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.

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.

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.

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.

Pneumonia has many risk factors and causes associated with it. On a pathological level , the direct causes for Pneumonia are:

• Bacterial infection
• One of the most common types of causes , where the bacteria gets into the lungs and begin to multiply. Some of the known bacteria that causes Pneumonia are Streptococcus Pneumonia , Mycoplasma Pneumonia ,
• Viral infection
• Fungal infection

For children or adults , the causes may differ but will result in the same kind of response of the lungs resulting in the same inflammatory response of the alveoli.

Self-test your … at home with these modified tests and see if you might have a ….

Use your key phrases abundantly here, if you need a few more.

1. Load progression in your tests.
2. Do not use “try to..” – keep to clear instructions. It’s an ‘must do’ instruction. These are tests, must be clear and simple, and avoid words like: “attempt” “try”
   “attempt to cross your painful leg”, “attempt to bend”, “try and twist”.

Describe at least:

• Weight-bearing
• Loaded
• Unloaded
• Stretch/ End of Range

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

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?

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 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.

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?

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

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

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.

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

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

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?

• 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.

• Pneumonitis
• Bronchopneumonia
• Pneumococcus