Wednesday, September 22

Physiotherapist or Traumatologist? What you need to know to choose the right query from the beginning | Health | Good Life



A bad stride that ends with a sore knee, perhaps the effort of preparing an opposition that has left your back like an accordion, or simply that you wake up in the morning with your neck completely stiff, rusty, immobile … case. The important thing is that your body complains, you would say you have a injury and you need help. Who are you going to call? Your neighbor has spoken to you the wonders of a physiotherapist who visits two minutes from your house, your brother-in-law does not stop giving you references of his trauma cousin and the ready on duty is clear: if the problem is in a joint, you are in the territory of rheumatologists. That you did not expect.

Confusion reigns, and it is logical; All three professionals can have a potential role in recovering from injury, relieving pain, or diagnosing illness. AND you may have to visit several different professionals to recover from your problem. But even in these cases, the order is relevant, and there are important guidelines for not wasting time and putting yourself in the best hands from the first moment.

More than crutches and splints

Just listen to the word traumatologist for crutches and the operating room to come to mind. The traumatologist treats traumas, blows, bad steps … But no, traumatology is not only that. According to Mikel Aramberri, traumatologist of the Spanish Rugby Team and director of the Alai Clinic, “an orthopedic surgeon and traumatologist treats pathologies that affect the locomotor system that, in addition to bones, includes muscles, ligaments and tendons. We see many fractures, but there are more and more consultations for atraumatic pain, such as shoulder pain or pain in the inner part of the knee. The former may be due to inflammation or rupture of the rotator cuff tendons. Regarding the knee, there are two main causes: degenerative tear of the medial meniscus and / or osteoarthritis of the medial compartment of the knee. Furthermore, we medically treat pathologies that can be treated conservatively, such as contractures ”.

“In young athletes, anterior cruciate ligament injuries abound, a more frequent injury in females. In elderly people, problems of shoulder tendon ruptures abound and, in many other cases, of osteoarthritis. Osteoporosis produces a high number of hip fractures in older people, generally due to trivial falls from their own height. In many of these cases they require an intervention to be able to restore mobility to the patient ”. Hence, its main task is to solve the surgical pathology of the skeletal system. “From putting knee, hip or shoulder prostheses to performing mini-invasive surgeries through arthroscopy or percutaneous surgery, to solve cruciate ligament injuries or bunions.”

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You don’t have to hit the table leg or bend your ankle while playing sports to visit the orthopedist. Even if your foot hurts one day out of the blue, this professional is a good first choice.. “We work as a team with many physiotherapists, but the most correct thing is to go to the traumatologist initially. Both the exploration and the complementary tests (X-rays, ultrasounds …) will allow an exact diagnosis and focus the treatment with the best guarantees ”. In the shoulder, for example, ultrasound scans can be done in the consultation, which provides a lot of information in real time about whether there is bursitis or subacromial inflammation, calcifications, tendon rupture … Other tests must be ordered outside the consultation. For example, when the orthopedic surgeon requires an X-ray to assess other aspects of the bone, or MRI and CT scans.

The best hands to regain mobility

For a mere statistical question – there are more physical therapy clinics at street level than trauma clinics – many times you will think about making an appointment with the physiotherapist as soon as your foot hurts or you have trouble moving your neck. A sudden situation of moderate pain, swelling, stiffness (sometimes a hard or ball-like area is noticeable) or difficulty in moving a limb, especially after playing sports, can put you on the track that you will need to go through your inquiry. An open injury or a huge bruise, acute pain, inability to move the limb and even the affected area sinking can indicate that there is a muscle or bone break. In that case, there are many ballots for the injury to end up in the operating room and in the hands of a traumatologist.

Even in that situation, if you choose to go to the physical therapist next door first, it shouldn’t be a problem. “Before approaching it with manual massage or another more invasive technique, we will first assess. If it is in our power, we try. If not, we suggest the right professional. A typical case is low back pain. It can be due to a muscle contracture, a herniated disc, problems in the pelvic floor and even a fibroid in the uterus. In the latter case, we recommend going to gynecology to treat the true cause of the problem ”, explains the physiotherapist Isidoro San Justo Molleda.

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Among the traumatic ailments of a muscular nature that are seen in his consultations are overloads and contractures. It may be because you have been painting the floor and your arm is stiff, or because you sit badly in the office chair, or because you have been training upstairs … “We see many cases of poor postural hygiene and sedentary lifestyle (for example, a lot of neck or back pain). But also due to an unavoidable joint degeneration due to age ”. The latter abound in athletes or in professions that repeat the same gesture. They also provide guidelines for preserving the results of your interventions. “Our function is not only to recover the functionality, but to give guidelines so that they are not repeated or chronified”. They also treat many sprains or strains of ligaments, dislocations, and post-surgery rehabilitation for fractures.

“Young people have sedentary leisure. Children and adolescents who spend hours with tablets or mobiles, playing or chatting. We see overloads similar to those of a person who works seated. Instead, in adults it is increasingly easier to see sports injuries”, Basically due to joint stress and overuse. Women deserve a separate chapter. “The use of heels or carrying huge bags with a lot of weight favor postural imbalances that end in contractures or muscular ailments in the posterior chains (the ‘shortening’ of the calf by wearing very high heels). On the other hand, they have variable endocrine cycles due to their own hormonal physiology. In the estrogenic stages of the menstrual cycle, their ligament laxity is greater ”. That means more elasticity, but also more risk of sprains.

And what does a rheumatologist do?

Not always the cause of a joint pain is an accident or poor posture. The problem may be within, and that is the rheumatologist’s business. “It is the medical specialty responsible for diseases of the locomotor system (bones, muscles, tendons and joints) and systemic autoimmune diseases. We address the muscle and joint pain associated with external signs of inflammation, increased outside temperature, redness or stiffness”Explains Paloma García de la Peña Lefebvre, a rheumatologist at the Fundación Instituto Inmunes. “A symptom that is repeated in many rheumatological diseases is the sensation that you are getting up as if rusty, that you have to spend a few minutes mobilizing your limbs to get going, as if it took a while for your joints to get greasy. It may be the feeling that you cannot move your neck or that you are not able to direct your feet well ”.

The determining clue is that happens without having made any notable physical effort neither that day nor the previous ones. And that, despite the days that pass, the stiffness, pain or inflammation do not subside. They even go to more. “Also if there is fatigue without apparent causes, because it is one of the most frequent symptoms in autoimmune diseases that are our field of activity. This is the case of lupus, fibromyalgia or rheumatoid arthritis ”.

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Pronouncing the word rheumatologist may make you think of your grandmother. If so, surely you are wrong. “It is a common mistake. We treat older people, for example, in cases of osteoporosis. But we also have young patients. Even children with childhood idiopathic arthritis. The important thing is that the rest of health professionals, from the family doctor to the physiotherapist, know how to distinguish the symptoms and refer them to a rheumatologist. In many pathologies treating them as soon as possible avoids permanent damage, for example, by the erosion of an inflamed bone ”.


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