Physiotherapy in the World of Medical Aesthetics


How could physiotherapy possibly fit into the world of medical aesthetics? Morever, should we even be using those words in the same in sentence? Roxanne Ashkar provides the answers.

As a qualified physiotherapist with more than 13 years of experience in orthopaedic manipulative therapy, I found myself excited, overwhelmed, and even a bit uneasy when asked to apply my mind on collaborating with aestheticians.

Physiotherapists are medical professionals who focus on the rehabilitation of physical dysfunction. In South Africa, the majority of physiotherapists work within the health system, providing rehabilitation services in areas such as paediatrics, neurology, orthopaedics, ergonomics and sports therapy. Physios are responsible for the diagnosis, care and management of the rehabilitation of each patient in their care, while liaising with other healthcare professionals to achieve this.

In a professional and holistic approach to treating patients, we are always applying our minds to improving the healthcare offering available to patients. My colleagues, aesthetic medical practitioners at the holistic wellness and aesthetic centre, Anti-Aging Art, share the same sentiment.

The genesis

Many patients seeking aesthetic treatment at our practice also complained about other ailments, such as neck pain, headaches, chronic migraines, myofascial pain syndrome and temporomandibular joint pain (jaw pain). My colleagues wanted to help these patients, especially those enquiring about botulinum toxin A (BT-A) as a suggested method of treatment.

Current research has shown that injecting BT-A directly into the affected trigger points (TPs) of patients suffering from myofascial pain syndrome provides the patient with a longer, sustained period of pain relief. Through the inhibition of acetylcholine, the tight band or TP is able to relax.

As physiotherapists, we are able to assess the pain patterns and isolate the exact TPs causing the problem. Through comprehensive assessments, we can identify whether the patient’s condition is articular or muscular in origin, or perhaps from some other health or psychosocial situation.

Once a pain pattern has been identified, treatment may then include soft tissue work, myofascial release, joint and neural mobilisation, dry needling, taping and various electrotherapy modalities.

Some patients, however, may require further treatment options, such as BT-A injections.Physiotherapists’ dry-needling experience and knowledge of anatomy also allow them to guide doctors as to the angle and depth of injection, to allow for the safe, targeted injection of BT-A.

Another benefit of physios and doctors working together, is that we are able to use the minimum amount of BT-A necessary to achieve the maximum effect. Our patients are supported through the process, as they are given guidance through corrective sleeping positions, educated in posture of both the spine and jaw, and taught corrective rehab exercises to sustain the effect of BT-A treatment after it wears off.

The outcomes we have seen through combining our treatments have been positive. Patients are responding to this combined treatment successfully and outcomes have been improved when compared to BT-A injections alone.

Tools of the trade

Physiotherapists are also well schooled in the use of many electrotherapy tools, including therapeutic ultrasound, interferential current, transcutaneous electrical nerve stimulation and neuromuscular stimulation devices. Some of these devices can be used together in aesthetic treatments to encourage facial muscle stimulation or relaxation, reduce swelling and to encourage skin tightening.

Most aestheticians will be familiar with redermalization – a process that is achieved by injecting a combination of hyaluronic acid and succinic acid into the skin to increase skin density and elasticity through the stimulation of fibroblasts. This process aims to reduce pigmentation marks,fine lines, wrinkles, hypotrophic scarring, moisture loss, stretch marks and to improve overall skin tone and texture. It’s basically an all-in-one treatment that many patients need.

The only downside to redermalization treatment is that multiple injections of viscous product into the skin leaves one with a red and bumpy appearance for up to three days post treatment.

So it was with this in mind that we decided to utilise therapeutic ultrasound to try reduce the swelling, in the hope that the mechanical vibration of the sound waves could help to integrate the product into the tissues and have a soothing effect.

The patients who had received ultrasound therapy experienced a shorter down-time and reported better outcomes  one month later, compared to those who had not.

This led us to investigate the differences using an objective imaging system and, in September 2017, we were invited to present the results of our pilot study on the inclusion of therapeutic ultrasound in redermalisation treatments at AMEC 2017 in Monte Carlo, Monaco

To date, we have successfully integrated various physiotherapy tools to enhance and support aesthetic treatments. The inclusion of physiotherapy in this growing area of medicine in South Africa is both exciting and beneficial to all our patients seeking out valuable and holistic healthcare.

A2 Disclaimer: This article is published for information purposes only, and should therefore not be taken as an endorsement or advertisement for any product or medical treatment –  nor should it be regarded as a replacement for sound medical advice. 

CURRENT Issue 25 – March 2018 (Autumn)

This article was written by Roxanne Ashkar and edited by the A2 team EXCLUSIVELY for the A2 Aesthetic & Anti-Ageing Magazine March 2018 Edition (Issue 25). 

A2 Magazine prints only four magazines each year – reporting seasonally on everything you need and want to know about aesthetics, anti-ageing, integrative medicine, quality and medical skin care, cosmetic dentistry and cosmetic surgery in South Africa – where to go, who to see, what to expect, something new and so much more! Never miss an edition – click here for more info about where you can buy the print and/or digital copy of A2 Magazine (including back copies).

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