Prevention (Primary Role of Physiotherapy):

• Regular Repositioning Schedule:
  • Bedridden Patients: Developing and implementing a turning schedule (typically every 2 hours, but individualized based on skin tolerance and support surface). Teaching caregivers proper turning techniques to minimize shear and friction.
  • Wheelchair Users: Encouraging weight shifts or repositioning every 15-30 minutes. Teaching “wheelchair push-ups” or providing tilt/recline mechanisms if able.
• Mobility
  • Active Range of Motion (AROM) Exercises: Encouraging and assisting patients to perform active movements within their capabilities to improve circulation, muscle strength, and joint mobility.
  • Passive Range of Motion (PROM) Exercises: For patients unable to move independently, performing gentle passive movements to prevent contractures and improve circulation.
  • Strengthening Exercises: To improve functional mobility and enable independent repositioning.
  • Early Mobilization: Getting patients out of bed and into a chair, or walking as soon as medically appropriate, to reduce prolonged pressure.
  • Therapeutic Positioning: Using pillows, wedges, and specialized cushions to offload bony prominences and distribute pressure evenly. Avoiding direct pressure on existing sores.
  • Support Surfaces: Recommending and advising on appropriate pressure-relieving mattresses (e.g., alternating air, low-air-loss) and cushions (e.g., gel, air) for beds and wheelchairs. Avoiding “donut” cushions, which can concentrate pressure.
  • Foot Care: Using heel protectors, foam boots, or elevating heels off the bed to prevent heel ulcers.
• Management (Advanced Physiotherapy for Existing Pressure Sores):

While wound care is primarily managed by nursing staff and wound specialists, physiotherapy plays a vital supporting role:

• • Pressure Relief:
    • Strict Adherence to Repositioning: Ensuring no pressure is placed on the ulcerated area. This often requires creative positioning.
• Advanced pressure-relieving mattresses and cushions.
  • Mobility :
    • Maintaining Function: Despite the presence of a sore, continue with mobility exercises (AROM, PROM, strengthening) for unaffected limbs and joints to maintain overall physical function and prevent deconditioning.
    • Progressive Mobilization: Once the wound is healing, gradually re-introducing mobility activities to improve independence. This might involve gait training with assistive devices, transfer training, or exercises in water (hydrotherapy) if the wound is appropriately covered and sealed.
• Pain Management :
  • Physiotherapists can use modalities like TENS (Transcutaneous Electrical Nerve Stimulation) or interferential current (IFC) to help manage pain associated with the pressure sore or surrounding musculoskeletal discomfort.
• Respiratory Management (for bedridden patients):
  • Breathing Exercises: Deep breathing exercises and incentive spirometry to prevent pulmonary complications (e.g., pneumonia) often associated with immobility.
  • Chest Physiotherapy: Manual techniques or devices to clear secretions if a patient has respiratory compromise.
• Contributing Factors
  • Spasticity Management: For patients with neurological conditions, managing spasticity through stretching, positioning, and splinting can reduce shear forces and improve comfort.
  • Contracture Prevention/Management: Aggressive stretching and positioning to prevent or reduce joint contractures that can worsen pressure distribution.
• Manual Therapy

While direct manual therapy on an open pressure sore is contra-indicated (due to infection risk and tissue damage), manual therapy techniques are crucial for preventing sores and managing surrounding tissues:

• Soft Tissue Mobilization:
  • For Prevention: Gentle massage of healthy, intact skin around bony prominences to improve circulation and tissue pliability in at-risk areas. Crucially, direct vigorous massage over red, non-blanchable areas or existing sores is avoided, as it can worsen tissue damage.
  • For Surrounding Tissues: Addressing muscle tightness or spasms in areas adjacent to the pressure sore that might be contributing to abnormal posture or reduced mobility.
• Joint Mobilization:
  • Maintaining or restoring joint range of motion through gentle mobilization of stiff joints (e.g., hips, knees, ankles, spine) that could lead to fixed deformities and increased pressure on certain areas. For example, a hip flexion contracture can increase pressure on the sacrum in a seated position.