Role of Physiotherapy in Diabetics

Physiotherapy is an ancient science, which involves physical treatment techniques, such as massage, and the use of electrotherapeutic and mechanical agents - rather than drug therapy - for the management of a condition. Physiotherapists play an important role in helping people to overcome disability and pain related to orthopaedic, musculoskeletal, neurological and rheumatological illnesses.

Any person with diabetes whose aching legs have experienced relief after a massage, or whose painful feet have been relaxed after a soak in cool water will testify to the importance of physiotherapy in relieving their symptoms.
Preventing diabetes

The Diabetes Prevention Project demonstrated that lifestyle modification, including intensive exercise, is more effective in preventing diabetes than pharmacological therapy, and highlighted the role of trained professionals in motivating people to follow lifestyle interventions. Similar results have been reported by the Malmö Study, the Da Qing Study, the Finnish Diabetes Prevention Study and the Wenying Study. Physiotherapists are able to help people, to plan an individualized exercise programme in order to maintain good blood glucose control and achieve optimal weight.

Furthermore, physiotherapy leads to metabolic improvements even in the absence of weight loss, reducing the frequency of cardiovascular events and improving life expectancy. Effective exercise counseling ensures both cardio-respiratory and musculoskeletal fitness. This helps people with diabetes improve their quality of life, and contributes to overall control of blood glucose. The use of alternative therapies, such as yoga, can contribute to the achievement of optimal cardio-respiratory health.

Physiotherapists can help people to maintain good blood glucose control and achieve optimal weight.

Physiotherapists, with their knowledge of physiology and anatomy, can suggest specific exercises for people with coexisting complication's, cautioning against certain movements that might be detrimental to their health. For example, an isotonic exercise like jogging will benefit a person with high blood pressure and diabetes, but the repeated foot trauma associated with jogging may harm someone with peripheral sensory neuropathy or Charcot foot.

Beyond exercise counseling

Most people with diabetes suffer from musculoskeletal complications, which might include frozen shoulder, back pain or osteoarthritis. Many people with poorly managed type 1 diabetes develop a syndrome of limited joint mobility. Diabetic amyotrophy is a type of neuropathy that involves muscle wasting and weakening, especially in the thighs. Carpal tunnel syndrome and sciatica are other neurological conditions that are commonly suffered by people with diabetes.

In all these conditions, physiotherapy plays a pivotal role in returning people to normal levels of health and well-being. The physiotherapist uses a combination of active and passive exercises, and mechanical and electrical aids to improve musculoskeletal and neurological functions.

Pain Relief

Physiotherapy offers various effective non-pharmacological approaches for pain relief. Transcutaneous electrical nerve stimulation (TENS) involves electrical nerve stimulation through the skin, sending a painless current to specific nerves. The mild electrical current generates heat that serves to relieve stiffness, improve mobility, and relieve pain. Interferential therapy (IFT) uses the strong physiological effects of low frequency electrical stimulation of nerves.

TENS and IFT are considered gold-standard therapies for the relief of neuropathic pain, and have proven benefits in the management of painful diabetic neuropathy, edema (build-up of fluid in tissue) and resistant foot ulcers. TENS has been shown to be most effective against burning and stabbing pain, but comparatively less efficient for the relief of painfully sensitive skin and restless legs syndrome. Other modalities, such as ultrasonic therapy and hot wax, are useful for specific conditions in both people with diabetes and people without the condition.

In spite of the benefits - safety, lack of drug interactions, efficacy, cost - associated with these methods, few centers' have adopted TENS/IFT as primary treatments for painful neuropathy. Perhaps this underscores the need to create specialized diabetes physiotherapy units, staffed by qualified physiotherapists specializing in the care of people with diabetes.

Physiotherapy can play an important role in preventing and managing foot problems.

Improving feet

Physiotherapy centers can play an important role in preventing and managing foot problems. Teaching the importance of correct gait and posture, along with the basic principles of off-loading when required, can prevent or stabilize a number of foot complications. In people with tropic ulcers, for example, which are typical in people with diabetes-related foot problems, the effective use of crutches or foot splints can ensure off-loading and early healing.

In people who are unfortunate enough to undergo an amputation, the physiotherapist helps with post-operative pain relief, rehabilitation, limitation of disability, and the optimum use of prostheses. Similar rehabilitative measures, exercises and therapeutic aids are available for people who are recovering from heart attack, stroke, peripheral vascular surgery, or other traumas or surgical interventions.

Wider benefits

Physiotherapeutic interventions, usually delivered on a one-to-one basis,are patient-centred, in line with the contemporary approach that all providers of chronic medical care, including endocrinologists, try to provide to people in their care. The time spent with the physiotherapist during the course of treatment can strengthen patient-provider bonding and enhance communication.

As the number of people with diabetes continues to rise, and as the existing diabetes population ages, the need for efficient physiotherapy services will continue to grow. Including specialized physiotherapists as equal members of the diabetes care team will help us to utilize their services effectively in order to improve the health and well-being of all people with diabetes.