Editorial - Journal of Clinical and Experimental Traumatology (2017) Volume 1, Issue 1
Role of physiotherapy in post-chikungunya musculoskeletal pain managementMd Monoarul Haque*
Director and Publication Secretary, Bangladesh Physical Therapy Association (BPA), Bangladesh
- *Corresponding Author:
- Md Monoarul Haque
Director and Publication Secretary
Bangladesh Physical Therapy Association (BPA)Dhaka
E-mail: [email protected]
Accepted date: September 01, 2017
Citation: Haque Md M(2016) Role of physiotherapy in post-chikungunya musculoskeletal pain management. 1(1): 1
Chikungunya is a re-emerging non-fatal viral fever, vectorborne disease and public health problem for Bangladesh now. In Bangladesh it is first introduced in Rajshahi and Chapainawabganj districts in 2008. Recently we observe its wide spread attack particularly in Dhaka city. According to World Health Organization (WHO), many chikungunya patients presented with arthralgia without fever. The joint pain becomes severe in the morning. Aggressive movements can exacerbate symptom but physiotherapy in the form of mild exercise is helpful. The pain may remit for 2-3 days and then reappear in a saddle back pattern.  Close supervision of physiotherapist is desirable in this situation. WHO also suggests treatment should be instituted in all suspect cases without waiting for serological or viral confirmation. During an epidemic, it is not imperative that all cases should be subjected for virologic/ serologic investigations.  So physiotherapy can be started from the initial stage of Chikungunya. Evidence suggests that physiotherapy should be considered, beginning in the acute phase of Chikungunya. Though cold therapy is recommended in acute and sub-acute stages of Chikungunya to reduce joint and muscle pain as well as aiming to minimize the osteo-articular damage, consequently enabling rehabilitation. [1-4] Bangladesh Physical Therapy Association (BPA) recently recommends and encourages patients to walk in plain land, active/active-assisted exercises, use their hands for activities in daily living (ADL) like eating, brushing, writing and regular isotonic exercises (Concentric and Eccentric) along with cold application in acute and sub-acute phases of Chikungunya in order to reduce pain, maintain muscle length, strength, tone and bulk, maintain range of movement and ultimate aim to prevent deformity. These protocol and isotonic therapeutic exercises must be guided and prescribed by physiotherapist-BPA added. Observing sudden vast attack of Chikungunya BPA published 15 support centers in Dhaka city where patients can get physiotherapy service with free of cost or very low cost. After publishing all support centers got tremendous response of patients and nearly thousand patients got physiotherapy consultation and service. Meanwhile Dhaka South City Corporation (DSCC) initiates home based free physiotherapy consultation and service for Chikungunya patients and this program is well appreciated by the patients. Print as well as electronic media play an immense role. Proper posture should be maintained to prevent contractures and deformities. Those patients developed contractures and deformities, proper and timely physiotherapy is recommended. Sustained and selective stretching as well as joint support can be recommended to restore joint. Non-weight bearing followed by partial weight bearing and weight bearing exercise may be suggested; e.g. slowly touching the occiput (back of the head) with the palm, slow ankle exercises, pulley assisted exercises, wheel bar exercises, crutch walking etc. Balance and coordination training exercises may be suggested if neurological problems persist. The manufacture and use of orthoses as an adjuvant measure may be required; this may achieve more rapid relief of pain and, above all, may help to prevent muscular atrophy consequent to the disuse of the compromised joint. It is worth mentioning that psychological support is important in all phases of the disease, especially to relieve the sadness and suffering arising from the state of pain and chronic swelling during a long period of consequent illness . Physiotherapy is primary health profession concerned with rehabilitation; in rehabilitation it is the physiotherapist who helps disabled people to maximize their potential capabilities of achieving function & independence for activities of ADL .
Bangladesh Physical Therapy Association (www.bd-bpa.org)
- World Health Organization. Guidelines on clinical management of chikungunya fever. 2008;1-17.
- Carlos Alexandre Antunes de Brito, Ana Karla Arraes von Sohsten, Clezio Cordeiro de Sá Leitão, et al. Pharmacologic management of pain in patients with Chikungunya: a guideline. Rev Soc Bras Med Trop 2016;49(6):668-79.
- Dhiraj R Shete, Jayant T, Reshma RK. Awareness of Physiotherapy in Medical Practioners at Rural Area. Am J Adv Med Sci. 2013;1(1):1-5.
- Guidelines on clinical management of chikungunya fever. 2016;1-26.
- World Confederation for Physical Therapy. Ethical Principles. London, UK: WCPT; 2017. Available from http://www.wcpt.org/ethical-principles