CONTENTS
1. WHAT IS ORTHOPEDICS? – V. Zhelev, D. Kanchev 15
1.1. Classification of orthopedic diseases 16
1.2. Examination and evaluation of an orthopedic patient conducted by a physiotherapist 16
1.3. Basic methods of treatment in orthopedics: 17
2. ENGINE-D. Kanchev, V. Zhelev 18
2.1. Tissues of living organisms 18
2.2. Human skeleton 20
3. INJURIES OF THE LOCOMOTIVE APPARATUS - V. Zhelev, D. Kanchev 33
3.1. Causes and damage to the musculoskeletal system 33
3.2. Impaired functions 34
3.3. Tissue healing 35
3.4. Basic methods of treatment for injuries of the musculoskeletal system 39
3.4.1. Non-operative treatment of closed fractures 39
3.4.2. Operative treatment of bone fractures 39
3.4.3. Phases and periods of the disease process. Phases and periods of application of physiotherapy 41

Physiotherapy for orthopedic and traumatological diseases. First part: general

4. ASEPTIC INFLAMMATION AFTER SOFT TISSUE INJURY. APPLICATION OF PHYSIOTHERAPY - D. Kanchev, V. Zhelev 43
4.1. Acute phase (phase of the reflex inflammatory reaction) 43
4.2. Subacute phase (healing phase) 44
4.3. Chronic phase (maturation and remodeling phase) 44
5. CHANGES IN TISSUES AS A CONSEQUENCE OF IMOBILIZATION AND THE IMPACT OF PHYSIOTHERAPY TO OVERCOME THEM - V. Zhelev, D. Kanchev 45
5.1. Changes in muscle tissue during immobilization. Effects of physiotherapy after removal of immobilization 46
5.2. Changes in joints and surrounding tissues during immobilization. Effects of physiotherapy 49
5.3. Changes in bone tissue during immobilization. Physiotherapy after removal of immobilization 52

6. FUNCTIONAL METHODS FOR RESEARCH, MEASUREMENT AND EVALUATION IN ORTHOPEDIC AND TRAUMATIC DISEASES OF THE MUSCLE-MOTOR SYSTEM - D. Kanchev, V. Zhelev 55
1. Basic requirements 55
2. Research in physiotherapy for diseases and injuries of the musculoskeletal system 55
3. Analysis of functional studies and measurements 56
4. Determining the rehabilitation potential 57
Methods for determining the physical development of a person 58
1. Somatoscopy 58
2. Anthropometry 61
2.1. Morphological anthropometric data 61
2.2. Functional data 6
2.3. Measurement of spinal deformities 65
2.4. Measurement of lower limb deformities 67
2.5. Methods for determining the degree of flat feet 69
2.6. Measurement of swelling in the area of the ankle joint 70
MEASUREMENT OF THE VOLUME OF MOTION IN THE JOINTS WITH THE ANGLIOMETER 71

1. Examination and measurement of muscle shortening 75
TESTS FOR DETERMINING THE DEGREE OF PAIN V. Zhelev 76
1. Merle 0'Dobbine 76 pain test
2. Routine pain test 77
3. Visual Analogue Scale (VAS) for pain 77
MEASUREMENT OF MUSCLE WEAKNESS, STRENGTH AND ENDURANCE 78
1. Manual muscle testing 78
2. Measuring the strength and endurance of muscle groups in seconds 78
3. Measurement of hand grip strength 79
4. Examination and evaluations of hand grip 80
GAIT TEST FOR LOSCULT-MOTOR INJURIES 86
TESTS FOR EVALUATION OF STATIC AND DYNAMIC BALANCE OF POSTURE 88
1. Updated test for assessment of balance, coordination and static physical exertion (D. Kanchev, 2015) 88
2. Test for assessment of static, dynamic balance and posture control (D. Kanchev, 2016) 897. INFLUENCE OF PHYSIOTHERAPY ON DISEASE CHANGES IN ORTHOPEDIC AND TRAUMATIC DISEASES OF THE MUSCLE-MOTOR SYSTEM - V. Zelev, D. Kanchev 95
1. Limited range of motion in the joints 95
2. Physiotherapy to restore the range of motion in the joints 97
8. MEASURES OF PHYSIOTHERAPY USED IN ORTHOPEDIC AND TRAUMATOLOGICAL FRACTURES OF THE MUSCLE-MOTOR SYSTEM - V. Zhelev, D. Kanchev 98
1. Treatment by provision 98
2. Therapeutic massage 98
3. Passive and autopassive exercises for the limbs (S. Kisner, L., Colby, 1996) 99
4. Techniques for relaxation and stretching (stretching) 104
4.1. Postisometric relaxation 105
4.2. Reciprocal innervation 107
4.3. Postreciprocal relaxation (PRR) 108
4.4. Postfacilitation stretching according to V. Janda (PFS - Postfacilitation Stretch, V. Janda, 1991) 109
4.5. Eccentric stretching 110
4.6. Autostretching 110
4.7. Selection of applied muscle-inhibitory techniques 112

5. Techniques of proprioceptive neuromuscular facilitation 114
6. Cryotherapy 118
7. Active exercises 122
7.1. Exercises from a light starting position 122
7.2. Analytical exercises 123
7.3. Weight-bearing exercises 123
7.4. Isometric exercises 129
7.5. Exercises for coordination, agility and sensorimotor stimulation 129
7.6. Exercises with a Swiss ball (Swiss-Ball) according to V. Zhelev and E. Lianou, 2001 131
7.7. Training in walking with aids 132

Physiotherapy for orthopedic and traumatological diseases. First part: general

8. Restoration of muscle strength and endurance 133
8.1. General data and methodology for restoring and increasing muscle strength 133
a/ General data 133
b/ Methodology for restoring and increasing muscle strength 134
8.2. Methods for increasing muscle strength and endurance 139
a/ Isometric methods 139
Isometric gymnastics 139
– Isometric methodology of St. Bankov and R. Genchev 140
– Isometric methodology of D. Rose 140
- Isometric methodology of E.A. Muller (1970) 141
b/ Isotonic methodology - by Delorme, Watkins 141
8.3. Main characteristics and requirements for restoring and increasing limb muscle strength 141
a) Basic requirements for the recovery of muscle strength 142
b) Methods of resistance 143
c) Methodology for restoring the muscle strength of the limbs by V. Zhelev, K. Ivanov (1984) 143
8.4. Development of strength endurance 146

9. PHYSIOTHERAPY FOR INJURIES OF THE LOCOMOTIVE SYSTEM - D. Kanchev 150
1. Impact of physiotherapy and requirements for its application in musculoskeletal injuries 150
2. Physiotherapy for soft tissue injuries 151
a) Physiotherapy in the acute phase of soft tissue damage - inflammation phase 152
b) Physiotherapy in the subacute phase of soft tissue damage – phase of controlled movements 154
c) Physiotherapy in the chronic phase of soft tissue damage - phase of functional recovery 157
10. PHYSIOTHERAPY IN NON-OPERATIVE TREATMENT OF FRACTURES -E. Kanchev, V. Zhelev 159
a) Physiotherapy in the immobilization period 160
b) Physiotherapy in the early post-mobilization period 162
c) Physiotherapy in the late post-mobilization period 164
11. PHYSIOTHERAPY IN OPERATIVE TREATMENT OF FRACTURES-C. Zhelev, D. Kanchev 165

1. Preoperative period 165
2. Postoperative period 166
a) Maximum sparing (early) postoperative period 166
Clinical symptoms 166
b) Moderately sparing (basic) postoperative period 167
c) Little sparing (late) postoperative period 168
Literature 169