Being “chesty” following a common cold or flu is normal amongst us all. Your chest has been a bit tight , you had a slight fever , your head is aching and you just cant seem to stay warm enough. These are all the “usual” signs and symptoms which usually eases up after a week. However , since you’ve acquired your cold, you’ve been a bit more “chesty” than usual , prolonging even after your flu symptoms has subsided. You still cannot seem to knock off that lingering chest wheeze and cough and have now found your chest is worsening. You find is harder to walk short distances , your breathes are becoming shorter and your cough is now barking along with bringing up thick yellow phlegm. You may have acquired Pneumonia , a common lung condition that affects people of all ages , with symptoms ranging from mild to life threatening.

Research has shown that in 2019 , Pneumonia has taken 2.5 million lives a year , with around 33% being children under the age of 5. Pneumonia effects all age groups although most commonly found to be fatal in ages around 50 – 80 years old. Pneumonia is a worsened progression of Bronchitis , of which both are highly treatable and manageable. Let’s have a look at all you need to know about Pneumonia.

How are my lungs made up?

To understand Pneumonia , it’s essential that we have a look at the basic anatomy of your lungs and the structures making it up.

Being responsible for respiratory , your lungs are situated in your thorax , made up of two cone shaped lobes. Pneumonia affects the alveoli structures in your lungs. To get a better anatomical understanding of your lungs , lets break this down.

The lobes of your lungs receive a tree like branch called the trachea or airway pipe. The trachea splits into further branches called the bronchus. The bronchus runs further into the lobes , splitting into smaller branches called your bronchi and eventually into the smallest ones , called your bronchioles.

At the end of your bronchioles are tiny alveoli ducts which end in fluid filled sacs called your alveoli sacs. The alveoli sacs and their ducts contain very important properties in order for normal breathing to take place. Each bronchiole stems into 2 – 11 alveolar ducts and each duct stems into 5 – 6 alveoli sacs. The usual amount of alveoli sacs in a human is around 480 million! Pneumonia is the inflammation of your alveoli and their ducts causing them to fill up with pus and mucus , making breathing very difficult.

The entire lung cavity is covered in a sheath , called your pleural sac and makes up your pleural membrane and cavity. There are many more structures that make up the lungs , although the above mentioned structures are vital to the understanding of what Pneumonia affects.

What does the alveoli actually do?

    As Pneumonia directly affects the alveoli , we have to understand the normal function of the alveoli. Having Pneumonia affects the structures mentioned below which essentially causes a issue in your alveoli’s ability to diffuse gas.

    There are two different types of alveoli , thus depending on their function. You get Type 1 cells which are called Pneumocytes and Type 2 cells called Pneumonocytes. Both of these cell types are found in the alveoli walls and the tissue surrounding them.

    Type 1 Pneumocytes

    These are bigger than type 2 cells and are not able to heal or replicate themselves , thus making the healing process of type 1 cells very difficult. They are thin and line the walls of the alveoli as well as being elastic – allowing breathing to be easier. Due to this make up , type 1 cells allow for gas exchange and diffusion between the air in the alveoli and the blood in the capillaries.

    Type 2 Pneumonocytes

    These type of cells are smaller than type 1 cells and are mainly found the in the walls of your alveoli in between you blood – air barrier. They responsible for secreting a type of substance known as pulmonary surfactant. This substance reduces the amount of surface tension on the alveoli and prevents them from collapsing and more importantly – helps the process of gas exchange between the alveoli and blood.

    I have Pneumonia … How did it happen?

    Pneumonia can be acquired via different routes , namely viral or bacterial or even fungal but that’s very rare. There are also three different types of acquired Pneumonia based on how or where you manage to contract it! These range from Community Acquired Pneumonia (Most common) , Hospital Acquired Pneumonia (Acquired through mechanically ventilated patients) and lastly Aspiration Pneumonia (Acquired when ingesting foreign particles such as mucus or vomit.)

    Lets say you have a common flu or upper respiratory tract infection. It usually lasts for a few days but this time you feel that your airway pipe is a bit more tender than usual. After a few days , you feel your chest becoming more painful and your symptoms are worsening. You may have originally been suffering with some acute bronchitis , although the bacterial or viral infection has travelled from your bronchi in your airways , eventually nesting in your alveoli. As the travelling microorganism sets inside your alveoli , you body sets off an immune response. This immune response causes vasodilation and an increase in vascular permeability. This causes an excess of fluid build up and collection , moving from your capillaries into your alveoli. With an inability to exchange gas effectively, it ultimately leads to a build up of carbon dioxide in your lungs as your alveoli is not able to exchange the oxygenated cells for deoxygenated ones , thus leaving you with an array of unwanted symptoms due to your alveoli being inflamed.

    Whichever way you acquired Pneumonia , your lungs are the main structures that are affected. Pneumonia affects up to 2.5 million people a year with around 33% of this being children under the age of 5.

      Causes of Pneumonia

      On a pathological level , there are three direct germs that cause Pneumonia , Bacteria , Viruses and Fungus.

      Bacterial infection

      This is one of the most common types of causes. This type of Pneumonia occurs when bacteria gets into the lungs and begin to multiply. Some of the known bacteria that causes Pneumonia are Streptococcus Pneumonia , Mycoplasma Pneumonia and Staphylococcus aureus.

      Viral infection

      Common viruses that are linked to causing Pneumonia are influenza , coronavirus , a common cold or a upper respiratory tract infection. These viruses are spread via air droplets whereby an infected person coughs near to you or by touching a surface that an infected person has touched. These germs spread into your lungs , causing Pneumonia.

      Fungal infection

      This type of Pneumonia is mainly caused by mold in certain area’s of the world and is much less common. It is acquired by breathing in air that has been exposed to a fungus such as Coccidioides. Unlike bacterial and viral infection, fungal Pneumonia cannot be spread from person to person.

      Children

      Children with a compromised immune system are at higher risk for developing Pneumonia. Amongst this , there are a few other causes:

      • Malnutrition: Some research has shown that infants who are malnourished have immunocompromised systems leading them to be more susceptible to Pneumonia.
      • Medical conditions: Chest conditions which are common amongst children such as Respiratory syncytial virus (RSV).

      Symptoms of Pneumonia

      Tests that you can do to see if you have Pneumonia

      Self testing for Pneumonia can be tricky to do alone as the basis of it requires medical assessment. However , there are certain markers which you can look out for.

        • Sit upright on a chair.
        • Slowly take three deep breathes in and out.
        • On your third breathe out , initiate a big “huff” in your throat as if you are about to cough.
        • Repeat this 3 times in a space of one minute.
        • If you are producing a thick yellow , green type of phlegm the test is positive for Pneumonia.
        • Sit comfortably at the edge of your bed or chair.
        • Place you index and middle finger on your opposite wrist , slightly below your thumb.
        • With a timer , set it for 30 seconds.
        • As you set off the timer , count how many pulse’s you have within a 30 second period.
        • When you have the result , multiply the number by 2.
        • If you have a heart rate higher than 100 beats per minute the test is positive for Pneumonia.
        • Sit comfortably at the edge of your bed or chair.
        • With your hand , tap gentle on the three zones of your chest.
        • First , just below your collar bone.
        • Second , in line with your chest on the outside of your torso.
        • Lastly , below the chest , on the outside of your torso.
        • Repeat this 3 times in a space of 1 minute.
        • If you have pain and discomfort while performing the taps , the test is positive for Pneumonia.
        • Sit comfortably with your feet slightly apart at the edge of you chair.
        • Set your timer to 60 seconds.
        • As you initiate the timer , count how many breathes you take within the 60 second time period.
        • If your breathing rate is more than 16 breathes per a minute , the test is positive for Pneumonia.

        How severe is my….?

        Choose 4/6 of the below signs and DISCUSS that you (as a professional) use to identify and classify as more severe than another person with the same diagnosis.

        Meaning: Imagine there’s a group of 20 patients, all with this same diagnosis and you must rank them from ‘less severe’ to ‘more severe’ ~ What markers/ signs will you look for to make your hierarchy and group them?

        • Frequency – Intermittent/Constant/ re-occuring
        • Movement or static positions (rest) flare pain.
        • Duration – Days, Weeks, Sudden, Short burst, change position of your … eases the pain.
        • Size – Radiate – Shoulder, Upper back, Head…
        • Intensity (pain) – bearable, pain doesn’t stop you, hesitant to
        • Colour: Bruising, Blue, Red,
        • Loading: Contraction, Low load required to bring on pain, High load (jump)
        • ROM: Limitation? Less than 10 degrees limitation (not a  problem) vs completely locked up.
        • Stiffness
        • Swelling
        • Intensity: Discomfort – Painful – Sharp sting

        WHY is it a serious type of injury?

        On a scale from 0-10 describe a picture of Regression.

        • Ligament tear Gr 1 – 3
        • Muscle strain, micro tear – complete separation split in fibers
        • Tendon phase of degeneration
        • Cartilage erosion, plugging, tears

        Diagnosis

        Physiotherapy diagnosis

        Describe a sentence to give the patient confidence that we’re the equipped/best at diagnosing this problem.
        “We can handle it” vs “Our knowledgable expert physiotherapists are well versed, confident, and experienced in their approach to diagnosing your…”

        We follow a structured plan to diagnose, classify the severity, and determine the hierarchy of priority that your knee needs. We stress, screen and scan all the possibilities that could be causing your pain. Identify any other injuries to surrounding structures. If there is an injury to the ligaments, meniscus, muscles or nerve, or cartilage we will find it.

        We understand the physiological healing stages you’ll go through, and custom-fit your treatment program. By knowing the extent of the tissue damage we can guide you through a structured program to recover faster and safely return to the things you love doing. That’s why our physiotherapists are the best at diagnosing this type of problem.

        Why is it crucial to get/understand a diagnosis? Does it mean anything? Or is it a death sentence? or will you treat it differently if you know what you’re dealing with?

        X-rays

        Muscles cannot be seen on an x-ray, so it will not be effective to diagnose a muscle spasm. X-rays will however show the integrity and alignment of joints in your spine. This will enable us to see if something is wrong with the structure of the bones in your spine or if there is a loss of disc space.

        What are you looking for on an X-ray? Cortical stress lines, Displacement measurements, What Classification is done via X-ray?

        Your physiotherapist can refer you to get x-rays taken if necessary.

        Diagnostic ultrasound

        Diagnostic ultrasound can be used to show the presence of a muscle tear (muscle strains), inflammation, swelling or simply increased contraction of a muscle (muscle spasms).

        If you need an ultrasound, your physio will refer you.

        MRI

        An MRI scan can image all of the structures in your lower back, including soft tissue, discs, nerves and bones. However, for a muscle spasm an image like this is unnecessary and very expensive. If your physiotherapist suspects anything more than just a muscle spasm, you will be referred to the right specialist.

        Is an MRI necessary for this diagnosis – if not when could it become a necessity?

        Why is the pain not going away?

        Discuss why the pain does not improve –

        • This section assumes that NO intervention/ treatment/ personal care/medical attention is applied….
        • A patient that leaves his fracture untreated, undiagnosed, what will happen
        • Without treatment “wait and see” approach. – what’s wrong with it and the problems they’ll face.
        • There is a risk of more critical and possibly irreversible damage if you don’t take the warning signs seriously.
        • What slows down your recovery period
        • Discuss – Non-union, Malunion, Prolonged healing, Abnormal Calllus formation,ect.
        • You become stuck in a cycle of pain, not knowing if it is safe to move or not
        • Make sure you are getting the right treatment from the start
        • Without intervention, or treatment why is the tissue state not improving?

        Why will this condition NOT resolve or recover on it’s own

        Remember here, you don’t need to justify or explain. Only state the instruction. (Delete this text block)

        What NOT to do

        • Do not ignore your symptoms such as chest pain , difficulty breathing and coughing.

        • Manage the pain by only taking pain medication. You will need medical attention and specified medication.

        • Socialising with friends and family as you can spread your infection.

        • Do not continue your daily activities as your body will need rest.

        • Leave your symptoms untreated, if you are uncertain of the diagnosis, rather call us and be safe

        What you SHOULD do

        • Medicate and rest as needed.

        • Follow your recovery advice. Listen to the professionals.

        • Stay away from friends and family. Do not be a super spreader.

        • Make an appointment to confirm the diagnosis and determine how severe the damage is.

        • Finish your treatment course as prescribed.

        Making it worse

        • Smoking and consuming alcohol.

        • Exercising such as running , jogging and going to the gym

        • Not getting enough rest and overexerting yourself.

        • Continue ignoring your symptoms.

        • Waiting too long to seek advice and medical care.

        Problems we see when patients come to us with …

        Complications (guaranteed, or high probability of developing with this problem/diagnosis/condition.

        • One concept per paragraph. Explain What resistance or problems can you encounter during the treatment process. Stay to the core message.
        • Speak to your patient as if each of these is happening to them.
        • Explain the WHY it’s a problem, not only state “it’s a problem”, but why…
        • Not bullets – they are only to guide your thoughts. Choose a few (not all), and explain why its more severe.
        • E.g. Not staying in the sling for the recommended period, “Taking the sling off occasionally to drive” Explain why its a problem.
        • Compensation expectations
        • Reasons that delay recovery time

        Pain medication (how long is normal/ acceptable)

        Misconceptions about treatment

        Physiotherapy treatment

        Please inspire confidence in your ability to test, identify, diagnose and treat/ deal with this.

        Example:

        Our priority is to determine the extent of the damage to your piriformis muscle. Then, we test the structures surrounding your hip and lower back to clear the nerve pathway and resolve the sciatic nerve pain. Avoiding nerve compression is crucial to prevent relapse and restore the sciatic nerve’s regular sliding. We must protect the muscle from overworking by differing forces away from the piriformis muscle, strengthen the surrounding muscles, correct the compensation, and retrain the correct firing pattern. This allows time for the piriformis muscle to adapt and heal. Our practitioners bring on a change and monitor the results until it’s working, and then we magnify the effects to get even better outcomes.

        Patient asks you:
        “So why should I come see you for … ?”
        Your answer is…

        • We can provide the best treatment for, provide guidance and answers., Implement a very effective and structured plan of action like
        • Use the antonyms of the words the patient complains of. Instibility – stability/stable, Fear – confidence, worried – calm/carefree, anxiety – serenity
        • And we will also look at (muscle strength, joint range of motion, flexibility, ligament stability, and nerve control.)
        • Gradual strengthening, control, and conditioning.

        Phases of rehabilitation

        Keep your focus on the primary problem structure.

        As long as I can see progression & functional expectations changing, Example:

        1. crutches
        2. 20% Weight (limited ROM)
        3. 50% weight (FROM)
        4. 100% weight with concentric & eccentric contractions
        5. Speed & Power (Jump)

        Please work the PEACE & LOVE protocol into the Plan of Action (Not all in the first phase)

        1. Balance on one leg
        2. Perform a lunge
        3. Squat to 90 degrees
        4. Balance reactions (stepping out sideways, forwards & backwards)
        5. Jump & Land from a step
        6. Do a Single leg jump
        7. Sit in a crouched position & get up
        8. Jump over a hurdle

        1st Phase: What you want to achieve (Week 0 – 1)

        Functional expectation, what we’ll do.

        E.g. “Our first aim is to get the proper diagnosis and identify and prioritize any contributing factors to your unique problem. Now, we can guide you in avoiding any aggravating activities for the time being and managing your symptoms. This includes a list of things that are safe to do and some that are not. “

        To progress to the next stage you should be able to …

        2nd Phase: What you want to achieve in Week 1 – 2

        What needs to happen in the tissue/ pathology to fix it

        This is the thing you should be able to do by now

        3rd Phase: What you want to achieve in Week 2 -3

        Treatment elaborated

        This is what you need to be able to do with ease so we can progress to the next phase of treatment.

        4th Phase: What you want to achieve in Week 3 – 4

        Re-inforce, strengthen, guide,

        What you should be able to do by this stage is ….

        5th Phase: Test return to normal life Week 4 – 6

        To makes sure you’re safe to turn to

        • Driving you should be able to
        • Jogging you should be able to
        • Run you should be able to
        • Work

        6th Phase: Final medical clearance tests (Week 

        By now, you should be able to jump and throw, but there are some specific stress tests you should be able to do.

        By now, you should be able to return to your routine. During the final week of your …….. treatment, we want you to be able to train at your full capacity. ………….. should be able to handle stretch stress, max load, and compressive forces.

        So we can sign off on your recovery, knowing you’re safe.

        Healing time

        Physio protocol time frame for healing (weeks/months)

        • A full recovery and return to sport will take longer and should not be confused with the healing period.
        • It takes about 3 to 4 months to return to exercise and sports.
        • You will need physiotherapy treatment twice a week for the first two weeks.
        • After this, your treatment sessions can be …
        • Remember: “Non-operative Treatment” or Non- Surgical Not conservative

        Other forms of treatment

        This section is about other treatments that can help the process services that can help – but we don’t provide.

        • Your doctor (GP) will probably
        • Pain meds, injections,
        • Getting your back or neck ‘aligned’ or ‘clicked’ in the hopes of improving the … will not improve the state of the muscle or change your pain. It could even worsen or trigger a muscle spasm. You need to look at the bigger picture.
        • A biokineticist will be able to help you in the final stages of your rehabilitation and get you back to training for your sport.
        • Wearing a back brace won’t be the solution to your problem.
        • Stretching or foam-rolling might ease your pain temporarily, but

        Is surgery an option?

        Surgery is necessary when …

        • These are the surgical checkboxes that must be ticked before surgery is even considered.
        • Surgery is only Halfway mark for a successful surgery, the rest is the reintegration, strengthening and adapting your body to the change.
        • Types of surgeries that can be done.
        • Why is rehab important after surgery?

        What else could it be?

        • Chronic Bronchitis – Similar to Pneumonia although this is the inflammation of your bronchi which lasts longer than a year. Symptoms include severe mucus build up and a chronic cough.
          • Emphysema – This is the enlargement and eventual breakdown of your alveoli and your bronchioles. Symptoms include laboured breathing and chest pain.
          • Acute Respiratory Distress Syndrome (ARDS) – This is a severe condition which is characterised by worsening symptoms within 7 days. Symptoms include poor oxygenation and pulmonary hypertension.
          • Asthma – Common reversible respiratory condition whereby the airways of the lungs constrict under irritation or allergic response. Asthma can be managed well with an inhaler.

          Also known as

          • Pneumonitis
          • Bronchopneumonia
          • Pneumococcus