12 Common Physical Therapy Treatments and Modalities

Exercise

Exercise is a controlled physical stress applied to the body to help improve strength, range of motion, or flexibility.

Exercise can be passive or active.

• Passive exercise is one that requires you to simply relax while another person, like a physical therapist, applies the stress. One example of this is a hamstring stretch where a person lifts your leg to elongate the hamstring muscle on the back of your thigh.
• Active exercise is exercise that you perform under your own power. Walking on a treadmill, hip strengthening exercises, or straight leg raising exercises are all active exercises.

If you attend physical therapy in a clinic, at home, or while in the hospital, you will likely be engaged in some form of exercise to help improve your mobility. Home exercises are often also prescribed.

The home program is a group of exercises that you perform on your own. They can be very important to helping you return to normal function.

Ultrasound

Ultrasound is a deep heating treatment used to treat many musculoskeletal conditions like sprains, strains, or tendonitis.

Ultrasound is administered by your physical therapist using an ultrasound machine. A wand called a sound head is pressed gently against your skin and moved in small circular sweeps near the site of injury. A small amount of gel is used so the ultrasound waves are absorbed into the skin and muscles.

Electrical Stimulation and TENS

Electrical stimulation is occasionally used in physical therapy to help decrease pain around injured tissue. Transcutaneous electrical neuromuscular stimulation (TENS) is one well-known form.

There are two theories about how the stimulation works: the gate theory and the opiate theory.

Other forms of electrical stimulation may be used to contract muscles. This is called neuromuscular electrical stimulation (NMES) and is used to help your injured muscles "relearn" how to function properly.

Traction

Traction is used in the treatment of low back pain and neck pain to help decrease pain and improve mobility in the spine.

To use lumbar traction, you must be strapped into a mechanical machine. There is a vest that helps support your ribs and another device that wraps around your pelvis. The vest and pelvic device are stabilized with straps, and a mechanical force is applied with a machine.

Cervical traction is applied in either the sitting or lying position. If sitting, a harness is attached to the head and a pulley system is used with a small weight attached. The weight provides the traction force while you sit comfortably in a chair.

In lying, or supine, traction, a specific device is used. You must lie down on your back and strap your forehead into the device. Then, a pneumatic pump is used to help provide the traction force to your neck.

Joint Mobilization

Joint mobilization occurs when your physical therapist passively moves the joints of your body in specific directions. This can help to decrease pain and improve mobility.

While you may think of your joints moving as hinges, there is a gliding motion that also occurs between the joints of the body. This gliding motion is increased during joint mobilizations. The degree to which your therapist moves each joint depends on the amount of pressure and the direction of force applied to the joint.

While joint mobilization is a passive treatment, your physical therapist can teach you self-mobilization techniques so you can manage your problem independently. This can help you return to normal function quickly and offer you a strategy to prevent future problems.

Massage

Massage is using the hands to knead the injured tissues of your body to help decrease pain, improve circulation, and decrease muscle tension.

There are many massage techniques, including effleurage, petrissage, and trigger point massage.

Heat

Moist heat, or hot packs, may be applied to your body if you have an injury or after physical therapy exercises. The heat helps to increase circulation to the injured tissues, relax the muscles, and provide pain relief.

In a physical therapy clinic, hot packs are kept in a device called a hydrocollator. This is a large tank of hot water. The hot packs are cloth packs filled with a sand, clay and silica mixture. They absorb the hot water and are wrapped in terry cloth covers and towels before being applied to your body.

The hot pack is usually kept on the injured body part for 15 to 20 minutes.

Ice

If you have an injury, cold packs or ice may be applied to your body to help decrease pain and control inflammation. Ice is usually used during the acute or initial phase of injury to limit localized swelling around tissues.

Cold packs are usually applied for 15 to 20 minutes. Like hot packs, care must be used to prevent skin damage from getting too cold.

Iontophoresis

Iontophoresis is a form of electrical stimulation that is used to deliver medication across the skin to inflamed or injured tissues.

Most often, a steroid like dexamethasone is used in the treatment of inflammation. This steroid can help decrease pain and swelling of tissues that occurs when they are inflamed.

Iontophoresis can be used in the treatment of other conditions as well, depending upon the medication that is used during treatment. It is not a replacement for active physical therapy, but can be added as part of an overall plan.

Laser or Light Therapy

Light therapy involves using light at a specific wavelength to help improve the healing process of injured tissues. The treatment is painless and usually lasts for approximately one to three minutes.

To apply light therapy, your physical therapist will hold the light-emitting wand directly over your injured body part and press a button to activate the light.

Light therapy can be used in the treatment of chronic pain, inflammation, or wound healing.

The theory behind light therapy is that photons of light carry energy, and this energy applied to injured tissues can help improve cellular processes and speed healing or decrease pain.

Kinesiology Taping

Kinesiology taping, or K-tape, is often used by physical therapists to augment your rehab program. The tape is made of a flexible fabric that stretches and pulls as you move.

Kinesiology tape is applied to the skin, and it can be kept in place for a few days.

It may be used for various purposes, including:

• Muscle inhibition
• Muscle facilitation
• Bruising and swelling management
• Pain relief

Since K-tape is a newer treatment modality, it has yet to be fully tested, and gains made with it may be due to the placebo effect.

Whirlpool

Whirlpools are a form of hydrotherapy and are used to help improve circulation, maintain clean wounds, or control inflammation.

Whirlpools can be hot or cold. The usual temperature for a hot whirlpool is between 98 and 110 degrees Fahrenheit. A cold whirlpool bath is typically 50 to 60 degrees Fahrenheit.

Whirlpool baths have a motor or agitator that helps move the water around the body part that is being treated. This motion can have a soothing effect, and can also be used in the treatment of wound debridement.

A typical whirlpool session involves placing your body part to be treated into the water and relaxing while the water swirls around it. Gentle exercises can be performed to help improve motion around the body part while it is in the whirlpool.

Care must be taken to ensure that the whirlpool bath is not too cold or hot, as temperature extremes can damage your skin during treatment.