example, back pain was treated by certain massage and grip techniques. The whole thing has described, among others, Hippocrates, who indicated in his writings, how dislocations or slight vertebral displacements would have to be adjusted again. From then on, several “bone setters” were on the road, which only gradually developed into the more cautious and knowledgeable classical orthopedics. What interests physicians and specialists in physical and rehabilitative medicine are primarily diseases of the musculoskeletal system that do not require surgery. This includes diseases of the muscles, spine, nerves, tendons and joints. This form of medical treatment is relatively new in Germany and was only established as a specialty in 1992. As the number of people with chronic pain and other multiple physical problems has increased tremendously in recent years, the specialty was finally introduced at German universities.
What is physical and rehabilitative medicine?
What interests physicians and specialists in physical and rehabilitative medicine are primarily the diseases related to the musculoskeletal system in the area that does not require surgery. Physical and rehabilitative medicine, also known as PRM for short, is a specialization in the field of classical orthopedics. Physicians in this field not only have additional knowledge in internal medicine, they are also trained to treat complex, chronic orthopedic or neurological problems in addition to internal diseases. PRM is covered by the German regulations for further training of medical specialists including specialized diagnostics, examination and rehabilitation of diseases or damages by physical or manual therapy, by natural healing methods, by balneotherapy and climatherapy. Therefore, specialists in this field usually work in rehabilitation centers and clinics. The training lasts five years. Examinations and treatments of patients with such ailments must enable a holistic medical approach. Specialists were not previously trained to implement the overall concept of such treatment in medical practices. Beyond the basic conservative orthopedic knowledge, physicians of this direction also offer chirotherapeutic, apparative, osteopathic and naturopathic therapies.
Treatments and therapies
Physical therapy pays particular attention to pain and limitations in the functions of the musculoskeletal system. Also examined are skin disorders. Manual therapy is used to treat all dysfunctions of the musculoskeletal system and to treat and massage these areas. One sub-area is chiropractic therapy, which deals with disorders specifically of the spine. The chirotherapist uses his hand alone in his treatment. The name of the therapy is derived from the Greek word for “hand” and is based on the basic idea of tracing physical pain and discomfort to misalignments of the joints and blockages. There are two techniques, the soft, called mobilization, which affects tensions in the muscles through pressure, and the hard, also called manipulation, which specifically improves joint restrictions through, for example, short impulses that cause a cracking sound. The application of naturopathy in the field of physical and rehabilitative medicine presupposes the body’s own abilities of self-healing through various methods. This can be done, for example, by acupuncture. The pains and irritations are also treated with means coming from nature, which are supposed to activate the self-healing. Balneotherapy is the science of using natural healing springs, mud and healing gases. This therapy takes place in the form of inhalations, drinking cures or baths. It was invented by the German physician Emil Osann, who intensively studied the effects of healing springs. In balneotherapy, the decisive factor is the higher content of dissolved substances in the medicinal spring water, including minerals such as hydrogen sulfide, carbon dioxide, radioactive substances or carbonic acid. The purpose of the baths is to relieve joints and muscles through the water, so that movements can be performed by the therapist that would otherwise cause too much pain to the patient.The baths are prescribed as sitting or full baths, also as steam or mud baths, can be warm, hot or cold. Drinking warm water, in turn, has a positive effect on the autonomic nervous system and relieves pain. Finally, climatic therapy also serves the bones and joints. Natural climatic environmental conditions of particular areas accelerate healing. Thus, stays near high or low mountain ranges or by the sea are prescribed to counteract rheumatic complaints.
Diagnosis and examination methods
Meanwhile, physical and rehabilitative medicine is recognized and is part of inpatient medical care. The views have changed. Whereas in the past everything was supposed to heal after surgery before any rehabilitation measures were taken at all, today the motto is to start as soon as possible. Through the various therapies of PRM, healing can be supported and promoted, while also preventing certain abilities from being lost or incorrectly retrained after, for example, a serious illness. Specialists of PRM support the patient specifically and individually to make a full recovery possible without limiting the quality of life after the disease. This can look like that a long-term rehabilitation is set, the patient is integrated also gradually into the old life and learns anew to master his everyday life and occupation. In case of any limitations and disabilities, a specialist in PRM can suggest individual adaptation and aids to facilitate the quality of life with the after-effects. Through various treatment methods, the patient not only receives physical and physiotherapeutic support, but is also guided to help themselves, including advice on their own training or exercises. In most cases, psychosomatically oriented support is also provided in order to be able to process and cope with the pain.
