Wednesday, November 20, 2024
Physiotherapy: What is contributing to Singapore’s physiotherapy upswing?
For Subscribers
What is contributing to Singapore’s physiotherapy upswing?
SINGAPORE – In recent years, physiotherapy has become a go-to treatment for many people – not just for injury recovery, but also for improving overall health, managing chronic conditions and enhancing athletic performance.
An analysis by Indian market research firm Insights10 showed that Singapore’s physiotherapy market size was worth about US$64 million (S$86 million) in 2022 and is expected to grow to US$101 million by 2030.
The report states that the growth is driven by a combination of factors: an ageing population, increasing awareness of the importance of physical health and a greater focus on preventative care.
Associate Professor Kwah Li Khim, president of the Singapore Physiotherapy Association, says: “As the country’s population steadily ages, we are seeing more people experiencing conditions such as osteoarthritis, stroke and other age-related mobility issues that require physiotherapy.”
There has also been more focus by the Ministry of Health on early rehabilitation and preventative care. This has resulted in more people turning to physiotherapists for physical therapy before and after surgery, as well as for injury prevention and wellness programmes, she notes.
Prof Kwah, who is also director of programmes at Singapore Institute of Technology’s health and social sciences cluster, highlights that physiotherapy will see growth in some areas. These include geriatric care, managing chronic diseases like stroke and cardiovascular diseases, as well as sports and orthopaedic therapy.
Physiotherapy clinics are taking root in Singapore, from neighbourhood centres to high-end rehabilitation hubs, as more people realise the importance of keeping their bodies in top condition.
Ms Kimberley Tan, 32, started Balance Physiotherapy in 2022 to provide home physiotherapy services. Over time, she realised there was an increasing demand for a rehabilitation-friendly space.
“With a variety of equipment and a supportive physical environment, I found added value in setting up a physical space for people who are able to travel out of their homes,” she says.
Together with Ms Wong Jiayen, 34, she started a clinic in Birch Road in August. Both of them are principal physiotherapists and clinical directors at the clinic.
Physiotherapy is designed to address each patient’s needs based on their condition, age, fitness level and goals. There are several types of physiotherapy and they help with different conditions.
Relief from age-related conditions
Singapore General Hospital (SGH) houses the largest physiotherapy department in the country. Therapists collaborate closely with multidisciplinary teams to help patients regain mobility, independence and improve their quality of life, especially after surgery and hospitalisation.
Mr Kenneth Goh, principal physiotherapist at SGH, says orthopaedic and musculoskeletal physiotherapists treat a wide range of conditions. These include conditions that arise after surgery such as total knee and hip replacement, and soft tissue repairs involving ligaments in the ankle, shoulder and knee.
In the early recovery stages, the focus is to reduce pain and swelling, ensure safe movement and prevent complications, he notes.
For example, after knee replacement surgery, patients start to practise walking. They may also do gentle flexibility exercises like bending the knee with the help of a towel, or lower limb strengthening exercises in bed such as straight leg raises, says Mr Goh.
They gradually add resistance to the strengthening exercises by using a resistance band or ankle weights, and work on returning to activities like climbing stairs, he notes.
Non-surgical conditions that physiotherapists at SGH see include chronic lower back pain, neck pain, ankle sprains and sports injuries.
Prices for a private patient start at $31, while for Singaporeans and permanent residents, prices start at $9 after subsidies.
At Balance Physiotherapy, Ms Wong commonly sees patients with musculoskeletal conditions such as frozen shoulder, and hip and knee osteoarthritis.
Physiotherapy for such conditions aims to relieve a person’s pain and discomfort, and improve quality of life through better movement, she says.
“It includes education and advice on how to manage the condition, pain-relief modalities, manual therapy to improve joint mobility and muscle flexibility, as well as exercise-based therapy for fitness and strengthening,” adds Ms Wong.
Manual therapy involves targeted movements of joints and applying pressure to tight areas in muscles to relieve pain and improve movement.
Madam J.K., who found out she had knee osteoarthritis after a fall in August, has been seeing Ms Wong to strengthen the muscles around her knee, and to improve her balance.
The 68-year-old retail assistant, who declines to share her full name, says physiotherapy has made a world of difference.
“Before starting physiotherapy, even short walks were tough because I often felt instability in my knee. Now, with the stretches and strengthening routines I have learnt, the stiffness has decreased, and I walk more confidently,” she adds.
The frequency of physiotherapy visits varies depending on the patient’s condition, stage of recovery and treatment plan.
For post-surgery conditions, such as anterior cruciate ligament repair in the knee, Ms Wong says sessions may be scheduled up to twice a week.
On the other hand, for conditions that are less debilitating and require more self-management with home exercises, such as recovery from lower back pain, sessions may be spaced out, up to once every three weeks, she adds.
Ms Tan says her geriatric patients at Balance Physiotherapy range from 70 to 101 years old. They typically have functional decline due to dementia, falls and balance issues.
“Some are fitter and well, but they choose to engage in therapy to be more active, prevent injuries and falls, and slow down ageing and muscle loss,” she says.
For older adults with limited mobility, Ms Lim Yuan Qi, a senior physiotherapist at SGH, says community-based therapy services can support and enhance their functional abilities.
“Home therapy visits are an option for those who are housebound, while day rehabilitation centres serve those who can travel short distances within their community. These centres, which often offer transport services, provide therapy with opportunities for social engagement, and can benefit mental and physical well-being,” says Ms Lim.
Treating injuries sustained during sports
At Balance Physiotherapy, Ms Wong typically sees people with conditions such as knee ligament injuries, ankle sprains and Achilles tendon injuries.
These injuries are usually sustained in sports like football and basketball, during pivoting movements, or when players land awkwardly from a jump or a collision.
She also often sees shoulder instability or rotator cuff injuries from sports such as volleyball and basketball, and combat sports like Brazilian jiu-jitsu.
Such injuries are typically sustained from repetitive high-velocity movements or direct trauma, she adds.
Ms Wong once treated an aspiring professional dancer who injured her back during a dance move.
“I advised her on movements that were safe to carry out, as well as movements to avoid. I also helped her analyse her dance movements and habitual postures which may have contributed to the injury,” she says.
With diligence in following through the rehabilitation process and strengthening exercises, the patient managed to restore full range of pain-free movement within two months, and returned to dancing with greater confidence.
Restoring function after neurological injury
Ms Tan of Balance Physiotherapy also sees patients with conditions such as stroke, Parkinson’s disease, myelopathy (disorder of the spinal cord) and motor neurone disease.
“These are degenerative conditions that can worsen over time. Physiotherapy helps patients to manage the symptoms and slow deterioration,” she says.
Some conditions affect patients’ respiratory function, so Ms Tan provides chest physiotherapy to help clear their lungs and improve their breathing. Chest physiotherapy involves the use of manual techniques, breathing devices and strengthening exercises to help patients remove phlegm and increase their lung capacity to reduce the risk of chest infection.
Her therapy often includes caregiver training to ensure they feel confident supporting their loved ones.
Ms Ruth Chua, a senior physiotherapist at SGH, says patients with a neurological injury may experience paralysis, weakness, loss of movement and function, or poor balance. This can affect their physical function, well-being and sense of independence.
One of Ms Tan’s patients had stiffness and weakness from a stroke, and numbness from cervical myelopathy. When she saw the 72-year-old, he had been housebound for at least four years due to his immobility. He also had a few falls which landed him in hospital.
“Within three months of rehabilitation, he was going out for walks with his wife and on his own. His walking is faster and less stiff, and he has improved cardiovascular endurance. He is no longer housebound and is much happier with his increased independence,” says Ms Tan.
Ms Chua explains that neurological physiotherapy employs approaches that promote neuroplasticity, which is the brain’s ability to adapt and form new connections in its healthy parts.
One key method is repetitive task-specific training, which involves practising movements that are meaningful to patients and relevant to their everyday activities, to improve motor skills and performance, she says.
Therapy also includes training a person’s gait and balance to enhance walking ability and stability in sitting and standing activities.
For instance, a person with Parkinson’s disease may experience a phenomenon known as “freezing of gait”, where they temporarily feel unable to move, or their feet seem stuck to the floor.
This can happen in different situations, making it difficult to initiate walking, turn while walking, or pass through narrow spaces, explains Ms Chua.
“Physiotherapy movement strategies and gait training can help them overcome the moment of freezing, and build confidence in their walking ability,” she says.
Strengthening heart and lungs
Cardiac physiotherapy is an important part of cardiac rehabilitation, which helps people with heart conditions participate in safe exercise and lower the risk of a subsequent cardiac event, say physiotherapists.
It can also help those with chronic heart conditions like stable heart failure and stable angina. Stable angina refers to chest pain or discomfort that happens when the heart is not receiving enough oxygen-rich blood, says Mr Gregory Fam, principal physiotherapist at the Singapore Heart Foundation.
“Many people with a heart condition tend to be sedentary, with little experience of exercise. Consequently, some people experience fear and anxiety after a heart event and fear of exertion, while others may overexert beyond safe limits,” he adds.
Exercises in cardiac rehab typically include a mix of aerobic, resistance and stretching. They include walking on the treadmill, cycling on a stationary bike, and using free weights and resistance machines.
Pulmonary physiotherapy, on the other hand, is targeted at patients recovering from lung surgery or those with lung conditions that cause breathlessness and phlegm retention, says Ms Jaclyn Chow, principal physiotherapist at Heart and Lung Physio.
Her patients typically include those who have undergone thoracic surgery and patients with asthma, bronchiectasis and chronic obstructive pulmonary disease.
Pulmonary physiotherapy consists of pulmonary rehabilitation and chest physiotherapy. Pulmonary rehabilitation focuses on tailored physical exercises and breathing techniques to help people feel less breathless or fatigued during exercise and daily activities.
One of Ms Chow’s patients, a 36-year-old male, experienced unusual breathlessness even during light activities or rest. He had sought help after various medical tests showed normal results.
After an assessment, Ms Chow discovered he habitually breathed through his mouth and upper chest, and did not use his diaphragm, the main muscle for breathing. He was constantly trying to take deeper breaths, as the air with each breath did not seem to be sufficient.
“Through breathing retraining, focused on aspects including breathing through the nose and activating the diaphragm, he saw improvement in four to five weeks. Now, the focus is on optimising his breathing during exercise,” says Ms Chow.
Healing after birth
Postnatal physiotherapy addresses the physical changes that happen in a woman’s body during pregnancy and after delivery, and the challenges she faces, says Ms Jenna Kee, a senior physiotherapist at KK Women’s and Children’s Hospital.
Common physical issues include back or pelvic girdle pain, involuntary leakage of urine or stool, and pelvic organ prolapse, where the bladder, uterus or bowel descend into the vaginal area, she says.
Physiotherapy also addresses painful sexual intercourse and diastasis recti, a condition where the connective tissue between the “six-pack” muscles separates.
A full postnatal physiotherapy programme, Ms Kee says, usually starts six to eight weeks after childbirth, after the mother’s check-up with a healthcare provider. The programme can last up to one year.
For example, postural education involves learning about the way we move and position our bodies to reduce strain on the back and pelvis during activities like breastfeeding or lifting a baby, says Ms Kee.
A tailored exercise programme also includes teaching strengthening and flexibility exercises that target weak and tight muscle groups, providing improved support for the back and pelvis, she says.
While primarily focused on physical rehabilitation, the effects of postnatal physiotherapy may extend beyond physical recovery for some women.
“As mothers regain strength and function, they often feel more confident in their bodies, which can positively impact self-esteem and body image,” says Ms Kee.
Join ST's Telegram channel and get the latest breaking news delivered to you.
Tuesday, November 19, 2024
Subscribe to:
Posts (Atom)
Posts
