Dr. Neeraj Athavale (PT): My journey into this specialized field began with my graduation from Krishna Institute of Medical Sciences and College of Physiotherapy, Karad, Maharashtra, where I first engaged into clinical practice. It was during that time that manual therapy was in its nascent, booming stage. I was motivated by the question: Why rely solely on high-tech equipment when we can use hands-on skills to address patient dysfunction?

This thought process was strongly influenced by my mentor in college, who guided me toward different manual therapy techniques. This deep interest led me to pursue my Master’s in Orthopedic Manual Therapy at KLE Institute College of Physiotherapy, Belgaum, Karnataka.

My motivation stemmed from a deep interest in understanding the biomechanics and functional recovery of the musculoskeletal system. KLE Institute offered a strong, evidence-based curriculum and provided excellent hands-on mentorship, allowing me to refine my skills under expert clinicians.

This specialized training significantly enhanced my diagnostic precision and manual handling techniques. It enabled me to design truly patient-centered, function-oriented rehabilitation programs, bolstered by improved clinical reasoning, palpation skills, and a commitment to evidence-based practice.

Dr. Neeraj Athavale (PT): Physiotherapy is now a well-recognized branch of health science, with orthopedic physiotherapy being a highly sought-after specialization. Currently, I serve as an Associate Professor at Bharati Vidyapeeth School of Physiotherapy and as the Head of the Physiotherapy Department at Bharati Hospital, Pune.

I envision the future of orthopedic physiotherapy by integrating technology with traditional manual therapy skills. I foresee physiotherapists adopting AI-based movement analysis, virtual rehabilitation platforms, and wearable feedback systems to enhance patient monitoring and engagement.

My vision for our department is to develop a research-driven, multidisciplinary orthopedic rehab unit. This unit emphasizes early intervention, preventive care, and objective functional outcome measures. We actively boost clinical research protocols in areas like early osteoarthritis and post-surgical rehabilitation. The demand for and career scope in orthopedic physiotherapy is incredibly bright, especially as we move towards technology-driven, multidisciplinary systems.

Dr. Neeraj Athavale (PT): Research is one of my favorite pursuits. I have primarily focused on manual therapy techniques related to early osteoarthritis, ergonomics, and specific topics like temporomandibular joint disorders (TMJD).

One of my most significant areas of focus is the impact of smartphone use on musculoskeletal and mental health—the 'Text Neck Syndrome.' These studies aim to bridge clinical observations with measurable outcomes, promoting early, conservative interventions and ergonomic awareness for the modern lifestyle. My core goal is to provide evidence supporting manual therapy as a cost-effective and patient-friendly first line of approach for musculoskeletal management.

For instance, a study I conducted six years ago on the awareness of Text Neck Syndrome in college-going students yielded shocking results. There was very little awareness among the younger generation regarding the hazards of excessive gadget use, which leads to issues like neck and hand pain, and even deformities like upper cross syndrome. This highlighted the urgent need for preventive and rehabilitative physiotherapy. I continue to contribute to both areas and am currently developing exercise protocols for geriatric problems, like early knee osteoarthritis, to help restrict the need for joint replacement surgeries.

Dr. Neeraj Athavale (PT): As an educator, I emphasize preventive physiotherapy and personalized rehabilitation and instill the same practice in my students. It is crucial for evidence-based research to be percolated into society.

I challenge my students to engage with newer technologies and conduct research on how our traditional manual therapy methods can go hand-in-hand with technological advancements. The younger generation seeks advanced, new concepts. Therefore, the core of our focus is on integrating newer technology with traditional therapies to maximize benefits for society. This integration is vital in our research and clinical training.

Dr. Neeraj Athavale (PT): My approach is always case-based, utilizing a combination of traditional and manual therapy techniques.

• Joint-Related Issues: I frequently use joint mobilization techniques such as Mulligan, Maitland, and Kaltenborn approaches. When necessary, I incorporate Grade V High-Velocity Thrust techniques (Midland Grade 5). Once the joint range is achieved, strengthening exercises are integrated.

• Soft Tissue Issues: For muscles, ligaments, and fascia, I use Soft Tissue Release Therapy, including Muscle Energy Technique (MET) and Myofascial Release (MFR), often assisted by foam rollers or Instrument-Assisted Soft Tissue Mobilization (IASTM).

• Movement Dysfunction: For issues like upper and lower cross syndrome, I practice Kinetic Control Therapy, which focuses on movement chain patterns and proper assessment of dysfunction.

• Nerve Tissue: Neural Tissue Dynamic (NTD) Mobilization is another critical manual therapy skill I regularly practice.

Dr. Neeraj Athavale (PT): Incorporating Evidence-Based Practice (EBP) presents challenges, primarily in rigorous documentation. As a researcher, I need to meticulously document the outcomes of every therapy, even a simple, case-based exercise protocol.

For example, if early mobilization for a painful arc syndrome case yields a positive result, that finding must be documented. If I don't document it, the successful therapy remains isolated and cannot be scaled or shared with the wider healthcare community.

The importance of EBP is this: proper documentation allows us to generate evidence that can be successfully applied to a larger patient population. This robust foundation of evidence-based practice, clinical decision-making, and hands-on skills, combined with a multidisciplinary approach, is the backbone of effective healthcare delivery. It ensures that the current trends and proven techniques are continually discussed and implemented, maximizing the benefit for our patients and society.

Dr. Neeraj Athavale (PT): Interdisciplinary collaboration is the backbone of our department at Bharati Hospital. We work closely with a complete team of orthopedic surgeons, rheumatologists, pain specialists, occupational therapists, nurses, physicians, and dietitians/nutritionists.

This is not a casual association; it is a robust, structured protocol. We hold regular case discussions, joint clinics, and combined discharge planning meetings to ensure that all interventions, including physiotherapy, are initiated at the right stage. This teamwork helps us optimize surgical and non-surgical outcomes and ensures the patient’s overall improvement.

Dr. Neeraj Athavale (PT): In the last two decades, the technological advancements in physiotherapy have been immense, covering both assessment and treatment tools.

Recent innovations include digital posture analysis, real-time EMG feedback, virtual rehabilitation platforms, 3D motion capture systems for gait/postural analysis, and plantar pressure systems. Robotics is also increasingly integrated into therapy.

While I constantly learn these new tools, it’s vital to remember that technology cannot replace the knowledge of a healthcare professional. Instead, we integrate these tools to boost our work. For instance, movement analysis helps us identify early asymmetries, and biofeedback provides greater awareness.

Telerehabilitation is another significant advancement, especially since the COVID era. It allows us to maintain continuity of care in remote areas by using technology to demonstrate and monitor a patient's exercises and posture precisely. These techno-assisted advancements are essential for integrating into our regular practice for the betterment of the patient and society.

Dr. Neeraj Athavale (PT): This particular case is very close to my heart, as it involved giving not just physical but also moral support. While working at Sancheti Hospital in Pune, Maharashtra, I had managed a patient who had suffered a severe assault, resulting in his fingers being severed at the metacarpophalangeal joint.

The plastic surgery team performed a very successful procedure, meticulously reattaching the arteries, muscles, and soft tissues. They then referred the patient for physiotherapy.

We began a gradual, focused physiotherapy regimen, using techniques like soft tissue mobilization, CPM (Continuous Passive Motion) techniques, and scar tissue mobilization. Within a three-month period, we achieved a complete range of motion in the fingers.

The patient, who earlier could not hold anything with his dominant hand—a psychologically traumatic situation—was able to perform all his functional activities. Six months later, he had successfully rebuilt all his functional abilities. This was a very heart-touching moment, providing true job satisfaction when the patient came back to thank me. It perfectly illustrates the vital role physiotherapy plays in achieving functional movement and full recovery.

Dr. Neeraj Athavale (PT): The most common challenges involve balancing heavy clinical loads with academic responsibilities and, critically, maintaining a uniform quality of care across all therapists, who often have varying opinions and skill sets. A continuous challenge is updating staff with newer techniques.

To address this, I focus on:

• Conducting regular skill upgradation workshops

• Establishing standardized protocols

• Promoting clinical audits

Dr. Neeraj Athavale (PT): The future of orthopedic physiotherapy is very bright and will increasingly emphasize preventive physiotherapy. Historically limited to sports, physiotherapy is now vital for everyone, from pediatrics to geriatrics, and plays a key role in prehabilitation (pre-surgery) to boost patient confidence and outcomes.

The trends point towards:

• Personalized rehabilitation

• AI-assisted movement science

• Early screening for musculoskeletal dysfunctions

• Integrating physiotherapists into primary healthcare teams