Physiotherapy plays a crucial role in the management of CSA, focusing on improving cardiovascular fitness, reducing symptoms, enhancing quality of life, and promoting self-management.

• Aerobic Exercise: Walking, cycling, swimming, jogging at a moderate intensity to improve cardiovascular endurance and reduce myocardial oxygen demand at rest.
• Resistance Training: Light to moderate resistance exercises to improve muscular strength and endurance, which can reduce the cardiovascular strain during daily activities.
• Flexibility Exercises: Stretching to improve range of motion and reduce musculoskeletal stiffness.
• Education: Comprehensive education on:

Understanding CSA and its causes

• Risk factor modification (diet, smoking cessation, blood pressure control, cholesterol management, diabetes management).
• Medication adherence and understanding.
• Recognizing and managing anginal symptoms.

When to seek medical attention.

• Risk Factor Modification: Physiotherapists work with patients to address modifiable risk factors through:-
• Dietary counseling: Promoting a heart-healthy diet.

Smoking cessation strategies.

• Stress management techniques: Relaxation exercises, mindfulness.
• Weight management.

Advanced Physiotherapy Techniques

• Joint Mobilization: Gentle, rhythmic movements applied to joints (e.g., thoracic spine, shoulder girdle) to restore normal joint play and reduce stiffness. This can be particularly beneficial for patients with thoracic outlet syndrome-like symptoms or limitations in arm movement.
• Soft Tissue Mobilization/Massage: Techniques applied to muscles and connective tissues to release tension, reduce muscle spasm, improve circulation, and alleviate pain (e.g., in the chest wall, neck, shoulders).
• Strain-Counterstrain: A gentle technique used to release muscle spasms by positioning the body in a way that shortens the affected muscle, holding it for a period, and then slowly returning to a neutral position.
• Muscle Energy Techniques (METs): Uses the patient’s own muscle contractions against a controlled resistance to improve range of motion, reduce muscle hypertonicity, and realign joints.
• Myofascial Release (MFR)
  • Purpose: To address restrictions in the myofascial system, a web of connective tissue that surrounds muscles, bones, and organs. Myofascial restrictions can lead to pain, stiffness, and reduced mobility, potentially mimicking or contributing to anginal symptoms (e.g., chest wall pain).
  • Techniques: Involves sustained, gentle pressure applied to restricted areas of the fascia to release tension and restore tissue mobility. Physiotherapists may use their hands, elbows, or specialized tools. This can be particularly useful for addressing tightness in the pectoralis muscles, intercostal muscles, or diaphragm.
• Kinesiology Taping
  • Purpose: To provide support, reduce pain, decrease swelling, improve circulation, and facilitate muscle function. While more commonly seen in sports injuries, it can be cautiously applied in specific situations for individuals with CSA to address musculoskeletal pain or postural issues.
  • Application: Elastic therapeutic tape is applied to the skin with specific tension and direction.

Potential Applications in CSA (with caution and specific indications):

• Pain Relief: Can be applied to areas of musculoskeletal pain (e.g., upper back, shoulder) to reduce discomfort, potentially allowing for greater participation in exercise.
• Postural Support: To gently encourage improved posture, especially if prolonged sitting or slouching contributes to chest wall discomfort.
• Lymphatic Drainage: If there’s any localized swelling that might impede movement (less common in direct relation to CSA, but might be present in comorbid conditions).

Breathing Exercises and Diaphragmatic Breathing:

• Purpose: To improve respiratory efficiency, reduce accessory muscle use, promote relaxation, and manage stress.
• Techniques: Teaching patients to breathe deeply and effectively using their diaphragm can improve oxygenation, reduce the work of breathing, and calm the nervous system, which can be beneficial during periods of anxiety or stress that might accompany anginal symptoms.