How can physiotherapy help chronic wounds?

Van Sports Physio Bedsores, Low-Level Laser Therapy, Wound care

Physiotherapy treatments available for wounds

  1. HVPC – High Voltage pulsed current
    – Uses pulsed electrical current to stimulate cellular growth
    – Research shows HVPC is helpful for pressure sores (see 7,9 below)
    – Treatment timeline depends:
    • on wound characteristics (type, size, depth)
    • minimum of 3 sessions

    – Start your rehab journey today – Book here

  2. LLLT – Low Level Laser Therapy Check our blog post here
    – Uses infrared light to stimulate cellular growth and regeneration (1,5)
    – Research shows GOOD results found with wavelength: 635 – 658 nm (1,3,6)
    – Laser can be used for all types of wounds
    – Not used in infected wounds
    – BEST for: pressure sores, venous wounds
    – Treatment timeline:
    • depends on the wound characteristics (type, size, depth)
    • minimum of 3 sessions
    – Start your rehab journey today – Book here

Combination of therapies for Wound Management

Absolute MUST:
– Posture change – every 2 hours to avoid pressure sores (11)
– Pressure relief – every 15 minutes for at least 2 minutes

Wheelchair Pressure offloading technique:

  1. Pushing up holding the armrests
  2. Side sitting
  3. Leaning forward
  4. Lying down on belly if possible

Other Treatments:
– Dressing change: see wound care nurse, nurse practitioner for management
– Compression stockings (some cases)
= reduce fluid retention
= promote venous return

Proper hygiene – clean, dry, hydrated, and supple skin heals faster 😊
Proper water and food intake
= nourished body heals faster
= see Dietitian/Nutritionist/Physician for guidance

FUTURE possibilities:

  • Tissue bioengineering (ongoing research)
    • development of cells and human tissues through bioengineering (8).

Physiotherapy plays a big role in prevention and treatment of wounds, along with a multi-disciplinary team involving physicians, nurse practitioners, wound care nurses, caregivers, dietitian/nutritionist among others.

What is a chronic wound?

Chronic wound = acute wound that has not healed in the expected time frame

Types of wounds

  1. Venous wound
    – most common type of chronic wounds
    – appears along ankle / shin area
    – caused by:

    pooling + retention of fluid

    inefficient pumping mechanism (lack of muscle help & poor recoil / elasticity of vessels)

    leads to venous stasis
    Skin vulnerability

    Risk factors include:
    – presence of varicose veins
    – history of blood clots
    – history/diagnosis of chronic venous insufficiency
    – lack of movement and mobility

  2. Diabetic wound
    – wound created by ‘usual’ mechanism (cut, pressure, abrasion, blister, friction, etc)
    BUT heals poorly or delayed healing due to HIGH blood sugar levels
    – delayed skin regeneration
  3. Pressure wound aka pressure sore, pressure ulcer or bedsores
    – most common in neurological conditions (bed ridden or wheelchair)
    – Common areas: (pressure sensitive areas / high pressure area
    • back of head
    • elbows
    • sacral/coccyx
    • sides of hip
    • ankle
    • heel

  4. Arterial wound
    – Due to poor arterial circulation (arterial blood flow) to tissue in the extremities
    – Vulnerability in skin integrity = easy to ‘break skin’
    – Poor healing due to poor blood flow
    – Common areas:
    • legs
    • feet
    • toes

    Risk factors include:
    – lack of movement / mobility
    – history of arterial diseases
    • hardening of arteries (Atherosclerosis)
    • thickening of arteries – fat build up (Arteriosclerosis)
    – trauma
    – blood vessel restriction
    – uncontrolled diabetes and high blood pressure
    – inflammatory disease of blood vessels (Vasculitis)

Picture of a pressure wound – staging depends on the amount of tissue taken

Picture of a pressure wound
Image reference: 4-Stages-of-Wounds-from-National-Pressure-Ulcer-Advisory-Panel.jpg (793×282) (

Classification of pressure wounds – by its type, size, depth, and any other characteristics such:

– Tunneling: channel or pathway that extends in any direction from the wound
– Undermining: tissue destruction underlying intact skin along wound borders.

Image reference: undermining vs tunneling – Bing images

Infection identification

Recognize signs and symptoms and seek medical treatment right away.
Some signs are:
– Bad smell from wound
– Yellowish, greenish discharge from wound
– Inflammation: redness, swelling, warmth, pain, fever
– Pus drainage

Untreated wounds might lead to:
– generalized infection
– pain
– poor/delayed healing
– more severe outcomes – GET IT CHECKED

Treatment prognosis

– depends on the specificities of the wound

  • type
  • size
  • depth

– Timeline:

  • Small wounds = 2 weeks to 2 months
  • Large wounds = 3 to 6 months
  • Wound healing stages:

    1. healing from inside out – Hemostasis
    2. Soft tissues grow back again – Inflammatory
    3. formation of a scab – Proliferative
    4. closing of the open area – Remodelling

    Case study

    1. Client
      • 70y client bedridden, dementia state
      • history of R thumb stage 4 chronic wound – over a year
      • Physiotherapy treatment: Low level laser application and pressure relief technique
      • 3 months treatment – 30 sessions


    2. Client
      • 79y client, poor mobility due to Post polio syndrome
      • Spine kyphosis
      • history of thoracic spine wound stage 4 for 3 years
      • Ongoing treatment – 7 sessions


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    10. Summary of the best evidence for postural change in the prevention of pressure injury in critically ill adult patients. Crossref DOI link: Published: 2021-11. Summary of the best evidence for postural change in the prevention of pressure injury in critically ill adult patients – Xue – Annals of Palliative Medicine (

    Useful resources

    1. Physiopedia: lllt and wound healing – Search Results – PubMed (
    2. National Library of Medicine: Pubmed – lllt and wound healing – Search Results – PubMed (
    3. WALT – World Association for Photobiomodualtion Therapy – DOSAGE OF LASER TREATMENT RECOMENDATIONS – WALT | World Association For Photobiomodulation Therapy (
    4. Swedish Laser Medical Society –